Symptom and Enteric Pathogen Indicators of Diarrhea After Study Enrollment Among Controls in the Vaccine Impact on Diarrhea in Africa Study Open Access

Le, Phong (Spring 2021)

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There is a high prevalence of pediatric diarrhea in low-to-middle income countries. The Vaccine Impact on Diarrhea in Africa (VIDA) study assessed the attributable fraction of pathogen etiologies on moderate to severe diarrhea among young children. The objective of this study was to assess the prior symptoms and enteric pathogen carriage of Vaccine Impact on Diarrhea in Africa (VIDA) study controls in relation to their onset of diarrhea after study enrollment (DASE). Understanding the background levels of diarrheal disease, enteric pathogen carriage, and symptomatic expression among VIDA reference populations in highly endemic areas would allow for the contextualization of analyses among VIDA cases. This analysis of VIDA controls indicated that there was a high background level of acute diarrhea (11%) and carriage of enteric pathogens (63%) at the Kenya site. Several controls that were free of diarrhea 7 days prior to enrollment may have been actively incubating a diarrheal disease. Norovirus GII, sapovirus, and ST ETEC were enteric pathogens associated with DASE among VIDA controls in this study as well as moderate-to-severe diarrhea (MSD) among VIDA cases in a previous study. As such, previous estimates of the importance of these enteric pathogens for MSD, given these previous estimates were based on a reference population that was not entirely disease-free, may be underestimates. Fever and vomiting presented 7 days prior to enrollment were associated with DASE and could serve as proxies for the expression of acute diarrhea soon after study enrollment. Fever and vomiting 7 days prior to enrollment should be considered as exclusion criteria for disease-free reference populations. These findings related to DASE and enteric pathogen detection in VIDA controls further underscored the need for close examination of disease-free reference populations.

Table of Contents

Page 1 - Introduction

Page 4 - Methods

Page 8 - Results

Page 13 - Discussion

Page 18 - References

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