Changes in etiology of acute gastroenteritis following the introduction of Rotavirus vaccine, Rotavac, in Tirupati, India Open Access

Abstract

India introduced Rotavac, an indigenous, oral Rotavirus vaccine, to the national immunization program beginning in 2016. Understanding the change in the etiological mix and ecology of diarrheal disease in India following the introduction of this vaccine is necessary to inform treatment and prevention efforts surrounding diarrheal diseases. The effects of the rotavirus introduction on the etiology and severity of diarrheal diseases were evaluated using data collected from children < 5 years of age hospitalized for acute gastroenteritis (AGE) in Tirupati, India between September 2012 and April 2019. Stool samples underwent laboratory analysis to detect the presence of norovirus, sapovirus and astrovirus. For each pathogen, we used age and date adjusted negative binomial regression to model the counts of pathogen positive stool samples prior to and following the introduction of the rotavirus vaccine. Ordinal logistic regression was used to compare the severity of AGE between these two periods. Over the study period, 1,581 children presented to hospital for AGE. At least one pathogen (norovirus, sapovirus or astrovirus) was present in 47% of all cases. We found a relationship between the vaccine period and astrovirus infection (IRR = 2.4; CI95%: 1.2, 5.1; p = 0.02). The odds of a child presenting with a moderate or severe episode in the post-vaccination period is 2.4 times that of children in the pre-vaccination period (CI95%: 1.9, 3.1). These findings suggest changes in the etiology of pediatric viral AGE in Tirupati, India following the introduction of the rotavirus vaccine where astrovirus, norovirus, and sapovirus contribute highly to detected pathogens of AGE in children.

Table of Contents

I.              Chapter I: Background………………………………………………………...1

II.            Chapter II: Manuscript………………………………………………….……14

a.    Introduction…………………………………………………………........15

b.    Methods…………………………..………………………………………...17

c.    Results……………………………...……………………………………....20

d.    Discussion………………………….......…………………………….......23

e.    References……………………………………………………………….....27

f.     Tables…………………………...……………………………………........33

                                              i.    Table 1: Vesikari Scoring System

                                            ii.    Table 2: Characteristics of the study population

                                          iii.    Table 3: Results of Chi-square analyses

                                           iv.    Table 4: Results of Negative binomial regression models adjusted for age

                                            v.    Figure 1: Time series of viral cause AGE

                                           vi.    Figure 2: Time series (line graphs) of viral cause AGE

                                         vii.    Figure 3: Boxplot of Vesikari Scores

III.          Chapter III: Summary, implications and future directions…..........37

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	rotavirus vaccine India children hospitalization diarrhea
Committee Chair / Thesis Advisor	Lopman, Benjamin, Emory University Baker, Julia, Emory University

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