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Multicenter Study
. 2016 Aug 5;11(8):e0160060.
doi: 10.1371/journal.pone.0160060. eCollection 2016.

Epidemiology, Seasonality and Factors Associated with Rotavirus Infection among Children with Moderate-to-Severe Diarrhea in Rural Western Kenya, 2008-2012: The Global Enteric Multicenter Study (GEMS)

Richard Omore  1   2 , Jacqueline E Tate  3 , Ciara E O'Reilly  4 , Tracy Ayers  4 , John Williamson  5 , Feny Moke  1 , Katie A Schilling  4 , Alex O Awuor  1 , Peter Jaron  1 , John B Ochieng  1 , Joseph Oundo  6 , Umesh D Parashar  3 , Michele B Parsons  4 , Cheryl C Bopp  4 , Dilruba Nasrin  7 , Tamer H Farag  7 , Karen L Kotloff  7 , James P Nataro  7   8 , Sandra Panchalingam  7 , Myron M Levine  7 , Kayla F Laserson  5   9 , J Pekka Nuorti  2 , Eric D Mintz  4 , Robert F Breiman  6   10
Affiliations
Multicenter Study

Epidemiology, Seasonality and Factors Associated with Rotavirus Infection among Children with Moderate-to-Severe Diarrhea in Rural Western Kenya, 2008-2012: The Global Enteric Multicenter Study (GEMS)

Richard Omore et al. PLoS One. .

Abstract

Objective: To evaluate factors associated with rotavirus diarrhea and to describe severity of illness among children <5 years old with non-dysenteric, moderate-to-severe diarrhea (MSD) in rural western Kenya.

Methods: We analyzed data from children <5 years old with non-dysenteric MSD enrolled as cases in the Global Enteric Multicenter Study (GEMS) in Kenya. A non-dysenteric MSD case was defined as a child with ≥3 loose stools in 24 hrs. and one or more of the following: sunken eyes, skin tenting, intravenous rehydration, or hospitalization, who sought care at a sentinel health center within 7 days of illness onset. Rotavirus antigens in stool samples were detected by ELISA. Demographic and clinical information was collected at enrollment and during a single follow-up home visit at approximately 60 days. We analyzed diarrhea severity using a GEMS 17 point numerical scoring system adapted from the Vesikari score. We used logistic regression to evaluate factors associated with rotavirus infection.

Results: From January 31, 2008 to September 30, 2012, among 1,637 (92%) non-dysenteric MSD cases, rotavirus was detected in stools of 245 (15.0%). Rotavirus-positive compared with negative cases were: younger (median age, 8 vs. 13 months; p<0.0001), had more severe illness (median severity score, 9 vs 8; p<0.0001) and had to be hospitalized more frequently (37/245 [15.1%] vs. 134/1,392 [9.6%]), p <0.013). Independent factors associated with rotavirus infection included age 0-11 months old (aOR = 5.29, 95% CI 3.14-8.89) and presenting with vomiting ≥3 times/24hrs (aOR = 2.58, 95% CI [1.91-3.48]). Rotavirus was detected more commonly in warm and dry months than in the cool and rainy months (142/691 [20%] vs 70/673 [10%]) p<0.0001).

Conclusions: Diarrhea caused by rotavirus is associated with severe symptoms leading to hospitalization. Consistent with other settings, infants had the greatest burden of disease.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. KEMRI/CDC HDSS study area (Asembo, Gem and Karemo) where GEMS Kenya Study was conducted.
Fig 2
Fig 2. Flow diagram of enrollment of MSD cases in GEMS-Kenya, and the number of non-dysenteric MSD rotavirus-positive and negative cases used for analysis, western Kenya 2008–2012.
Fig 3
Fig 3. Rotavirus positivity among non-dysenteric MSD cases by age group, western Kenya 2008–2012.
Fig 4
Fig 4. The seasonal distribution of rotavirus-positive compared with negative cases among children with non-dysenteric moderate-to-severe diarrhea (MSD) in western Kenya, January, 2008- February, 2011.
See this image and copyright information in PMC

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