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. 2017 Sep 11;12(9):e0183392.
doi: 10.1371/journal.pone.0183392. eCollection 2017.

Estimating global, regional and national rotavirus deaths in children aged <5 years: Current approaches, new analyses and proposed improvements

Andrew Clark  1 , Robert Black  2 , Jacqueline Tate  3 , Anna Roose  4 , Karen Kotloff  4 , Diana Lam  4 , William Blackwelder  4 , Umesh Parashar  3 , Claudio Lanata  5   6 , Gagandeep Kang  7 , Christopher Troeger  8 , James Platts-Mills  9 , Ali Mokdad  8 ; Global Rotavirus Surveillance Network; Colin Sanderson  1 , Laura Lamberti  10 , Myron Levine  4 , Mathuram Santosham  2 , Duncan Steele  10
Affiliations

Estimating global, regional and national rotavirus deaths in children aged <5 years: Current approaches, new analyses and proposed improvements

Andrew Clark et al. PLoS One. .

Abstract

Background: Rotavirus is a leading cause of diarrhoeal mortality in children but there is considerable disagreement about how many deaths occur each year.

Methods and findings: We compared CHERG, GBD and WHO/CDC estimates of age under 5 years (U5) rotavirus deaths at the global, regional and national level using a standard year (2013) and standard list of 186 countries. The global estimates were 157,398 (CHERG), 122,322 (GBD) and 215,757 (WHO/CDC). The three groups used different methods: (i) to select data points for rotavirus-positive proportions; (ii) to extrapolate data points to individual countries; (iii) to account for rotavirus vaccine coverage; (iv) to convert rotavirus-positive proportions to rotavirus attributable fractions; and (v) to calculate uncertainty ranges. We conducted new analyses to inform future estimates. We found that acute watery diarrhoea was associated with 87% (95% CI 83-90%) of U5 diarrhoea hospitalisations based on data from 84 hospital sites in 9 countries, and 65% (95% CI 57-74%) of U5 diarrhoea deaths based on verbal autopsy reports from 9 country sites. We reanalysed data from the Global Enteric Multicenter Study (GEMS) and found 44% (55% in Asia, and 32% in Africa) rotavirus-positivity among U5 acute watery diarrhoea hospitalisations, and 28% rotavirus-positivity among U5 acute watery diarrhoea deaths. 97% (95% CI 95-98%) of the U5 diarrhoea hospitalisations that tested positive for rotavirus were entirely attributable to rotavirus. For all clinical syndromes combined the rotavirus attributable fraction was 34% (95% CI 31-36%). This increased by a factor of 1.08 (95% CI 1.02-1.14) when the GEMS results were reanalysed using a more sensitive molecular test.

Conclusions: We developed consensus on seven proposals for improving the quality and transparency of future rotavirus mortality estimates.

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Conflict of interest statement

Competing Interests: ML was the Principal Investigator of the Global Enteric Multicenter Study (GEMS) supported by the Bill and Melinda Gates Foundation (Grant #38874), and has previously served as a consultant to Merck Vaccines. KK has received funding from Merck, Sharp and Dohme to study the safety and effectiveness of rotavirus vaccine among African infants. This does not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors declare no conflict of interest.

Figures

Fig 1
Fig 1. Country-level differences in GBD vs CHERG estimates of the proportion of U5 deaths due to diarrhoea in the year 2013 by WHO region.
Fig 2
Fig 2. Country-level variation in the fraction of U5 diarrhoea deaths due to rotavirus in the year 2013 by source of estimates and by WHO region.
Fig 3
Fig 3. Meta-analysis showing the proportion of U5 diarrhoea hospitalisations associated with acute watery diarrhoea (AWD) for selected sites in Africa and Asia.
Fig 4
Fig 4. Meta-analysis showing the proportion of U5 diarrhoea deaths associated with acute watery diarrhoea (AWD) for selected sites in Africa and Asia.
Fig 5
Fig 5. Global estimates of the number of rotavirus deaths <5 years in the year 2013 by source of estimates.
See this image and copyright information in PMC

References

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