Author: "Parashar UD" - Searchworks@Jio Institute Digital Library Search Results

Your search keyword '"Parashar UD"' showing total 563 results

Start Over Author "Parashar UD"

563 results on '"Parashar UD"'

1. Aetiology and incidence of diarrhoea requiring hospitalisation in children under 5 years of age in 28 low-income and middle-income countries: findings from the Global Pediatric Diarrhea Surveillance network

Author: Cohen, AL, Platts-Mills, JA, Nakamura, T, Operario, DJ, Antoni, S, Mwenda, JM, Weldegebriel, G, Rey-Benito, G, de Oliveira, LH, Ortiz, C, Daniels, DS, Videbaek, D, Singh, S, Njambe, E, Sharifuzzaman, M, Grabovac, V, Nyambat, B, Logronio, J, Armah, G, Dennis, FE, Seheri, ML, Magagula, N, Mphahlele, J, Fumian, TM, Maciel, ITA, Leite, JPG, Esona, MD, Bowen, MD, Samoilovich, E, Semeiko, G, Abraham, D, Giri, S, Praharaj, I, Kang, G, Thomas, S, Bines, J, Liu, N, Kyu, HH, Doxey, M, McQuade, ETR, McMurry, TL, Liu, J, Houpt, ER, Tate, JE, Parashar, UD, Serhan, F, Cohen, AL, Platts-Mills, JA, Nakamura, T, Operario, DJ, Antoni, S, Mwenda, JM, Weldegebriel, G, Rey-Benito, G, de Oliveira, LH, Ortiz, C, Daniels, DS, Videbaek, D, Singh, S, Njambe, E, Sharifuzzaman, M, Grabovac, V, Nyambat, B, Logronio, J, Armah, G, Dennis, FE, Seheri, ML, Magagula, N, Mphahlele, J, Fumian, TM, Maciel, ITA, Leite, JPG, Esona, MD, Bowen, MD, Samoilovich, E, Semeiko, G, Abraham, D, Giri, S, Praharaj, I, Kang, G, Thomas, S, Bines, J, Liu, N, Kyu, HH, Doxey, M, McQuade, ETR, McMurry, TL, Liu, J, Houpt, ER, Tate, JE, Parashar, UD, and Serhan, F
Abstract: INTRODUCTION: Diarrhoea remains a leading cause of child morbidity and mortality. Systematically collected and analysed data on the aetiology of hospitalised diarrhoea in low-income and middle-income countries are needed to prioritise interventions. METHODS: We established the Global Pediatric Diarrhea Surveillance network, in which children under 5 years hospitalised with diarrhoea were enrolled at 33 sentinel surveillance hospitals in 28 low-income and middle-income countries. Randomly selected stool specimens were tested by quantitative PCR for 16 causes of diarrhoea. We estimated pathogen-specific attributable burdens of diarrhoeal hospitalisations and deaths. We incorporated country-level incidence to estimate the number of pathogen-specific deaths on a global scale. RESULTS: During 2017-2018, 29 502 diarrhoea hospitalisations were enrolled, of which 5465 were randomly selected and tested. Rotavirus was the leading cause of diarrhoea requiring hospitalisation (attributable fraction (AF) 33.3%; 95% CI 27.7 to 40.3), followed by Shigella (9.7%; 95% CI 7.7 to 11.6), norovirus (6.5%; 95% CI 5.4 to 7.6) and adenovirus 40/41 (5.5%; 95% CI 4.4 to 6.7). Rotavirus was the leading cause of hospitalised diarrhoea in all regions except the Americas, where the leading aetiologies were Shigella (19.2%; 95% CI 11.4 to 28.1) and norovirus (22.2%; 95% CI 17.5 to 27.9) in Central and South America, respectively. The proportion of hospitalisations attributable to rotavirus was approximately 50% lower in sites that had introduced rotavirus vaccine (AF 20.8%; 95% CI 18.0 to 24.1) compared with sites that had not (42.1%; 95% CI 33.2 to 53.4). Globally, we estimated 208 009 annual rotavirus-attributable deaths (95% CI 169 561 to 259 216), 62 853 Shigella-attributable deaths (95% CI 48 656 to 78 805), 36 922 adenovirus 40/41-attributable deaths (95% CI 28 469 to 46 672) and 35 914 norovirus-attributable deaths (95% CI 27 258 to 46 516). CONCLUSIONS: Despite the substantial impact of r
Published: 2022

2. Multiple Introductions and Predominance of Rotavirus Group A Genotype G3P[8] in Coastal Kenya in 2018, 4 Years After Nationwide Vaccine Introduction

Author: Breiman Rf, Murunga N, Agoti Cn, Mike J. Mwanga, Parashar Ud, Nokes Dj, Tate Je, Verani, Gicheru E, and Omore R
Subjects: Rotavirus, Genotype, medicine, biochemistry, Biology, medicine.disease_cause, Group A, Vaccine introduction, 3. Good health, Demography
Abstract: Globally, rotavirus group A (RVA) remains a major cause of severe childhood diarrhea, despite the use of vaccines in > 100 countries. RVA sequencing for local outbreaks facilitates investigation into strain composition, origins, spread, and vaccine failure. In 2018, we collected 248 stool samples from children aged
Published: 2020
Full Text: View/download PDF

3. Current and new rotavirus vaccines.

Author: Burke, RM, Tate, JE, Kirkwood, CD, Steele, AD, Parashar, UD, Burke, RM, Tate, JE, Kirkwood, CD, Steele, AD, and Parashar, UD
Abstract: PURPOSE OF REVIEW: As of 2019, four rotavirus vaccines have been prequalified by the WHO for use worldwide. This review highlights current knowledge regarding rotavirus vaccines available, and provides a brief summary of the rotavirus vaccine pipeline. RECENT FINDINGS: Data generated from use of currently available products supports their effectiveness and impact in diverse settings. Rotavirus vaccines have a favorable risk-benefit profile, but previous associations of rotavirus vaccination with intussusception necessitate continued monitoring for this rare but serious adverse event. Implementation of rotavirus vaccines was jeopardized in late 2018 and 2019 by a shortage of vaccine supply. Fortunately, with the prequalification of two additional vaccines in 2018, countries have increased choice in products with different characteristics, pricing, and implementation strategies. Other vaccines currently in development may open up further immunization strategies, such as neonatal vaccination schedules or parenteral administration. SUMMARY: Rotavirus vaccines have demonstrated impact in reducing diarrheal morbidity and mortality worldwide. As countries begin to introduce the newly prequalified vaccines, additional data will become available on the safety and effectiveness of those products. Products in the pipeline have distinct profiles and could be an essential part of the expansion of rotavirus vaccine use worldwide.
Published: 2019

4. Experiences with rotavirus vaccines: can we improve rotavirus vaccine impact in developing countries?

Author: Steele, AD, Victor, JC, Carey, ME, Tate, JE, Atherly, DE, Pecenka, C, Diaz, Z, Parashar, UD, Kirkwood, CD, Steele, AD, Victor, JC, Carey, ME, Tate, JE, Atherly, DE, Pecenka, C, Diaz, Z, Parashar, UD, and Kirkwood, CD
Abstract: Rotavirus vaccines have been introduced into over 95 countries globally and demonstrate substantial impact in reducing diarrheal mortality and diarrheal hospitalizations in young children. The vaccines are also considered by WHO as "very cost effective" interventions for young children, particularly in countries with high diarrheal disease burden. Yet the full potential impact of rotavirus immunization is yet to be realized. Large countries with big birth cohorts and where disease burden is high in Africa and Asia have not yet implemented rotavirus vaccines at all or at scale. Significant advances have been made demonstrating the impact of the vaccines in low- and lower-middle income countries, yet the modest effectiveness of the vaccines in these settings is challenging. Current research highlights these challenges and considers alternative strategies to overcome them, including alternative immunization schedules and host factors that may inform us of new opportunities.
Published: 2019

5. Impact of monovalent rotavirus vaccine on diarrhoea-associated post-neonatal infant mortality in rural communities in Malawi: a population-based birth cohort study

Author: Bar-Zeev, N, King, C, Phiri, T, Beard, J, Mvula, H, Crampin, AC, Heinsbroek, E, Lewycka, S, Tate, JE, Parashar, UD, Costello, A, Mwansambo, C, Heyderman, RS, French, N, Cunliffe, NA, Nakagomi, O, Verani, JR, and Whitney, CG
Abstract: Background: \ud Rotavirus is a major contributor to child mortality. The effect of rotavirus vaccine on diarrhoea mortality has been estimated in middle-income but not low-income settings, where mortality is high and vaccine effectiveness in reducing admissions to hospital is lower. Empirical population-based mortality studies have not been done in any setting. Malawi introduced monovalent rotavirus vaccine (RV1) in October, 2012. We aimed to investigate the impact and effectiveness of the RV1 vaccine in reducing diarrhoea-associated mortality in infants aged 10–51 weeks.\ud \ud Methods: \ud In this population-based cohort study, we included infants born between Jan 1, 2012, and June 1, 2015, in Mchinji, Central Malawi and analysed data on those surviving 10 weeks. Individual vaccination status was extracted from caregiver-held records or report at home visits at 4 months and 1 year of age. Survival to 1 year was confirmed at home visit, or cause of death ascertained by verbal autopsy. We assessed impact (1 minus mortality rate ratio following vs before vaccine introduction) using Poisson regression. Among vaccine-eligible infants (born from Sept 17, 2012), we assessed effectiveness (1 minus hazard ratio) using Cox regression.\ud \ud Findings: \ud Between Jan 1, 2012, and June 1, 2015, we recruited 48 672 livebirths in Mchinji, among whom 38 518 were vaccine-eligible and 37 570 survived to age 10 weeks. Two-dose versus zero-dose effectiveness analysis included 28 141 infants, of whom 101 had diarrhoea-associated death before 1 year of age. Diarrhoea-associated mortality declined by 31% (95% CI 1–52; p=0·04) after RV1 introduction. Effectiveness against diarrhoea-mortality was 34% (95% CI –28 to 66; p=0·22).\ud \ud Interpretation: \ud RV1 was associated with substantial reduction in diarrhoea-associated deaths among infants in this rural sub-Saharan African setting. These data add considerable weight to evidence showing the impact of rotavirus vaccine programmes.\ud \ud Funding: \ud Wellcome Trust and GlaxoSmithKline Biologicals.
Published: 2018

6. Emergence of Double- and Triple-Gene Reassortant G1P[8]Rotaviruses Possessing a DS-1-Like Backbone after RotavirusVaccine Introduction in Malawi

Author: Jere, KC, Chaguza, C, Bar-Zeev, N, Lowe, J, Peno, C, Kumwenda, B, Nakagomi, O, Tate, JE, Parashar, UD, Heyderman, RS, French, N, Cunliffe, NA, Iturriza-Gomara, M, and Lewycka, S
Subjects: Rotavirus, Malawi, Genetic Drift, Rotavirus Vaccines, genome reassortment, Genetic Variation, High-Throughput Nucleotide Sequencing, Genome, Viral, RNA-Dependent RNA Polymerase, Vaccines, Attenuated, phylodynamics, lineage turnover, Rotavirus Infections, Gastroenteritis, Genetic Diversity and Evolution, whole-genome sequencing, Humans, RNA, Viral, Antigens, Viral, Phylogeny, Reassortant Viruses
Abstract: To combat the high burden of rotavirus gastroenteritis, multiple African countries have introduced rotavirus vaccines into their childhood immunization programs. Malawi incorporated a G1P[8] rotavirus vaccine (Rotarix) into its immunization schedule in 2012. Utilizing a surveillance platform of hospitalized rotavirus gastroenteritis cases, we examined the phylodynamics of G1P[8] rotavirus strains that circulated in Malawi before (1998 to 2012) and after (2013 to 2014) vaccine introduction. Analysis of whole genomes obtained through next-generation sequencing revealed that all randomly selected prevaccine G1P[8] strains sequenced (n = 32) possessed a Wa-like genetic constellation, whereas postvaccine G1P[8] strains (n = 18) had a DS-1-like constellation. Phylodynamic analyses indicated that postvaccine G1P[8] strains emerged through reassortment events between human Wa- and DS-1-like rotaviruses that circulated in Malawi from the 1990s and hence were classified as atypical DS-1-like reassortants. The time to the most recent common ancestor for G1P[8] strains was from 1981 to 1994; their evolutionary rates ranged from 9.7 × 10−4 to 4.1 × 10−3 nucleotide substitutions/site/year. Three distinct G1P[8] lineages chronologically replaced each other between 1998 and 2014. Genetic drift was the likely driver for lineage turnover in 2005, whereas replacement in 2013 was due to reassortment. Amino acid substitution within the outer glycoprotein VP7 of G1P[8] strains had no impact on the structural conformation of the antigenic regions, suggesting that it is unlikely that they would affect recognition by vaccine-induced neutralizing antibodies. While the emergence of DS-1-like G1P[8] rotavirus reassortants in Malawi was therefore likely due to natural genotype variation, vaccine effectiveness against such strains needs careful evaluation. IMPORTANCE The error-prone RNA-dependent RNA polymerase and the segmented RNA genome predispose rotaviruses to genetic mutation and genome reassortment, respectively. These evolutionary mechanisms generate novel strains and have the potential to lead to the emergence of vaccine escape mutants. While multiple African countries have introduced a rotavirus vaccine, there are few data describing the evolution of rotaviruses that circulated before and after vaccine introduction. We report the emergence of atypical DS-1-like G1P[8] strains during the postvaccine era in Malawi. Three distinct G1P[8] lineages circulated chronologically from 1998 to 2014; mutation and reassortment drove lineage turnover in 2005 and 2013, respectively. Amino acid substitutions within the outer capsid VP7 glycoprotein did not affect the structural conformation of mapped antigenic sites, suggesting a limited effect on the recognition of G1-specific vaccine-derived antibodies. The genes that constitute the remaining genetic backbone may play important roles in immune evasion, and vaccine effectiveness against such atypical strains needs careful evaluation.
Published: 2017

7. Case-control vaccine effectiveness studies: Preparation, design, and enrollment of cases and controls.

Author: Verani, JR, Baqui, AH, Broome, CV, Cherian, T, Cohen, C, Farrar, JL, Feikin, DR, Groome, MJ, Hajjeh, RA, Johnson, HL, Madhi, SA, Mulholland, K, O'Brien, KL, Parashar, UD, Patel, MM, Rodrigues, LC, Santosham, M, Scott, JA, Smith, PG, Sommerfelt, H, Tate, JE, Victor, JC, Whitney, CG, Zaidi, AK, Zell, ER, Verani, JR, Baqui, AH, Broome, CV, Cherian, T, Cohen, C, Farrar, JL, Feikin, DR, Groome, MJ, Hajjeh, RA, Johnson, HL, Madhi, SA, Mulholland, K, O'Brien, KL, Parashar, UD, Patel, MM, Rodrigues, LC, Santosham, M, Scott, JA, Smith, PG, Sommerfelt, H, Tate, JE, Victor, JC, Whitney, CG, Zaidi, AK, and Zell, ER
Abstract: Case-control studies are commonly used to evaluate effectiveness of licensed vaccines after deployment in public health programs. Such studies can provide policy-relevant data on vaccine performance under 'real world' conditions, contributing to the evidence base to support and sustain introduction of new vaccines. However, case-control studies do not measure the impact of vaccine introduction on disease at a population level, and are subject to bias and confounding, which may lead to inaccurate results that can misinform policy decisions. In 2012, a group of experts met to review recent experience with case-control studies evaluating the effectiveness of several vaccines; here we summarize the recommendations of that group regarding best practices for planning, design and enrollment of cases and controls. Rigorous planning and preparation should focus on understanding the study context including healthcare-seeking and vaccination practices. Case-control vaccine effectiveness studies are best carried out soon after vaccine introduction because high coverage creates strong potential for confounding. Endpoints specific to the vaccine target are preferable to non-specific clinical syndromes since the proportion of non-specific outcomes preventable through vaccination may vary over time and place, leading to potentially confusing results. Controls should be representative of the source population from which cases arise, and are generally recruited from the community or health facilities where cases are enrolled. Matching of controls to cases for potential confounding factors is commonly used, although should be reserved for a limited number of key variables believed to be linked to both vaccination and disease. Case-control vaccine effectiveness studies can provide information useful to guide policy decisions and vaccine development, however rigorous preparation and design is essential.
Published: 2017

8. Case-control vaccine effectiveness studies: Data collection, analysis and reporting results.

Author: Verani, JR, Baqui, AH, Broome, CV, Cherian, T, Cohen, C, Farrar, JL, Feikin, DR, Groome, MJ, Hajjeh, RA, Johnson, HL, Madhi, SA, Mulholland, K, O'Brien, KL, Parashar, UD, Patel, MM, Rodrigues, LC, Santosham, M, Scott, JA, Smith, PG, Sommerfelt, H, Tate, JE, Victor, JC, Whitney, CG, Zaidi, AK, Zell, ER, Verani, JR, Baqui, AH, Broome, CV, Cherian, T, Cohen, C, Farrar, JL, Feikin, DR, Groome, MJ, Hajjeh, RA, Johnson, HL, Madhi, SA, Mulholland, K, O'Brien, KL, Parashar, UD, Patel, MM, Rodrigues, LC, Santosham, M, Scott, JA, Smith, PG, Sommerfelt, H, Tate, JE, Victor, JC, Whitney, CG, Zaidi, AK, and Zell, ER
Abstract: The case-control methodology is frequently used to evaluate vaccine effectiveness post-licensure. The results of such studies provide important insight into the level of protection afforded by vaccines in a 'real world' context, and are commonly used to guide vaccine policy decisions. However, the potential for bias and confounding are important limitations to this method, and the results of a poorly conducted or incorrectly interpreted case-control study can mislead policies. In 2012, a group of experts met to review recent experience with case-control studies evaluating vaccine effectiveness; we summarize the recommendations of that group regarding best practices for data collection, analysis, and presentation of the results of case-control vaccine effectiveness studies. Vaccination status is the primary exposure of interest, but can be challenging to assess accurately and with minimal bias. Investigators should understand factors associated with vaccination as well as the availability of documented vaccination status in the study context; case-control studies may not be a valid method for evaluating vaccine effectiveness in settings where many children lack a documented immunization history. To avoid bias, it is essential to use the same methods and effort gathering vaccination data from cases and controls. Variables that may confound the association between illness and vaccination are also important to capture as completely as possible, and where relevant, adjust for in the analysis according to the analytic plan. In presenting results from case-control vaccine effectiveness studies, investigators should describe enrollment among eligible cases and controls as well as the proportion with no documented vaccine history. Emphasis should be placed on confidence intervals, rather than point estimates, of vaccine effectiveness. Case-control studies are a useful approach for evaluating vaccine effectiveness; however careful attention must be paid to the collection, ana
Published: 2017

9. Cost-effectiveness of monovalent rotavirus vaccination of infants in Malawi: a postintroduction analysis using individual patient–level costing data

Author: Bar-Zeev, N, Tate, JE, Pecenka, C, Chikafa, J, Mvula, H, Wachepa, R, Mwansambo, C, Mhango, T, Chirwa, G, Crampin, AC, Parashar, UD, Costello, A, Heyderman, RS, French, N, Atherly, D, Cunliffe, NA, and Lewycka, S
Subjects: Male, Rotavirus, Malawi, Pediatrics, Cost effectiveness, Cost-Benefit Analysis, medicine.disease_cause, Cohort Studies, 0302 clinical medicine, Medicine, Prospective Studies, 030212 general & internal medicine, health care economics and organizations, 2. Zero hunger, education.field_of_study, rotavirus vaccine, Vaccination, 1. No poverty, Health Care Costs, Rotavirus vaccine, Gastroenteritis, 3. Good health, Hospitalization, Infectious Diseases, Child, Preschool, Female, Quality-Adjusted Life Years, Cohort study, Microbiology (medical), medicine.medical_specialty, 030231 tropical medicine, Population, Vaccines, Attenuated, Rotavirus Infections, 03 medical and health sciences, Environmental health, Humans, Disability-adjusted life year, education, cost-effectiveness, Immunization Programs, business.industry, Rotavirus Vaccines, Infant, developing countries, Quality-adjusted life year, Africa, Health Expenditures, business
Abstract: Background. Rotavirus vaccination reduces childhood hospitalization in Africa, but cost-effectiveness has not been determined using real-world effectiveness and costing data. We sought to determine monovalent rotavirus vaccine cost-effectiveness in Malawi, one of Africa's poorest countries and the first Gavi-eligible country to report disease reduction following introduction in 2012.\ud \ud Methods. This was a prospective cohort study of children with acute gastroenteritis at a rural primary health center, a rural first referral–level hospital and an urban regional referral hospital in Malawi. For each participant we itemized household costs of illness and direct medical expenditures incurred. We also collected Ministry of Health vaccine implementation costs. Using a standard tool (TRIVAC), we derived cost-effectiveness.\ud \ud Results. Between 1 January 2013 and 21 November 2014, we recruited 530 children aged
Published: 2016

10. Rotavirus vaccination and intussusception - Science, surveillance, and safety: A review of evidence and recommendations for future research priorities in low and middle income countries

Author: Yen, C, Healy, K, Tate, JE, Parashar, UD, Bines, J, Neuzil, K, Santosham, M, Steele, AD, Yen, C, Healy, K, Tate, JE, Parashar, UD, Bines, J, Neuzil, K, Santosham, M, and Steele, AD
Abstract: As of January 2016, 80 countries have introduced rotavirus vaccines into their national immunization programs. Many have documented significant declines in rotavirus-specific and all-cause diarrheal illnesses following vaccine introduction. Two globally licensed rotavirus vaccines have been associated with a low risk of intussusception in several studies. In July 2014, the Rotavirus Organization of Technical Allies Council convened a meeting of research and advocacy organizations, public health experts, funders, and vaccine manufacturers to discuss post-marketing intussusception surveillance and rotavirus vaccine impact data. Meeting objectives were to evaluate updated data, identify and prioritize research gaps, discuss best practices for intussusception monitoring in lower-income settings and risk communication, and provide insight to country-level stakeholders on best practices for intussusception monitoring and communication. Meeting participants agreed with statements from expert bodies that the benefits of vaccination with currently available rotavirus vaccines outweigh the low risk of vaccination-associated intussusception. However, further research is needed to better understand the relationship of intussusception to wild-type rotavirus and rotavirus vaccines and delineate potential etiologies and mechanisms of intussusception. Additionally, evidence from research and post-licensure evaluations should be presented with evidence of the benefits of vaccination to best inform policymakers deciding on vaccine introduction or vaccination program sustainability.
Published: 2016

11. Direct and indirect effects of rotavirus vaccination: Comparing predictions from transmission dynamic models

Author: Pitzer, VE, Atkins, KE, de Blasio, BF, van Effelterre, T, Atchison, CJ, Harris, JP, Shim, E, Galvani, AP, Edmunds, WJ, Viboud, C, Patel, MM, Grenfell, BT, Parashar, UD, Lopman, BA, Pitzer, VE, Atkins, KE, de Blasio, BF, van Effelterre, T, Atchison, CJ, Harris, JP, Shim, E, Galvani, AP, Edmunds, WJ, Viboud, C, Patel, MM, Grenfell, BT, Parashar, UD, and Lopman, BA
Abstract: Early observations from countries that have introduced rotavirus vaccination suggest that there may be indirect protection for unvaccinated individuals, but it is unclear whether these benefits will extend to the long term. Transmission dynamic models have attempted to quantify the indirect protection that might be expected from rotavirus vaccination in developed countries, but results have varied. To better understand the magnitude and sources of variability in model projections, we undertook a comparative analysis of transmission dynamic models for rotavirus. We fit five models to reported rotavirus gastroenteritis (RVGE) data from England and Wales, and evaluated outcomes for short- and long-term vaccination effects. All of our models reproduced the important features of rotavirus epidemics in England and Wales. Models predicted that during the initial year after vaccine introduction, incidence of severe RVGE would be reduced 1.8-2.9 times more than expected from the direct effects of the vaccine alone (28-50% at 90% coverage), but over a 5-year period following vaccine introduction severe RVGE would be reduced only by 1.1-1.7 times more than expected from the direct effects (54-90% at 90% coverage). Projections for the long-term reduction of severe RVGE ranged from a 55% reduction at full coverage to elimination with at least 80% coverage. Our models predicted short-term reductions in the incidence of RVGE that exceeded estimates of the direct effects, consistent with observations from the United States and other countries. Some of the models predicted that the short-term indirect benefits may be offset by a partial shifting of the burden of RVGE to older unvaccinated individuals. Nonetheless, even when such a shift occurs, the overall reduction in severe RVGE is considerable. Discrepancies among model predictions reflect uncertainties about age variation in the risk and reporting of RVGE, and the duration of natural and vaccine-induced immunity, highlighting im
Published: 2012

12. First rotavirus vaccine licensed: Is there really a need?

Author: Glass, RI, primary, Bresee, JS, additional, Parashar, UD, additional, Holman, RC, additional, and Gentsch, JR, additional
Published: 1999
Full Text: View/download PDF

13. Two rotavirus outbreaks caused by genotype G2P[4] at large retirement communities: cohort studies.

Author: Cardemil CV, Cortese MM, Medina-Marino A, Jasuja S, Desai R, Leung J, Rodriguez-Hart C, Villarruel G, Howland J, Quaye O, Tam KI, Bowen MD, Parashar UD, Gerber SI, and Rotavirus Investigation Team
Abstract: BACKGROUND: Outbreaks of rotavirus gastroenteritis in elderly adults are reported infrequently but are often caused by G2P[4] strains. In 2011, outbreaks were reported in 2 Illinois retirement facilities. OBJECTIVE: To implement control measures, determine the extent and severity of illness, and assess risk factors for disease among residents and employees. DESIGN: Cohort studies using surveys and medical chart abstraction. SETTING: Two large retirement facilities in Cook County, Illinois. PATIENTS: Residents and employees at both facilities and community residents with rotavirus disease. MEASUREMENTS: Attack rates, hospitalization rates, and rotavirus genotype. RESULTS: At facility A, 84 of 324 residents (26%) were identified with clinical or laboratory-confirmed rotavirus gastroenteritis (median age, 84 years) and 11 (13%) were hospitalized. The outbreak lasted 7 weeks. At facility B, 90 case patients among 855 residents (11%) were identified (median age, 88 years) and 19 (21%) were hospitalized. The facility B outbreak lasted 9.3 weeks. Ill employees were identified at both locations. In each facility, attack rates seemed to differ by residential setting, with the lowest rates among those in more separated settings or with high baseline level of infection control measures. The causative genotype for both outbreaks was G2P[4]. Some individuals shed virus detected by enzyme immunoassay or genotyping reverse transcription polymerase chain reaction for at least 35 days. G2P[4] was also identified in 17 of 19 (89%) samples from the older adult community but only 15 of 40 (38%) pediatric samples. LIMITATION: Medical or cognitive impairment among residents limited the success of some interviews. CONCLUSION: Rotavirus outbreaks can occur among elderly adults in residential facilities and can result in considerable morbidity. Among older adults, G2P[4] may be of unique importance. Health professionals should consider rotavirus as a cause of acute gastroenteritis in adults. PRIMARY FUNDING SOURCE: None. [ABSTRACT FROM AUTHOR]
Published: 2012
Full Text: View/download PDF

14. Hospitalizations and mortality associated with norovirus outbreaks in nursing homes, 2009-2010.

Author: Trivedi TK, DeSalvo T, Lee L, Palumbo A, Moll M, Curns A, Hall AJ, Patel M, Parashar UD, Lopman BA, Trivedi, Tarak K, DeSalvo, Traci, Lee, Lore, Palumbo, Aimee, Moll, Maria, Curns, Aaron, Hall, Aron J, Patel, Manish, Parashar, Umesh D, and Lopman, Benjamin A
Abstract: Context: Norovirus outbreaks are common among vulnerable, elderly populations in US nursing homes.Objectives: To assess whether all-cause hospitalization and mortality rates are increased during norovirus outbreak vs nonoutbreak periods in nursing homes, and to identify factors associated with increased risk.Design, Setting, and Participants: A retrospective cohort study of Medicare-certified nursing homes in Oregon, Wisconsin, and Pennsylvania that reported at least 1 confirmed or suspected norovirus outbreak to the Centers for Disease Control and Prevention's National Outbreak Reporting System (NORS), January 2009 to December 2010. Deaths and hospitalizations occurring among residents of these nursing homes were identified through the Medicare Minimum Data Set (MDS).Main Outcome Measures: Rates of all-cause hospitalization and mortality during outbreak compared with nonoutbreak periods were estimated using a random-effects Poisson regression model controlling for background seasonality in both outcomes.Results: The cohort consisted of 308 nursing homes that reported 407 norovirus outbreaks to NORS. Per MDS, 67 730 hospitalizations and 26 055 deaths occurred in these homes during the 2-year study. Hospitalization rates were 124.0 (95% CI, 119.4-129.1) vs 109.5 (95% CI, 108.6-110.3) hospitalizations per nursing home−year during outbreak vs nonoutbreak periods, yielding a seasonally adjusted rate ratio (RR) of 1.09 (95% CI, 1.05-1.14). Similarly, mortality rates were 53.7 (95% CI, 50.6-57.0) vs 41.9 (95% CI, 41.4-42.4) deaths per nursing home−year in outbreak vs nonoutbreak periods (seasonally adjusted RR, 1.11; 95% CI, 1.05-1.18). The increases in hospitalizations and mortality were concentrated in the first 2 weeks (week 0 and 1) and the initial week (week 0) of the outbreak, respectively. Homes with lower daily registered nurse (RN) hours per resident (<0.75) had increased mortality rates during norovirus outbreaks compared with baseline (RR, 1.26; 95% CI, 1.14-1.40), while no increased risk (RR, 1.03; 95% CI, 0.96-1.12) was observed in homes with higher daily RN hours per resident (P = .007 by likelihood ratio test); the increase in hospitalization rates did not show a similar pattern.Conclusion: Norovirus outbreaks were associated with significant concurrent increases in all-cause hospitalization and mortality in nursing homes. [ABSTRACT FROM AUTHOR]
Published: 2012
Full Text: View/download PDF

15. Trends in intussusception hospitalizations among US infants before and after implementation of the rotavirus vaccination program, 2000-2009.

Author: Yen C, Tate JE, Steiner CA, Cortese MM, Patel MM, Parashar UD, Yen, Catherine, Tate, Jacqueline E, Steiner, Claudia A, Cortese, Margaret M, Patel, Manish M, and Parashar, Umesh D
Abstract: Background: Although US data have not documented an intussusception risk with current rotavirus vaccines, international data indicate a possible low risk, primarily after the first dose.Methods: Among infants in 26 US states comprising 75% of the birth cohort, we examined age-specific trends in population-level intussusception hospitalization rates before (2000-2005) and after (2007-2009) rotavirus vaccine introduction.Results: Compared with 2000-2005 (35.3 per 100,000), the rate was greater in 2007 (39.0 per 100,000; rate ratio [RR], 1.10; 95% confidence interval [CI], 1.04-1.18), similar in 2008 (33.4 per 100,000; RR, 0.95; 95% CI, .89-1.01), and lower in 2009 (32.9 per 100,000; RR, 0.93; 95% CI, .87-.99). Among infants aged 8-11 weeks, compared with 2000-2005 (6.9 per 100,000), a small, significant increase was observed in each of 2007 (11.4 per 100,000; RR, 1.64; 95% CI, 1.08-2.50), 2008 (12.2 per 100,000; RR, 1.76; 95% CI, 1.17-2.65), and 2009 (11.0 per 100,000; RR, 1.59; 95% CI, 1.04-2.44).Conclusions: Following rotavirus vaccine introduction, a small increase in intussusception rates was seen among US infants aged 8-11 weeks, to whom most first doses of vaccine are given; no sustained population-level change in overall rates was observed. [ABSTRACT FROM AUTHOR]
Published: 2012
Full Text: View/download PDF

16. Factors associated with bowel resection among infants with intussusception in the United States.

Author: Johnson B, Gargiullo P, Murphy TV, Parashar UD, and Patel MM
Published: 2012
Full Text: View/download PDF

17. Infant rotavirus vaccination may provide indirect protection to older children and adults in the United States.

Author: Lopman BA, Curns AT, Yen C, and Parashar UD
Abstract: (See the editorial commentary by Glass, on pages 975-7.) Following the introduction of rotavirus vaccination in the United States, rotavirus and cause-unspecified gastroenteritis discharges significantly decreased in 2008 in the 0-4, 5-14, and 15-24-year age groups, with significant reductions observed in March, the historic peak rotavirus month, in all age groups. We estimate that 15% of the total 66 000 averted hospitalizations and 20% of the $204 million in averted direct medical costs attributable to the vaccination program were among unvaccinated 5-24 year-olds. This study demonstrates a previously unrecognized burden of severe rotavirus in the population >5 years and the primacy of very young children in the transmission of rotavirus. [ABSTRACT FROM AUTHOR]
Published: 2011

18. Monovalent Rotavirus Vaccine Provides Protection Against an Emerging Fully Heterotypic G9P[4] Rotavirus Strain in Mexico.

Author: Yen C, Figueroa JR, Uribe ES, Carmen-Hernández LD, Tate JE, Parashar UD, Patel MM, and Richardson López-Collado V
Abstract: After the introduction of monovalent rotavirus vaccine (RV1) in Mexico in 2006-2007, diarrhea mortality and morbidity declined substantially among Mexican children under 5 years of age. In January 2010, surveillance identified the emergence of a novel G9P[4] rotavirus strain nationwide. We conducted a case-control study to assess the field effectiveness of RV1 against severe rotavirus gastroenteritis caused by this unusual strain and to determine whether the G9P[4] emergence was related to vaccine failure or failure to vaccinate. RV1 was 94% effective (95% confidence interval, 16%-100%) against G9P[4] rotavirus-related hospitalization, indicating that its emergence was likely unrelated to vaccine pressure. [ABSTRACT FROM AUTHOR]
Published: 2011
Full Text: View/download PDF

19. Incidence of acute gastroenteritis and role of norovirus, Georgia, USA, 2004-2005.

Author: Hall AJ, Rosenthal M, Gregoricus N, Greene SA, Ferguson J, Henao OL, Vinjé J, Lopman BA, Parashar UD, Widdowson MA, Hall, Aron J, Rosenthal, Mariana, Gregoricus, Nicole, Greene, Sharon A, Ferguson, Jeana, Henao, Olga L, Vinjé, Jan, Lopman, Ben A, Parashar, Umesh D, and Widdowson, Marc-Alain
Abstract: Approximately 179 million cases of acute gastroenteritis (AGE) occur annually in the United States. However, lack of routine clinical testing for viruses limits understanding of their role among persons seeking medical care. Fecal specimens submitted for routine bacterial culture through a health maintenance organization in Georgia, USA, were tested with molecular diagnostic assays for norovirus, rotavirus, astrovirus, sapovirus, and adenovirus. Incidence was estimated by using national health care utilization rates. Routine clinical diagnostics identified a pathogen in 42 (7.3%) of 572 specimens; inclusion of molecular viral testing increased pathogen detection to 15.7%. Community AGE incidence was 41,000 cases/100,000 person-years and outpatient incidence was 5,400/100,000 person-years. Norovirus was the most common pathogen, accounting for 6,500 (16%) and 640 (12%) per 100,000 person-years of community and outpatient AGE episodes, respectively. This study demonstrates that noroviruses are leading causes of AGE among persons seeking medical care. [ABSTRACT FROM AUTHOR]
Published: 2011
Full Text: View/download PDF

20. Sociodemographic and dietary risk factors for natural infant intussusception in the United States.

Author: Johnson B, Gargiullo P, Murphy TV, Parashar UD, and Patel MM
Published: 2010
Full Text: View/download PDF

21. Rotavirus vaccines: current prospects and future challenges.

Author: Glass RI, Parashar UD, Bresee JS, Turcios R, Fischer TK, Widdowson M, Jiang B, and Gentsch JR
Published: 2006
Full Text: View/download PDF

22. Surveillance of childhood diarrhoeal disease in Hong Kong, using standardized hospital discharge data.

Author: Nelson EAS, Tam JS, Yu LM, Glass RI, Parashar UD, Fok TF, Nelson, E A S, Tam, J S, Yu, L M, Glass, R I, Parashar, U D, and Fok, T F
Published: 2004
Full Text: View/download PDF

23. Epidemiologic and molecular trends of 'Norwalk-like viruses' associated with outbreaks of gastroenteritis in the United States.

Author: Fankhauser RL, Monroe SS, Noel JS, Humphrey CD, Bresee JS, Parashar UD, Ando T, and Glass RI
Abstract: Between July 1997 and June 2000, fecal specimens from 284 outbreaks of nonbacterial gastroenteritis were submitted to the Centers for Disease Control and Prevention for testing for 'Norwalk-like viruses' (NLVs). Specimens were examined by reverse-transcription polymerase chain reaction and direct electron microscopy for the presence of NLVs. Adequate descriptive data were available from 233 of the outbreaks, and, of these, 217 (93%) were positive for NLVs. Restaurants and events with catered food were the most common settings, and contaminated food was the most common mode of transmission. Genogroup II (GII) strains were the predominant type (73%), with genogroup I strains causing 26% of all NLV-positive outbreaks. Certain GII clusters (GII/1,4,j) were more commonly associated with outbreaks in nursing home settings than with outbreaks in other settings. Strain diversity was great: one potential new sequence cluster was implicated in multiple outbreaks, and strains belonging to a tentative new genogroup were identified. Copyright © 2002 Infectious Diseases Society of America [ABSTRACT FROM AUTHOR]
Published: 2002
Full Text: View/download PDF

24. 'Norwalk-like viruses': public health consequences and outbreak management.

Author: Parashar UD, Quiroz ES, Mounts AW, Monroe SS, Fankhauser RL, Ando T, Noel JS, Bulens SN, Beard RS, Li J, Bresee JS, Glass RI, and US Department of Health and Human Services. Centers for Disease Control and Prevention
Abstract: 'Norwalk-like viruses' (NLVs) cause outbreaks of gastroenteritis and are spread frequently through contaminated food or water. Molecular diagnostics now enables detecting viruses in clinical and environmental specimens, linking of NLV strains causing outbreaks in multiple geographic locations, and tracing them to their sources in contaminated food or water. This report reviews recent advances in NLV detection and provides guidelines and recommendations for investigating NLV-related outbreaks, including specimen collection and disease prevention and control. This report also updates information provided in CDC's previously published, Viral Agents of Gastroenteritis: Public Health Importance and Outbreak Management (MMWR 1990;39 [No. RR-5]:1-24). These CDC recommendations are intended for public health professionals who investigate outbreaks of acute gastroenteritis but could be useful in academic and research settings as well. [ABSTRACT FROM AUTHOR]
Published: 2001

25. Trends in intussusception-associated hospitalizations and death among US infants.

Author: Parashar UD, Holman RC, Cummings KC, Staggs NW, Curns AT, Zimmerman CM, Kaufman SF, Lewis JE, Vugia DJ, Powell KE, and Glass RI
Abstract: Context. The newly licensed tetravalent rhesus-human reassortant rotavirus vaccine has been withdrawn following reports of intussusception among vaccinated infants.Objective. To describe the epidemiology of intussusception-associated hospitalizations and deaths among US infants.Design. This retrospective cohort study examined hospital discharge data from the National Hospital Discharge Survey for 1988-1997, Indian Health Service (IHS) for 1980-1997, California for 1990-1997, Indiana for 1994-1998, Georgia for 1997-1998, and MarketScan for 1993-1996, and mortality data from the national multiple cause-of-death data for 1979-1997 and linked birth/infant death data for 1995-1997.Patients. Infants (<1 year old) with an International Classification of Diseases, Ninth Revision, Clinical Modification code for intussusception (560.0) listed on their hospital discharge or mortality record, respectively.Results. During 1994-1996, annual rates for intussusception-associated infant hospitalization varied among the data sets, being lowest for the IHS (18 per 100 000; 95% confidence interval [CI] = 9-35 per 100 000) and greatest for the National Hospital Discharge Survey (56 per 100 000; 95% CI = 33-79 per 100 000) data sets. Rates among IHS infants declined from 87 per 100 000 during 1980-1982 to 12 per 100 000 during 1995-1997 (relative risk =7.6, 95% CI = 3.2-18.2). Intussusception-associated hospitalizations were uncommon in the first 2 months of life, peaked from 5 to 7 months old, and showed no consistent seasonality. Intussusception-associated infant mortality rates declined from 6.4 per 1 000 000 live births during 1979-1981 to 2.3 per 1 000 000 live births during 1995-1997 (relative risk = 2.8, 95% CI = 1.8-4.3). Infants whose mothers were <20 years old, nonwhite, unmarried, and had an education level below grade 12 years were at an increased risk for intussusception-associated death.Conclusions. Intussusception-associated hospitalization rates varied among the data sets and decreased substantially over time in the IHS data. Although intussusception-associated infant deaths in the United States have declined substantially over the past 2 decades, some deaths seem to be related to reduced access to, or delays in seeking, health care and are potentially preventable. [ABSTRACT FROM AUTHOR]
Published: 2000
Full Text: View/download PDF

26. Case-control study of risk factors for human infection with a new zoonotic paramyxovirus, nipah virus, during a 1998-1999 outbreak of severe encephalitis in Malaysia.

Author: Parashar UD, Sunn LM, Ong F, Mounts AW, Arif MT, Ksiazek TG, Kamaluddin MA, Mustafa AN, Kaur H, Ding LM, Othman G, Radzi HM, Kitsutani PT, Stockton PC, Arokiasamy J, Gary HE Jr., Anderson LJ, and Nipah Encephalitis Outbreak Investigation Team
Abstract: An outbreak of encephalitis affecting 265 patients (105 fatally) occurred during 1998-1999 in Malaysia and was linked to a new paramyxovirus, Nipah, that infected pigs, humans, dogs, and cats. Most patients were pig farmers. Clinically undetected Nipah infection was noted in 10 (6%) of 166 community-farm controls (persons from farms without reported encephalitis patients) and 20 (11%) of 178 case-farm controls (persons from farms with encephalitis patients). Case patients (persons with Nipah infection) were more likely than community-farm controls to report increased numbers of sick/dying pigs on the farm (59% vs. 24%, P=.001) and were more likely than case-farm controls to perform activities requiring direct contact with pigs (86% vs. 50%, P=.005). Only 8% of case patients reported no contact with pigs. The outbreak stopped after pigs in the affected areas were slaughtered and buried. Direct, close contact with pigs was the primary source of human Nipah infection, but other Copyright © 2000 The University of Chicago [ABSTRACT FROM AUTHOR]
Published: 2000
Full Text: View/download PDF

27. Traveler's diarrhea at sea: three outbreaks of waterborne enterotoxigenic Escherichia coli on cruise ships.

Author: Daniels NA, Neimann J, Karpati A, Parashar UD, Greene KD, Wells JG, Srivastava A, Tauxe RV, Mintz ED, and Quick R
Abstract: Enterotoxigenic Escherichia coli (ETEC) has become the leading bacterial cause of gastroenteritis outbreaks on cruise ships. Investigation of recent outbreaks of ETEC gastroenteritis on 3 cruise ships indicated that all were associated with consuming beverages with ice cubes on board the ship (relative risk [RR], 1.4, 95% confidence interval [CI], 1.0-1.9, P=.02; RR, 1.9, 95% CI, 1.3-2. 9, P<.001; and RR, 1.3, 95% CI, 1.0-1.6, P<.01), and 2 were associated with drinking unbottled water (RR, 2.7, 95% CI, 1.8-4.1, P<.001; RR, 1.7, 95% CI, 1.3-2.3, P<.001). Multiple ETEC serotypes were detected in patients' stool specimens in each of the 3 outbreaks, and 12 (38%) of 32 isolates were resistant to > or =3 antimicrobial agents. ETEC appears to be emerging as a waterborne pathogen on cruise ships. Water bunkered in overseas ports was the likely source of ETEC infection in these outbreaks. To ensure passenger safety, cruise ships that take on water in foreign ports must ensure that water treatment and monitoring systems function properly. Copyright © 2000 The University of Chicago [ABSTRACT FROM AUTHOR]
Published: 2000
Full Text: View/download PDF

28. Topical antimicrobials applied to the umbilical cord stump: a new intervention against neonatal tetanus.

Author: Parashar, UD, Bennett, JV, Boring, JR, Hlady, WG, Parashar, U D, Bennett, J V, Boring, J R, and Hlady, W G
Abstract: Background: Previous case-control studies of neonatal tetanus (NNT), a leading cause of infant mortality in developing countries, have suggested that antimicrobials applied after delivery to the umbilical cord stump may protect against this disease. However, assessment of their protective effect has been limited by the low prevalence of antimicrobial use in developing countries.Methods: We conducted a population-based, matched, case-control study to assess the use of antimicrobials and other factors potentially related to NNT in rural parts of Bangladesh. We studied 359 cases (infants who were normal at birth but who died between the 3rd and 30th day of life after an illness characterized by signs of NNT), each matched to three living controls for gender, residence, and date of birth.Results: In univariate analyses, the application of either antibiotics or disinfectants at delivery, and the continuous or any application of disinfectants were protective against NNT. The application of antibiotics at delivery (odds ratio [OR] = 0.21, P = 0.019), hand washing by the delivery attendant (OR = 0.64, P = 0.005), and prior maternal immunization with tetanus toxoid (OR = 0.50, P < 0.001) remained protective in conditional logistic-regression analyses. Application of animal dung to the umbilical stump (OR = 2.31, P = 0.047) was hazardous.Conclusions: Effective and inexpensive topical antimicrobials provide a new prevention opportunity that could be used by traditional birth attendants and mothers to provide additional benefits to NNT control programmes based on maternal immunization with tetanus toxoid. Promotion of hygienic delivery and cord-care practices and increasing tetanus toxoid coverage remain cornerstones for the prevention of NNT deaths. [ABSTRACT FROM AUTHOR]
Published: 1998
Full Text: View/download PDF

29. The promise of new rotavirus vaccines.

Author: Glass RI and Parashar UD
Published: 2006

30. Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP)

Author: Cortese MM, Parashar UD, and Centers for Disease Control and Prevention (CDC)
Abstract: Rotavirus is the most common cause of severe gastroenteritis in infants and young children worldwide. Before initiation of the rotavirus vaccination program in the United States in 2006, approximately 80% of U.S. children had rotavirus gastroenteritis by age 5 years. Each year during the 1990s and early 2000s, rotavirus resulted in approximately 410,000 physician visits, 205,000272,000 emergency department visits, and 55,00070,000 hospitalizations among U.S. infants and children, with total annual direct and indirect costs of approximately $1 billion. In February 2006, a live, oral, human-bovine reassortant rotavirus vaccine (RotaTeq(R) [RV5]) was licensed as a 3-dose series for use among U.S. infants for the prevention of rotavirus gastroenteritis, and the Advisory Committee on Immunization Practices (ACIP) recommended routine use of RV5 among U.S. infants (CDC. Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2006;55[No. RR-12]). In April 2008, a live, oral, human attenuated rotavirus vaccine (Rotarix(R) [RV1]) was licensed as a 2-dose series for use among U.S. infants, and in June 2008, ACIP updated its rotavirus vaccine recommendations to include use of RV1. This report updates and replaces the 2006 ACIP statement for prevention of rotavirus gastroenteritis. ACIP recommends routine vaccination of U.S. infants with rotavirus vaccine. RV5 and RV1 differ in composition and schedule of administration. RV5 is to be administered orally in a 3-dose series, with doses administered at ages 2, 4, and 6 months. RV1 is to be administered orally in a 2-dose series, with doses administered at ages 2 and 4 months. ACIP does not express a preference for either RV5 or RV1. The recommendations in this report also address the maximum ages for doses, contraindications, precautions, and special situations for the administration of rotavirus vaccine. [ABSTRACT FROM AUTHOR]
Published: 2009

31. Removing the age restrictions for rotavirus vaccination: a benefit-risk modeling analysis.

Author: Patel MM, Clark AD, Sanderson CF, Tate J, Parashar UD, Patel, Manish M, Clark, Andrew D, Sanderson, Colin F B, Tate, Jacqueline, and Parashar, Umesh D
Abstract: Background: To minimize potential risk of intussusception, the World Health Organization (WHO) recommended in 2009 that rotavirus immunization should be initiated by age 15 weeks and completed before 32 weeks. These restrictions could adversely impact vaccination coverage and thereby its health impact, particularly in developing countries where delays in vaccination often occur.Methods and Findings: We conducted a modeling study to estimate the number of rotavirus deaths prevented and the number of intussusception deaths caused by vaccination when administered on the restricted schedule versus an unrestricted schedule whereby rotavirus vaccine would be administered with DTP vaccine up to age 3 years. Countries were grouped on the basis of child mortality rates, using WHO data. Inputs were estimates of WHO rotavirus mortality by week of age from a recent study, intussusception mortality based on a literature review, predicted vaccination rates by week of age from USAID Demographic and Health Surveys, the United Nations Children's Fund (UNICEF) Multiple Indicator Cluster Surveys (MICS), and WHO-UNICEF 2010 country-specific coverage estimates, and published estimates of vaccine efficacy and vaccine-associated intussusception risk. On the basis of the error estimates and distributions for model inputs, we conducted 2,000 simulations to obtain median estimates of deaths averted and caused as well as the uncertainty ranges, defined as the 5th-95th percentile, to provide an indication of the uncertainty in the estimates. We estimated that in low and low-middle income countries a restricted schedule would prevent 155,800 rotavirus deaths (5th-95th centiles, 83,300-217,700) while causing potentially 253 intussusception deaths (76-689). In contrast, vaccination without age restrictions would prevent 203,000 rotavirus deaths (102,000-281,500) while potentially causing 547 intussusception deaths (237-1,160). Thus, removing the age restrictions would avert an additional 47,200 rotavirus deaths (18,700-63,700) and cause an additional 294 (161-471) intussusception deaths, for an incremental benefit-risk ratio of 154 deaths averted for every death caused by vaccine. These extra deaths prevented under an unrestricted schedule reflect vaccination of an additional 21%-25% children, beyond the 63%-73% of the children who would be vaccinated under the restricted schedule. Importantly, these estimates err on the side of safety in that they assume high vaccine-associated risk of intussusception and do not account for potential herd immunity or non-fatal outcomes.Conclusions: Our analysis suggests that in low- and middle-income countries the additional lives saved by removing age restrictions for rotavirus vaccination would far outnumber the potential excess vaccine-associated intussusception deaths. Please see later in the article for the Editors' Summary. [ABSTRACT FROM AUTHOR]
Published: 2012
Full Text: View/download PDF

32. Sibling transmission of vaccine-derived rotavirus (RotaTeq) associated with rotavirus gastroenteritis.

Author: Payne DC, Edwards KM, Bowen MD, Keckley E, Peters J, Esona MD, Teel EN, Kent D, Parashar UD, and Gentsch JR
Published: 2010
Full Text: View/download PDF

33. Adoption of rotavirus vaccination by pediatricians and family medicine physicians in the United States.

Author: Kempe A, Patel MM, Daley MF, Crane LA, Beaty B, Stokley S, Barrow J, Babbel C, Dickinson LM, Tempte JL, and Parashar UD
Published: 2009
Full Text: View/download PDF

34. Projected Impact of the new rotavirus vaccination program on hospitalizations for gastroenteritis and rotavirus disease among US children <LT>5 years of age during 2006-2015.

Author: Curns AT, Coffin F, Glasser JW, Glass RI, and Parashar UD
Abstract: BACKGROUND: Rotavirus causes approximately one-third to one-half (55,000-70,000 hospitalizations per year) of hospitalizations for acute gastroenteritis (AGE) among US children <5 years of age. We forecasted the potential reduction in the number of hospitalizations for rotavirus disease and AGE in US children during 2006-2015 as a result of the new rotavirus vaccine introduced in 2006. METHODS: The mean number of hospitalizations for AGE by calendar month among US children was determined using the National Hospital Discharge Survey from the period 1993-2005. From these baseline prevaccine estimates, we forecasted the effect of vaccine in reducing the number of hospitalizations for rotavirus disease and AGE during 2006-2015 with use of estimates of vaccine effectiveness and uptake. RESULTS: During 2006-2015, approximately 313,000 (45%) of an estimated 703,190 hospitalizations for rotavirus disease would be directly prevented by vaccination. A significant reduction in the number of hospitalizations for AGE should be detectable among infants aged 0-11 months during the first quarter of 2009, followed by children aged 12-23 months during 2010, and all children <5 years of age during 2011. CONCLUSIONS: Vaccination is expected to substantially reduce the health burden of hospitalizations for rotavirus disease among US children during 2006-2015, and the impact of vaccination based on direct protective effects alone was expected to first occur for hospitalizations for AGE among infants during winter 2009. [ABSTRACT FROM AUTHOR]
Published: 2009
Full Text: View/download PDF

35. Rotavirus vaccination and intussusception: can we decrease temporally associated background cases of intussusception by restricting the vaccination schedule?

Author: Tai JH, Curns AT, Parashar UD, Bresee JS, and Glass RI
Published: 2006
Full Text: View/download PDF

36. The global burden of diarrhoeal disease in children.

Author: Parashar UD, Bresee JS, and Glass RI
Published: 2003

37. The epidemiology of enteric caliciviruses from humans: a reassessment using new diagnostics.

Author: Glass RI, Noel J, Ando T, Fankhauser R, Belliot G, Mounts A, Parashar UD, Bresee JS, and Monroe SS
Abstract: In the United States, acute gastroenteritis is one of the most commonly noted illnesses on hospital discharge records and death certificates, yet few of these cases have an etiologic diagnosis. The application of new molecular diagnostic methods has shown caliciviruses (previously referred to as the Norwalk family of viruses or small round structured viruses) to be the most common cause of acute gastroenteritis (AGE) outbreaks in the United States, and they may emerge as a common cause of sporadic cases of AGE among both children and adults. Novel molecular methods have permitted outbreak strains to be traced back to their common source and have led to the first identification of virus in implicated vehicles of infection-water, shellfish, and foods contaminated both at their source and by food handlers. The broad application of these methods to routine diagnosis in hospitals and public health laboratories is advancing our appreciation of the full burden of calicivirus-associated diarrhea, and it is opening new avenues for its prevention and control. Copyright © 2000 The University of Chicago [ABSTRACT FROM AUTHOR]
Published: 2000
Full Text: View/download PDF

38. The future of rotavirus vaccines: a major setback leads to new opportunities.

Author: Glass RI, Bresee JS, Parashar UD, Jiang B, and Gentsch J
Published: 2004
Full Text: View/download PDF

39. 2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis.

Author: Tate JE, Burton AH, Boschi-Pinto C, Steele AD, Duque J, Parashar UD, and WHO-coordinated Global Rotavirus Surveillance Network
Published: 2012

40. Rotavirus vaccines.

Author: Molinaro GA, Lee DA, Lee P, Simonson L, Taylor RJ, Kapikian AZ, Ruiz LP Jr., O'Ryan M, Ruiz-Palacios GM, Clemens R, Vesikari T, DiNubile MJ, Heaton PM, Glass RI, and Parashar UD
Published: 2006

41. Norovirus gastroenteritis.

Author: Cremon C, De Giorgio R, Barbara G, Glass RI, Parashar UD, and Estes MK
Published: 2010
Full Text: View/download PDF

42. Rotavirus vaccine effectiveness stratified by national-level characteristics: an introduction to the 24-country MNSSTER-V Project, 2007-2023.

Author: Burnett E, Umana J, Anwari P, Mujuru HA, Groome MJ, Van Trang N, Iniguez V, Gheorghita S, Sahakyan G, Nazurdinov A, Michael F, Mandomando I, Desormeaux AM, Eraliev U, Enweronu-Laryea C, Nalunkuma C, Bonkoungou I, Muhsen K, Luhata Lungayo C, Omore R, Goldfarb DM, Robinson AL, McCracken J, Uwimana J, N'Zue K, Rey-Benito G, Weldegebriel G, Mwenda JM, Parashar UD, and Tate JE
Abstract: Background: Rotavirus vaccines are moderately protective against illness in high mortality settings compared with low mortality settings. Vaccine effectiveness (VE) evaluations may clarify our understanding of these disparities, but estimates among key subpopulations and against rare outcomes are not available in many analyses due to sample size. We combined 25 datasets from test-negative design case-control evaluations in 24 countries that enrolled children with medically-attended diarrhea, laboratory-confirmed rotavirus stool testing, and documented vaccination status. We calculated rotavirus VE stratified by country-level characteristics., Methods: Children 3-59 months old with birthdates and surveillance hospital arrival dates were included; other variables were standardized as available. Children were considered vaccinated if they received ≥1 dose of rotavirus vaccine >14 days before arrival. We summarized child- and country- level characteristics, including national <5-year-old child mortality rate (U5M). Following the manufacturer recommended dose schedule, complete- and partial-series adjusted VE were estimated using logistic regression models., Results: We included 6,626 rotavirus positive children (cases) and 19,459 rotavirus negative children (controls). Adjusted complete series VE was significantly higher among children from countries in the low and medium U5M strata (74% (95%CI: 64-81)) compared to all groups within the high U5M strata (range: 52% (95%CI: 42- 60) to 46% (95%CI: 31-57)). Partial series were lower than complete series estimates., Conclusions: These findings are consistent with the published literature, though they suggest heterogeneity in vaccine performance within broad child mortality levels. Our findings also highlight the importance of complete-series vaccination., (Published by Oxford University Press on behalf of Infectious Diseases Society of America 2024.)
Published: 2024
Full Text: View/download PDF

43. Clinical Severity of Enteric Viruses Detected Using a Quantitative Molecular Assay Compared With Conventional Assays in the Global Enteric Multicenter Study.

Author: Cates J, Powell H, Platts-Mills J, Nasrin D, Panchalingam S, Sow SO, Traore A, Sur D, Ramamurthy T, Zaidi AKM, Kabir F, Faruque ASG, Ahmed D, Breiman RF, Omore R, Ochieng JB, Hossain MJ, Antonio M, Mandomando I, Vubil D, Nataro JP, Levine MM, Parashar UD, Kotloff KL, and Tate JE
Subjects: Humans, Infant, Child, Preschool, Infant, Newborn, Female, Male, Gastroenteritis virology, Gastroenteritis diagnosis, Rotavirus isolation & purification, Rotavirus genetics, Feces virology, Norovirus isolation & purification, Norovirus genetics, Severity of Illness Index
Abstract: Background: Quantitative molecular assays are increasingly used for detection of enteric viruses., Methods: We compared the clinical severity using the modified Vesikari score (mVS) of enteric viruses detected by conventional assays (enzyme immunoassays [EIAs] for rotavirus and adenovirus 40/41 and conventional polymerase chain reaction for astrovirus, sapovirus, and norovirus) and a quantitative molecular assay (TaqMan Array Card [TAC]) among children aged 0-59 months in the Global Enteric Multicenter Study. For rotavirus and adenovirus 40/41, we compared severity between EIA-positive and TAC-positive cases assigned etiologies using different cycle threshold (Ct) cutoffs., Results: Using conventional assays, the median mVS (interquartile range) was 10 (8-11) for rotavirus, 9 (7-11) for adenovirus 40/41, 8 (6-10) for astrovirus, sapovirus, and norovirus GII, and 7 (6-9) for norovirus GI. Compared with rotavirus EIA-positive cases, the median mVS was 2 and 3 points lower for EIA-negative/TAC-positive cases with Ct <32.6 or Ct ≥32.6 and <35, respectively (P < .001). Adenovirus 40/41 EIA-positive and EIA-negative/TAC-positive cases were similar, regardless of Ct cutoff., Conclusions: Quantitative molecular assays compared with conventional assays, such as EIA, may influence the severity of identified cases, especially for rotavirus. Cutoffs to assign etiology for quantitative assays should be considered in the design and interpretation of enteric virus studies., Competing Interests: Potential conflicts of interest. D. S. reports employment and shares with GSK Vaccines, outside the submitted work. A. K. M. Z. was involved in this work as the site principial investigator of the GEMS study at the Aga Khan University during 2008–2012; she is currently the President of Gender Equality at the Bill & Melinda Gates Foundation and has not influenced this analysis from her position there. K. L. K. received funding from the Bill & Melinda Gates Foundation for part of the submitted work and outside the submitted work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (Published by Oxford University Press on behalf of Infectious Diseases Society of America 2024.)
Published: 2024
Full Text: View/download PDF

44. Infectious etiology of intussusception in Indian children less than 2 years old: a matched case-control analysis.

Author: Praharaj I, Reddy SN, Nair NP, Tate JE, Giri S, Thiyagarajan V, Mohan VR, Revathi R, Maheshwari K, Hemavathy P, Kumar N, Gupte MD, Arora R, Senthamizh S, Mekala S, Goru KB, Pamu P, Badur M, Pradhan S, Dash M, Mohakud NK, Ray RK, Gathwala G, Gupta M, Kanojia R, Gupta R, Goyal S, Sharma P, Mathew MA, Kochukaleekal Jacob TJ, Sundaram B, Girish Kumar CP, Dorairaj P, Pitchumani R, Maniam R, Kumaravel S, Jain H, Goswami JK, Wakhlu A, Gupta V, Liu J, Houpt ER, Parashar UD, and Kang G
Abstract: Background: Enteric infections are hypothesized to be associated with intussusception in children. A small increase in intussusception following rotavirus vaccination has been seen in some settings. We conducted post-marketing surveillance for intussusception following rotavirus vaccine, Rotavac introduction in India and evaluated association of intussusception with enteric pathogens., Methods: In a case-control study nested within a large sentinel hospital-based surveillance program in India, stool samples from 272 children aged less than 2 years admitted for intussusception and 272 age-, gender- and location-matched controls were evaluated with Taqman array card based molecular assays to detect enteric viruses, bacterial enteropathogens and parasites. Matched case-control analysis with conditional logistic regression evaluated association of enteropathogens with intussusception. Population attributable fractions (PAF) were calculated for enteropathogens significantly associated with intussusception., Results: The most prevalent enteropathogens in cases and controls were enteroaggregative Escherichia coli, adenovirus 40/41, adenovirus C serotypes and enteroviruses. Children with intussusception were more likely to harbor adenovirus C serotypes (adjusted odds-ratio (aOR) = 1.74; 95% confidence interval (CI) 1.06-2.87) and enteroviruses (aOR = 1.77; 95% CI 1.05-2.97) than controls. Rotavirus was not associated with increased intussusception risk. Adenovirus C (PAF = 16.9%; 95% CI 4.7% - 27.6%) and enteroviruses (PAF = 14.7%; 95% CI 4.2% - 24.1%) had the highest population attributable fraction for intussusception., Conclusion: Adenovirus C serotypes and enteroviruses were significantly associated with intussusception in Indian children. Rotavirus was not associated with risk of intussusception., (© 2024. The Author(s).)
Published: 2024
Full Text: View/download PDF

45. Rotavirus Vaccine Effectiveness Against Severe Acute Gastroenteritis: 2009-2022.

Author: Diallo AO, Wikswo ME, Sulemana I, Sahni LC, Boom JA, Ramani S, Selvarangan R, Moffatt ME, Harrison CJ, Halasa N, Chappell J, Stewart L, Staat MA, Schlaudecker E, Quigley C, Klein EJ, Englund JA, Zerr DM, Weinberg GA, Szilagyi PG, Albertin C, Johnston SH, Williams JV, Michaels MG, Hickey RW, Curns AT, Honeywood M, Mijatovic-Rustempasic S, Esona MD, Bowen MD, Parashar UD, Gautam R, Mirza SA, and Tate JE
Subjects: Humans, Infant, Child, Preschool, Male, Female, Case-Control Studies, Acute Disease, United States epidemiology, Severity of Illness Index, Rotavirus immunology, Hospitalization statistics & numerical data, Rotavirus Vaccines immunology, Rotavirus Vaccines therapeutic use, Rotavirus Vaccines administration & dosage, Gastroenteritis prevention & control, Gastroenteritis virology, Gastroenteritis epidemiology, Rotavirus Infections prevention & control, Rotavirus Infections epidemiology, Vaccine Efficacy
Abstract: Background: Rotavirus was the leading cause of acute gastroenteritis among US children until vaccine introduction in 2006, after which, substantial declines in severe rotavirus disease occurred. We evaluated rotavirus vaccine effectiveness (VE) over 13 years (2009-2022)., Methods: We analyzed data from the New Vaccine Surveillance Network using a test-negative case-control design to estimate rotavirus VE against laboratory-confirmed rotavirus infections among children seeking care for acute gastroenteritis (≥3 diarrhea or ≥1 vomiting episodes within 24 hours) in the emergency department (ED) or hospital. Case-patients and control-patients were children whose stool specimens tested rotavirus positive or negative, respectively, by enzyme immunoassay or polymerase chain reaction assays. VE was calculated as (1-adjusted odds ratio)×100%. Adjusted odds ratios were calculated by multivariable unconditional logistic regression., Results: Among 16 188 enrolled children age 8 to 59 months, 1720 (11%) tested positive for rotavirus. Case-patients were less often vaccinated against rotavirus than control-patients (62% versus 88%). VE for receiving ≥1 dose against rotavirus-associated ED visits or hospitalization was 78% (95% confidence interval [CI] 75%-80%). Stratifying by a modified Vesikari Severity Score, VE was 59% (95% CI 49%-67%), 80% (95% CI 77%-83%), and 94% (95% CI 90%-97%) against mild, moderately severe, and very severe disease, respectively. Rotavirus vaccines conferred protection against common circulating genotypes (G1P[8], G2P[4], G3P[8], G9P[8], and G12[P8]). VE was higher in children <3 years (73% to 88%); protection decreased as age increased., Conclusions: Rotavirus vaccines remain highly effective in preventing ED visits and hospitalizations in US children., (Copyright © 2024 by the American Academy of Pediatrics.)
Published: 2024
Full Text: View/download PDF

46. Correlates of Rotavirus Vaccine Shedding and Seroconversion in a US Cohort of Healthy Infants.

Author: Burke RM, Payne DC, McNeal M, Conrey SC, Burrell AR, Mattison CP, Casey-Moore MC, Mijatovic-Rustempasic S, Gautam R, Esona MD, Thorman AW, Bowen MD, Parashar UD, Tate JE, Morrow AL, and Staat MA
Subjects: Humans, Infant, Female, Male, United States, Immunoglobulin A blood, Immunoglobulin A immunology, Cohort Studies, Longitudinal Studies, Birth Cohort, Adult, Vaccination, Rotavirus Vaccines immunology, Rotavirus Vaccines administration & dosage, Virus Shedding, Antibodies, Viral blood, Rotavirus immunology, Seroconversion, Rotavirus Infections prevention & control, Rotavirus Infections immunology, Feces virology, Immunoglobulin G blood, Immunoglobulin G immunology
Abstract: Background: Rotavirus is a leading cause of severe pediatric gastroenteritis; 2 highly effective vaccines are used in the United States (US). We aimed to identify correlates of immune response to rotavirus vaccination in a US cohort., Methods: Pediatric Respiratory and Enteric Virus Acquisition and Immunogenesis Longitudinal (PREVAIL) is a birth cohort of 245 mother-child pairs enrolled in 2017-2018 and followed for 2 years. Infant stool samples and symptom information were collected weekly. Shedding was defined as reverse-transcription polymerase chain reaction detection of rotavirus vaccine virus in stools collected 4-28 days after dose 1. Seroconversion was defined as a 3-fold rise in immunoglobulin A between the 6-week and 6-month blood draws. Correlates were analyzed using generalized estimating equations and logistic regression., Results: Prevaccination immunoglobulin G (IgG) (odds ratio [OR], 0.84 [95% confidence interval {CI}, .75-.94] per 100-unit increase) was negatively associated with shedding. Shedding was also less likely among infants with a single-nucleotide polymorphism inactivating FUT2 antigen secretion ("nonsecretors") with nonsecretor mothers, versus all other combinations (OR, 0.37 [95% CI, .16-.83]). Of 141 infants with data, 105 (74%) seroconverted; 78 (77%) had shed vaccine virus following dose 1. Prevaccination IgG and secretor status were significantly associated with seroconversion. Neither shedding nor seroconversion significantly differed by vaccine product., Conclusions: In this US cohort, prevaccination IgG and maternal and infant secretor status were associated with rotavirus vaccine response., Competing Interests: Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (Published by Oxford University Press on behalf of Infectious Diseases Society of America 2024.)
Published: 2024
Full Text: View/download PDF

47. Monovalent rotavirus vaccine effectiveness and long-term impact among children <5 years old in Antananarivo, Madagascar, 2010-2022.

Author: Raboba JL, Rahajamanana VL, Rakotojoelimaria HE, Masembe YV, Martin PR, Weldegebriel GG, Diallo AO, Burnett E, Tate JE, Parashar UD, Mwenda JM, Seheri M, Magagula N, Mphahlele J, and Robinson AL
Abstract: Background: Monovalent rotavirus vaccine substantially reduced rotavirus disease burden after introduction (May 2014) in Madagascar. We examined the effectiveness and long-term impact on acute watery diarrhea and rotavirus-related hospitalizations among children <5 years old at two hospitals in Antananarivo, Madagascar (2010-2022)., Methods: We used a test-negative case-control design to estimate monovalent rotavirus vaccine effectiveness (VE) against laboratory-confirmed rotavirus hospitalizations among children age 6-23 months with documented vaccination status adjusted for year of symptom onset, rotavirus season, age group, nutritional status, and clinical severity. To evaluate the impact, we expanded to children age 0-59 months with acute watery diarrhea. First, we used admission logbook data to compare the proportion of all hospitalizations attributed to diarrhea in the pre-vaccine (January 2010-December 2013), transition period (January 2014-December 2014), and post-vaccine (January 2015-December 2022) periods. Second, we used active surveillance data (June 2013-May 2022) to describe rotavirus positivity and detected genotypes by vaccine introduction period and surveillance year (1 June-31 May)., Result: Adjusted VE of at least one dose against hospitalization due to rotavirus diarrhea among children age 6-23 months was 61 % (95 % CI: -39 %-89 %). The annual median proportion of hospitalizations attributed to diarrhea declined from 28 % in the pre-vaccine to 10 % in the post-vaccine period. Rotavirus positivity among hospitalized children age 0-59 months with acute watery diarrhea was substantially higher during the pre-vaccine (59 %) than the post-vaccine (23 %) period. In the pre-vaccine period, G3P[8] (76 %) and G2P[4] (12 %) were the dominant genotypes detected. Although genotypes varied by surveillance year, G1P[8] and G2P[4] represented >50 % of the genotypes detected post-introduction., Conclusions: Rotavirus vaccine has been successfully implemented in Madagascar's routine childhood immunization program and had a large impact on rotavirus disease burden, supporting continued use of rotavirus vaccines in Madagascar., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)
Published: 2024
Full Text: View/download PDF

48. Effectiveness and impact of monovalent rotavirus vaccination in Afghanistan: a test-negative case-control analysis.

Author: Anwari P, Burnett E, Safi N, Samsor A, Safi H, Chavers TP, Parashar UD, Clark AD, and Tate JE
Subjects: Humans, Afghanistan epidemiology, Case-Control Studies, Infant, Male, Female, Child, Preschool, Vaccines, Attenuated administration & dosage, Hospitalization statistics & numerical data, Sentinel Surveillance, Vaccination statistics & numerical data, Rotavirus Vaccines administration & dosage, Rotavirus Infections prevention & control, Rotavirus Infections epidemiology, Gastroenteritis prevention & control, Gastroenteritis virology, Gastroenteritis epidemiology, Vaccine Efficacy statistics & numerical data
Abstract: Background: Afghanistan introduced monovalent rotavirus vaccine (Rotarix) into its national immunisation schedule in January, 2018. While post-licensure studies have shown substantial declines in rotavirus gastroenteritis cases and deaths globally, there is little evidence of rotavirus vaccine effectiveness and impact from low-income countries in Asia. We aimed to evaluate the effectiveness of the Rotarix vaccine and the impact of Rotarix vaccine on rotavirus gastroenteritis hospitalisations (ie, hospital admissions) among children younger than 5 years in Afghanistan., Methods: We used a test-negative case-control design embedded in an active sentinel surveillance platform to evaluate vaccine effectiveness. Children born on or after Jan 1, 2018, who had documentation of their rotavirus vaccination status and who were admitted for acute gastroenteritis at one of four sentinel hospitals from May, 2018 to December, 2021 were eligible to be included. We used an unconditional logistic regression model to estimate vaccine effectiveness and 95% CIs for a complete series of doses compared with no rotavirus vaccine doses among patients admitted with acute gastroenteritis. Vaccine effectiveness against hospitalisation was calculated as (1 - [odds of being vaccinated in cases] / [odds of being vaccinated in controls]) × 100%. We compared pre-vaccine (2013-15) and post-vaccine (2019-21) surveillance data from two sites to calculate vaccine impact., Findings: The vaccine effectiveness analysis included 1172 cases and 2173 controls. Approximately 2108 (63·0%) of 3345 cases and controls were male, 1237 (37·0%) were female, and 2171 (65·0%) were aged 6-11 months. Two doses of Rotarix were 45% (95% CI 22-62) effective against rotavirus hospitalisation in children aged 6-59 months, adjusting for age, severity, admission year, and rotavirus season. Rotavirus positivity decreased from 51% pre-vaccine to 39% post-vaccine, resulting in a 39% adjusted reduction in rotavirus positivity among children younger than 5 years admitted with acute gastroenteritis., Interpretation: Rotarix showed moderate effectiveness in preventing rotavirus gastroenteritis hospitalisations, consistent with findings in other low-income countries. These findings support the continued administration of the rotavirus vaccine in Afghanistan., Funding: Gavi, the Vaccine Alliance., Translation: For the Dari translation of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Published: 2024
Full Text: View/download PDF

49. Rotavirus Genotypes in the Postvaccine Era: A Systematic Review and Meta-analysis of Global, Regional, and Temporal Trends by Rotavirus Vaccine Introduction.

Author: Amin AB, Cates JE, Liu Z, Wu J, Ali I, Rodriguez A, Panjwani J, Tate JE, Lopman BA, and Parashar UD
Subjects: Humans, Child, Preschool, Infant, Global Health, Vaccination, Rotavirus Vaccines immunology, Rotavirus Vaccines administration & dosage, Rotavirus genetics, Rotavirus immunology, Rotavirus classification, Rotavirus Infections prevention & control, Rotavirus Infections epidemiology, Rotavirus Infections virology, Genotype
Abstract: Background: Even moderate differences in rotavirus vaccine effectiveness against nonvaccine genotypes may exert selective pressures on circulating rotaviruses. Whether this vaccine effect or natural temporal fluctuations underlie observed changes in genotype distributions is unclear., Methods: We systematically reviewed studies reporting rotavirus genotypes from children <5 years of age globally between 2005 and 2023. We compared rotavirus genotypes between vaccine-introducing and nonintroducing settings globally and by World Health Organization (WHO) region, calendar time, and time since vaccine introduction., Results: Crude pooling of genotype data from 361 studies indicated higher G2P[4], a nonvaccine genotype, prevalence in vaccine-introducing settings, both globally and by WHO region. This difference did not emerge when examining genotypes over time in the Americas, the only region with robust longitudinal data. Relative to nonintroducing settings, G2P[4] detections were more likely in settings with recent introduction (eg, 1-2 years postintroduction adjusted odds ratio [aOR], 4.39; 95% confidence interval [CI], 2.87-6.72) but were similarly likely in settings with more time elapsed since introduction, (eg, 7 or more years aOR, 1.62; 95% CI, .49-5.37)., Conclusions: When accounting for both regional and temporal trends, there was no substantial evidence of long-term vaccine-related selective pressures on circulating genotypes. Increased prevalence of G2P[4] may be transient after rotavirus vaccine introduction., Competing Interests: Potential conflicts of interest. B. A. L. reports personal fees outside the submitted work from Epidemiologic Research and Methods, LLC and Hillevax, Inc; and has participated on the Data Safety Monitoring Board for the HICRota study in Zambia. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (Published by Oxford University Press on behalf of Infectious Diseases Society of America 2023.)
Published: 2024
Full Text: View/download PDF

50. Etiology of diarrheal hospitalizations following rotavirus vaccine implementation and association of enteric pathogens with malnutrition among under-five children in India.

Author: Varghese T, Mills JAP, Revathi R, Antoni S, Soeters HM, Emmanuel Njambe TO, Houpt ER, Tate JE, Parashar UD, and Kang G
Abstract: Malnourished children are at higher risk of mortality and morbidity following diarrheal illness and certain enteropathogens have been associated with malnutrition in children. Very few studies have comprehensively looked at the etiology of diarrhea in malnourished children and most have used conventional diagnostic methods with suboptimal sensitivity. We used a highly sensitive molecular approach against a broad range of pathogens causing diarrhea and examined their association with malnutrition. In addition, we looked at the pathogen diversity of pediatric diarrhea, three years after the nationwide rotavirus vaccine introduction to understand the evolving landscape of pathogens, which is crucial for planning strategies to further reduce the diarrhea burden. Clinical details and diarrheal stool samples were collected from hospitalized children aged < 5 years from three sentinel sites in India for a period of one year. The samples were tested by qPCR for 16 established causes of diarrhea using TaqMan Array Cards. A total of 772 children were enrolled, from whom 482 (62.4%) stool specimens were tested. No specific pathogen was associated with diarrhea among children with acute or chronic malnutrition compared to those with better nutritional status. Overall, adenovirus was the leading pathogen (attributable fraction (AF) 16.9%; 95% CI 14.1 to 19.2) followed by rotavirus (AF 12.6%; 95% CI 11.8 to 13.1) and Shigella (AF 10.9%; 95% CI 8.4 to 16.4). The majority of diarrhea requiring hospitalization in children aged < 2 years could be attributed to viruses, while Shigella was the most common pathogen among children aged > 2 years. These data on the prevalence and epidemiology of enteropathogens identified potential pathogens for public health interventions., (© 2024. The Author(s).)
Published: 2024
Full Text: View/download PDF

Catalog

Books, media, physical & digital resources

See catalog results

Searchworks

Select search scope, currently: Articles Catalog books, media & more in Jio Institute collections Articles journal articles & other e-resources

Search

Search Constraints

Refine your results

Search Limiters

Topic

Publication Year Range

Language

Publication Type

Journal

Region

Database

Publisher

563 results on '"Parashar UD"'

Search Results

Catalog

Select search scope, currently: Articles

Catalog

books, media & more in Jio Institute collections

Articles

journal articles & other e-resources