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Introduction Because vital registration and surveillance data on etiology-specific causes of death are frequently unavailable, incomplete or inaccurate, statistical models are commonly used to estimate burden of disease. Mathers et [...], Objective To illustrate the effects of failing to account for model uncertainty when modelling is used to estimate the global burden of disease, with specific application to childhood deaths from rotavirus infection. Methods To estimate the global burden of rotavirus infection, different random-effects meta-analysis and meta- regression models were constructed by varying the Stratification criteria and including different combinations of covariates. Bayesian model averaging was used to combine the results across models and to provide a measure of uncertainty that reflects the choice of model and the sampling variability. Findings In the models examined, the estimated number of child deaths from rotavirus infection varied between 492 000 and 664 000. While averaging over the different models' estimates resulted in a modest increase in the estimated number of deaths (541 000 as compared with the World Health Organization's estimate of 527 000), the width of the 95% confidence interval increased from 105 000 to 198 000 deaths when model uncertainty was taken into account. Conclusion Sampling variability explains only a portion of the overall uncertainty in a modelled estimate. The uncertainty owing to both the sampling variability and the choice of model(s) should be given when disease burden results are presented. Failure to properly account for uncertainty in disease burden estimates may lead to inappropriate uses of the estimates and inaccurate prioritization of global health needs. Objectif Illustrer les effets de rabsence de prise en compte de L'incertitude des modeles quand la modelisation est utilisee pour estimer les effets globaux induits par la maladie, avec une application specifique a la mortalite infantile liee a L'infection par rotavirus. Methodes Pour estimer la charge giobale de L'infection par rotavirus, differents modeles de meta-analyse d'effet aleatoire et de meta-regression ont ete elabores en faisant varier les criteres de stratification et en incluant differentes associations de covariantes. Un modele bayesien de calcul de moyenne a ete utilise pour combiner les resultats entre les modeles et fournir une mesure de l'incertitude qui reflete la variabilite du choix du modele et de rechantillonnage. Resultats Dans les modeles examines, le nombre estime d'enfants morts par infection de rotavirus variait entre 492 000 et 664 000. Tandis que le calcul de la moyenne des estimations des differents modeles donnait une Iegere augmentation du nombre estime de morts (541 000, par comparaison aux 527 000 estimes par l'Organisation mondiale de la Sante), l'ampleur de L'intervalle de confiance de 95% passait de 105 000 a 198 000 morts Iorsque L'incertitude du modele etait prise en compte. Conclusion La variabilite de L'echantillonnage n'explique qu'une partie de l'incertitude globale dans une estimation par modele. L'incertitude liee a la fois a la variabilite de L'echantillonnage et au choix de modele(s) doit etre indiquee dans la presentation de resultats concernant les effets induits par la maladie. Ne pas prendre en compte L'incertitude comme il se doit dans les estimations des effets de la maladie peut conduire a un usage inapproprie des estimations et a une affectation erronee des priorites dans les besoins globaux de sante. Objetivo Ilustrar las consecuencias que acarrea no contemplar la incertidumbre del modelo cuando dicho modelo se emplea para calcular la carga de enfermedad global, especialmente en el caso de las muertes infantiles por una infeccion por rotavirus. Metodos Con el fin de calcular la carga global de la infeccion por rotavirus, se desarrollaron diversos modelos de metaanalisis y metarregresion de erectos aleatorios modificando los criterios de estratificacion e incluyendo diversas combinaciones de covariables. Se empleo el metodo bayesiano de estimacion de la media para combinar los resultados entre los modelos y ofrecer una medida de incertidumbre que reflejara la eleccion de modelo y la variabilidad del muestreo. Resultados En los modelos examinados, la cantidad estimada de muertes infantiles provocadas por una infeccion por rotavirus oscilo entre 492 000 y 664 000. Si bien la media de las estimaciones de los diversos modelos dio como resultado un aumento moderado en la cantidad estimada de muertes (541 000 en comparacion con la estimacion de la Organizacion Mundial de la Salud, de 527 000); la amplitud del intervalo de confianza del 95% provoco un aumento de 105 000 a 198 000 muertes cuando se tomo en consideracion la incertidumbre de los modelos. Conclusion La variabilidad del muestreo explica unicamente una parte de la incertidumbre global de una estimacion extraida empleando un modelo. La incertidumbre atribuible tanto a la variabilidad del muestreo como a la eleccion de uno o varios modelos debe indicarse cuando se presenten los resultados de carga de enfermedad. No contemplar debidamente la incertidumbre de las estimaciones en la carga de enfermedad, podria acarrear un uso inadecuado de las estimaciones y una priorizacion inexacta de las necesidades sanitarias globales.

A total of 3,101 fecal specimens were collected during an 8-year survey for rotavirus infection in Sao Paulo, Brazil. Group A rotavirus was detected in 774 (25.0%) specimens. Of these, [...]

High loads of Norwalk-like viruses (NLVs) may be in sewage. That might justify more studies addressing the efficacy of NLV removal by sewage water treatment methods. NLV RNA was found by reverse transcriptase PCR (RT-PCR) in sewage water concentrates. Analysis of sequences of the RT-PCR products showed identical sequences in stools of patients and related sewage samples. In 6 of 11 samples not related to outbreaks, multiple NLV genotypes were seen.

Infectious diarrheal diseases and protein-energy malnutrition (PEM) are major causes of child morbidity and mortality worldwide. In the present study, PEM was superimposed on rotavirus infection in neonatal pigs to simulate chronic small intestinal stress in malnourished infants with vital gastroenteritis. Two-day-old cesarean-derived pigs (n = 39) were allotted to three treatment groups: 1) noninfected, full-fed; 2) infected, full-fed; and 3) infected, malnourished. Two days postinfection, severe diarrhea and weight loss (11%) were accompanied by reductions in villus height (60%) and lactase activity (78%) and increased crypt depth (32%) in infected full-fed compared with noninfected pigs (P < 0.05). Malnutrition blunted (P < 0.05) increases in crypt depth elicited by rotavirus. By 9 d postinfection, body weight was 59% less, villus height and lactase activity remained lower (50%), and crypt depth remained greater (62%) in infected full-fed compared with noninfected pigs (P < 0.05). However, diarrhea began to clear in infected full-fed, but not in infected malnourished pigs. Plasma insulin-like growth factor-I (IGF-I) was reduced 68% and crypt depth was reduced 19% in infected-malnourished compared with infected full-fed pigs (P < 0.05). Sixteen days postinfection, full-fed pigs had recovered from rotaviral infection; however, in infected-malnourished pigs, diarrhea and growth stasis persisted, and plasma IGF-I, villus height and alkaline phosphatase activity remained reduced compared with infected full-fed pigs (P < 0.05). Overall, PEM prolonged diarrhea and delayed small-intestinal recovery, indicating that nutritional status during diarrhea is essential for recovery from rotaviral enteritis. KEY WORDS: * rotavirus * malnutrition * pigs * neonate * small intestine