Rotavirus surveillance in Kilifi District, Kenya

1
Rotavirus surveillance in Kilifi District, Kenya
Nokes DJ, Abwao J, Peenze I, Dewar J, Maghenda J,
Gatakaa H, Pamba A, Bauni E, Scott JA, Maitland
K, Williams, TN
2
Disease burden

• Extrapolations based on key assumptions
• proportion of diarrhoea attributable to RV
• death rates equal for all causes of diarrhoea

in children lt5 yrs per annum
Parashar et al, 2003 2006
3
gt80 severe RV disease in poor countries

• 1000 deaths

Parashar et al, EID 2006
4
Vaccination

• No alternative? Priority LDCs (WHO 2000)

• African rotavirus network
• Vaccine safety/efficacy
• Laboratory surveillance network
• Burden of disease
• Sero- geno-typing
• Intussusception
• Trial sites

5
rationale

• epidemiology, clinical spectrum incidence of
  severe RV disease in rural Kenya District
• vaccine testing site

6
KEMRI / Wellcome Trust Programme, Kilifi, Kenya
7
(No Transcript)
8
linked surveillance
9
methods 1

• clinico-epidemiology
• January 2002 - December 2004
• cases children lt13 years presenting to KDH with
  symptoms that included diarrhoea
• controls - no diarrhoea (13)

• sampled within 24 hrs
• tested for group A rotavirus by ELISA
• confirmed by PAGE

10
methods 2

• disease burden
• numerator
• cases of diarrhoea
• resident in DSS at admission
• stratified by RV status
• denominator
• mid-point population
• stratified by age and sub-location

11
results
admissions - 15,347
12
epidemiology
38 of infant diarrhoea GARVve
13
epidemiology
14
clinical spectrum
15
disease burden
cases per annum / 100,000 by age
In Kenya gt28,000 preventable GARV lt5 admissions
per annum
16

• Variation in GARV lt5 incidence (/100,000/yr)
• Access to KDH
• Other Health Facilities

17
conclusions

• Incidence 500/100,000 lt5yr
• Minimum estimates may be double
• 29 of all diarrhoea (38 infants)
• lt20 GARV occurs in first 6 months

• Acute otherwise healthy children
• Severe disease life threatening
• Mortality low well managed

• Kenya gt28,000 cases GARV /annum lt5yr
• vaccine testing site?
• Resources avoid death?

18

• Participants
• Staff DSS team, ward field workers, nurses,
  clinicians, lab teams
• Institutions KEMRI, Oxford University,
  University of Warwick, Imperial College London,
  MRC Medunsa, South Africa
• Financial Wellcome Trust, COSMIC, INDEPTH

19
(No Transcript)
20
Comparative incidence Kilifi DSS
Admissions 2002-05