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Ahead of Print -Rotavirus Surveillance in Urban and Rural Areas of Niger, April 2010–March 2012 - Volume 20, Number 4—April 2014 - Emerging Infectious Disease journal - CDC

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Ahead of Print -Rotavirus Surveillance in Urban and Rural Areas of Niger, April 2010–March 2012 - Volume 20, Number 4—April 2014 - Emerging Infectious Disease journal - CDC





Volume 20, Number 4—April 2014

Research

Rotavirus Surveillance in Urban and Rural Areas of Niger, April 2010–March 2012

Anne-Laure PageComments to Author , Viviane Jusot, Abdoul-Aziz Mamaty, Lagare Adamou, Jérôme Kaplon, Pierre Pothier, Ali Djibo, Mahamane L. Manzo, Brahima Toure, Céline Langendorf, Jean-Marc Collard, and Rebecca F. Grais
Author affiliations: Epicentre, Paris, France (A.-L. Page, C. Langendorf, R.F. Grais); Epicentre, Niamey, Niger (V. Jusot, A.-A. Mamaty, B. Toure)Centre de Recherche Médicale et Sanitaire (CERMES), Niamey (L. Adamou, J.-M. Collard)University Hospital of Dijon, Dijon, France (J. Kaplon, P. Pothier)Ministry of Health, Niamey (A. Djibo, M.L. Manzo)Niamey University, Niamey (A. Djibo)

Abstract

Knowledge of rotavirus epidemiology is necessary to make informed decisions about vaccine introduction and to evaluate vaccine impact. During April 2010–March 2012, rotavirus surveillance was conducted among 9,745 children <5 years of age in 14 hospitals/health centers in Niger, where rotavirus vaccine has not been introduced. Study participants had acute watery diarrhea and moderate to severe dehydration, and 20% of the children were enrolled in a nutrition program. Of the 9,745 children, 30.5% were rotavirus positive. Genotyping of a subset of positive samples showed a variety of genotypes during the first year, although G2P[4] predominated. G12 genotypes, including G12P[8], which has emerged as a predominant strain in western Africa, represented >80% of isolates during the second year. Hospitalization and death rates and severe dehydration among rotavirus case-patients did not differ during the 2 years. The emergence of G12P[8] warrants close attention to the characteristics of associated epidemics and possible prevention measures.
As the leading cause of severe gastroenteritis in children, rotavirus is responsible for ≈450,000 deaths each year among children <5 years of age, mainly in low-income countries (1,2). Two rotavirus vaccines that have been prequalified by the World Health Organization, Rotarix (GlaxoSmithKline Biologicals, Rixensart, Belgium) and Rotateq (Merck, Whitehouse Station, NJ, USA), have been introduced widely in high- and middle-income countries, where their effect on rotavirus-related hospital admissions and deaths has been demonstrated (3). These vaccines are being introduced in several low-income countries in Africa and Asia, where their efficacy is lower (46) and impact data are limited (7).
Four rotavirus genotypes were historically recognized as predominant: G1P[8], G2P[4], G3P[8], and G4P[8]. These genotypes represented 88% of all rotavirus strains worldwide, and genotype G1P[8] has been responsible for >70% of the rotavirus infections in North America, Europe, and Australia (8). Since 2000, the prevalence of G1 strains has been declining, and other genotypes, such as G9 and G12, have emerged (9). In Africa, G12 strains were first detected in southern Africa, mostly in association with P[6] (1012), and G12P[8] recently emerged as a predominant strain in western Africa (13,14) and some regions of Spain (15), Argentina (16), and the United States (17).
Because questions remain about vaccine efficacy and impact in low-resource settings, countries planning to introduce rotavirus vaccine must have knowledge of rotavirus epidemiology and circulating genotypes to evaluate the potential effect of vaccine programs. Niger is one of 34 countries approved by GAVI Alliance for financial support, but rotavirus vaccine has not yet been introduced in the country. We present rotavirus surveillance data for children <5 years of age in 14 hospitals and health centers in urban and rural Niger.


Dr Page is a biologist and epidemiologist at Epicentre/Médecins Sans Frontières, Paris, France. Her primary research interests are the etiology and diagnosis of infectious diseases.

Acknowledgments

We thank the children and their families and communities for their participation in the study. We are grateful to Francisco Luquero for fruitful discussions, and we thank Florence Fermon, Myriam Henkens, Jean Rigal, Pedro Pablo Palma, Eric Comte, and Bertrand Draguez for promoting the study and for their interest in the results. We also thank Céline Fremy for technical assistance.
This work was funded by Médecins Sans Frontières.

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Tables

Technical Appendix

Suggested citation for this article: Page AL, Jusot V, Mamaty AA, Adamou L, Kaplon J, Pothier P, et al. Rotavirus surveillance in urban and rural areas of Niger, April 2010–March 2012. Emerg Infect Dis. 2014 Apr [date cited]. http://dx.doi.org/10.3201/eid2004.131328External Web Site Icon
DOI: 10.3201/eid2004.131328

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