Jana Lai Masters of Applied Epidemiology Scholar, Australian National University and Murdoch Childrens Research Institute, Melbourne
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1 High rates of hospitalised acute gastroenteritis and severe acute malnutrition in Kiribati children prior to Rotavirus vaccine introduction: A retrospective review Jana Lai Masters of Applied Epidemiology Scholar, Australian National University and Murdoch Childrens Research Institute, Melbourne
2 Diarrhoeal disease and rotavirus 2 nd leading cause of death after neonatal period 1 Globally 1.7billion cases/year 578,000 deaths/year Rotavirus most common cause of severe diarrhoeal disease in infants and young children worldwide 1,2,3 Contributes 30-50% of hospitalised diarrhoea cases 215,000 deaths in U5 Rotavirus vaccine-preventable 3 1 Liu et al. Lancet 2015; 385: pp Tate et al. Clin Infect Dis 2016; 62: pps WHO website
3 Rotavirus vaccine impact Developed setting (US/Finland): 75-95% vaccine effectiveness against severe rotavirus gastroenteritis hospitalisation Developing settings (Africa/SE Asia): 50-70% vaccine effectiveness against severe rotavirus gastroenteritis hospitalisation - Impaired immunity 5 - Other intestinal infections 5 - Impaired nutrition C. Kirkwood The rotavirus vaccine pipeline and priorities for development, 12 th International Rotavirus Symposium, September 2016, Melbourne, Australia 5 Serazin et al. Nat Immuno 2010; 11:pp
4 Kiribati
5 Kiribati and Rotavirus Vaccine Diarrhoea estimated to cause 11% all U5 deaths In 2002, 11% all hospitalisation in U5 due to acute gastroenteritis (AGE) UNICEF implementing Integrated Global Action Plan for Prevention and Control of Pneumonia and Diarrhoea (GAPPD) to address burden Rotavirus vaccine (Rotarix) started mid 2015
6 Aims To determine the incidence of acute gastroenteritis (AGE) and severe acute malnutrition (SAM) pre-vaccine introduction To describe the epidemiology of hospitalised AGE and SAM pre-vaccine introduction
7 Methods Tungaru Central Hospital electronic database/ hospital admission records June 2010-April 2015 (AGE) June 2010-Dec 2013 (SAM) Children aged <5yo admitted with AGE/SAM 2010 Census data
8 Results AGE Table: Characteristics of AGE hospitalisations in children <5 years at Tungaru Central Hospital from June 2010 April 2015 Characteristics N=554 Median age in months 13.4 (IQR ) Sex* Male Female Case fatality ratio (n=39) 7% 329 (59%) 224 (40%) Proportion of all-cause U5 admissions 554/4474 (12%) Proportion of all-cause U5 mortality 38/244 (16%) *Sex unknown for 1 case
9 ม.ค.-10 เม.ย.-10 ก.ค.-10 ต.ค.-10 ม.ค.-11 เม.ย.-11 ก.ค.-11 ต.ค.-11 ม.ค.-12 เม.ย.-12 ก.ค.-12 ต.ค.-12 ม.ค.-13 เม.ย.-13 ก.ค.-13 ต.ค.-13 ม.ค.-14 เม.ย.-14 ก.ค.-14 ต.ค.-14 ม.ค.-15 เม.ย.-15 Monthly hospitalisation per 100,000 in U5s Monthly incidence of U5 AGE hospitalisation from June April 2015 Average annual incidence = 1,266 per 100,000 (95%CI 1,161-1,377) Diarrhoea outbreak 13/16 stools RV pos (81%) G3P type 500 Diarrhoea outbreak Testing done OS, RV pos Month
10 Results SAM Table: Characteristics of SAM hospitalisations in children <5 years at Tungaru Central Hospital from June 2010 Dec 2013 Characteristics N=143 Median age in months 12.8 (IQR ) Sex Male Female Case fatality ratio (n=30)* 21% 68 (48%) 75 (52%) Proportion of all-cause U5 admissions 143/3024 (5%) Proportion of all-cause U5 deaths 30/192 (16%) *Outcome of 1 case unknown Average annual incidence = 453 per 100,000 (95%CI )
11 Discussion/Limitations Hospitalised AGE incidence is high compared to developed countries in the region such as Australia 6 High rates of hospitalised SAM High mortality in AGE cases Under estimation of true AGE burden in the community Excluded outer islands Only hospitalised cases 6 Parashar et al. Clin Infect Dis 2016: 62:ppS91-5
12 Conclusions/Recommendations Rotavirus vaccine effectiveness may be reduced by high rates of SAM VE all-cause 17-55% 7 VE rotavirus 49-89% 7 VE still expected to be 50-75% Still likely to reduce AGE burden by 15-30% For future AGE outbreaks, aetiology to be defined to demonstrate vaccine effectiveness Review of fatal AGE cases to determine comorbidities Attention still needed to address WASH (Water, sanitation and hygiene) issues in Kiribati 7 Dey et al. MJA 2012; 197:pp453-7
13 Acknowledgements Study funded by WHO MCRI A/Prof Fiona Russell WHO WPRO Dr Kim Fox Dr Nyambat Batmunkh WHO Kiribati Dr Andre Reiffer Agnes Nikuata MoH Beia Tabwaia Statistics department TCH Dr Ereti Timeon Paediatric staff Hospital record staff
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