| 1. |
- Bucardo, Filemon, et al.
(author)
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Pediatric norovirus diarrhea in Nicaragua
- 2008
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In: Journal of Clinical Microbiology. - 0095-1137 .- 1098-660X. ; 46:8, s. 2573-2580
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Journal article (peer-reviewed)abstract
- Information about norovirus (NoV) infections in Central America is limited. Through a passive community and hospital pediatric diarrhea surveillance program, a total of 542 stool samples were collected between March 2005 and February 2006 in León, Nicaragua. NoV was detected in 12% (65/542) of the children; of these, 11% (45/409) were in the community and 15% (20/133) were in the hospital, with most strains (88%) belonging to genogroup II. NoV infections were age and gender associated, with children of <2 years of age (P < 0.05) and girls (P < 0.05) being most affected. Breast-feeding did not reduce the number of NoV infections. An important proportion (57%) of NoV-infected children were coinfected with diarrheagenic Escherichia coli. A significant proportion (18/31) of NoV-positive children with dehydration required intravenous rehydration. Nucleotide sequence analysis (38/65) of the N-terminal and shell region in the capsid gene revealed that at least six genotypes (GI.4, GII.2, GII.4, GII.7, GII.17, and a potentially novel cluster termed "GII.18-Nica") circulated during the study period, with GII.4 virus being predominant (26/38). The majority (20/26) of those GII.4 strains shared high nucleotide homology (99%) with the globally emerging Hunter strain. The mean viral load was approximately 15-fold higher in children infected with GII.4 virus than in those infected with other G.II viruses, with the highest viral load observed for the group of children infected with GII.4 and requiring intravenous rehydration. This study, the first of its type from a Central American country, suggests that NoV is an important etiological agent of acute diarrhea among children of <2 years of age in Nicaragua.
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| 2. |
- Becker-Dreps, Sylvia, et al.
(author)
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Etiology of Childhood Diarrhea After Rotavirus Vaccine Introduction A Prospective, Population-based Study in Nicaragua
- 2014
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In: The Pediatric Infectious Disease Journal. - : Lippincott, Williams andamp; Wilkins. - 0891-3668 .- 1532-0987. ; 33:11, s. 1156-1163
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Journal article (peer-reviewed)abstract
- Background: Nicaragua was the first developing nation to implement routine immunization with the pentavalent rotavirus vaccine (RV5). In this RV5-immunized population, understanding infectious etiologies of childhood diarrhea is necessary to direct diarrhea treatment and prevention efforts. Methods: We followed a population-based sample of children less than5 years in Leon, Nicaragua for diarrhea episodes through household visits. Information was obtained on RV5 history and sociodemographics. Stool samples collected during diarrhea episodes and among healthy children underwent laboratory analysis for viral, bacterial and parasitic enteropathogens. Detection frequency and incidence of each enteropathogen was calculated. Results: The 826 children in the cohort experienced 677 diarrhea episodes during 607.5 child-years of exposure time (1.1 episodes per child-year). At least 1 enteropathogen was detected among 61.1% of the 337 diarrheal stools collected. The most common enteropathogens among diarrheal stools were: norovirus (20.4%), sapovirus (16.6%), enteropathogenic Escherichia coli (11.3%), Entamoeba histolytica/dispar (8.3%), Giardia lamblia (8.0%) and enterotoxigenic E. coli (7.7%), with rotavirus detected among 5.3% of diarrheal stools. Enteropathogenic Escherichia coli and enterotoxigenic E. coli were frequently detected among stools from healthy children. Among children with diarrhea, norovirus was more commonly detected among younger children (less than2 years) and G. lamblia was more commonly detected among older children (2-4 years). The mean age of rotavirus detection was 34.6 months. Conclusions: In this Central American community after RV5 introduction, rotavirus was not commonly detected among children with diarrhea. Prevention and appropriate management of norovirus and sapovirus should be considered to further reduce the burden of diarrheal disease.
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| 3. |
- Bucardo, Filemon, et al.
(author)
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Pediatric norovirus GII.4 infections in Nicaragua, 1999-2015
- 2017
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In: Infection, Genetics and Evolution. - : ELSEVIER SCIENCE BV. - 1567-1348 .- 1567-7257. ; 55, s. 305-312
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Journal article (peer-reviewed)abstract
- Objectives: Investigate clinical and epidemiological factors of pediatric GII.4 norovirus infections in children with acute gastroenteritis (AGE) in Nicaragua between 1999 and 2015. Methods: We retrospectively analyzed laboratory and epidemiologic data from 1,790 children amp;lt;= 7 years with AGE from 6 hospitals in Nicaragua (n = 538), and 3 community clinics (n = 919) and households (n = 333) in Leon, between 1999 and 2015. Moreover, asymptomatic children from community clinics (n = 162) and households (n = 105) were enrolled. Norovirus was detected by real-time PCR and genotyped by sequencing the N-terminal and shell region of the capsid gene. Results: Norovirus was found in 19% (n = 338) and 12% (n = 32) of children with and without AGE, respectively. In total, 20 genotypes including a tentatively new genotype were detected. Among children with AGE, the most common genotypes were GII.4 (53%), GII.14 (7%), GII.3 (6%) and GI.3 (6%). In contrast, only one (1.4%) GII.4 was found in asymptomatic children. The prevalence of GII.4 infections was significantly higher in children between 7 and 12 months of age. The prevalence of GII.4 was lowest in households (38%), followed by community clinics (50%) and hospitals (75%). Several different GII.4 variants were detected and their emergence followed the global temporal trend. Conclusions: Overall our study found the predominance of pediatric GII.4 norovirus infections in Nicaragua mostly occurring in children between 7 and 12 months of age, implicating GII.4 as the main norovirus vaccine target.
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| 4. |
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| 5. |
- Becker-Dreps, Sylvia, et al.
(author)
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Community Diarrhea Incidence Before and After Rotavirus Vaccine Introduction in Nicaragua
- 2013
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In: American Journal of Tropical Medicine and Hygiene. - : American Society of Tropical Medicine and Hygiene. - 0002-9637 .- 1476-1645. ; 89:2, s. 246-250
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Journal article (peer-reviewed)abstract
- We estimated the incidence of watery diarrhea in the community before and after introduction of the pentavalent rotavirus vaccine in Leon, Nicaragua. A random sample of households was selected before and after rotavirus vaccine introduction. All children < 5 years of age in selected households were eligible for inclusion. Children were followed every 2 weeks for watery diarrhea episodes. The incidence rate was estimated as numbers of episodes per 100 child-years of exposure time. A mixed effects Poisson regression model was fit to compare incidence rates in the pre-vaccine and vaccine periods. The pre-vaccine cohort (N = 726) experienced 36 episodes per 100 child-years, and the vaccine cohort (N = 826) experienced 25 episodes per 100 child-years. The adjusted incidence rate ratio was 0.60 (95% confidence interval [CI] 0.40, 0.91) during the vaccine period versus the pre-vaccine period, indicating a lower incidence of watery diarrhea in the community during the vaccine period.
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| 6. |
- Espinoza, Felix
(author)
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Rotavirus in pediatric gastroenteritis in Nicaraguan children
- 2004
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Doctoral thesis (other academic/artistic)abstract
- Rotavirus, the most common diarrheic pathogen in children worldwide, causes approximately one third of diarrhea-associated hospitalizations and 800,000 deaths per year. To prevent the enormous health burden of rotavirus-associated disease is a global public health goal developed as well as implementation of safe and effective vaccines to be used in developing countries. We examined the epidemiology and disease burden of rotavirus diarrhea among hospitalized and outpatient children in Leon, Nicaragua, through several studies carried out from 1991 to 2003. Rotavirus was detected in 28-40% of children hospitalized for diarrhea and in 15% who were treated as outpatients. The mean age distribution of children hospitalized with rotavirus diarrhea, varied from 9.2 months in 1994 to 14 months in 2002-2003. Overall median duration of hospitalization was two days. Rotavirus was detected year-round but generally exhibited seasonal peaks during the dry months (February to June). In our material, collected during 2001 to 2003, rotavirus strains of serotype G1 P[8] were the predominant, followed by G2 P[4] and G3 P[8], G4 P[6] and 4% were uncommon strains. A shift for G types was observed; genotype G2 was the most prevalent during 2001 (70%) but decreased in 2002 when the predominating genotype became G1 (75%). The G3 genotype, which was not detected in 2001, emerged late in 2002 and was the most dominant strain in 2003 (59%). The health care costs of rotavirus diarrhea hospitalization were estimated through the register of hospital stay (bed day), the cost of the treatment and laboratory services, and additional expenses by the parents. The mean total costs including the costs paid by the family and by the Health Ministry sources were calculated to USD 117.4 per child hospitalized with rotavirus diarrhea. However, children with rotavirus negative stools spent longer time in hospital compared to children whose stools were positive (3.6 versus 2.9 days), and the calculated costs for these children rose to USD 147.9. Overall, among the total population less than 3 years of age in Nicaragua, we estimated that 2,603 cases of hospitalization due to rotavirus associated diarrhea occurs per year in Nicaragua, a disease burden which represents a cost of more than USD 270,000 from the Health care sources. If all cases of severe diarrhea are considered, including other etiologies of gastroenteritis, the total cost burden amounts to more than USD 800,000, a sum that represents around 0.6 % of the total budget of the national Health care sources. Besides, the total cost for these parents was estimated to amount to further USD 90,000. Our results confirm that rotavirus is the most important cause of severe diarrhea in Nicaragua and represent an important disease burden in hospital costs. A rotavirus, vaccine program should be of considerable benefit to prevent these severe cases.
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