Community transmission of rotavirus infection in a vaccinated population in Blantyre, Malawi: a prospective household cohort study.

Bennett, Aisleen, Pollock, Louisa, Bar-Zeev, Naor, Lewnard, Joseph A, Jere, Khuzwayo C ORCID: 0000-0003-3376-8529, Lopman, Benjamin, Iturriza-Gomara, Miren ORCID: 0000-0001-5816-6423, Pitzer, Virginia E and Cunliffe, Nigel A ORCID: 0000-0002-5449-4988
(2020) Community transmission of rotavirus infection in a vaccinated population in Blantyre, Malawi: a prospective household cohort study. The Lancet Infectious Diseases, 21 (5). pp. 731-740.

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Background Rotavirus vaccine effectiveness is reduced among children in low-income countries. Indirect (transmission-mediated) effects of rotavirus vaccine might contribute to the total population effect of vaccination. We aimed to examine risk factors for transmission of rotavirus to household contacts in Blantyre, Malawi, and estimated the effectiveness of rotavirus vaccine in preventing transmission of infection to household contacts. Methods In this prospective household cohort study, we recruited children born after Sept 17, 2012, and aged at least 6 weeks (vaccine-eligible children) with acute rotavirus gastroenteritis and their household contacts, in four government health facilities in Blantyre, Malawi. Clinical data, a bulk stool sample, and 1–2 mL of serum were collected from case children at presentation. Clinical data and stool samples were also prospectively collected from household contacts over 14 days from presentation. A single stool sample was collected from control households containing asymptomatic children who were frequency age-matched to case children. Samples were tested for rotavirus using semi-quantitative real-time PCR and for anti-rotavirus IgA using a semi-quantitative sandwich ELISA. Risk factors for household transmission of rotavirus infection and clinical disease, including disease severity and faecal shedding density, were identified using mixed effects logistic regression. Vaccine effectiveness against transmission was estimated as 1 minus the ratio of secondary attack rates in vaccinated and counterfactual unvaccinated populations, using vaccine effectiveness estimates from the associated diarrhoeal surveillance platform to estimate the counterfactual secondary attack rate without vaccination. Findings Between Feb 16, 2015, and Nov 11, 2016, we recruited 196 case households (705 members) and 55 control households (153 members). Household secondary attack rate for rotavirus infection was high (434 [65%] of 665 individuals) and secondary attack rate for clinical disease was much lower (37 [5%] of 698). Asymptomatic infection in control households was common (40 [28%] of 144). Increasing disease severity in an index child (as measured by Vesikari score) was associated with increased risk of transmission of infection (odds ratio 1·17 [95% CI 1·06–1·30) and disease (1·28 [1·08–1·52]) to household contacts. Estimated vaccine effectiveness against transmission was 39% (95% CI 16–57). Interpretation Rotavirus vaccine has the potential to substantially reduce household rotavirus transmission. This finding should be considered in clinical and health economic assessments of vaccine effectiveness.

Item Type: Article
Uncontrolled Keywords: Feces, Humans, Rotavirus, Rotavirus Infections, Diarrhea, Immunoglobulin A, Rotavirus Vaccines, Vaccination, Incidence, Cohort Studies, Prospective Studies, Family Characteristics, Databases, Factual, Adolescent, Adult, Middle Aged, Child, Child, Preschool, Malawi, Female, Male, Young Adult
Depositing User: Symplectic Admin
Date Deposited: 08 Jan 2021 15:26
Last Modified: 18 Jan 2023 23:05
DOI: 10.1016/s1473-3099(20)30597-1
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