Hospital-based Surveillance of Rotavirus Gastroenteritis ...
Transcript of Hospital-based Surveillance of Rotavirus Gastroenteritis ...
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Hospital-based Surveillance of Rotavirus Gastroenteritis
in Latin America
The Latin America Rotavirus Vaccine Study Group Presented by Miguel O’Ryan
ProfessorInstitute of Biomedical Sciences
University of Chile
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• Background– RV-associated disease burden data are limited
•Opportunity– Set up of phase III RV vaccine trial
•Objective– Describe disease burden of RV GE in Latin America
•Methods– Prospective, multi-center, hospital-based study in 11
countries– Inclusion Criteria
• Children <3 years • Treated at hospital site for Gastroenteritis
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Study Sites in Latin America
Ciudad de México(MX)
Durango (MX)
Belem (BZ)
Santo Domingo (DR)
Léon (NI)
Tegucigalpa (HO)
Panamá (PA)
Viña del Mar (CH)Concepción-Talcahuano
Chiriqui (PA)
Mendoza (AG)
Valencia (VE)
Cali (CO)
Estado de México (MX)
Morelos (MX)
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Study Duration by Country- limitation of study -
Country Nov-02 Dec-02 Jan-03 Feb-03 Mar-03 Apr-03 May-03 Jun-03 Jul-03 Aug-03 Sep-03
VenezuelaBrazilCosta RicaMexico PanamaChileDominican RepublicHondurasArgentinaNicaraguaColombia
Range: 50-220 days; Median: 158 days
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Results
Baseline DataDiarrhea episodes 8,031
Completed questionnaires and stool samples
81% (6,521)
Hospitalized patients (inpatients) 78%
Median age 1 year
Male : Female ratio 1.4 : 1
Rotavirus positive/tested (%) 3,122/6,361 (49%)
Hospitalized patients (inpatients) 2,421 (78%)
Male : Female ratio 1.4 : 1
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0%
20%
40%
60%
80%
Dec Jan Feb Mar Apr May Jun
% o
f po
sitiv
e RV
sam
ples
Mexico (n=1154) / Range 10% - 79%
0%
20%
40%
60%
80%
Dec Jan Feb Mar Apr May Jun
% of
pos
itive
RV
sam
ples
Venezuela (n=301) / Range 8% - 7 8%
0%
20%
40%
60%
80%
Dec Jan Feb Mar Apr May Jun
% o
f po
sitiv
e RV
sam
ples
Costa Rica (n=635) / Range 11% - 63%
0%
20%
40%
60%
80%
Dec Jan Feb Mar Apr May Jun
% o
f po
sitiv
e R
V sa
mpl
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Dom Rep (n=395) / Range 35% - 80%
Proportion of RV Positive by Month
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0 6 12 18 24 30
Age in months
Perc
ent
Overall Cumulative Age Distribution of RV+ Children (%)
12 months 54% 24 months 90%6 months 18%
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hile
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Cumulative age distribution of rotavirus positive children at 12 months of age, by country
54%
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Median delay between RV GE onset andhospital adm ission 2 days
Received oral hydration (single or combinationtherapy) 52%
Received antibiotic therapy 27%
Results
Treatment RV+ GE• Before coming to hospital site
Received oral-intravenous hydration (single or combination therapy) 69-77%
Received antibiotic therapy 24%
• At hospital site
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Overa
llCol
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icaMex
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dura
sPan
ama
Argen
tina
Chile
Nicara
gua
Venez
uela
Brazil
Median Duration of Hospitalization Due to RV Gastroenteritis
(2 days)
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Outcome of Hospitalized RV+ Cases
Fully recovered at time of discharge 96%
Sequelae at time of discharge 4%
Died (2 patients among 3,122 RV+ children) <1%
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1240 RV Strains Serotyped (~ 110/country)
Country G1 G2 G3 G4 G9 UntypOverall 51% 1% 10% 18% 3% 17%Argentina 96% 0% 0% 0% 0% 4%Brazil 57% 1% 0% 2% 8% 31%Chile 21% 1% 0% 66% 0% 12%Colombia 88% 0% 0% 0% 0% 13%Costa Rica 30% 0% 68% 2% 0% 0%Dominican 46% 2% 21% 0% 0% 31%Honduras 100% 0% 0% 0% 0% 0%Mexico 48% 3% 5% 11% 9% 23%Nicaragua 28% 3% 33% 20% 0% 16%Panama 89% 4% 7% 0% 0% 0%Venezuela 42% 0% 13% 19% 0% 26%
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Household Costs of RV Gastroenteritis
Collaboration Emory University
• Obtained information family expenditures
• Caregiver cost questionnaire (subset of cases)
– payments for medical treatment
– out of pocket expenses (travel, additional supplies)
– time lost from work
– qualitative impact on households
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0% 10% 20% 30% 40% 50% 60% 70%
Overall
Chile
Venezuela
Honduras
Brazil
Costa Rica
Argentina
Mexico
Panama
Dominican
Nicaragua
Colombia
Proportion of Parents Who Took Paid Time Off (overall 40%)
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0 5 10 15 20 25 30
Overall
Colombia
Costa Rica
Honduras
Panama
Dominican
Mexico
Venezuela
Brazil
Argentina
Chile
Nicaragua
Hours Lost From Paid Work (Median 12 hours)
hours
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3%
13%
24%
33%
51%
0% 10% 20% 30% 40% 50% 60%
Sold assets
Asked for donation
Used Savings
Cut Expenses
Borrowed
Source of Money to Pay for Illness Associated Expenses
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Impacto de Infección por Rotavirus en LatinoaméricaO’Ryan M, Pérez-Schael et al. Ped Infect Dis J 2001; 20:685-93
Santiago:
Sótero del RíoBs. Aires:
Ricardo Gutiérrez
Valencia:
Jorge Lizarraga
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Visitas Médicas: Número de deposiciones:
Lugar Totales Diarrea aguda Obtenidas Rota +
Argentina 116,596 4,375 (3.8%) 1,133 (26%) 438 (39%)
Chile 123,320 6,599 (5.4%) 1,739 (26%) 585 (34%)
Venezuela 36,787 3,370 (9.2%) 2,929 (87%) 848 (29%)
Impacto de la diarrea aguda total y por rotavirusen visitas médicas
Niños < 36 meses de edad, período estudio 48 meses
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Hospitalizaciones: Número de deposiciones:
Lugar Totales Diarrea aguda Obtenidas Rota +
Argentina 2.550 56 (2.2%) 34(61%) 24 (71%)
Chile 4.773 283(5.9%) 276 (98%) 130 (47%)
Venezuela 8076 1071(13%) 946 (88%) 355 (38%)
Impacto de la diarrea aguda total y por rotavirusen hospitalizaciones
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Impacto de Enfermedad Por Rotavirus ExtrapoladaO’Ryan M, Pérez-Schael et al. Ped Infect Dis J 2001; 20:685-93
Visitas Médicas HospitalizacionesPaís Totales Pob < 3 años Totales Pob < 3 años
Argentina 106.000 1/20 20.875 1:100
Chile 57.761 1/22 8.800 1:136
Venezuela 96.000 1/18 31.000 1:55
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Conclusion-Summary
• Rotavirus causes a highly significant proportion of diarrhea cases among children < 3 years of age in Latin America:
– 40-50% of cases requiring hospitalization– 30-40% of cases requiring ER visit
• Seasonal variations and age prevalence variations among countries.– Small proportion (<20%) occurring in < 6 months of age.
• Marked overuse of antimicrobials for rotavirus diarrhea, significant need for IV rehydration.
• Low mortality as expected for a prospective surveillance study• Different serotype patterns across countries within the same season
– Low circulation of G2 types during the period – Emerging G9 in certain countries
• Households in Latin America are economically affected by RV GE – additional point to consider outside “health care perspective”