title: Outbreak of rotavirus gastroenteritis with high mortality, Nicaragua, 2005.
abstract: OBJECTIVE
  We investigated a nationwide outbreak of severe rotavirus gastroenteritis in Nicaragua in children under 5 years old, leading to many consultations, hospitalizations, and deaths. We questioned whether a vaccine might have prevented these illnesses and deaths, sought to identify risk factors for death, and developed a clinical profile of children hospitalized with diarrhea.
  
  
  METHODS
  We conducted a case-control study to determine whether children who died had access to routine immunizations, a proxy predicting access to a rotavirus vaccine. We identified risk factors for death among children who died in the outbreak compared with surviving age-matched controls with diarrhea. We collected stools, clinical data, and immunization data on children hospitalized for diarrhea to test for rotavirus, develop the profile, and forecast future access to a rotavirus vaccine.
  
  
  RESULTS
  The outbreak from February to April 2005 caused 47 470 consultations and 52 deaths. Approximately 80% of cases and controls and 60% of children hospitalized with diarrhea had access to routine immunizations and would likely have had access to a rotavirus vaccine. With a vaccine efficacy of 85%, up to 51% of severe rotavirus cases and up to 68% of deaths could have been prevented if a rotavirus vaccine were available as part of routine childhood immunizations. Study of 35 case-control pairs indicated that severe illnesses, malnutrition, and care by traditional healers were risk factors for death. Rotavirus was found in 42% of samples from hospitalized children and was associated with severe disease and dehydration.
  
  
  CONCLUSIONS
  The impact of the seasonal outbreaks of rotavirus disease could be diminished with a rotavirus vaccine, improvements in oral rehydration programs, and training of traditional healers in the proper management of children with acute diarrhea.
authors.affiliation: Ministerio de Salud, Managua, Nicaragua.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Amador
authors.forename: Andrea
authors.initials: A
authors.lastname: Vicari
authors.forename: Reina M
authors.initials: RM
authors.lastname: Turcios-Ruiz
authors.forename: Ana Christian
authors.initials: AC
authors.lastname: Melendez D
authors.forename: Mark
authors.initials: M
authors.lastname: Malek
authors.forename: Fabiana
authors.initials: F
authors.lastname: Michel
authors.forename: Sylvain
authors.initials: S
authors.lastname: Aldighieri
authors.forename: Tara
authors.initials: T
authors.lastname: Kerin
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Bresee
authors.forename: Roger I
authors.initials: RI
authors.lastname: Glass
authors.forename: Jon K
authors.initials: JK
authors.lastname: Andrus
mesh_terms: D016022:Case-Control Studies; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000401:mortality / Q000821:virology*; D006801:Humans; D007223:Infant; D008297:Male; D009527:Nicaragua / Q000453:epidemiology; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000401:mortality