Outbreak of rotavirus gastroenteritis with high mortality, Nicaragua, 2005.
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.
Amador
Juan José
JJ
Ministerio de Salud, Managua, Nicaragua.
Vicari
Andrea
A
Turcios-Ruiz
Reina M
RM
Melendez D
Ana Christian
AC
Malek
Mark
M
Michel
Fabiana
F
Aldighieri
Sylvain
S
Kerin
Tara
T
Bresee
Joseph S
JS
Glass
Roger I
RI
Andrus
Jon K
JK
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