title: Use of population-based surveillance to determine the incidence of rotavirus gastroenteritis in an urban slum and a rural setting in Kenya.
abstract: BACKGROUND
  Rotavirus gastroenteritis is a major cause of mortality among children <2 years of age. Disease burden data are important for introducing and sustaining new rotavirus vaccines in immunization programs.
  
  
  METHODS
  We analyzed population-based infectious disease surveillance data from 2007 to 2010 from Kenyan sites in rural and urban slum areas. Stool specimens were collected from patients of all ages presenting to study clinics with diarrheal disease and tested for rotavirus by enzyme immunoassay. Incidence rates were adjusted using data on healthcare utilization (from biweekly home visits) and proportion of stools collected at study clinics from patients meeting case definitions.
  
  
  RESULTS
  Rotavirus was detected in 285 (9.0%) of 3174 stools tested, including 122 (11.9%) from children <5 years of age and 162 (7.6%) from participants ≥5 years of age. Adjusted incidence rates for infants were 13,419 and 12,135 per 100,000 person-years of observation in rural and urban areas, respectively. Adjusted incidence rates were high in adults across age ranges. The rates suggest that annually, among children <5 years of age, there are >54,500 cases of rotavirus-associated gastroenteritis in rural Nyanza Province and >16,750 cases in Nairobi urban slums.
  
  
  CONCLUSIONS
  Community-based surveillance in urban and rural Kenya suggests that rotavirus plays an important role as a cause of acute gastroenteritis in adults, as well as in children. In addition to substantially preventing illness and complications from diarrheal disease in children, rotavirus infant immunization has the potential of indirectly preventing diarrheal disease in older children and adults, assuming children are the predominant sources of transmission.
authors.affiliation: From *Kenya Medical Research Institute-Global Disease Detection Division/Centers for Disease Control and Prevention (KEMRI-CDC), Nairobi and Kisumu, Kenya; and †National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.forename: Leonard
authors.initials: L
authors.lastname: Cosmas
authors.forename: Allan
authors.initials: A
authors.lastname: Audi
authors.forename: William
authors.initials: W
authors.lastname: Mwiti
authors.forename: Henry
authors.initials: H
authors.lastname: Njuguna
authors.forename: Godfrey M
authors.initials: GM
authors.lastname: Bigogo
authors.forename: Beatrice
authors.initials: B
authors.lastname: Olack
authors.forename: John B
authors.initials: JB
authors.lastname: Ochieng
authors.forename: Newton
authors.initials: N
authors.lastname: Wamola
authors.forename: Joel M
authors.initials: JM
authors.lastname: Montgomery
authors.forename: John
authors.initials: J
authors.lastname: Williamson
authors.forename: Umesh D
authors.initials: UD
authors.lastname: Parashar
authors.forename: Deron C
authors.initials: DC
authors.lastname: Burton
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Tate
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Feikin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005759:Gastroenteritis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008875:Middle Aged; D011159:Population Surveillance; D011204:Poverty Areas; D012401:Rotavirus; D012400:Rotavirus Infections / Q000453:epidemiology*; D012424:Rural Population; D014505:Urban Population; D055815:Young Adult