Diarrhea incidence and intestinal infections among rotavirus vaccinated infants from a poor area in Brazil: a spatial analysis.
BACKGROUND
Acute diarrhea is the second leading cause of mortality among children under 5 years of age in developing countries. The pathogen most strongly associated with diarrhea is rotavirus followed by enteric pathogens such as bacteria, helminthes and protozoan. Adequate sanitation and water supply contribute to decrease acute diarrhea incidence of most etiologic agents, although vaccination remains the most important intervention to control rotavirus acute diarrhea. This study aimed to describe environmental conditions and analyze spatially the acute diarrhea and intestinal infection among rotavirus vaccinated infants from Laranjeiras-Sergipe, Brazil.


METHODS
Children were enrolled between 2 and 11 months of age and followed through 12 months. Demographic, socioeconomic and environmental data were obtained from a questionnaire, and immunization data were obtained from children vaccination card. Children stool samples were collected each month in order to run laboratory analyses. The household spatial localization was obtained by using a Global Positioning System (GPS). Spatial analysis was performed using the TerraView computer program and Kernel intensity estimation.


RESULTS
A total of 1,113 stool samples were collected with 80 being diarrhea associated. Diarrhea incidence rate was 0.5 ± 1.0 episodes/child/year. The overall infection rates by Ascaris lumbricoides, Endolimax nana, Giardia lamblia and rotavirus were 5.1%, 3.0%, 0.9% and 2.6%, respectively. 3.8% of diarrhea-associated stool samples were positive for rotavirus and 11.3% were positive for helminths and protozoans. There were some changes on spatial distribution of intestinal infections and diarrhea episodes along the four trimesters evaluated.


CONCLUSIONS
The studied infants live equally in precarious conditions of sanitation which probably explain the significant rates of parasitic infections appearing in early life. The low acute diarrhea incidence in the studied rotavirus vaccinated population and the low number of symptomatic rotavirus infection may indicate vaccination efficacy to prevent acute diarrhea among young children in a poor environmental sanitary setting.
Núcleo de Pós-Graduação em Medicina, Universidade Federal de Sergipe, Aracaju, SE, Brazil. claudimarybs@bol.com.br.
Claudimary Bispo
CB
Santos
Karina Conceição G M
KC
Araújo
Anne
A
Jardim-Botelho
Márcio Bezerra
MB
Santos
Alda
A
Rodrigues
Silvio Santana
SS
Dolabella
Ricardo Queiroz
RQ
Gurgel
D000562:Amebiasis / Q000453:epidemiology; D001196:Ascariasis / Q000453:epidemiology; D001938:Brazil / Q000453:epidemiology; D003906:Developing Countries; D003967:Diarrhea / Q000453:epidemiology*; D005260:Female; D005873:Giardiasis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007410:Intestinal Diseases / Q000453:epidemiology*; D007411:Intestinal Diseases, Parasitic / Q000453:epidemiology*; D008297:Male; D011203:Poverty / Q000706:statistics & numerical data; D011446:Prospective Studies; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000627:therapeutic use*; D012499:Sanitation; D062206:Spatial Analysis; D011795:Surveys and Questionnaires; D014881:Water Supply
D022243:Rotavirus Vaccines