title: Etiology of childhood diarrhea after rotavirus vaccine introduction: a prospective, population-based study in Nicaragua.
abstract: BACKGROUND
  Nicaragua was the first developing nation to implement routine immunization with the pentavalent rotavirus vaccine (RV5). In this RV5-immunized population, understanding infectious etiologies of childhood diarrhea is necessary to direct diarrhea treatment and prevention efforts.
  
  
  METHODS
  We followed a population-based sample of children <5 years in León, Nicaragua for diarrhea episodes through household visits. Information was obtained on RV5 history and sociodemographics. Stool samples collected during diarrhea episodes and among healthy children underwent laboratory analysis for viral, bacterial and parasitic enteropathogens. Detection frequency and incidence of each enteropathogen was calculated.
  
  
  RESULTS
  The 826 children in the cohort experienced 677 diarrhea episodes during 607.5 child-years of exposure time (1.1 episodes per child-year). At least 1 enteropathogen was detected among 61.1% of the 337 diarrheal stools collected. The most common enteropathogens among diarrheal stools were: norovirus (20.4%), sapovirus (16.6%), enteropathogenic Escherichia coli (11.3%), Entamoeba histolytica/dispar (8.3%), Giardia lamblia (8.0%) and enterotoxigenic E. coli (7.7%), with rotavirus detected among 5.3% of diarrheal stools. Enteropathogenic Escherichia coli and enterotoxigenic E. coli were frequently detected among stools from healthy children. Among children with diarrhea, norovirus was more commonly detected among younger children (< 2 years) and G. lamblia was more commonly detected among older children (2-4 years). The mean age of rotavirus detection was 34.6 months.
  
  
  CONCLUSIONS
  In this Central American community after RV5 introduction, rotavirus was not commonly detected among children with diarrhea. Prevention and appropriate management of norovirus and sapovirus should be considered to further reduce the burden of diarrheal disease.
authors.affiliation: From the *School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; †Department of Microbiology and Parasitology, Faculty of Medical Sciences, National Autonomous University of Nicaragua, León (UNAN-León); ‡Center for Epidemiology and Health (CIDS), León, Nicaragua; §Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; ¶Center for Health Research (CIS), León, Nicaragua; ‖Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention. Atlanta, GA; **Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; and ††Division of Gastroenterology, Vanderbilt University, Nashville, TN.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Becker-Dreps
authors.forename: Filemon
authors.initials: F
authors.lastname: Bucardo
authors.forename: Samuel
authors.initials: S
authors.lastname: Vilchez
authors.forename: Luis Enrique
authors.initials: LE
authors.lastname: Zambrana
authors.forename: Lan
authors.initials: L
authors.lastname: Liu
authors.forename: David J
authors.initials: DJ
authors.lastname: Weber
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Peña
authors.forename: Leslie
authors.initials: L
authors.lastname: Barclay
authors.forename: Jan
authors.initials: J
authors.lastname: Vinjé
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hudgens
authors.forename: Johan
authors.initials: J
authors.lastname: Nordgren
authors.forename: Lennart
authors.initials: L
authors.lastname: Svensson
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Morgan
authors.forename: Félix
authors.initials: F
authors.lastname: Espinoza
authors.forename: Margarita
authors.initials: M
authors.lastname: Paniagua
mesh_terms: D000367:Age Factors; D017250:Caliciviridae Infections / Q000150:complications* / Q000821:virology; D002675:Child, Preschool; D003967:Diarrhea / Q000382:microbiology* / Q000469:parasitology*; D004748:Entamoeba histolytica / Q000302:isolation & purification; D004749:Entamoebiasis / Q000150:complications*; D054308:Enteropathogenic Escherichia coli / Q000302:isolation & purification; D054307:Enterotoxigenic Escherichia coli / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000150:complications* / Q000382:microbiology; D005243:Feces / Q000382:microbiology / Q000469:parasitology; D005260:Female; D005759:Gastroenteritis / Q000150:complications* / Q000821:virology; D016829:Giardia lamblia / Q000302:isolation & purification; D005873:Giardiasis / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D009527:Nicaragua; D029322:Norovirus / Q000302:isolation & purification; D011446:Prospective Studies; D012401:Rotavirus / Q000302:isolation & purification; D012400:Rotavirus Infections / Q000150:complications / Q000517:prevention & control*; D022243:Rotavirus Vaccines; D029341:Sapovirus / Q000302:isolation & purification
chemical_list: D022243:Rotavirus Vaccines