title: Epidemiology, Seasonality and Factors Associated with Rotavirus Infection among Children with Moderate-to-Severe Diarrhea in Rural Western Kenya, 2008-2012: The Global Enteric Multicenter Study (GEMS).
abstract: OBJECTIVE
  To evaluate factors associated with rotavirus diarrhea and to describe severity of illness among children <5 years old with non-dysenteric, moderate-to-severe diarrhea (MSD) in rural western Kenya.
  
  
  METHODS
  We analyzed data from children <5 years old with non-dysenteric MSD enrolled as cases in the Global Enteric Multicenter Study (GEMS) in Kenya. A non-dysenteric MSD case was defined as a child with ≥3 loose stools in 24 hrs. and one or more of the following: sunken eyes, skin tenting, intravenous rehydration, or hospitalization, who sought care at a sentinel health center within 7 days of illness onset. Rotavirus antigens in stool samples were detected by ELISA. Demographic and clinical information was collected at enrollment and during a single follow-up home visit at approximately 60 days. We analyzed diarrhea severity using a GEMS 17 point numerical scoring system adapted from the Vesikari score. We used logistic regression to evaluate factors associated with rotavirus infection.
  
  
  RESULTS
  From January 31, 2008 to September 30, 2012, among 1,637 (92%) non-dysenteric MSD cases, rotavirus was detected in stools of 245 (15.0%). Rotavirus-positive compared with negative cases were: younger (median age, 8 vs. 13 months; p<0.0001), had more severe illness (median severity score, 9 vs 8; p<0.0001) and had to be hospitalized more frequently (37/245 [15.1%] vs. 134/1,392 [9.6%]), p <0.013). Independent factors associated with rotavirus infection included age 0-11 months old (aOR = 5.29, 95% CI 3.14-8.89) and presenting with vomiting ≥3 times/24hrs (aOR = 2.58, 95% CI [1.91-3.48]). Rotavirus was detected more commonly in warm and dry months than in the cool and rainy months (142/691 [20%] vs 70/673 [10%]) p<0.0001).
  
  
  CONCLUSIONS
  Diarrhea caused by rotavirus is associated with severe symptoms leading to hospitalization. Consistent with other settings, infants had the greatest burden of disease.
authors: Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.|University of Tampere School of Health Sciences, Tampere, Finland.
authors: Richard
authors: R
authors: Omore
authors: Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors: Jacqueline E
authors: JE
authors: Tate
authors: Division of Foodborne, Waterborne and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors: Ciara E
authors: CE
authors: O'Reilly
authors: Division of Foodborne, Waterborne and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors: Tracy
authors: T
authors: Ayers
authors: US Centers for Disease Control and Prevention, Kisumu, Kenya.
authors: John
authors: J
authors: Williamson
authors: Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors: Feny
authors: F
authors: Moke
authors: Division of Foodborne, Waterborne and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors: Katie A
authors: KA
authors: Schilling
authors: Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors: Alex O
authors: AO
authors: Awuor
authors: Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors: Peter
authors: P
authors: Jaron
authors: Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors: John B
authors: JB
authors: Ochieng
authors: Global Disease Detection Division, Kenya Office of the US Centers for Disease Control and Prevention, Nairobi, Kenya.
authors: Joseph
authors: J
authors: Oundo
authors: Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors: Umesh D
authors: UD
authors: Parashar
authors: Division of Foodborne, Waterborne and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors: Michele B
authors: MB
authors: Parsons
authors: Division of Foodborne, Waterborne and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors: Cheryl C
authors: CC
authors: Bopp
authors: University of Maryland, School of Medicine, Center for Vaccine Development, Baltimore, MD, United States of America.
authors: Dilruba
authors: D
authors: Nasrin
authors: University of Maryland, School of Medicine, Center for Vaccine Development, Baltimore, MD, United States of America.
authors: Tamer H
authors: TH
authors: Farag
authors: University of Maryland, School of Medicine, Center for Vaccine Development, Baltimore, MD, United States of America.
authors: Karen L
authors: KL
authors: Kotloff
authors: University of Maryland, School of Medicine, Center for Vaccine Development, Baltimore, MD, United States of America.|Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, United States of America.
authors: James P
authors: JP
authors: Nataro
authors: University of Maryland, School of Medicine, Center for Vaccine Development, Baltimore, MD, United States of America.
authors: Sandra
authors: S
authors: Panchalingam
authors: University of Maryland, School of Medicine, Center for Vaccine Development, Baltimore, MD, United States of America.
authors: Myron M
authors: MM
authors: Levine
authors: US Centers for Disease Control and Prevention, Kisumu, Kenya.|CDC India, Delhi, India.
authors: Kayla F
authors: KF
authors: Laserson
authors: University of Tampere School of Health Sciences, Tampere, Finland.
authors: J Pekka
authors: JP
authors: Nuorti
authors: Division of Foodborne, Waterborne and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors: Eric D
authors: ED
authors: Mintz
authors: Global Disease Detection Division, Kenya Office of the US Centers for Disease Control and Prevention, Nairobi, Kenya.|Emory Global Health Institute, Emory University, Atlanta Georgia, United States of America.
authors: Robert F
authors: RF
authors: Breiman
mesh_terms: D000956:Antigens, Viral / Q000032:analysis; D016022:Case-Control Studies; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D005243:Feces / Q000821:virology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D012401:Rotavirus / Q000302:isolation & purification / Q000378:metabolism; D012400:Rotavirus Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D012424:Rural Population; D012621:Seasons; D012720:Severity of Illness Index; D015996:Survival Rate; D014839:Vomiting / Q000209:etiology
chemical_list: D000956:Antigens, Viral