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BURDEN, CLINICAL CHARACTERISTICS, RISK FACTORS, AND SEASONALITY OF ADENOVIRUS 40/41 DIARRHEA IN CHILDREN IN EIGHT LOW-RESOURCE SETTINGS
Author
Guga, Godfrey
Elwood, Sarah
Kimathi, Caroline
Kang, Gagandeep
Kosek, Margaret N.
Lima, Aldo A. M.
Bessong, Pascal O.
Samie, Amidou
Haque, Rashidul
Leite, Jose Paulo
Bodhidatta, Ladaporn
Iqbal, Najeeha
Page, Nicola
Kiwelu, Ireen
Bhutta, Zulfiqar A.
Ahmed, Tahmeed
Liu, Jie
McQuade, Elizabeth T. Rogawski
Houpt, Eric
Platts-Mills, James A.
Mduma, Estomih R.
Elwood, Sarah
Kimathi, Caroline
Kang, Gagandeep
Kosek, Margaret N.
Lima, Aldo A. M.
Bessong, Pascal O.
Samie, Amidou
Haque, Rashidul
Leite, Jose Paulo
Bodhidatta, Ladaporn
Iqbal, Najeeha
Page, Nicola
Kiwelu, Ireen
Bhutta, Zulfiqar A.
Ahmed, Tahmeed
Liu, Jie
McQuade, Elizabeth T. Rogawski
Houpt, Eric
Platts-Mills, James A.
Mduma, Estomih R.
Affilliation
Haydom Global Health Research Centre, Haydom, Tanzania.
Division of Infectious Diseases and International Health, University of Virginia. Charlottesville, Virginia, USA.
Haydom Global Health Research Centre, Haydom, Tanzania.
Christian Medical. College, Vellore, India.
University of Virginia. Charlottesville. Division of Infectious Diseases and International Health. Virginia, USA / Asociación Benéfica PRISMA, Iquitos. Peru.
Universidade Federal do Ceará. Fortaleza, CE, Brasil.
University of Venda, Thohoyandou. South Africa.
University of Venda, Thohoyandou. South Africa.
International Centre for Diarrhoeal Disease Research. Bangladesh. Dhaka, Bangladesh.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.
Armed Forces Research Institute of Medical Sciences. Bangkok,Thailand.
Aga Khan University. Karachi, Pakistan.
National Institute for Communicable Diseases. Johannesburg, South Africa.
Kilimanjaro Clinical Research Institute. Moshi, Tanzania.
National Institute for Communicable Diseases. Johannesburg, South Africa.
International Centre for Diarrhoeal Disease Research, Bangladesh. Dhaka, Bangladesh.
Division of Infectious Diseases and International Health, University of Virginia. Charlottesville, Virginia, USA / School of Public Health, Qingdao University, Shandong, China.
Rollins School of Public Health, Emory University. Atlanta, Georgia, USA.
Division of Infectious Diseases and International Health, University of Virginia. Charlottesville, Virginia, USA .
Division of Infectious Diseases and International Health, University of Virginia. Charlottesville, Virginia, USA .
Haydom Global Health Research Centre, Haydom, Tanzania.
Division of Infectious Diseases and International Health, University of Virginia. Charlottesville, Virginia, USA.
Haydom Global Health Research Centre, Haydom, Tanzania.
Christian Medical. College, Vellore, India.
University of Virginia. Charlottesville. Division of Infectious Diseases and International Health. Virginia, USA / Asociación Benéfica PRISMA, Iquitos. Peru.
Universidade Federal do Ceará. Fortaleza, CE, Brasil.
University of Venda, Thohoyandou. South Africa.
University of Venda, Thohoyandou. South Africa.
International Centre for Diarrhoeal Disease Research. Bangladesh. Dhaka, Bangladesh.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.
Armed Forces Research Institute of Medical Sciences. Bangkok,Thailand.
Aga Khan University. Karachi, Pakistan.
National Institute for Communicable Diseases. Johannesburg, South Africa.
Kilimanjaro Clinical Research Institute. Moshi, Tanzania.
National Institute for Communicable Diseases. Johannesburg, South Africa.
International Centre for Diarrhoeal Disease Research, Bangladesh. Dhaka, Bangladesh.
Division of Infectious Diseases and International Health, University of Virginia. Charlottesville, Virginia, USA / School of Public Health, Qingdao University, Shandong, China.
Rollins School of Public Health, Emory University. Atlanta, Georgia, USA.
Division of Infectious Diseases and International Health, University of Virginia. Charlottesville, Virginia, USA .
Division of Infectious Diseases and International Health, University of Virginia. Charlottesville, Virginia, USA .
Haydom Global Health Research Centre, Haydom, Tanzania.
Abstract
Background. The application of molecular diagnostics has identified enteric group adenovirus serotypes 40 and 41 as important causes of diarrhea in children. However, many aspects of the epidemiology of adenovirus 40/41 diarrhea have not been described. Methods. We used data from the 8-site Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project birth cohort study to describe site- and age-specific incidence, risk factors, clinical characteristics, and seasonality.
Results. The incidence of adenovirus 40/41 diarrhea was substantially higher by quantitative polymerase chain reaction than enzyme immunoassay and peaked at 30 episodes per 100 child-years in children aged 7–15 months, with substantial variation in incidence between sites. A significant burden was also seen in children 0–6 months of age, higher than other viral etiologies with the exception of rotavirus. Children with adenovirus 40/41 diarrhea were more likely to have a fever than children with norovirus, sapovirus, and astrovirus (adjusted odds ratio [aOR], 1.62; 95% CI, 1.16–2.26) but less likely than children with rotavirus (aOR, 0.66; 95% CI, 0.49–0.91). Exclusive breastfeeding was strongly protective against adenovirus 40/41 diarrhea (hazard ratio, 0.64; 95% CI, 0.48–0.85), but no other risk factors were identified. The seasonality of adenovirus 40/41 diarrhea varied substantially between sites and did not have clear associations with seasonal variations in temperature or rainfall.
Conclusions. This study supports the situation of adenovirus 40/41 as a pathogen of substantial importance, especially in infants. Fever was a distinguishing characteristic in comparison to other nonrotavirus viral etiologies, and promotion of exclusive breastfeeding may reduce the high observed burden in the first 6 months of life.
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