Differences in epidemiology of enteropathogens in children pre- and post-rotavirus vaccine introduction in Kilifi, coastal Kenya

Abstract

ABSTRACTBackgroundIn July 2014, Kenya introduced the Rotarix® vaccine into its national immunization program. The impact of this vaccination programme on the local epidemiology of enteropathogens is unclear.MethodsThe TaqMan Array Card (TAC) was used for screening for 28 different enteropathogens in 718 stools from children less than 13 years of age who presented with diarrhea and were admitted to Kilifi County Hospital, coastal Kenya, in 2013 (before vaccine introduction) and in 2016-2018 (after vaccine introduction). The differences between pre- and post-Rotarix® vaccination periods were examined using univariate and multivariable logistic regressions.ResultsIn 665 specimens (92.6%), one or more enteropathogens were detected, while in 323 specimens (48.6%), three or more enteropathogens were detected. There was a significant increase in the proportion of samples containing enteroaggregative Escherichia coli (35.7% vs 45.3%, p=0.014), cytomegalovirus (4.2% vs 9.9%, p=0.008), Vibrio cholerae (0.0% vs 2.3%, p=0.019), Strongyloides species (0.8% vs 3.6%, p=0.048) and Dientamoeba fragilis (2.1% vs 7.8%, p=0.004) post-vaccine introduction. Sapovirus detection decreased significantly (7.6% vs 4.0%, p=0.030) post-vaccine introduction. The proportion of samples that tested positive for rotavirus group A did not statistically differ between the pre- and post-vaccine periods (27.4% vs. 23.5%, p=0.253).ConclusionsIn this setting, the burden of childhood enteropathogen infection was high both pre- and post-rotavirus vaccination introduction, with some specific changes in the burden of enteropathogens in hospitalized children after rotavirus vaccination introduction.