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RotaFlash: Rotavirus surveillance in Africa and worldwide

24 January 2014

Studies confirm importance of rotavirus surveillance in Africa

Special supplement to the Pediatric Infectious Disease Journal describes the critical role of monitoring disease burden and vaccine impact

Rotavirus surveillance, or the tracking and monitoring of disease data, is highlighted in a series of articles released this month as critical to successful and sustained rotavirus vaccine introduction. Rotavirus surveillance helps measure the proportion of diarrhea hospitalizations and deaths due to rotavirus, the age distribution of rotavirus cases, the seasonality of rotavirus disease, and it monitors the diversity of circulating strains. Additionally, surveillance data serves as a baseline against which the safety of rotavirus vaccines can be measured.

Rotavirus Disease Burden in Africa,” (open access) the January 2014 supplement to the Pediatric Infectious Disease Journal (PIDJ), includes articles on rotavirus disease burden, strain diversity, and intussusception monitoring from African countries in the World Health Organization (WHO)-coordinated Global Rotavirus Surveillance Network (GRSN).

This special, extended RotaFlash summarizes key findings from the PIDJ supplement and discusses the value of surveillance for the future of rotavirus vaccines.
Development and expansion of rotavirus surveillance in Africa
Rotavirus surveillance in Africa has expanded considerably since the WHO Regional Office for Africa began supporting member states in 2006 to establish sentinel (or active data collection) surveillance for rotavirus diarrhea in children less than five years of age. The WHO African Rotavirus Surveillance Network (AFRSN) grew from just four sentinel hospital sites in four sub-Saharan countries in 2006 to 34 sites in 20 countries in 2012. The WHO Regional Office for the Eastern Mediterranean supports the Eastern Mediterranean Rotavirus Gastroenteritis Surveillance Network, which includes north African countries. Additional countries in Africa that are not part of the GRSN conduct surveillance independently or through support from other partners.
Fifteen African countries—11 with GAVI support—have introduced rotavirus vaccines into their national immunization programs. As the rollout of rotavirus vaccines across Africa continues to accelerate, findings from the AFRSN and other surveillance programs will prove invaluable for rotavirus vaccine implementation, monitoring, and evaluation efforts.
The GAVI Alliance has provided financial support to WHO for rotavirus surveillance networks in Africa and in other regions of the world to establish baseline data on the occurrence of rotavirus disease and rotavirus strain diversity, to coordinate capacity building activities, and to help monitor vaccine impact after introduction.
Strategic review of the WHO-coordinated Global Rotavirus Surveillance Network (GRSN)
The AFRSN is one of six regional WHO rotavirus surveillance networks worldwide that are part of the WHO-coordinated GRSN, which was launched in 2008.
In 2013, WHO and partners conducted a strategic review of the GRSN. WHO concluded that the network successfully met its objectives, which included documenting presence of disease, describing disease epidemiology, using surveillance as a platform for special studies in some countries, and using the data for policy decisions. WHO also noted that the quality and usefulness of the network would be enhanced if all countries (GAVI-eligible and non-GAVI-eligible) would participate in the data collection and dissemination.
The WHO-coordinated GRSN produces the “Global Rotavirus Information and Surveillance Bulletin” twice a year with rotavirus surveillance data from participating countries.
Surveillance confirms the importance of rotavirus as a cause of diarrheal disease across Africa
Between 2006 and 2012, 42,693 children less than five years of age hospitalized for acute diarrhea in 34 participating hospitals in 20 African countries were enrolled in the WHO-coordinated GRSN. Approximately 41% of the children tested for rotavirus had the disease. The PIDJ supplement provides detailed analyses of rotavirus burden in ten countries, with the percentage of gastroenteritis cases found at hospital sentinel sites testing positive for rotavirus ranging from 20% in rural western Kenya to 56% in Nigeria. In all countries, rotavirus was most commonly found in children less than two years of age.
Rotavirus strain monitoring reveals diversity of strains in Africa
Information on the prevalence and circulation of rotavirus strains in Africa and worldwide is collected to monitor the impact of rotavirus vaccines against diverse strains, inform the development of future rotavirus vaccines, and document characteristics of different rotavirus strains. While the Rotarix® vaccine is comprised of one rotavirus strain and the RotaTeq® vaccine is comprised of five rotavirus strains, both vaccines have shown efficacy against a wide range of strains, even those strains not contained in the vaccines. Laboratory surveillance of rotavirus strains in Africa shows a diverse range of circulating rotavirus strains.
Increased monitoring of intussusception through surveillance in Africa
Intussusception is a serious and potentially life-threatening condition that occurs when the intestine becomes blocked. People of any age can get intussusception, but it is most common in infants between two and nine months of age. The risk of intussusception that has been associated with rotavirus vaccines is low—approximately 1 to 5 cases per 100,000 infants who get vaccinated—and it usually occurs within a week after the 1st or 2nd vaccine dose. Surveillance helps scientists better understand this low-level risk of intussusception that has been observed in some high-income and middle-income countries.
Pre-and post-rotavirus vaccine introduction monitoring of intussusception is important and provides a baseline against which the relative risk of intussusception following vaccine introduction can be measured. Data on intussusception in Africa, however, are sparse. As reported in this supplement, pre-vaccine monitoring in Zambia and Rwanda has revealed that intussusception occurs naturally, mostly in infants under one year of age, and has generally poor case management and high case fatality. Another article in the PIDJ supplement highlighted how increased awareness of intussusception could help save lives. In South Africa, one physician was able to recognize and properly treat a case of intussusception due to information learned while attending the Seventh African Rotavirus Symposium in 2012.
Eighth African Rotavirus Symposium: Call for abstracts
The Eighth African Rotavirus Symposium, the annual meeting of the African Rotavirus Surveillance Network, is being held in Livingstone, Zambia on June 12–13, 2014 with the theme of “Rotavirus Landscape in Africa – Towards Prevention and Control." The Symposium will include a review of current rotavirus research and epidemiological trends and will feature a forum for countries to share lessons learned from rotavirus vaccine introductions. Those who wish to participate as presenters at the Symposium may submit an abstract of a scientific paper or synthesis of recent rotavirus research or program findings.
The Symposium is organized by the African Rotavirus Network and hosted by CIDRZ and ARK. Collaborators include the University Teaching Hospital; the Zambian Ministry of Community Development, Mother and Child Health; and the Ministry of Health.
PATH collaborates on rotavirus vaccine activities with the CDC, WHO, UNICEF, vaccine manufacturers, and countries around the world. RotaFlash is funded by the GAVI Alliance.

For information on rotavirus disease and vaccines and to access the RotaFlash archives, please visit our website. For information on diarrheal disease, please visit DefeatDD’s website. For information on the GAVI Alliance’s support for rotavirus vaccine introduction, please click here.
Please click RotaFlash for the full e-newsletter available online.

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