Rotavirus disease burden in Africa and the need to accelerate introduction of vaccines
Jason M Mwenda, Richard Mihigo, Carol Tevi-Benissan, Mutale Mumba, Deo Nshimirimana
Corresponding author: Jason M Mwenda, e-mail:
WHO Regional Office for Africa, Brazzaville, Congo, Immunization, Vaccines and Emergencies (IVE) Cluster
Diarrhoea is a major cause of death among children under five years of age globally.1 Rotavirus is the leading cause of severe diarrhoea, resulting in an estimated 453 000 deaths in 2008, most of which occurred in developing countries of sub-Saharan Africa and South-East Asia.2 Rotavirus also causes considerable morbidity, with global estimates of 2.3 million hospitalizations and 24 million outpatient visits annually among children aged under five years.2,3 Rotavirus vaccines are an essential part of an integrated approach to the control of diarrhoea that also includes interventions, such as access to safe drinking water, sanitation and hand washing facilities; breastfeeding; vitamin A and zinc supplementation; and appropriate case management.4 In 2009, WHO made a recommendation that Member States consider introducing rotavirus vaccines in all national immunization programmes and particularly in countries with high diarrhoea-related mortality.5
This article, the result of a literature review, highlights published regional and country specific annual deaths in the WHO Regional Office for Africa.
In order to estimate the number of deaths attributable to rotavirus infection prior to widespread introduction of rotavirus vaccines, available published papers were reviewed to establish the baseline of rotavirus mortality before the introduction of rotavirus vaccines. PubMed was searched, with the keyword “rotavirus” as a primary search term, to identify studies published between January 2001 and January 2011 and before the roll out of rotavirus vaccines in the African Region. Papers citing data from countries that participated in the WHO-coordinated Rotavirus Surveillance Network during 2009 and which detected rotavirus-related diarrhoea with enzyme immunoassay (EIA) in at least 100 children under five years who were admitted to hospital with diarrhoea were included.6 For the countries with several sites, data from all sites were used. In this analysis, for countries that have introduced rotavirus vaccine into their national immunization programme, data subsequent to the introduction were excluded since the main objective was to establish a baseline of the rotavirus specific mortality pre-introduction of vaccines.
© WHO/Julie Pudlowski
Data from the regional Rotavirus Surveillance Network, a network of sentinel surveillance sites in over 21 countries, indicate that rotavirus is responsible for approximately 40% of acute gastroenteritis hospitalizations among children under five years prior to widespread use of rotavirus vaccination (Table 1). Some of these data from the Rotavirus Surveillance Network were cited in the literature reviewed.
In the published analysis, Tate et al (2012)2 estimate that worldwide, each year, rotavirus-related diarrhoea results in 453 000 deaths (varying from 420 000 to 494 000) in children younger than five years, which account for 37% of diarrhoea-related deaths and 5% of all deaths in this age group.2,6 More than half these deaths (230 000) occurred in African children.7,8 Rotavirus sentinel surveillance data available from sub-Saharan Africa were used in these disease estimates and the country specific rotavirus annual death rates in the African Region. The figures were modified from Tate et al (2012).2
Country and regional specific data on annual rotavirus death exist and are available via published literature and the WHO web site.
Nine of the ten countries in the African Region with the highest annual deaths due to rotavirus have established sentinel surveillance, generating high quality data. Six of the ten countries have either introduced or are scheduled to introduce rotavirus vaccines in their national immunization programmes. Hence, it will be possible to use this established surveillance system to monitor the impact of rotavirus vaccines and conduct another analysis three years after vaccine introduction to determine the vaccination programme’s impact7,8 including on circulating rotavirus strains.9
Surveillance data and data from other sources have been used to estimate deaths due to rotavirus. This information has been used to advocate for rotavirus vaccine introduction and to monitor the effect of vaccination on mortality before and after the introduction of vaccines. Introduction of commercially available rotavirus vaccines could substantially reduce deaths attributable to diarrhoea in the African Region.
- Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, et al. Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012; 379:2151–61.
- Tate JE, Burton AH, Boschi-Pinto C, Steele AD, Duque J, Parashar UD; WHO-coordinated Global Rotavirus Surveillance Network. 2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis. Lancet Infect Dis 2012; 12:136–41.
- Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI. Global illness and deaths caused by rotavirus disease in children. Emerg Infect Dis 2003; 9:565–72
- WHO-UNICEF. Ending preventable child deaths from pneumonia and diarrhoea by 2025: the integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD). France: WHO Press 2013.
- WHO. Rotavirus vaccines. WHO position paper. Wkly Epidemiol Rec 2013; 88:49–64.
- Mwenda JM, Ntoto KM, Abebe A, et al. Burden and epidemiology of rotavirus diarrhea in selected African countries: preliminary results from the African Rotavirus Surveillance Network. J Infect Dis 2010; 202 Supplement:S5–S11.
- Mwenda JM, Tate JE, Steele AD, Parashar UD. Preparing for the Scale-up of Rotavirus Vaccine Introduction in Africa: Establishing Surveillance Platforms to Monitor Disease Burden and Vaccine Impact. Paediatric Infect Dis 2014; 33(1) Supplement 1:S1–S5.
- Mwenda JM, Tate JE, Parashar UD, Mihigo R, Agócs M, Serhan F, Nshimirimana D. African Rotavirus Surveillance Network – A Brief Overview. Paediatric Infect Dis 2014; 33(1) Supplement 1:S6–S8.
- Seheri LM, Nemarude AL, Peenze I, Netshifhefhe L, Nyaga MM, Ngobeni HG, Maphalala G, Maake LL, Steele AD, Mwenda JM, Mphahlele MJ. Update of Rotavirus strains circulating in Africa from 2007 through 2011. Paediatric Infect Dis 2014; 33(1) Supplement 1:S76–S83.
ga('create', 'UA-101501857-1', 'auto');