Estimating global, regional and national rotavirus deaths in children aged <5 years: Current approaches, new analyses and proposed improvements

Global Rotavirus Surveillance Network

Research output: Contribution to journalArticle

Abstract

Background: Rotavirus is a leading cause of diarrhoeal mortality in children but there is considerable disagreement about how many deaths occur each year. Methods and findings: We compared CHERG, GBD and WHO/CDC estimates of age under 5 years (U5) rotavirus deaths at the global, regional and national level using a standard year (2013) and standard list of 186 countries. The global estimates were 157,398 (CHERG), 122,322 (GBD) and 215,757 (WHO/CDC). The three groups used different methods: (i) to select data points for rotavirus-positive proportions; (ii) to extrapolate data points to individual countries; (iii) to account for rotavirus vaccine coverage; (iv) to convert rotavirus-positive proportions to rotavirus attributable fractions; and (v) to calculate uncertainty ranges. We conducted new analyses to inform future estimates. We found that acute watery diarrhoea was associated with 87% (95% CI 83–90%) of U5 diarrhoea hospitalisations based on data from 84 hospital sites in 9 countries, and 65% (95% CI 57–74%) of U5 diarrhoea deaths based on verbal autopsy reports from 9 country sites. We reanalysed data from the Global Enteric Multicenter Study (GEMS) and found 44% (55% in Asia, and 32% in Africa) rotavirus-positivity among U5 acute watery diarrhoea hospitalisations, and 28% rotavirus-positivity among U5 acute watery diarrhoea deaths. 97% (95% CI 95–98%) of the U5 diarrhoea hospitalisations that tested positive for rotavirus were entirely attributable to rotavirus. For all clinical syndromes combined the rotavirus attributable fraction was 34% (95% CI 31–36%). This increased by a factor of 1.08 (95% CI 1.02–1.14) when the GEMS results were reanalysed using a more sensitive molecular test. Conclusions: We developed consensus on seven proposals for improving the quality and transparency of future rotavirus mortality estimates.

Original languageEnglish (US)
Article numbere0183392
JournalPLoS One
Volume12
Issue number9
DOIs
StatePublished - Sep 1 2017

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Rotavirus
Rotavirus Vaccines
death
Transparency
Diarrhea
diarrhea
Hospitalization
Centers for Disease Control and Prevention (U.S.)
Multicenter Studies
Child Mortality
water
Uncertainty
Autopsy
necropsy
uncertainty
vaccines

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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Estimating global, regional and national rotavirus deaths in children aged <5 years : Current approaches, new analyses and proposed improvements. / Global Rotavirus Surveillance Network.

In: PLoS One, Vol. 12, No. 9, e0183392, 01.09.2017.

Research output: Contribution to journalArticle

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abstract = "Background: Rotavirus is a leading cause of diarrhoeal mortality in children but there is considerable disagreement about how many deaths occur each year. Methods and findings: We compared CHERG, GBD and WHO/CDC estimates of age under 5 years (U5) rotavirus deaths at the global, regional and national level using a standard year (2013) and standard list of 186 countries. The global estimates were 157,398 (CHERG), 122,322 (GBD) and 215,757 (WHO/CDC). The three groups used different methods: (i) to select data points for rotavirus-positive proportions; (ii) to extrapolate data points to individual countries; (iii) to account for rotavirus vaccine coverage; (iv) to convert rotavirus-positive proportions to rotavirus attributable fractions; and (v) to calculate uncertainty ranges. We conducted new analyses to inform future estimates. We found that acute watery diarrhoea was associated with 87{\%} (95{\%} CI 83–90{\%}) of U5 diarrhoea hospitalisations based on data from 84 hospital sites in 9 countries, and 65{\%} (95{\%} CI 57–74{\%}) of U5 diarrhoea deaths based on verbal autopsy reports from 9 country sites. We reanalysed data from the Global Enteric Multicenter Study (GEMS) and found 44{\%} (55{\%} in Asia, and 32{\%} in Africa) rotavirus-positivity among U5 acute watery diarrhoea hospitalisations, and 28{\%} rotavirus-positivity among U5 acute watery diarrhoea deaths. 97{\%} (95{\%} CI 95–98{\%}) of the U5 diarrhoea hospitalisations that tested positive for rotavirus were entirely attributable to rotavirus. For all clinical syndromes combined the rotavirus attributable fraction was 34{\%} (95{\%} CI 31–36{\%}). This increased by a factor of 1.08 (95{\%} CI 1.02–1.14) when the GEMS results were reanalysed using a more sensitive molecular test. Conclusions: We developed consensus on seven proposals for improving the quality and transparency of future rotavirus mortality estimates.",
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T1 - Estimating global, regional and national rotavirus deaths in children aged <5 years

T2 - Current approaches, new analyses and proposed improvements

AU - Global Rotavirus Surveillance Network

AU - Clark, Andrew

AU - Black, Robert E

AU - Tate, Jacqueline

AU - Roose, Anna

AU - Kotloff, Karen

AU - Lam, Diana

AU - Blackwelder, William

AU - Parashar, Umesh

AU - Lanata, Claudio

AU - Kang, Gagandeep

AU - Troeger, Christopher

AU - Platts-Mills, James

AU - Mokdad, Ali

AU - Sanderson, Colin

AU - Lamberti, Laura

AU - Levine, Myron

AU - Santosham, Mathuram

AU - Steele, Duncan

AU - Soenarto, Yati

AU - Rugambwa, Celse

AU - Mpabalwani, Evans

AU - Mwenda, Jason

AU - Murray, Jill

AU - Cohen, Adam

PY - 2017/9/1

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N2 - Background: Rotavirus is a leading cause of diarrhoeal mortality in children but there is considerable disagreement about how many deaths occur each year. Methods and findings: We compared CHERG, GBD and WHO/CDC estimates of age under 5 years (U5) rotavirus deaths at the global, regional and national level using a standard year (2013) and standard list of 186 countries. The global estimates were 157,398 (CHERG), 122,322 (GBD) and 215,757 (WHO/CDC). The three groups used different methods: (i) to select data points for rotavirus-positive proportions; (ii) to extrapolate data points to individual countries; (iii) to account for rotavirus vaccine coverage; (iv) to convert rotavirus-positive proportions to rotavirus attributable fractions; and (v) to calculate uncertainty ranges. We conducted new analyses to inform future estimates. We found that acute watery diarrhoea was associated with 87% (95% CI 83–90%) of U5 diarrhoea hospitalisations based on data from 84 hospital sites in 9 countries, and 65% (95% CI 57–74%) of U5 diarrhoea deaths based on verbal autopsy reports from 9 country sites. We reanalysed data from the Global Enteric Multicenter Study (GEMS) and found 44% (55% in Asia, and 32% in Africa) rotavirus-positivity among U5 acute watery diarrhoea hospitalisations, and 28% rotavirus-positivity among U5 acute watery diarrhoea deaths. 97% (95% CI 95–98%) of the U5 diarrhoea hospitalisations that tested positive for rotavirus were entirely attributable to rotavirus. For all clinical syndromes combined the rotavirus attributable fraction was 34% (95% CI 31–36%). This increased by a factor of 1.08 (95% CI 1.02–1.14) when the GEMS results were reanalysed using a more sensitive molecular test. Conclusions: We developed consensus on seven proposals for improving the quality and transparency of future rotavirus mortality estimates.

AB - Background: Rotavirus is a leading cause of diarrhoeal mortality in children but there is considerable disagreement about how many deaths occur each year. Methods and findings: We compared CHERG, GBD and WHO/CDC estimates of age under 5 years (U5) rotavirus deaths at the global, regional and national level using a standard year (2013) and standard list of 186 countries. The global estimates were 157,398 (CHERG), 122,322 (GBD) and 215,757 (WHO/CDC). The three groups used different methods: (i) to select data points for rotavirus-positive proportions; (ii) to extrapolate data points to individual countries; (iii) to account for rotavirus vaccine coverage; (iv) to convert rotavirus-positive proportions to rotavirus attributable fractions; and (v) to calculate uncertainty ranges. We conducted new analyses to inform future estimates. We found that acute watery diarrhoea was associated with 87% (95% CI 83–90%) of U5 diarrhoea hospitalisations based on data from 84 hospital sites in 9 countries, and 65% (95% CI 57–74%) of U5 diarrhoea deaths based on verbal autopsy reports from 9 country sites. We reanalysed data from the Global Enteric Multicenter Study (GEMS) and found 44% (55% in Asia, and 32% in Africa) rotavirus-positivity among U5 acute watery diarrhoea hospitalisations, and 28% rotavirus-positivity among U5 acute watery diarrhoea deaths. 97% (95% CI 95–98%) of the U5 diarrhoea hospitalisations that tested positive for rotavirus were entirely attributable to rotavirus. For all clinical syndromes combined the rotavirus attributable fraction was 34% (95% CI 31–36%). This increased by a factor of 1.08 (95% CI 1.02–1.14) when the GEMS results were reanalysed using a more sensitive molecular test. Conclusions: We developed consensus on seven proposals for improving the quality and transparency of future rotavirus mortality estimates.

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