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Global Burden of<br />
Rotavirus Disease<br />
Sixth International Rotavirus Symposium<br />
Mexico City<br />
July 2004
Causes of severe acute gastroenteritis<br />
among children
Detection rate of rotavirus in hospitalized<br />
diarrhea cases by income group (1986-2000)<br />
<strong>Parashar</strong> et al, 2003
Rotavirus mortality by income group<br />
Income Group<br />
Diarrheal<br />
deaths<br />
% due<br />
to RV<br />
Rotavirus<br />
deaths<br />
Risk of dying<br />
from RV<br />
by age 5<br />
Low<br />
1,805,000<br />
20<br />
361,000<br />
1 in 205<br />
Low-middle<br />
274,000<br />
25<br />
69,000<br />
1 in 542<br />
Upper-middle<br />
33,000<br />
31<br />
10,000<br />
1 in 1,152<br />
High<br />
Global distribution of rotavirus deaths<br />
(n=440,000)<br />
<strong>Parashar</strong> et al, 2003
Declining rotavirus mortality?<br />
Study<br />
Year<br />
DD Deaths<br />
25% RV<br />
RV deaths<br />
(millions)<br />
Snyder<br />
1982<br />
4.6<br />
IOM<br />
1986<br />
3.5<br />
870,000<br />
Martines<br />
1990<br />
3.2<br />
25% RV<br />
Bern<br />
1992<br />
3.3<br />
WDR<br />
1993<br />
2.5<br />
22% RV<br />
600,000<br />
Murray<br />
1998<br />
2.4 – 2.9<br />
<strong>Parashar</strong><br />
2003<br />
2.1<br />
1986-1999<br />
440,000<br />
CHERG<br />
2004<br />
1.56
Vietnam: Hospital Surveillance for<br />
Rotavirus, July 1998 - June 2000<br />
Sector/Cities<br />
North<br />
Hanoi<br />
Haiphong<br />
South<br />
Khanh Hoa<br />
Ho Chi Minh City<br />
Hospitals<br />
National Children’s Hospital<br />
St. Paul’s Children’s Hospital<br />
Children’s Hospital<br />
General Hospital<br />
General Pediatrics N. 1<br />
General Pediatrics N. 2<br />
Rotavirus<br />
Specimens<br />
screened<br />
Rotavirus<br />
positives<br />
N N %<br />
1233<br />
390<br />
886<br />
589<br />
1724<br />
946<br />
5768<br />
657<br />
185<br />
531<br />
348<br />
982<br />
544<br />
3247<br />
53<br />
47<br />
60<br />
59<br />
57<br />
58<br />
56<br />
Van Mann, et all, JID, 2001
Rotavirus hospitalizations in the Asian<br />
Rotavirus Surveillance Network, 2001-2002<br />
China: 41%<br />
Median = 45%<br />
Taiwan: 41%<br />
Hong Kong: 29%<br />
Myanmar: 56%<br />
Vietnam: 60%<br />
Bresee et al, EID 2004<br />
Malaysia: 56%<br />
Indonesia: 39%
What is the true fraction of severe<br />
diarrhea cases attributable to rotavirus?<br />
Study<br />
Year<br />
DD Deaths<br />
Study<br />
Year<br />
RV deaths<br />
(millions)<br />
Snyder<br />
1982<br />
4.6<br />
IOM<br />
1986<br />
3.5<br />
870,000<br />
Martines<br />
1990<br />
3.2<br />
Bern<br />
WDR<br />
Murray<br />
<strong>Parashar</strong><br />
1992<br />
1993<br />
1998<br />
2003<br />
3.3<br />
2.5<br />
2.4 – 2.9<br />
2.1<br />
20%?<br />
30%?<br />
45%?<br />
600,000<br />
440,000<br />
CHERG<br />
2004<br />
1.56<br />
?
EPIDEMIOLOGISTS
Updated literature review<br />
• Studies published 2000 to present<br />
• Study period 1994 onwards<br />
• Inpatient diarrhea cases<br />
• Active, prospective surveillance<br />
• At least one full calendar year data<br />
• At least 100 diarrhea cases evaluated<br />
41 studies met all these criteria
Median detection rates of rotavirus by<br />
income group, 2000-2004<br />
Income<br />
Group<br />
Number of studies<br />
Median rotavirus detection rate (%)<br />
2000-2004<br />
Low<br />
Low-middle<br />
Upper-middle<br />
High<br />
Overall<br />
13<br />
15<br />
7<br />
6<br />
41<br />
39<br />
40<br />
38<br />
44<br />
39
Median detection rates of rotavirus by<br />
income group, 1986-1999 vs. 2000-2004<br />
Income<br />
Group<br />
Number of studies<br />
Median rotavirus detection rate (%)<br />
1986-1999<br />
2000-2004<br />
Low<br />
13<br />
20<br />
39<br />
Low-middle<br />
15<br />
25<br />
40<br />
Upper-middle<br />
7<br />
31<br />
38<br />
High<br />
6<br />
34<br />
44<br />
Overall<br />
41<br />
22<br />
39
Detection rate of rotavirus in hospitalized<br />
diarrhea cases, 1986-1999 vs. 2000-2004<br />
2000-2004 1986-1999<br />
80<br />
70<br />
60<br />
50<br />
% RV Positive<br />
40<br />
30<br />
20<br />
10<br />
Low income<br />
Low-middle<br />
income<br />
High-middle<br />
income<br />
High income<br />
0<br />
100 1000 10000 100000<br />
GNP Per Capita
Updated rotavirus mortality estimate<br />
Study<br />
Year<br />
DD Deaths<br />
Study<br />
Year<br />
RV deaths<br />
(millions)<br />
Snyder<br />
1982<br />
4.6<br />
IOM<br />
1986<br />
3.5<br />
870,000<br />
Martines<br />
1990<br />
3.2<br />
Bern<br />
1992<br />
3.3<br />
WDR<br />
1993<br />
2.5<br />
600,000<br />
Murray<br />
1998<br />
2.4 – 2.9<br />
39%<br />
<strong>Parashar</strong><br />
2003<br />
2.1<br />
440,000<br />
CHERG<br />
2004<br />
1.56<br />
608,000
Why are RV detection rates higher in<br />
recent studies?<br />
• Bacterial diarrheas may have been<br />
reduced by better hygiene/sanitation<br />
• More severe diarrhea cases may be<br />
enrolled in studies<br />
• Improved surveillance and rotavirus<br />
detection methods<br />
• Other reasons?
Next Steps<br />
• Refine current preliminary analysis<br />
• Additional surveillance studies<br />
» Updated data<br />
» Local information for advocacy<br />
• Periodically review and update global<br />
mortality estimates
Overview of DB/Surveillance networks<br />
EURO<br />
EMRO<br />
ARSN<br />
PAHO RV Surv<br />
Network<br />
WHO African<br />
RV Network
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