Accepted Manuscript Title: The epidemiology and aetiology of diarrhoeal disease in infancy in southern Vietnam: a birth cohort study Author: Katherine L Anders Corinne N Thompson Nguyen Thi Van Thuy Nguyen Minh Nguyet Le Thi Phuong Tu Tran Thi Ngoc Dung Voong Vinh Phat Nguyen Thi Hong Van Nguyen Trong Hieu Nguyen Thi Hong Tham Phan Thi Thanh Ha Le Bich Lien Nguyen Van Vinh Chau Stephen Baker Cameron P Simmons PII: DOI: Reference:
S1201-9712(15)00074-0 http://dx.doi.org/doi:10.1016/j.ijid.2015.03.013 IJID 2295
To appear in:
International Journal of Infectious Diseases
Received date: Revised date: Accepted date:
28-1-2015 13-3-2015 17-3-2015
Please cite this article as: Anders KL, Thompson CN, Thuy NTV, Nguyet NM, Tu LTP, Dung TTN, Phat VV, Van NTH, Hieu NT, Tham NTH, Ha PTT, Lien LB, Chau NVV, Baker S, Simmons CP, The epidemiology and aetiology of diarrhoeal disease in infancy in southern Vietnam: a birth cohort study, International Journal of Infectious Diseases (2015), http://dx.doi.org/10.1016/j.ijid.2015.03.013 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
The epidemiology and aetiology of diarrhoeal disease in infancy in southern Vietnam: a birth cohort study
3 4 5 6
Katherine L Anders a,b,c*§, Corinne N Thompson a,b,d§, Nguyen Thi Van Thuy a , Nguyen Minh Nguyet a,e, Le Thi Phuong Tu a, Tran Thi Ngoc Dung a, Voong Vinh Phat a, Nguyen Thi Hong Van a, Nguyen Trong Hieu f, Nguyen Thi Hong Tham g, Phan Thi Thanh Ha h, Le Bich Lien i, Nguyen Van Vinh Chau e, Stephen Baker a,b,d, Cameron P Simmons a,b,j
ip t
1 2
7 8
a
9
Chi Minh City, Vietnam
cr
Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho
b
11
University, Oxford, UK
12
c
13
Australia
14
d
15
e
The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
16
f
Hung Vuong Hospital, Ho Chi Minh City, Vietnam
17
g
Dong Thap Hospital, Cao Lanh, Vietnam
18
h
District 8 Hospital, Ho Chi Minh City, Vietnam
19
i
Children’s Hospital No. 1, Ho Chi Minh City, Vietnam
20
j
Department of Microbiology and Immunology, University of Melbourne, Australia
an
Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford
M
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne,
te
d
The London School of Hygiene and Tropical Medicine, London, UK
Ac ce p
21
us
10
22 23 24
*
25
§
26 27 28 29 30 31
Email addresses: KLA, [email protected]; CNT, [email protected]; NTVT, [email protected]; NMN, [email protected]; LTPT, [email protected]; TTND, [email protected]; VVP: [email protected]; NTHV, [email protected]; NTH, [email protected]; NTHT, [email protected]; PTTH, [email protected]; LBL, [email protected]; NVVC, [email protected]; SB, [email protected]; CPS, [email protected].
Corresponding author: Katherine L. Anders, Oxford University Clinical Research Unit, Hospital for Tropical Diseaes, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam. Email: [email protected]. Telephone: +84 8 38384012. Fax: +84 8 39238904. Co-first authors: these authors contributed equally to this work
1 Page 1 of 33
Abstract
33
Objectives
34
Previous studies indicate a high burden of diarrhoeal disease in Vietnamese children,
35
however longitudinal community-based data on burden and aetiology are limited. We present
36
findings from a large, prospective cohort study of diarrhoeal disease in infants in southern
37
Vietnam.
38
Methods
39
Infants were enrolled at birth in urban Ho Chi Minh City and a semi-rural district in southern
40
Vietnam, and followed for 12 months (n=6,706). Diarrhoeal illness episodes were identified
41
through clinic-based passive surveillance, hospital admissions and self-reports.
42
Results
43
The minimum incidence of diarrhoeal illness in the first year of life was 271/1,000 infant-
44
years of observation for the whole cohort. Rotavirus was the most commonly detected
45
pathogen (50% of positive samples), followed by norovirus (24%), Campylobacter (20%),
46
Salmonella (18%) and Shigella (16%). Repeat infections were identified in 9% of infants
47
infected with rotavirus, norovirus, Shigella or Campylobacter, and 13% of those with
48
Salmonella infections.
49
Conclusions
50
We prospectively quantified the minimum incidence of diarrhoeal disease in infants in both
51
urban and semi-rural settings in southern Vietnam. A large proportion of laboratory-
52
diagnosed disease was caused by rotavirus and norovirus. These data highlight the unmet
53
need for a rotavirus vaccine in Vietnam and provide evidence of the previously unrecognized
54
burden of norovirus in infants.
Ac ce p
te
d
M
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us
cr
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32
2 Page 2 of 33
te
d
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Key words: diarrhoeal disease, infectious diarrhoea, infants, epidemiology, cohort study, rotavirus
Ac ce p
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3 Page 3 of 33
57
Background
59
Diarrhoea remains a substantial cause of morbidity and mortality amongst children
60
globally.1,2 In a study in rural central Vietnam, the incidence of diarrhoea in children under 5
61
years of age was found to exceed 115 episodes/1000 child years.3 Risk factors for diarrhoea
62
in Vietnam include, as in many settings, male gender, age less than two years and poor
63
socioeconomic indicators such as household crowding and poor hygienic habits.4,5 There are
64
no equivalent population-based estimates of diarrhoea in southern, tropical Vietnam where
65
~40% of the country’s population live.
66
A recent study in southern Vietnam illustrated the relative contributions of rotavirus,
67
norovirus and the bacterial pathogens Shigella, Salmonella and Campylobacter spp. as the
68
aetiological agents of diarrhoea in hospitalized children under five years of age in Ho Chi
69
Minh City (HCMC).6 How well these data represent the community level burden of
70
diarrhoeal disease is unclear. Further, these data suggest that the majority of hospitalized
71
diarrhea cases are in children
S1201-9712(15)00074-0 http://dx.doi.org/doi:10.1016/j.ijid.2015.03.013 IJID 2295
To appear in:
International Journal of Infectious Diseases
Received date: Revised date: Accepted date:
28-1-2015 13-3-2015 17-3-2015
Please cite this article as: Anders KL, Thompson CN, Thuy NTV, Nguyet NM, Tu LTP, Dung TTN, Phat VV, Van NTH, Hieu NT, Tham NTH, Ha PTT, Lien LB, Chau NVV, Baker S, Simmons CP, The epidemiology and aetiology of diarrhoeal disease in infancy in southern Vietnam: a birth cohort study, International Journal of Infectious Diseases (2015), http://dx.doi.org/10.1016/j.ijid.2015.03.013 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
The epidemiology and aetiology of diarrhoeal disease in infancy in southern Vietnam: a birth cohort study
3 4 5 6
Katherine L Anders a,b,c*§, Corinne N Thompson a,b,d§, Nguyen Thi Van Thuy a , Nguyen Minh Nguyet a,e, Le Thi Phuong Tu a, Tran Thi Ngoc Dung a, Voong Vinh Phat a, Nguyen Thi Hong Van a, Nguyen Trong Hieu f, Nguyen Thi Hong Tham g, Phan Thi Thanh Ha h, Le Bich Lien i, Nguyen Van Vinh Chau e, Stephen Baker a,b,d, Cameron P Simmons a,b,j
ip t
1 2
7 8
a
9
Chi Minh City, Vietnam
cr
Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho
b
11
University, Oxford, UK
12
c
13
Australia
14
d
15
e
The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
16
f
Hung Vuong Hospital, Ho Chi Minh City, Vietnam
17
g
Dong Thap Hospital, Cao Lanh, Vietnam
18
h
District 8 Hospital, Ho Chi Minh City, Vietnam
19
i
Children’s Hospital No. 1, Ho Chi Minh City, Vietnam
20
j
Department of Microbiology and Immunology, University of Melbourne, Australia
an
Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford
M
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne,
te
d
The London School of Hygiene and Tropical Medicine, London, UK
Ac ce p
21
us
10
22 23 24
*
25
§
26 27 28 29 30 31
Email addresses: KLA, [email protected]; CNT, [email protected]; NTVT, [email protected]; NMN, [email protected]; LTPT, [email protected]; TTND, [email protected]; VVP: [email protected]; NTHV, [email protected]; NTH, [email protected]; NTHT, [email protected]; PTTH, [email protected]; LBL, [email protected]; NVVC, [email protected]; SB, [email protected]; CPS, [email protected].
Corresponding author: Katherine L. Anders, Oxford University Clinical Research Unit, Hospital for Tropical Diseaes, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam. Email: [email protected]. Telephone: +84 8 38384012. Fax: +84 8 39238904. Co-first authors: these authors contributed equally to this work
1 Page 1 of 33
Abstract
33
Objectives
34
Previous studies indicate a high burden of diarrhoeal disease in Vietnamese children,
35
however longitudinal community-based data on burden and aetiology are limited. We present
36
findings from a large, prospective cohort study of diarrhoeal disease in infants in southern
37
Vietnam.
38
Methods
39
Infants were enrolled at birth in urban Ho Chi Minh City and a semi-rural district in southern
40
Vietnam, and followed for 12 months (n=6,706). Diarrhoeal illness episodes were identified
41
through clinic-based passive surveillance, hospital admissions and self-reports.
42
Results
43
The minimum incidence of diarrhoeal illness in the first year of life was 271/1,000 infant-
44
years of observation for the whole cohort. Rotavirus was the most commonly detected
45
pathogen (50% of positive samples), followed by norovirus (24%), Campylobacter (20%),
46
Salmonella (18%) and Shigella (16%). Repeat infections were identified in 9% of infants
47
infected with rotavirus, norovirus, Shigella or Campylobacter, and 13% of those with
48
Salmonella infections.
49
Conclusions
50
We prospectively quantified the minimum incidence of diarrhoeal disease in infants in both
51
urban and semi-rural settings in southern Vietnam. A large proportion of laboratory-
52
diagnosed disease was caused by rotavirus and norovirus. These data highlight the unmet
53
need for a rotavirus vaccine in Vietnam and provide evidence of the previously unrecognized
54
burden of norovirus in infants.
Ac ce p
te
d
M
an
us
cr
ip t
32
2 Page 2 of 33
te
d
M
an
us
cr
ip t
Key words: diarrhoeal disease, infectious diarrhoea, infants, epidemiology, cohort study, rotavirus
Ac ce p
55 56
3 Page 3 of 33
57
Background
59
Diarrhoea remains a substantial cause of morbidity and mortality amongst children
60
globally.1,2 In a study in rural central Vietnam, the incidence of diarrhoea in children under 5
61
years of age was found to exceed 115 episodes/1000 child years.3 Risk factors for diarrhoea
62
in Vietnam include, as in many settings, male gender, age less than two years and poor
63
socioeconomic indicators such as household crowding and poor hygienic habits.4,5 There are
64
no equivalent population-based estimates of diarrhoea in southern, tropical Vietnam where
65
~40% of the country’s population live.
66
A recent study in southern Vietnam illustrated the relative contributions of rotavirus,
67
norovirus and the bacterial pathogens Shigella, Salmonella and Campylobacter spp. as the
68
aetiological agents of diarrhoea in hospitalized children under five years of age in Ho Chi
69
Minh City (HCMC).6 How well these data represent the community level burden of
70
diarrhoeal disease is unclear. Further, these data suggest that the majority of hospitalized
71
diarrhea cases are in children
