"Epidemiological Features of Rotavirus Infection among children below 5 years old in Jordan,

Rationale for Vaccine Introduction,2015"

Kareman Juma`ah Al-Zain Senior Community Medicine Specialist

Ministry of Health/ Jordan

Funded by the European Union

The LOGO of your institute and/ o the

funders of the Investigation (if any)

Background • Jordan is cholera free country since 1981.• Diarrheal surveillance system established

since eighties.• Despite control measures taken diarrhea still

has high incidence rate among communicable diseases.

• Majority of admitted cases are among children under five years old.

Background

• Globally, rotaviruses are generally recognized as the most common enteropathogens identified among infants and young children hospitalized with dehydrating diarrhea.

• In 2007 rotavirus surveillance system was established in Jordan to monitor the rotavirus infection and define the circulating genotype to support vaccine introduction.

Objective of the study

• Estimation of incidence of hospitalizations associated with rotavirus.

• Determination of age and seasonal distribution of hospitalizations.

• Estimation of proportion of diarrhea hospitalizations attributable to rotavirus.

• Identification of prevalent strains of rotavirus in population under five years old.

Methods • A Cross sectional hospital- based study.• Data was collected by trained nurses and

laboratory technicians.• Stool specimens were collected for rotavirus

testing and genotyping.• Cases were described by age group, sex,

clinical features and genotype.

Methods • Sentinel Sites:• Three hospitals were selected from different

geographical areas: North, Middle and South covering approximately 32% of all population.

Middle: Albashir hospitalNorth: Princess Rahma hospitalSouth: Alkarak hospital

Methods • Using standardized Case Definition:• A child under 5 years of age (< 60 months of age) and admitted to

a designated sentinel hospital for treatment of gastroenteritis.• Data Collection Methods:• Questionnaire includes:• Patient information: ID, name, age (by months), sex and address.• Clinical information: duration of symptoms, symptoms (fever,

diarrhea, No. of episodes of diarrhea, vomiting, No. of episodes of vomiting), dehydration status, treatment, duration of hospitalization, outcome.

• Laboratory information: EIA rotavirus identification in stool, genotype G and P.

Sample Size• All children under 5 years of age (less than 60

months of age) presenting to the three selected hospitals with acute gastroenteritis and requiring hospitalization for treatment of gastroenteritis and fit the adopted case definition.

Methods • Inclusion criteria: • All the following criteria should be satisfied for enrolling the

case: • Child less five years of age (<60 months). • Presence of gastroenteritis of less or equal to 7 days.• Admitted for treatment of gastroenteritis as a primary illness. • Exclusion Criteria: presence of any of the following– Child with bloody diarrhoea.– Patient acquired gastroenteritis during his hospitalization for

treatment of other diseases (hospital acquired gastroenteritis).

Results:

• Starting in May 2007 to December 2014 a total number of 1345 stool samples were tested, 727 cases were positive for rotavirus (47%).

• Among confirmed cases, 138 cases (19%) aged between 6-11 months and 210 cases (29%) were male.

• Diarrhea was present in 99.5% of cases and vomiting in 42%.• Mean stay duration of hospitalized cases was 3 days with

average cost 150 $/ day. • The prevalent combined genotype is G1P8, followed by G2P4

and G9PUT.

Results

Rotavirus Genotyping Results

Conclusions:

• Rotavirus infection represents a major cause of gastroenteritis in children less than 5 years old, especially in infants between 6-11 months.

• Disease usually presents with diarrhoea and vomiting and require admission to hospitals.

• Rotavirus infection can be prevented and vaccination should be implemented to effectively reduce the health and economic burden of rotavirus gastroenteritis in Jordan.

Thank you