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Volume 20, Number 7—July 2014
Letter

Rotavirus Epidemiology in Bangui, Central African Republic, 20081

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To the Editor: Infection with group A rotavirus is among the leading causes of gastroenteritis in children, especially in sub-Saharan Africa (1). Data with regard to the incidence of rotavirus-A disease in the Central African Republic are limited (2). To estimate the prevalence of rotavirus-A disease among young children before introduction of rotavirus-A vaccine in Bangui, the capital of the Central African Republic, we performed a prospective study during February–September 2008. The target sample size, based on an expected 20% prevalence of rotavirus diarrhea and a 5% significance level, was 250 cases. All patients were children 0–5 years of age, who were hospitalized for acute diarrhea at the Complexe Pédiatrique, Bangui, the main hospital for children in the Central African Republic, and all had an illness that met the World Health Organization definition of a suspected case of rotavirus-A gastroenteritis (www.who.int/nuvi/surveillance/RV_Case_Defs.pdf). After informed consent and epidemiologic and clinical data had been obtained, a fecal specimen was collected from each child. Samples were transported to the Institut Pasteur de Bangui, where they were tested for rotavirus-A antigen by using the VIKIA Rota-Adeno test, (VIKIA Rota-Adeno; bioMérieux SA, Lyon, France). Results were immediately reported ​​ to the referring physician.

Rotavirus-A G-type (virus protein [VP] 7) and P-type (VP4) genotyping were performed by using previously described 2-step amplification methods (3). Extracted double-stranded RNA was denatured at 97°C for 5 min, and VP7 and VP4 were amplified by reverse transcription PCR (RT-PCR) by using consensus primers 9Con1-L/ VP7R (3) and Con3/Con2 (3), respectively, and the One-Step RT-PCR kit (QIAGEN, Inc., Valencia, CA, USA) according to the manufacturer’s instructions. RT-PCR was conducted by using a GeneAMP PCR System 9700 thermocycler (Applied Biosystems, Foster City, CA, USA) with the following thermocycling profile: 30 min at 42°C; 15 min at 95°C; 35 cycles of 30 s at 94°C, 30 s at 42°C, and 45 s at 72°C; followed by a final 7-min extension at 72°C. G-typing used primer 9Con1-L in combination with primers 9T1–1, 9T1-Dg, 9T-2, 9T-3P, 9T-4, and 9T-9B; P-typing used primer Con3 in combination with primers 1T-1, 1T1-VN, 2T-1, 3T-1, 4T-1, 5T-1, and 1T1-Wa. Genotyping reactions were analyzed by use of electrophoresis on a 3% agarose gel.

Data were analyzed by using Stata 11 software (StataCorp, College Station, TX, USA). Prevalence was expressed in percentages. The χ2 test was used to analyze categorical variables and testing by the Yates correction, as appropriate. A 95% confidence interval was calculated, and p​​<0.05 was considered significant. Ethical and administrative permissions were obtained from the National Committee of Ethics of the Central African Republic; the Complexe Pédiatrique, Bangui; and the Central African Republic Government Ministries.

A total of 250 infants and young children with diarrhea (159 male and 91 female, mean age 8.2 months) were enrolled in this study. Results obtained by the VIKIA Rota-Adeno test revealed that 100 (40%) of these children were infected with rotavirus-A, mostly male children (61/100, p˂0.5).The proportions of rotavirus-A infection in children <9 months of age and those ≥10 months of age were 37.3% (62/166) and 45.2% (38/84), respectively, (p = 0.2). Rotavirus-A infections were more prevalent during February–March (67/108, 62.0%) than during April–September (33/142, 23.2%) (p<10−6). Because data were collected for only 8 months, annual rotavirus-A prevalence might have been underestimated or overestimated, a possible limitation of the study.

Among the 100 ROTAV-A–positive -patients, 32 samples were randomly selected for genotyping. Among these samples, type G1 predominated (62.8%, 22/32); among P genotypes, type P[8] predominated (50%, 16/32), followed by P[6] (25%, 8/32). The predominant genotypic combination was G1P[8] (43.7%, 14/32) and G1P[6] (25%, 8/32) (Table).

Despite the limitations of a short study period and low number of genotyped strains, this study reports useful information. It reveals that 40% of children hospitalized with acute diarrhea at Complexe Pédiatrique, Bangui, were infected with rotavirus-A during the study period, which included the end of the rotavirus-A gastroenteritis season. Most patients were <9 months of age. These results are similar to those found in the 1980s study at Complexe Pédiatrique, Bangui (2), which were that the major serotype/genotype was G1 (71.3%), followed by G2 (15.4%) and G3 (13.3%) (4). After 25 years, the predominant circulating genotypes are G1P[8] and G1P[6] along with G2P[4] and G9P[8]. Our study results are similar to those of recent studies conducted in other African countries (58) and confirm results of studies that found that the same genotypes circulated in western Cameroon in 2003, albeit at different percentages (4,9).

Our study provides relevant data about the genotypes of rotavirus-A from children in the Central African Republic, 25 years after the most recent study (2). These data represent baseline information that will help with monitoring for potential changes in genotype prevalence after the introduction of rotavirus-A vaccine in the Central African Republic.

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Acknowledgments

We thank Jean Fandema for help with genotyping tests and Jamie Lewis for materiel support.

This work was supported by an Institut Pasteur grant (ACIP A-11-2007) and by the Bill and Melinda Gates Foundation through the SURVAC project funds (grant no. 51214).

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Ionela Gouandijka-Vasilache, Alexandre Manirakiza, Jean Chrysostom Gody, Virginie Banga-Mingo, Odilon Omon Kongombe, Mathew D. Esona, Michael D. Bowen, and Diane Waku-Kouomou

Author affiliations: Institut Pasteur, Bangui, Central African Republic (I. Gouandjika-Vasilache, A. Manirakiza, V. Banga-Mingo); Complexe Pédiatrique, Bangui (J. Chrysostom Gody); Village SOS Enfants, Bouar, Central African Republic (O. Omon Kongombe); US Centers for Disease Control and Prevention, Atlanta, Georgia, USA (M.D. Esona, M.D. Bowen, D. Waku-Kouomou)

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References

  1. Tate  JE, Burton  AH, Boschi-Pinto  C, Steele  AD, Duque  J, Parashar  UD. 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;12:13641 . DOIPubMed
  2. Georges-Courbot  MC, Monges  J, Beraud-Cassel  AM, Gouandjika  I, Georges  AJ. Prospective longitudinal study of rotavirus infections in children from birth to two years of age in Central Africa. Ann Inst Pasteur Virol. 1988;139:4218 . DOIPubMed
  3. World Health Organization. Manual of rotavirus detection and characterization methods. WHO/IVB/08.17. 2008 [cited 2014 Apr 8]. http://apps.who.int/iris/handle/10665/70122
  4. Georges-Courbot  MC, Beraud  AM, Beards  GM, Campbell  AD, Gonzalez  JP, Georges  AJ, Subgroups, serotypes, and electrophoretypes of rotavirus isolated from children in Bangui, Central African Republic. J Clin Microbiol. 1988;26:66871 .PubMed
  5. Ndze  VN, Akum  AE, Kamga  GH, Enjema  LE, Esona  MD, Banyai  K, Epidemiology of rotavirus diarrhea in children under 5 years in northern Cameroon. Pan Afr Med J. 2012;11:73 .PubMed
  6. Odimayo  MS, Olanrewaju  WI, Omilabu  SA, Adegboro  B. Prevalence of rotavirus-induced diarrhea among children under 5 years in Ilorin, Nigeria. J Trop Pediatr. 2008;54:3436 . DOIPubMed
  7. Mwenda  JM, Ntoto  KM, Abebe  A, Enweronu-Laryea  C, Amina  I, McHomvu  J, Burden and epidemiology of rotavirus diarrhea in selected African countries: preliminary results from the African Rotavirus Surveillance Network. J Infect Dis. 2010;202(Suppl):S511 . DOIPubMed
  8. Kabue  JP, Peenzer de Beer  M, Esona  MD, Lunfungula  C, Biamungu  M, Simba  TR, Characterization of human rotavirus recovered from children with acute diarrhea in Kinshasa, Democratic Republic of Congo. J Infect Dis. 2010;202(Suppl):S1937 . DOIPubMed
  9. Esona  MD, Armah  GE, Steele  AD. Molecular epidemiology of rotavirus infection in western Cameroon. J Trop Pediatr. 2003;49:1603 . DOIPubMed

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Table

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Cite This Article

DOI: 10.3201/eid2007.131839

1This work was presented as a poster at the 7th African Rotavirus Symposium, Pre-conference Symposium, at the International African Vaccinology Conference, Lagoon Beach Hotel, Cape Town, South Africa; November 8–11, 2012.

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Table of Contents – Volume 20, Number 7—July 2014

Page created: June 18, 2014
Page updated: June 18, 2014
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The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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