Marc-Alain Widdowson

Publications of Marc-Alain Widdowson

• Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis.

  Authors: Harish Nair, W Abdullah Brooks, Mark Katz, Anna Roca, James A Berkley, Shabir A Madhi, James Mark Simmerman, Aubree Gordon, Masatoki Sato, Stephen Howie [......] Robert F Breiman, Daniel R Feikin, Keith P Klugman, Sonja J Olsen, Bradford D Gessner, Peter F Wright, Igor Rudan, Shobha Broor, Eric A F Simões, Harry Campbell

  Lancet. 11/2011; 378(9807):1917-30.

  The global burden of disease attributable to seasonal influenza virus in children is unknown. We aimed to estimate the global incidence of and mortality from lower respiratory infections associatedThe global burden of disease attributable to seasonal influenza virus in children is unknown. We aimed to estimate the global incidence of and mortality from lower respiratory infections associated with influenza in children younger than 5 years. We estimated the incidence of influenza episodes, influenza-associated acute lower respiratory infections (ALRI), and influenza-associated severe ALRI in children younger than 5 years, stratified by age, with data from a systematic review of studies published between Jan 1, 1995, and Oct 31, 2010, and 16 unpublished population-based studies. We applied these incidence estimates to global population estimates for 2008 to calculate estimates for that year. We estimated possible bounds for influenza-associated ALRI mortality by combining incidence estimates with case fatality ratios from hospital-based reports and identifying studies with population-based data for influenza seasonality and monthly ALRI mortality. We identified 43 suitable studies, with data for around 8 million children. We estimated that, in 2008, 90 million (95% CI 49-162 million) new cases of influenza (data from nine studies), 20 million (13-32 million) cases of influenza-associated ALRI (13% of all cases of paediatric ALRI; data from six studies), and 1 million (1-2 million) cases of influenza-associated severe ALRI (7% of cases of all severe paediatric ALRI; data from 39 studies) occurred worldwide in children younger than 5 years. We estimated there were 28,000-111,500 deaths in children younger than 5 years attributable to influenza-associated ALRI in 2008, with 99% of these deaths occurring in developing countries. Incidence and mortality varied substantially from year to year in any one setting. Influenza is a common pathogen identified in children with ALRI and results in a substantial burden on health services worldwide. Sufficient data to precisely estimate the role of influenza in childhood mortality from ALRI are not available. WHO; Bill & Melinda Gates Foundation.

• Incidence of acute gastroenteritis and role of norovirus, Georgia, USA, 2004-2005.

  Authors: Aron J Hall, Mariana Rosenthal, Nicole Gregoricus, Sharon A Greene, Jeana Ferguson, Olga L Henao, Jan Vinjé, Ben A Lopman, Umesh D Parashar, Marc-Alain Widdowson

  Emerging infectious diseases. 08/2011; 17(8):1381-8.

  Approximately 179 million cases of acute gastroenteritis (AGE) occur annually in the United States. However, lack of routine clinical testing for viruses limits understanding of their role amongApproximately 179 million cases of acute gastroenteritis (AGE) occur annually in the United States. However, lack of routine clinical testing for viruses limits understanding of their role among persons seeking medical care. Fecal specimens submitted for routine bacterial culture through a health maintenance organization in Georgia, USA, were tested with molecular diagnostic assays for norovirus, rotavirus, astrovirus, sapovirus, and adenovirus. Incidence was estimated by using national health care utilization rates. Routine clinical diagnostics identified a pathogen in 42 (7.3%) of 572 specimens; inclusion of molecular viral testing increased pathogen detection to 15.7%. Community AGE incidence was 41,000 cases/100,000 person-years and outpatient incidence was 5,400/100,000 person-years. Norovirus was the most common pathogen, accounting for 6,500 (16%) and 640 (12%) per 100,000 person-years of community and outpatient AGE episodes, respectively. This study demonstrates that noroviruses are leading causes of AGE among persons seeking medical care.

• Foodborne illness acquired in the United States.

  Authors: Elaine Scallan, Robert M Hoekstra, Marc-Alain Widdowson, Aron J Hall, Patricia M Griffin

  Emerging infectious diseases. 07/2011; 17(7):1339-40.

  In Response: We welcome the suggestions by Hedberg (1) and Johnson (2) on how future estimates of foodborne illness in the United States could be improved (3,4). We agree with Johnson that ourIn Response: We welcome the suggestions by Hedberg (1) and Johnson (2) on how future estimates of foodborne illness in the United States could be improved (3,4). We agree with Johnson that our estimates of foodborne illness probably reflect underrecognition of the extent of extraintestinal disease (2). Our estimates of foodborne illness caused by major pathogens included 7 pathogens that cause conditions other than gastroenteritis. However, our estimates of foodborne illness caused by unspecified agents relied on reports of acute gastroenteritis. We did not include illness caused by known foodborne agents that do not typically cause gastroenteritis, such as ciguatoxins and some mushroom toxins, for which insufficient data were available to estimate agent-specific episodes of illness (4).

• Epidemiologic and virologic assessment of the 2009 influenza A (H1N1) pandemic on selected temperate countries in the Southern Hemisphere: Argentina, Australia, Chile, New Zealand and South Africa.

  Authors: Maria D Van Kerkhove, Anthony W Mounts, Sabine Mall, Katelijn A H Vandemaele, Mary Chamberland, Thais dos Santos, Julia Fitzner, Marc-Alain Widdowson, Jennifer Michalove, Joseph Bresee [......] Lucille Blumberg, Ayanda Cengimbo, Chuma Makunga, Jo McAnerney, Veerle Msimang, Dhamari Naidoo, Adrian Puren, Barry Schoub, Juno Thomas, Marietjie Venter

  Influenza and other respiratory viruses. 04/2011; 5(6):e487-98.

  INTRODUCTION AND SETTING: Our analysis compares the most comprehensive epidemiologic and virologic surveillance data compiled to date for laboratory-confirmed H1N1pdm patients between 1 April 2009 -INTRODUCTION AND SETTING: Our analysis compares the most comprehensive epidemiologic and virologic surveillance data compiled to date for laboratory-confirmed H1N1pdm patients between 1 April 2009 - 31 January 2010 from five temperate countries in the Southern Hemisphere-Argentina, Australia, Chile, New Zealand, and South Africa. We evaluate transmission dynamics, indicators of severity, and describe the co-circulation of H1N1pdm with seasonal influenza viruses. In the five countries, H1N1pdm became the predominant influenza strain within weeks of initial detection. South Africa was unique, first experiencing a seasonal H3N2 wave, followed by a distinct H1N1pdm wave. Compared with the 2007 and 2008 influenza seasons, the peak of influenza-like illness (ILI) activity in four of the five countries was 3-6 times higher with peak ILI consultation rates ranging from 35/1,000 consultations/week in Australia to 275/100,000 population/week in New Zealand. Transmission was similar in all countries with the reproductive rate ranging from 1.2-1.6. The median age of patients in all countries increased with increasing severity of disease, 4-14% of all hospitalized cases required critical care, and 26-68% of fatal patients were reported to have ≥1 chronic medical condition. Compared with seasonal influenza, there was a notable downward shift in age among severe cases with the highest population-based hospitalization rates among children <5 years old. National population-based mortality rates ranged from 0.8-1.5/100,000. The difficulty experienced in tracking the progress of the pandemic globally, estimating its severity early on, and comparing information across countries argues for improved routine surveillance and standardization of investigative approaches and data reporting methods.

• Foodborne illness acquired in the United States--major pathogens.

  Authors: Elaine Scallan, Robert M Hoekstra, Frederick J Angulo, Robert V Tauxe, Marc-Alain Widdowson, Sharon L Roy, Jeffery L Jones, Patricia M Griffin

  Emerging infectious diseases. 01/2011; 17(1):7-15.

  Estimates of foodborne illness can be used to direct food safety policy and interventions. We used data from active and passive surveillance and other sources to estimate that each year 31 majorEstimates of foodborne illness can be used to direct food safety policy and interventions. We used data from active and passive surveillance and other sources to estimate that each year 31 major pathogens acquired in the United States caused 9.4 million episodes of foodborne illness (90% credible interval [CrI] 6.6-12.7 million), 55,961 hospitalizations (90% CrI 39,534-75,741), and 1,351 deaths (90% CrI 712-2,268). Most (58%) illnesses were caused by norovirus, followed by nontyphoidal Salmonella spp. (11%), Clostridium perfringens (10%), and Campylobacter spp. (9%). Leading causes of hospitalization were nontyphoidal Salmonella spp. (35%), norovirus (26%), Campylobacter spp. (15%), and Toxoplasma gondii (8%). Leading causes of death were nontyphoidal Salmonella spp. (28%), T. gondii (24%), Listeria monocytogenes (19%), and norovirus (11%). These estimates cannot be compared with prior (1999) estimates to assess trends because different methods were used. Additional data and more refined methods can improve future estimates.

• Burden and epidemiology of rotavirus diarrhea in selected African countries: preliminary results from the African Rotavirus Surveillance Network.

  Authors: Jason M Mwenda, Kinkela Mina Ntoto, Almaz Abebe, Christabel Enweronu-Laryea, Ismail Amina, Jackson Mchomvu, Annet Kisakye, Evans M Mpabalwani, Isoro Pazvakavambwa, George E Armah, L M Seheri, Nicholas M Kiulia, N Page, Marc-Alain Widdowson, A Duncan Steele

  The Journal of infectious diseases. 09/2010; 202 Suppl:S5-S11.

  Severe rotavirus diarrhea in children <5 years of age is a major public health problem; however, limited regional and country specific data on rotavirus disease burden are available from sub-SaharanSevere rotavirus diarrhea in children <5 years of age is a major public health problem; however, limited regional and country specific data on rotavirus disease burden are available from sub-Saharan Africa. In June 2006, the World Health Organization Regional Office for Africa initiated rotavirus surveillance in selected African countries. With use of standardized methodology developed by the World Health Organization, children <5 years of age who were hospitalized with severe diarrhea were enrolled, and stool specimens were collected for detection of rotavirus strains with use of a commercial enzyme immunoassay. Rotavirus strains were further characterized for G and P types with use of a reverse-transcriptase polymerase chain reaction. From June 2006 through December 2008, rotavirus surveillance was established at 14 sites in 11 African countries. Of 5461 stool samples collected from children enrolled in 8 countries with 1 or 2 complete years of data, 2200 (40%) were positive for rotavirus. Ninety percent of all rotavirus hospitalizations occurred among children aged 3-12 months. Predominant types included G1P[8] (21%), G2P[4] (7%), and P [8] (29%); however, unusual types were also detected, including G8P[6] (5%), G8P[8] (1%), G12P[6] (1%), and G12P[6] (1%). A high percentage of mixed rotavirus infections was also detected. These preliminary results indicate that rotavirus is a major cause of severe diarrheal disease in African children.

• Health care transmission of a newly emergent adenovirus serotype in health care personnel at a military hospital in Texas, 2007.

  Authors: Fernanda C Lessa, Philip L Gould, Neil Pascoe, Dean D Erdman, Xiaoyan Lu, Michel L Bunning, Vincent C Marconi, Lisa Lott, Marc-Alain Widdowson, Larry J Anderson, Arjun Srinivasan

  The Journal of infectious diseases. 12/2009; 200(11):1759-65.

  BACKGROUND: Adenoviruses can cause outbreaks of febrile respiratory illness in military trainees, but until 2007, adenovirus serotype 14 (Ad14) was never associated with such outbreaks. From AprilBACKGROUND: Adenoviruses can cause outbreaks of febrile respiratory illness in military trainees, but until 2007, adenovirus serotype 14 (Ad14) was never associated with such outbreaks. From April through June 2007, 15 trainees at one base were hospitalized for pneumonia due to Ad14. Subsequent reports of febrile respiratory illness among health care personnel suggested nosocomial transmission. METHODS: Health care personnel participants completed a questionnaire and provided blood and nasal wash specimens for Ad14 diagnostic testing. We defined a confirmed case of Ad14 infection as one with titers > or = 1:80 or nasal wash specimens positive for Ad14 by polymerase chain reaction, whereas a possible case was defined by titers of 1:20 or 1:40. We also collected environmental samples. RESULTS: Among 218 tested health care personnel, 35 (16%) had titers > or = 1:20; of these, 7 had possible cases and 28 had confirmed cases of infection. Confirmed case patients were more likely to report febrile respiratory illness (57% vs 11%; P< .001) and to have had direct contact with patients with Ad14 infection (82% vs 62%; P.04 ). Of the 23 confirmed case patients with direct contact with Ad14-infected patients, 52% reported that patients were not in contact and droplet precautions at the time of exposure. Ad14 was recovered from several hospital surfaces. CONCLUSION: Our findings of possible nosocomial transmission of Ad14 highlight the need to reinforce infection control guidelines.

• A decade of the Asian Rotavirus Surveillance Network: achievements and future directions.

  Authors: E Anthony S Nelson, Marc-Alain Widdowson, Paul E Kilgore, Duncan Steele, Umesh D Parashar

  Vaccine. 11/2009; 27 Suppl 5:F1-3.

• Importance and challenges of accurately counting rotavirus deaths in China, 2002.

  Authors: Eileen L Yee, Zhao-Yin Fang, Na Liu, Stephen C Hadler, Xiaofeng Liang, Huaqing Wang, Xu Zhu, Baoming Jiang, Umesh Parashar, Marc-Alain Widdowson, Roger I Glass

  Vaccine. 11/2009; 27 Suppl 5:F46-9.

  Rotavirus mortality is an important component of the total burden of rotavirus disease for children under 5 years old, but accurate estimation is difficult for many developing countries. Here weRotavirus mortality is an important component of the total burden of rotavirus disease for children under 5 years old, but accurate estimation is difficult for many developing countries. Here we applied a more direct method to improve estimates of rotavirus mortality in China using 2002 Chinese-specific data. Results indicate that in 2002, approximately 13,400 children under 5 years old in China died from rotavirus and 70% of these deaths occur in rural areas. Thus, a national rotavirus immunization program targeting rural areas with high mortality from diarrhoea could dramatically reduce these deaths and urban areas could reduce childhood hospitalizations attributed to rotavirus by 43%.

• Global rotavirus surveillance: determining the need and measuring the impact of rotavirus vaccines.

  Authors: Marc-Alain Widdowson, Duncan Steele, Jazmin Vojdani, John Wecker, Umesh Parashar

  The Journal of infectious diseases. 11/2009; 200 Suppl 1:S1-8.

  Rotavirus remains the most common cause of severe childhood diarrhea worldwide and of diarrheal mortality in poor countries. In 2003, the GAVI Alliance launched the Rotavirus Vaccine Program and theRotavirus remains the most common cause of severe childhood diarrhea worldwide and of diarrheal mortality in poor countries. In 2003, the GAVI Alliance launched the Rotavirus Vaccine Program and the Accelerated Development and Introduction Plan to close the gap of access to rotavirus vaccines in industrialized and developing countries by generating data on rotavirus disease burden, projected impact, and cost-effectiveness of vaccination and by conducting clinical trials of existing vaccines in impoverished settings. By the end of 2008, rotavirus vaccines were licensed in >100 countries, although only 17 countries have introduced routine rotavirus vaccination. Increased uptake of the vaccine by countries with the highest childhood mortality will depend in part on a solid evidence base of estimated burden and cost of rotavirus illness. Since 2001, regional surveillance networks worldwide have generated burden and strain data from 196 sites in 59 countries. Among children aged <5 years who are hospitalized for severe diarrhea in different regions of the world, a regional median of 39% (range by country, 20%-73%) test positive for rotavirus. Rotavirus vaccines are a cost-effective intervention and may be cost saving with a GAVI Alliance subsidy from the health care perspective. Punctual vaccination and high coverage of populations at highest risk of mortality will maximize the impact of vaccination. Surveillance platforms will allow measurement of the rapid impact of rotavirus vaccine introduction on the heavy burden of rotavirus on child health worldwide.

• The burden of hospitalizations and clinic visits for rotavirus disease in children aged <5 years in the Philippines.

  Authors: Celia C Carlos, Marianette T Inobaya, Joseph S Bresee, Marietta L Lagrada, Agnettah M Olorosa, Carl D Kirkwood, Marc-Alain Widdowson

  The Journal of infectious diseases. 11/2009; 200 Suppl 1:S174-81.

  Recent data on the burden of hospitalization and clinic visits for rotavirus gastroenteritis are needed to support the decision to introduce rotavirus vaccine in the Philippines. From 2005 throughRecent data on the burden of hospitalization and clinic visits for rotavirus gastroenteritis are needed to support the decision to introduce rotavirus vaccine in the Philippines. From 2005 through 2006, children aged <5 years with acute diarrhea who attended 1 of 7 clinics and/or hospitals in Muntinlupa City, the Philippines, were enrolled. Clinical and demographic data were collected, and a stool specimen was obtained for rotavirus testing and typing for G and P antigens. The incidences of different clinical outcomes of rotavirus gastroenteritis were determined for 3 townships under surveillance and were extrapolated to the Philippines with use of national data sets. The prevalence of rotavirus was 31% (171/560) among children hospitalized with diarrhea, 30% (155/520) among those who presented to the emergency department, and 15% (56/385) among those who presented to a clinic. The annual estimated incidence (per 100,000 children aged <5 years) of rotavirus gastroenteritis in outpatient, emergency department, and inpatient settings was 755, 451, and 279, respectively. Of 274 strains, 50 (18%) were nontypeable. Of the 128 strains that underwent G and P typing, 98% belong to the globally common strains G3P[P], G2P[4], and G1P[8]. The burden of rotavirus gastroenteritis in the Philippines is high and is predominantly caused by strains against which current vaccines have shown good efficacy, suggesting that routine immunization will have a large impact on rotavirus disease burden.

• Rotavirus disease burden and impact and cost-effectiveness of a rotavirus vaccination program in kenya.

  Authors: Jacqueline E Tate, Richard D Rheingans, Ciara E O'Reilly, Benson Obonyo, Deron C Burton, Jeffrey A Tornheim, Kubaje Adazu, Peter Jaron, Benjamin Ochieng, Tara Kerin, Lisa Calhoun, Mary Hamel, Kayla Laserson, Robert F Breiman, Daniel R Feikin, Eric D Mintz, Marc-Alain Widdowson

  The Journal of infectious diseases. 11/2009; 200 Suppl 1:S76-84.

  The projected impact and cost-effectiveness of rotavirus vaccination are important for supporting rotavirus vaccine introduction in Africa, where limited health intervention funds areThe projected impact and cost-effectiveness of rotavirus vaccination are important for supporting rotavirus vaccine introduction in Africa, where limited health intervention funds are available. Hospital records, health utilization surveys, verbal autopsy data, and surveillance data on diarrheal disease were used to determine rotavirus-specific rates of hospitalization, clinic visits, and deaths due to diarrhea among children <5 years of age in Nyanza Province, Kenya. Rates were extrapolated nationally with use of province-specific data on diarrheal illness. Direct medical costs were estimated using record review and World Health Organization estimates. Household costs were collected through parental interviews. The impact of vaccination on health burden and on the cost-effectiveness per disability-adjusted life-year and lives saved were calculated. Annually in Kenya, rotavirus infection causes 19% of hospitalizations and 16% of clinic visits for diarrhea among children <5 years of age and causes 4471 deaths, 8781 hospitalizations, and 1,443,883 clinic visits. Nationally, rotavirus disease costs the health care system $10.8 million annually. Routine vaccination with a 2-dose rotavirus vaccination series would avert 2467 deaths (55%), 5724 hospitalizations (65%), and 852,589 clinic visits (59%) and would save 58 disability-adjusted life-years per 1000 children annually. At $3 per series, a program would cost $2.1 million in medical costs annually; the break-even price is $2.07 per series. A rotavirus vaccination program would reduce the substantial burden of rotavirus disease and the economic burden in Kenya.

• How much could rotavirus vaccines reduce diarrhea-associated mortality in northern Ghana? A model to assess impact.

  Authors: Melissa L Arvay, Aaron T Curns, Sophia Terp, George Armah, Peter Wontuo, Umesh D Parashar, Fred Binka, Roger I Glass, Marc-Alain Widdowson

  The Journal of infectious diseases. 11/2009; 200 Suppl 1:S85-91.

  Effective rotavirus vaccines could substantially reduce the approximately 500,000 deaths due to rotavirus disease per year worldwide, although the impact will depend on vaccine effectiveness, timingEffective rotavirus vaccines could substantially reduce the approximately 500,000 deaths due to rotavirus disease per year worldwide, although the impact will depend on vaccine effectiveness, timing of administration, and coverage. We modeled vaccine impact on rotavirus-associated mortality in rural Ghana. All deaths due to acute diarrhea among children during 1998-2004 in the Kassena-Nankana District of Ghana were identified, and the number of deaths due to rotavirus disease was estimated using hospital laboratory surveillance data. Assuming rotavirus vaccine would be included in the current Expanded Program on Immunization schedule, we estimated the reduction in rotavirus-associated mortality with use of the current coverage and timing of diphtheria, tetanus, and pertussis vaccine administration and various age-restricted schedules. Of the 381 deaths due to diarrhea, 131 (34%) were estimated to be caused by rotavirus infection. On the basis of current diphtheria, tetanus, and pertussis vaccine coverage and timing, a 90% efficacious 3-dose rotavirus vaccine would prevent 70% of deaths due to rotavirus infection if administered without age restrictions, 53% if only initiated among children <12 weeks of age, and 52% if the course also was completed by 32 weeks of age. Rotavirus vaccine has the potential to substantially reduce rotavirus-associated mortality in rural Ghana. Although timely vaccination should be encouraged, extending the current age recommendation for initiation of rotavirus vaccination could increase the coverage and impact of vaccination.

• Burden of severe rotavirus diarrhea in indonesia.

  Authors: Yati Soenarto, Abu T Aman, Achirul Bakri, Herman Waluya, Agus Firmansyah, Muzal Kadim, Iesje Martiza, Dwi Prasetyo, Nenny S Mulyani, Titis Widowati, Soetjiningsih, I Putu Gede Karyana, Wayan Sukardi, Joseph Bresee, Marc-Alain Widdowson

  The Journal of infectious diseases. 11/2009; 200 Suppl 1:S188-94.

  Globally, rotavirus is the leading cause of diarrhea-related hospitalizations and deaths among young children, but the burden of rotavirus disease in Indonesia is poorly documented. From JanuaryGlobally, rotavirus is the leading cause of diarrhea-related hospitalizations and deaths among young children, but the burden of rotavirus disease in Indonesia is poorly documented. From January through December 2006, we conducted prospective surveillance (inpatient and outpatient) among children aged <5 years at 6 hospitals in 6 provinces of Indonesia, using standardized methodology. Of 2240 enrolled children hospitalized for diarrhea, 1345 (60%) were rotavirus positive. Of 176 children enrolled in outpatient clinics in 3 hospitals, 73 (41%) were rotavirus positive. Among children hospitalized for diarrhea, dehydration was more common among those who tested positive for rotavirus than among those who did not (91% vs 82%; P < .05), as was vomiting (86% vs 67%; P < .05). Children aged 6-23 months experienced 72% of all rotavirus episodes. Rotavirus prevalence increased slightly in the cool, dry season. The most commonly detected genotypes were G9 (30%) and P[6] (56%). G1P[6] and G9P[6] accounted for 34% and 21% of strains, respectively. A high proportion of genotype P[6] was detected, in combination with the common G types G1 and G9. Available rotavirus vaccines would likely be efficacious against the most common circulating strains, but continued monitoring of uncommon genotypes is needed.

• Hospital-Based Surveillance of Rotavirus Diarrhea in the People's Republic of China, August 2003-July 2007.

  Authors: Zhao-Jun Duan, Na Liu, Su-Hua Yang, Jing Zhang, Li-Wei Sun, Jing-Yu Tang, Yu Jin, Zeng-Qing Du, Jin Xu, Qing-Bin Wu, Zhi-li Tong, Si-Tang Gong, Yuan Qian, Jian-Min Ma, Xu-Chun Liao, Marc-Alain Widdowson, Baoming Jiang, Zhao-Yin Fang

  The Journal of infectious diseases. 11/2009; 200 Suppl 1:S167-73.

  Rotaviruses cause acute diarrhea worldwide. Previous studies of rotavirus diarrhea in China found that rotavirus infection is the most common cause of severe diarrhea in young children. In theRotaviruses cause acute diarrhea worldwide. Previous studies of rotavirus diarrhea in China found that rotavirus infection is the most common cause of severe diarrhea in young children. In the present study, surveillance of rotavirus diarrhea was conducted involving 9549 children aged <5 years who were admitted for treatment of diarrhea at 11 sentinel hospitals in China from August 2003 through July 2007. Group A rotavirus was detected in 3749 (47.8%) of the 7846 fecal specimens by using enzyme-linked immunosorbent assay. Rotavirus isolates were characterized by reverse-transcriptase polymerase chain reaction to determine G and P genotypes. All the strains that are common worldwide were detected; G3P[8] was the most common. An unusual G5 strain was detected in 2 specimens. Of all episodes of rotavirus diarrhea, 94% occurred during the first 2 years of life, peaking at 6-23 months of age. Our findings indicate that globally common rotavirus strains continue to be a major cause of severe childhood diarrhea in China. Introduction of routine immunization with effective rotavirus vaccines would substantially reduce this burden.

• Sentinel hospital surveillance for rotavirus in latin american and Caribbean countries.

  Authors: Lucia Helena De Oliveira, M Carolina Danovaro-Holliday, Jon Kim Andrus, Ana Maria Bispo de Fillipis, Jon Gentsch, Cuauhtemoc Ruiz Matus, Marc-Alain Widdowson

  The Journal of infectious diseases. 11/2009; 200 Suppl 1:S131-9.

  The burden of rotavirus disease in the Latin American region has been poorly understood despite the promise of effective vaccines. We describe here the implementation and results of a rotavirusThe burden of rotavirus disease in the Latin American region has been poorly understood despite the promise of effective vaccines. We describe here the implementation and results of a rotavirus surveillance network in the Latin American and Caribbean region. From 2005 through 2007, stool specimens and epidemiologic information were gathered from children <5 years of age who were hospitalized for acute diarrhea (3 looser-than-normal stools within <24 h) lasting <14 days with use of a standardized generic protocol. Stool samples were tested for rotavirus, and a proportion of detected strains were typed. The proportion of samples positive for rotavirus was applied to World Health Organization diarrhea-related mortality estimates to calculate rotavirus-associated mortality. In 2007, the network comprised 54 sites in 11 countries. During 2006-2007, specimens were collected from 19,817 children; 8141 of these specimens were positive for rotavirus. The median percentage of positive specimens in the country was 31.5% (range, 24%-47%). The risk of death from rotavirus diarrhea by age 5 years was 1 of 2874. Strong rotavirus winter seasonality was apparent, even in tropical Central America. Globally common strains (P[8] G1, P[8] G9, and P[4] G2) accounted for >75% of strains, although unusual strains, including G12, were detected at low levels. As rotavirus vaccines continue to be introduced in Latin America, maintenance of surveillance will provide robust pre-introduction data and a platform for estimating vaccine effectiveness and other measures of impact.

• Epidemiology of rotavirus gastroenteritis among children <5 years of age in Morocco during 1 year of sentinel hospital surveillance, June 2006-May 2007.

  Authors: Mohammed Benhafid, Mohammed Youbi, John D Klena, Jon R Gentsch, Nadia Teleb, Marc-Alain Widdowson, Rajae Elaouad

  The Journal of infectious diseases. 11/2009; 200 Suppl 1:S70-5.

  In anticipation of vaccine introduction, we assessed the epidemiology, burden, and genotype of infecting strains of rotavirus disease among Moroccan children hospitalized for acuteIn anticipation of vaccine introduction, we assessed the epidemiology, burden, and genotype of infecting strains of rotavirus disease among Moroccan children hospitalized for acute gastroenteritis. From June 2006 through May 2007, 345 children <5 years of age who had acute gastroenteritis and were admitted to 4 sentinel hospitals in different regions of Morocco were enrolled in this surveillance study, and stool specimens were tested for the presence of rotavirus with use of enzyme immunoassay. RNA from positive samples was genotyped by reverse-transcriptase polymerase chain reaction. Overall, 314 children had complete data available, and among these, 138 (44%) tested positive for rotavirus. Rotavirus infection was most common among children <24 months of age (95% of all hospitalizations for rotavirus infection). Rotavirus infection was detected year-round at all 4 sites but was most prevalent from September through January. Genotype analysis demonstrated that 30.6% of samples were G1[P8], 26% were G9[P8], 7.5% were G2[P6], 3.7% were G1[P6], and 0.7% were G2[P8]. Nucleotide sequencing analysis of G- or P-untypeable strains showed that 4.5% were G9[P8], 2.2% were G1[8], 2.2% were G2[P6], and 1.5% were G2[P4]. A high frequency of mixed infection (21%) was found, of which G1G2[P8] accounted for the majority (16.4%). Rotavirus was responsible for 44% of all hospitalizations for diarrhea among young children at these 4 separate sites in Morocco. These data will help inform a decision on the introduction of rotavirus vaccine in Morocco. Continued and extended surveillance in Morocco will be important to monitor changes in the epidemiology of rotavirus disease and the impact of vaccination after introduction.

• Molecular Epidemiology of GII.4 Noroviruses in the US between 1994 and 2006.

  Authors: Du-Ping Zheng, Marc-Alain Widdowson, Roger I Glass, Jan Vinjé

  Journal of clinical microbiology. 10/2009;

  Human noroviruses (NoVs) of genogroup II, genotype 4 (GII.4) are the most common strains detected in outbreaks of acute gastroenteritis worldwide. To gain insight into the epidemiology and geneticHuman noroviruses (NoVs) of genogroup II, genotype 4 (GII.4) are the most common strains detected in outbreaks of acute gastroenteritis worldwide. To gain insight into the epidemiology and genetic variation of GII.4 strains, we analyzed 773 NoV-outbreaks reported to CDC from 1994-2006. Of these, 629 (81.4%) were caused by GII viruses and 342 (44.2%) were GII.4 strains. The proportion of GII.4-outbreaks increased from 5% in 1994 to 85% in 2006 but distinct annual differences were noted including sharp increases in 1996, 2003, and 2006 each associated with newly emerging GII.4 strains. Sequence analysis of complete VP1 gene of GII.4 strains identified in this study and from GenBank segregated these viruses into at least 9 distinct sub-clusters which had 1.3-3.2% amino acid variation between strains in different sub-clusters. We propose that GII.4 sub-clusters be defined as having > 5% sequence variation between strains. Our data confirm other studies on the rapid emergence and displacement of highly virulent GII.4 strains.

• Outbreak of Severe Respiratory Disease Associated with Emergent Human Adenovirus Serotype 14 at a US Air Force Training Facility in 2007.

  Authors: Jacqueline E Tate, Michel L Bunning, Lisa Lott, Xiaoyan Lu, John Su, David Metzgar, Lorie Brosch, Catherine A Panozzo, Vincent C Marconi, Dennis J Faix, Mila Prill, Brian Johnson, Dean D Erdman, Vincent Fonseca, Larry J Anderson, Marc-Alain Widdowson

  The Journal of infectious diseases. 05/2009;

  Background. In 2007, a US Air Force training facility reported a cluster of severe respiratory illnesses associated with a rare human adenovirus (Ad) serotype, Ad14. We investigated this outbreak toBackground. In 2007, a US Air Force training facility reported a cluster of severe respiratory illnesses associated with a rare human adenovirus (Ad) serotype, Ad14. We investigated this outbreak to better understand its epidemiology, clinical spectrum, and associated risk factors. Methods. Data were collected from ongoing febrile respiratory illness (FRI) surveillance and from a retrospective cohort investigation. Because an Ad7 vaccine is in development, Ad7 antibody titers in pretraining serum samples from trainees with mild and those with severe Ad14 illness were compared. Results. During 2007, an estimated 551 (48%) of 1147 trainees with FRI were infected with Ad14; 23 were hospitalized with pneumonia, 4 required admission to an intensive care unit, and 1 died. Among cohort members ([Formula: see text]), the Ad14 infection rate was high (50%). Of those infected, 40% experienced FRI. No cohort members were hospitalized. Male sex (risk ratio [RR], 4.7 [95% confidence interval {CI}, 2.2-10.1]) and an ill close contact (RR, 1.6 [95% CI, 1.2-2.2]) were associated with infection. Preexisting Ad7 neutralizing antibodies were found in 7 (37%) of 19 Ad14-positive trainees with mild illness but in 0 of 16 trainees with Ad14 pneumonia ([Formula: see text]). Conclusions. Emergence of Ad14, a rare Ad serotype, caused a protracted outbreak of respiratory illness among military recruits. Most infected recruits experienced FRI or milder illnesses. Some required hospitalization, and 1 died. Natural Ad7 infection may protect against severe Ad14 illness.

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• Outbreak of Norovirus Infection among River Rafters Associated with Packaged Delicatessen Meat, Grand Canyon, 2005.

  Authors: Mark Malek, Ezra Barzilay, Adam Kramer, Brendan Camp, Lee-Ann Jaykus, Blanca Escudero-Abarca, Greg Derrick, Patricia White, Charles Gerba, Charles Higgins, Jan Vinje, Roger Glass, Michael Lynch, Marc-Alain Widdowson

  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 12/2008;

  Background. @nbsp; Norovirus is often transmitted by infected food handlers at the point of service, whereas reports of food contamination before wholesale distribution are rare. In September 2005,Background. @nbsp; Norovirus is often transmitted by infected food handlers at the point of service, whereas reports of food contamination before wholesale distribution are rare. In September 2005, we investigated reports of gastroenteritis among rafters who went on unrelated trips on the Colorado River. Methods. @nbsp; We surveyed all companies that launched rafting trips during the period from 14 August through 19 September 2005 to identify trips in which >/=3 rafters became ill. We conducted a case-control study. Case patients were persons who experienced diarrhea or vomiting that commenced </=72 h after the trip launch; control subjects were persons who did not become ill </=72 h after launch. We tested stool samples and food specimens for norovirus. We performed a traceback investigation of the suspected food vehicle and inspected the implicated processing plant. Results. @nbsp; Three or more rafters developed gastroenteritis during 13 (14%) of 91 trips, for a total of 137 ill persons. Of the 57 case patients who became ill </=72 h after trip launch, 55 (96%) reported eating delicatessen meat, compared with 75 (79%) of 95 control subjects (odds ratio, 7.3; 95% confidence interval, 1.7-66.7). All delicatessen meat eaten by case patients came from 1 batch purchased from 1 processing plant and had been sliced, vacuum-packed, and frozen (temperature, -23 degrees C) for 7-28 days. An employee sliced this batch with bare hands 1 day after recovery from gastroenteritis. Identical norovirus sequences were identified in stool specimens obtained from rafters on 3 different trips; 2 of 5 meat packages also tested positive for norovirus by reverse-transcriptase polymerase chain reaction and DNA hybridization. Conclusions. @nbsp; Food handlers can contaminate ready-to-eat meats with norovirus during processing. Meat-processing practices should include specific measures to prevent contamination with enteric viruses and subsequent widespread outbreaks.