RESUMEN
BACKGROUND: Rotavirus is the leading cause of severe acute gastroenteritis (AGE) in children <5â¯years of age in Myanmar. The purpose of this analysis is to report from the sentinel surveillance system for rotavirus gastroenteritis (RVGE), which collects information on the epidemiology and circulating genotypes to assess the disease burden and support vaccine introduction in Myanmar. METHODS: Prospective, active surveillance for RVGE-associated hospitalizations was conducted during 2009 -2014 at Yangon Children's Hospital. Stool samples collected from children <5â¯years of age admitted for AGE were screened for rotavirus antigen by ELISA (ProSpecT™ Rotavirus, OXOID-UK). G and P genotyping was performed by reverse transcription polymerase chain reaction. RESULTS: Overall, 1860/3724 (49.9%) of stool samples tested positive for rotavirus, ranging from 42-56% of hospitalized AGE cases each year. RVGE was predominant in the 6-11â¯months age group 889/1860 (47.8%) as compared with 12-23â¯months 633/1860 (34.0%), 0-5 months 226/1860 (12.2 %) and 24-59â¯months 112/1860 (6.0%). RVGE occurred in a seasonal cycle with peak occurrence in the cold and dry months (November to February), accounting for 65.3% (1151/1763) among enrolled AGE cases. Vomiting (84.1% Vs 67.9%; Pâ¯<â¯.01), fever (84.5% Vs 75.6%; Pâ¯<â¯.01) and dehydration (78% Vs 69%; Pâ¯<â¯.01) were more frequently observed in RVGE than non-RVGE. Genotyping revealed that G1P[8] was predominant from January to June 2009, G12P[8] was predominant throughout 2009-2012 which was replaced in 2012-2013 by G2P[4] and changed again to G1P[8] in 2013-2014 and G9P[8] in late 2014. CONCLUSIONS: Rotavirus is accounting for approximately half of AGE-associated hospitalizations among children <5â¯years of age in Myanmar. There is immense diversity of rotavirus strains similar to that reported previously for other countries in the region. Information gained from this surveillance system highlights consideration of rotavirus vaccine introduction into this target population.
Asunto(s)
Diarrea/epidemiología , Hospitalización/estadística & datos numéricos , Infecciones por Rotavirus/epidemiología , Vigilancia de Guardia , Enfermedad Aguda , Antígenos Virales/genética , Preescolar , Diarrea/virología , Ensayo de Inmunoadsorción Enzimática , Heces/virología , Femenino , Fiebre , Gastroenteritis/epidemiología , Gastroenteritis/virología , Genotipo , Humanos , Lactante , Recién Nacido , Masculino , Estudios Prospectivos , Rotavirus/genética , Rotavirus/aislamiento & purificación , Infecciones por Rotavirus/diagnóstico , Vacunas contra Rotavirus/administración & dosificación , Estaciones del AñoRESUMEN
BACKGROUND: A third of all deaths in children aged <5 years occur in the neonatal period. Neonatal intensive care is often considered too complex and expensive to be implemented in resource poor settings. Consequently the reductions that have been made in infant mortality in the poorest countries have not been made in the neonatal period. This manuscript describes the activities surrounding the introduction of special care baby unit (SCBU) in a refugee setting and the resulting population impact. METHODS: A SCBU was developed in Maela refugee camp on the Thailand-Myanmar border. This unit comprised of a dedicated area, basic equipment, drugs and staff training. Training was built around neonatal guidelines, comprising six clinical steps: recognition, resuscitation, examination, supportive medical care, specialised medical care, and counselling of parents with sick newborns. RESULTS: From January 2008 until December 2011, 952 infants were admitted to SCBU. The main admission diagnoses were early onset neonatal sepsis, jaundice and prematurity. Early prematurity (<34 weeks) carried the highest risk of mortality (OR 9.5, 95% CI 5.4-16.5, p<0.001). There was a significant decrease in mortality from 19.3% (2008) to 4.8% (2011) among the infants admitted for prematurity (p=0.03). The neonatal mortality in Maela camp as a whole declined by 51% from 21.8 to 10.7 deaths per 1000 live births over the corresponding period (p=0.04). Staff expressed more confidence in their ability to take care of neonates and there was a more positive attitude towards premature infants. CONCLUSION: Neonatal mortality can be reduced in a resource poor setting by introduction of a simple low cost unit specialising in care of sick neonates and run by local health workers following adequate training. Training in recognition and provision of simple interventions at a high standard can increase staff confidence and reduce fatalistic attitudes towards premature neonates.