Five-year cohort study on the burden of hospitalisation for acute diarrhoeal disease in African HIV-infected and HIV-uninfected children: potential benefits of rotavirus vaccine

Abstract

Introduction: Diarrhoea remains an important cause of death in children under five years of age, including in areas with high prevalence of HIV infection. Rotavirus contributes significantly to childhood diarrhoea in South Africa but data on the burden of rotavirus disease in HIV-infected children are limited.

Methods: This secondary data analysis, involving a cohort of 39,879 children enrolled into a pneumococcal conjugate vaccine efficacy trial, evaluated the incidence of hospitalisation for acute gastroenteritis in HIV-infected and HIV-uninfected children under five years of age from Soweto, South Africa. The data were used to evaluate the potential burden of hospitalisation that would be preventable with rotavirus vaccine.

Results: Acute gastroenteritis (AGE) was identified as a leading cause of hospitalisation in the cohort and was associated with 21% of all hospitalisations. Twenty-six percent of the AGE hospitalisations occurred in HIV-infected children. The incidence of AGE was greatest in the under-6 months age group and 90% of cases occurred within the first two years of life. The overall incidence of AGE was 5.4 fold (CI(95%) 4.9, 6.0) higher in HIV-infected compared to HIV-uninfected children. In addition, the estimates of rotavirus incidence were 2.3 fold (CI(95%) 1.8, 2.9) higher in HIV-infected compared to HIV-uninfected children. HIV-infected children were 1.8 fold (CI(95%) 1.4, 2.4) more likely to have prolonged hospitalisation and the case fatality rate was 4.0 (CI(95%) 2.0, 7.8) fold higher in HIV-infected compared to HIV-uninfected children.

Conclusion: Despite rotavirus reportedly being less frequently identified in hospitalised HIV-infected children, the absolute burden of rotavirus-associated hospitalisation is likely to be greater compared to HIV-uninfected children. The introduction of rotavirus vaccine into the national immunisation program in South Africa is likely to benefit HIV-infected and HIV-uninfected children and reduce the overall burden of AGE hospitalisation in our childhood population.