Rotavirus is a major cause of death and complications in infants, especially in sub-Saharan Africa. In this randomized clinical trial in Niger, a low-cost, heat-stable rotavirus vaccine was shown to ...have nearly 70% efficacy against severe rotavirus gastroenteritis.
Rotavirus is a leading cause of severe gastroenteritis among young children and is responsible for approximately 37% of deaths from diarrhea among children younger than 5 years of age worldwide.
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Two live, oral, attenuated rotavirus vaccines (Rotarix, GlaxoSmithKline, and RotaTeq, Merck) have met the prequalification requirements of the World Health Organization (WHO), stipulations that allow for purchase by United Nations agencies.
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The efficacy of these vaccines has been shown, with an important effect on hospital admissions and mortality.
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Sub-Saharan Africa has the highest rate of death associated with rotavirus disease,
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but vaccination on a large scale presents challenges. . . .
How can rotavirus gastroenteritis be prevented? Because rotavirus infects nearly all children in both industrialised and developing countries early in life, good hygiene and sanitation alone are ...considered inadequate for prevention. ...to sustain global implementation of vaccination, an adequate supply of affordable rotavirus vaccines must be assured. Areas for future research Exploring the role of rotavirus in extraintestinal clinical syndromes (such as neurologic manifestations, necrotizing enterocolitis) Investigating the value of clinical signs and symptoms in assessing dehydration, particularly in general practice Defining the optimal dose of oral rehydration solution for each grade of dehydration, so that consistent recommendations can be made Identifying treatments (including antiviral agents) with clinical efficacy against rotavirus gastroenteritis Community based action research and sociocultural research on knowledge, attitudes, perceptions, cultural practices, and health seeking behaviours with regard to rotavirus infection Understanding the benefit-risk profile of routine rotavirus vaccination in a diverse range of geographic and socioeconomic settings Investigating the effectiveness and impact of rotavirus vaccination in low income settings Identifying interventions (such as additional vaccine doses or alternate schedules, supplementation with micronutrients) or alternative approaches (such as parenteral vaccines) that might improve the performance of rotavirus vaccines in low income settings Additional educational resources Resources for healthcare professionals Centers for Disease Control and Prevention. CD008521 (subscription required) PATH ( http://sites.path.org/rotavirusvaccine/rotavirus-advocacy-and-communications-toolkit/ )-Free rotavirus disease and vaccine resources PATH ( http://sites.path.org/rotavirusvaccine/current-issue-of-rotaflash-jpg/ )-Breaking news and updates on rotavirus vaccines Resources for patients and parents Centers for Disease Control and Prevention at ( www.cdc.gov/rotavirus/index.html )-Basic information on the symptoms, treatment, and prevention of rotavirus gastroenteritis Tips for non-specialists All children are infected with rotavirus in the first 3-5 years of life, regardless of hygiene and sanitation conditions Vaccines are therefore the most effective way to prevent rotavirus diarrhea Treatment of rotavirus diarrhea relies on hydration therapy Rotavirus vaccines have performed well in countries where they are used routinely; in some settings, they have conferred additional benefits to unvaccinated children and adults through herd protection Although rotavirus vaccines work less well in developing countries, the potential to prevent severe disease and deaths is greater because of the high disease burden in these settings The documented health benefits of rotavirus vaccines far outweigh the small risk of intussusception that has been seen in some settings Contributors: UDP searched the literature and is guarantor.
Universal rotavirus (RV) vaccination is expected to reduce hospitalizations for acute gastroenteritis (GE) of children by eliminating most of severe RVGE, but it does not have any effect on norovirus ...(NV), the second most common causative agent of GE in children. After the introduction of the RV vaccine into the National Immunization Programme (NIP) of Finland in 2009, we conducted a prospective 2-year survey of GE in children seen in Tampere University Hospital either as outpatients or inpatients and compared the results with a similar 2-year survey conducted prior to NIP in the years 2006–2008. Compared with the pre-NIP 2-year period, in 2009–2011, hospitalizations for RVGE were reduced by 76 % and outpatient clinic visits were reduced by 81 %. NVGE showed a slight decreasing trend and accounted for 34 % of all cases of GE seen in hospital in pursuance of RVGE having decreased to 26 % (down from 52 %). In cases admitted to the hospital ward, RV accounted for 28 % and NV accounted for 37 %.The impact of RV vaccination was reflected as a 57 % decrease in all hospital admissions and 62 % decrease in all outpatient clinic visits for GE of any cause.
Conclusion
: RV vaccination in NIP has led to a major reduction of hospital admissions and clinic visits due to RVGE, but has had no effect on NVGE. After 2 years of NIP, NV has become the leading cause of acute GE in children seen in hospital.
We conducted a large surveillance study among members of an integrated healthcare delivery system in Pacific Northwest of the United States to estimate medical costs attributable to medically ...attended acute gastroenteritis (MAAGE) on the day care was sought and during 30-day follow-up. We used multivariable regression to compare costs of MAAGE and non-MAAGE cases matched on age, gender, and index time. Differences accounted for confounders, including race, ethnicity, and history of chronic underlying conditions. Analyses included 73,140 MAAGE episodes from adults and 18,617 from children who were Kaiser Permanente Northwest members during 2014-2016. Total costs were higher for MAAGE cases relative to non-MAAGE comparators as were costs on the day care was sought and costs during follow-up. Costs of MAAGE are substantial relative to the cost of usual-care medical services, and much of the burden accrues during short-term follow-up.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Implemented in 2009, the National Outbreak Reporting System provides surveillance for acute gastroenteritis outbreaks in the United States resulting from any transmission mode. Data from the first 2 ...years of surveillance highlight the predominant role of norovirus. The pathogen-specific transmission pathways and exposure settings identified can help inform prevention efforts.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Emerging evidence points to a strong association between the gut microbiota and the risk, development and progression of gastrointestinal cancers such as colorectal cancer (CRC) and hepatocellular ...carcinoma (HCC). Bile acids, produced in the liver, are metabolized by enzymes derived from intestinal bacteria and are critically important for maintaining a healthy gut microbiota, balanced lipid and carbohydrate metabolism, insulin sensitivity and innate immunity. Given the complexity of bile acid signalling and the direct biochemical interactions between the gut microbiota and the host, a systems biology perspective is required to understand the liver-bile acid-microbiota axis and its role in gastrointestinal carcinogenesis to reverse the microbiota-mediated alterations in bile acid metabolism that occur in disease states. An examination of recent research progress in this area is urgently needed. In this Review, we discuss the mechanistic links between bile acids and gastrointestinal carcinogenesis in CRC and HCC, which involve two major bile acid-sensing receptors, farnesoid X receptor (FXR) and G protein-coupled bile acid receptor 1 (TGR5). We also highlight the strategies and cutting-edge technologies to target gut-microbiota-dependent alterations in bile acid metabolism in the context of cancer therapy.
Severe diarrhea from rotavirus remains an important cause of illness in infants. In this trial, investigators in Indonesia assessed the potential benefit of a neonatal rotavirus vaccine.
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