Despite rotavirus vaccination, diarrhea remains a leading cause of child mortality. We collected stool specimens from 684 children <5 years of age hospitalized with diarrhea (cases) and 527 asymptomatic community controls for 4 years after rotavirus vaccine introduction in Malawi. Specimens were tested for 29 pathogens, using polymerase chain reaction analysis. Three or more pathogens were detected in 71% of cases and 48% of controls. Pathogens significantly associated with diarrhea included rotavirus (in 34.7% of cases and 1.5% of controls), enteric adenovirus (in 29.1% and 2.7%, respectively), Cryptosporidium (in 27.8% and 8.2%, respectively), heat-stable enterotoxin-producing Escherichia coli (in 21.2% and 8.5%, respectively), typical enteropathogenic E. coli (in 18.0% and 8.3%, respectively), and Shigella/enteroinvasive E. coli (in 15.8% and 5.7%, respectively). Additional interventions are required to prevent diarrhea due to rotavirus and other common causal pathogens.
Iturriza-Gómara, M., Jere, K. C., Hungerford, D., Bar-Zeev, N., Shioda, K., Kanjerwa, O., … Cunliffe, N. A. (2019). Etiology of Diarrhea among Hospitalized Children in Blantyre, Malawi, following Rotavirus Vaccine Introduction: A Case-Control Study. Journal of Infectious Diseases, 220(2), 213–218. https://doi.org/10.1093/infdis/jiz084