Report & Analysis Summary | Infectious Disease & Vaccines
Summary of Long-term Trends in Enteric Virus Prevalence Among Young Children in South Africa (2009–2023)
Time to read: 04:52
Time to listen: 08:52
Originally Published: 25 October 2024
Type of article: Summary of Report
MedED Catalogue Reference: MNCS004
Category: Infectious Diseases, Vaccines & Antimicrobials
Cross-reference: Vaccines, Paediatrics & Neonatology
Keywords: enterovirus, rotavirus, adenovirus,vaccines, diarrhoeal disease, NCID
Originally Published in Public Health Bulletin, a National Institute for Communicable Diseases publication. This is a summary of the original report and in no way represents the original research. Links to all original material can be found at the end of this summary.
Key Take Aways
1. Enteric viruses, such as rotavirus, adenovirus, and norovirus, remain a major cause of diarrhoea and childhood mortality in South Africa
2. The rotavirus vaccine has significantly reduced rotavirus prevalence and related deaths, highlighting the need for continued vaccination efforts and enhanced public health interventions.
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Overview | Report Purpose | Methods | Findings | High-level Recommednations | Conclusion Original Research |
Overview
Globally, these viruses account for approximately 1.5 million deaths each year in children under five, underscoring their profound impact on child health. According to the report, enteric diseases in South Africa are a major cause of diarrhoea, leading to an estimated 15% of all childhood deaths in this age group. Notable viruses include rotavirus, adenovirus, and norovirus, which are easily transmissible through contaminated food, water, and close contact, resulting in widespread outbreaks, particularly in communities with inadequate access to clean water and sanitation.
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Report Purpose
This report examines the long-term trends in enteric virus prevalence among children under five seeking treatment for diarrhoea at selected sentinel sites in South Africa between 2009 and 2023.
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Method
This 15-year surveillance study examined the prevalence of enteric viruses in children under five years old across various sentinel sites in South Africa, with a particular focus on the impact of the rotavirus (RV) vaccine introduced in 2009.
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Findings
Between 2009 and 2023, a total of 11,250 cases were enrolled, with 10,567 involving children under the age of five. Of these, 97% were registered at hospital sites.
General Occurrence
The enteric virus activity peaked between April and August, coinciding with South Africa’s cooler months.
Virus Prevalence
Rotavirus was identified in 30% of stool samples collected, predominantly affecting children under five years old.
Adenovirus was found in 15% of cases, also primarily impacting younger children, while norovirus was detected in 10% of samples
Adenovirus prevalence increased significantly, rising from 20% in 2009 to 25% in 2022, with adenovirus type R accounting for 42% of the adenoviral strains.
Regarding other viral pathogens, norovirus GII accounted for an overall prevalence of 11%.
Vaccination Uptake and Impact
The impact of the RV vaccination campaign was evident, as no rotavirus was found in samples from children who died between 2018 and 2021, and only two deaths related to RV infection were recorded in 2022.
The median age of infection for rotavirus cases was 8 months (interquartile range [IQR] 5–13 months), and the detection rate was higher in hospitals compared to clinics (26% vs. 20%). The baseline prevalence of rotavirus was 62% in 2009, while it currently stands at 22%.
In terms of clinical outcomes, the study recorded a mortality rate of 2% over the study period (170 out of 9,085 cases). Of these, rotavirus accounted for 18% of the deaths (30 out of 170).
The report also assessed the impact of COVID-19, finding that the prevalence of rotavirus dropped to 7% in 2020, while vaccination coverage declined to between 70% and 89% for a single dose (80–94% in 2019 vs. 70–89% in 2020 and 69–84% in 2021).
High-level Recommendations
Based on the findings, the researchers made several recommendations including the following:
Ongoing monitoring and surveillance
It is imperative to continue and strengthen surveillance systems for enteric viruses, particularly in vulnerable populations such as children under five years old. Ongoing monitoring will facilitate early detection of outbreaks and timely public health responses.
Implement targeted vaccination programs.
Given the high prevalence of rotavirus and adenovirus in young children, targeted vaccination programmes should be promoted. To improve vaccination rates, the use of the paediatric rotavirus (RV) vaccine should be strongly encouraged among parents and healthcare workers. Administration is recommended at 6 and 14 weeks through the Expanded Programme on Immunisation (EPI) at both public and private clinics.
Improved public health education
Education initiatives aimed at parents and caregivers should be implemented to increase awareness of the symptoms of enteric infections, the importance of hygiene, and safe food and water practices, particularly in communities at higher risk, alongside improvements in access to clean water and adequate sanitation facilities, especially in underserved areas. This will help reduce the transmission of enteric viruses and enhance overall community health.
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Conclusion
In conclusion, the findings from the report confirm that enteric viruses pose a significant health threat to young children in South Africa. Ongoing surveillance and targeted public health initiatives are essential to mitigate the impact of these infections, particularly in vulnerable populations. By implementing the recommended strategies, it may be possible to reduce the burden of enteric viruses and enhance child health outcomes across the country.
Access the original Report
Report Download: Page, N., Nadan, S., Johnstone, S., Kruger, T., Netshikweta, R., Strydom, N., Sekwadi, P., & Groome, M. (2024). Trends in enteric virus circulation in children under 5 years of age at selected sentinel sites in South Africa from 2009 to 2023. Public Health Bulletin. National Institute for Communicable Diseases.
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