Estimating global, regional and national rotavirus deaths in children aged <5 years: Current approaches, new analyses and proposed improvements

• Published in: PloS one 2017-09, Vol.12 (9), p.e0183392-e0183392
• Main Authors: Clark, Andrew, Black, Robert, Tate, Jacqueline, Roose, Anna, Kotloff, Karen, Lam, Diana, Blackwelder, William, Parashar, Umesh, Lanata, Claudio, Kang, Gagandeep, Troeger, Christopher, Platts-Mills, James, Mokdad, Ali, Sanderson, Colin, Lamberti, Laura, Levine, Myron, Santosham, Mathuram, Steele, Duncan
• Format: Article
• Language: English
• Subjects: Age Factors; Autopsies; Autopsy; Biology and life sciences; Child mortality; Child, Preschool; Children; Children & youth; Complications and side effects; Data points; Demographic aspects; Developing countries; Diarrhea; Diarrhea - mortality; Diarrhea - prevention & control; Diarrhea - virology; Disease control; Disease prevention; Epidemiology; Estimates; Fatalities; Gems; Global Health; Health surveillance; Hospitalization; Humans; Immunization; Infant; Infant, Newborn; LDCs; Medicine; Medicine and Health Sciences; Methods; Mortality; People and Places; Population Surveillance; Prognosis; Public health; Rotavirus; Rotavirus - classification; Rotavirus - immunology; Rotavirus infections; Rotavirus Infections - diagnosis; Rotavirus Infections - mortality; Rotavirus Infections - prevention & control; Rotavirus Infections - virology; Rotavirus Vaccines - immunology; Transparency; United Kingdom; United States; Viruses
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0183392

Rotavirus is a leading cause of diarrhoeal mortality in children but there is considerable disagreement about how many deaths occur each year. We compared CHERG, GBD and WHO/CDC estimates of age under 5 years (U5) rotavirus deaths at the global, regional and national level using a standard year (2013) and standard list of 186 countries. The global estimates were 157,398 (CHERG), 122,322 (GBD) and 215,757 (WHO/CDC). The three groups used different methods: (i) to select data points for rotavirus-positive proportions; (ii) to extrapolate data points to individual countries; (iii) to account for rotavirus vaccine coverage; (iv) to convert rotavirus-positive proportions to rotavirus attributable fractions; and (v) to calculate uncertainty ranges. We conducted new analyses to inform future estimates. We found that acute watery diarrhoea was associated with 87% (95% CI 83-90%) of U5 diarrhoea hospitalisations based on data from 84 hospital sites in 9 countries, and 65% (95% CI 57-74%) of U5 diarrhoea deaths based on verbal autopsy reports from 9 country sites. We reanalysed data from the Global Enteric Multicenter Study (GEMS) and found 44% (55% in Asia, and 32% in Africa) rotavirus-positivity among U5 acute watery diarrhoea hospitalisations, and 28% rotavirus-positivity among U5 acute watery diarrhoea deaths. 97% (95% CI 95-98%) of the U5 diarrhoea hospitalisations that tested positive for rotavirus were entirely attributable to rotavirus. For all clinical syndromes combined the rotavirus attributable fraction was 34% (95% CI 31-36%). This increased by a factor of 1.08 (95% CI 1.02-1.14) when the GEMS results were reanalysed using a more sensitive molecular test. We developed consensus on seven proposals for improving the quality and transparency of future rotavirus mortality estimates.