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dc.contributor.authorClark, Andrew, B.A., M.A.
dc.contributor.authorBlack, Robert E.
dc.contributor.authorTate, Jacqueline
dc.identifier.citationClark, A., Black, R., Tate, J., Roose, A., Kotloff, K., Lam, D., et al. (2017) Estimating global, regional and national rotavirus deaths in children aged <5 years: Current approaches, new analyses and proposed improvements. PLoS ONE 12(9): e0183392. DOI:
dc.descriptionAdditional authors: Roose, Anna; Kotloff, Karen; Lam, Diana; Blackwelder, William; Parashar, Umesh; Lanata, Claudio; Kang, Gagandeep; Troeger, Christopher; Platts-Mills, James; Mokdad, Ali; Global Rotavirus Surveillance Network; Sanderson, Colin; Lamberti, Laura; Levine, Myron; Santosham, Mathuram; Steele, Duncanen_US
dc.description.abstractBackground: Rotavirus is a leading cause of diarrhoeal mortality in children but there is considerable disagreement about how many deaths occur each year. Methods and findings: 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. Conclusions: We developed consensus on seven proposals for improving the quality and transparency of future rotavirus mortality estimates.en_US
dc.description.sponsorshipThe Bill and Melinda Gates Foundation— (Investment Code OPP1147721)en_US
dc.subject.meshChild, Preschoolen_US
dc.subject.meshDeveloping Countriesen_US
dc.subject.meshInfant, Newbornen_US
dc.subject.meshPublic Health Surveillanceen_US
dc.subject.meshRotavirus Infections--mortalityen_US
dc.subject.meshStatistics as Topicen_US
dc.titleEstimating global, regional and national rotavirus deaths in children aged <5 years: Current approaches, new analyses and proposed improvementsen_US

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