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Rotavirus mortality in India: estimates based on a nationally representative survey of diarrhoeal deaths

2012; World Health Organization; Volume: 90; Issue: 10 Linguagem: Inglês

10.2471/blt.12.101873

1564-0604

Shaun K. Morris, Shally Awasthi, Ajay Khera, Diego G. Bassani, Gagandeep Kang, Umesh D. Parashar, Rajesh Kumar, Anita Shet, Roger I. Glass, Prabhat Jha,

Viral Infections and Immunology Research

MethodsWe ascertained the number of deaths from diarrhoea among children during 2001-2003 on the basis of findings from the Million Death Study. 2,12,13The Million Death Study is an ongoing project conducted with the Registrar General of India and collaborators to determine causes of death in India.The study derives its data from a nationally representative sample of 6.3 million people in 1.1 million households within the Sample Registration System, a large, routine demographic survey performed by the Registrar General of India in all 28 Indian states and seven union territories that has been the primary system for the collection of Indian fertility and mortality data since 1971.Sample units are randomly selected to ensure that they are representative of the population at the state level.Enrolment in the system is voluntary and its confidentiality and consent procedures are defined as part of the Registration of Births and Deaths Act of 1969.Additional details about the Sample Registration System are available elsewhere. 12Objective To estimate the number of rotavirus-associated deaths among Indian children younger than five years.Methods We surveyed more than 23 000 child deaths from a nationally representative survey of 1.1 million Indian households during 2001-2003.Diarrhoeal deaths were characterized by region, age and sex and were combined with the proportion of deaths attributable to rotavirus, as determined by hospital microbiologic data collected by the Indian Rotavirus Strain Surveillance Network from December 2005 to November 2007.Rotavirus vaccine efficacy data from clinical trials in developing countries were used to estimate the number of deaths preventable by a national vaccination programme.Data were analysed using Stata SE version 10. Findings Rotavirus caused an estimated 113 000 deaths (99% confidence interval, CI: 86 000-155 000); 50% (54 700) and 75% (85 400) occurred before one and two years of age, respectively.One child in 242 died from rotavirus infection before five years of age.Rotavirusassociated mortality rates overall, among girls and among boys were 4.14 (99% CI: 3.14-5.68),4.89 (99% CI: 3.75-6.79)and 3.45 (99% CI: 2.58-4.66)deaths per 1000 live births, respectively.Rates were highest in Bihar, Uttar Pradesh and Madhya Pradesh, which together accounted for > 50% of deaths (64 400) nationally.Rotavirus vaccine could prevent 41 000-48 000 deaths among children aged 3-59 months.Conclusion The burden of rotavirus-associated mortality is high among Indian children, highlighting the potential benefits of rotavirus vaccination.