Evaluation of Rotavirus Surveillance System and Characterization of Rotavirus-associated Diarrheal Cases - Kenya, 2014–2018

  • Public health surveillance
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Background:
Rotavirus is a leading cause of severe diarrhea in children globally, it causes estimated 7% of mortality in children aged <5 years in Kenya. Kenya introduced Rotavirus vaccination in July 2014 and to date has four rotavirus sentinel sites. We sought to evaluate the surveillance system and describe reported cases.
Methods:
We reviewed rotavirus-associated diarrhea data in MS Access database. We defined a case as a record of any child aged <5 years hospitalized for acute diarrhoea at Kenyatta National Hospital from 2014–2018. We collected demographic characteristics, clinical information, ELISA test result, immunization status, vaccine doses received and calculated descriptive statistics using Epi-Info 7. We used CDC guidelines to evaluate the following system attributes; simplicity (ease of data flow), acceptability (willingness to allow specimen collection), timeliness (stool samples col- lected, reaching site laboratory within 2 days), flexibility (adaptation to change) and positive predictive value (PVP) based on ELISA Results:. Data completeness was assessed using quality audit tool.
Results:
We reviewed 989 records; 205/989 (21.0%) were positive for rotavirus, median age was 19 months (IQR: 16.0), males were 557/989 (56.4%), 811/989 (82.0%) had received rotavirus vaccination with only 568/989 (57.4%) receiving > 2 doses. Number of cases increased from January to March of each year and 110/989(11.1%) reported in March 2017. The system had three levels of reporting and clear data flow; 879/989 (88.9%) of samples were collected on time; the place variables were updated to reflect current devolved system. Completeness of immunization status variable was 56%, number of vaccine doses received was missing in 314/989 (31.8%) records. PVP was 20.7% (205/989).
Conclusion
The system was simple, flexible and acceptable but had low PVP. Incomplete reporting and timeliness was still a challenge. Surveillance system did not achieve herd immunity since vaccination coverage was below 95%. We recommend regular data quality assessment be conducted.

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