Key result
Infants from Vellore experienced a peak rotavirus incidence of 1.05 infections per child-year in the first 6 months of life, earlier than those from Karonga who peaked at 1.41 in the second 6 months.
Cohort (n=439)
Yes
Absolute Event Rate: 1.05% vs 0.34%
Infants in an urban Indian setting experience peak rotavirus incidence earlier in life (first 6 months) compared to a rural Malawian setting (second 6 months), which may inform optimal timing for rotavirus vaccination.
Setting-specific rotavirus peaks may inform vaccination timing; leaves open whether prospective trials will support schedule adjustments.
Accurate estimates of rotavirus incidence in infants are crucial given disparities in rotavirus vaccine effectiveness from low-income settings. Sero-surveys are a pragmatic means of estimating incidence however serological data is prone to misclassification. This study used mixture models to estimate incidence of rotavirus infection from anti-rotavirus immunoglobulin A (IgA) titres in infants from Vellore, India, and Karonga, Malawi. IgA titres were measured using serum samples collected at 6 month intervals for 36 months from 373 infants from Vellore and 12 months from 66 infants from Karonga. Mixture models (two component Gaussian mixture distributions) were fit to the difference in titres between time points to estimate risk of sero-positivity and derive incidence estimates. A peak incidence of 1.05(95% confidence interval [CI]: 0.64, 1.64) infections per child-year was observed in the first 6 months of life in Vellore. This declined incrementally with each subsequent time interval. Contrastingly in Karonga incidence was greatest in the second 6 months of life (1.41 infections per child year [95% CI: 0.79, 2.29]). This study demonstrates that infants from Vellore experience peak rotavirus incidence earlier than those from Karonga. Identifying such differences in transmission patterns is important in informing vaccine strategy, particularly where vaccine effectiveness is modest.
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Bennett et al. (2017) conducted a cohort in Rotavirus infection (n=439). Vellore cohort (India) vs. Karonga cohort (Malawi) was evaluated on Incidence of rotavirus infection in the first 6 months of life (episodes per child-year) (95% CI 0.64-1.64). Infants from Vellore experienced a peak rotavirus incidence of 1.05 infections per child-year in the first 6 months of life, earlier than those from Karonga who peaked at 1.41 in the second 6 months.