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Title: Acute gastroenteritis associated with enterotoxigenic Escherichia coli and norovirus in children in Malawi
Author: Trainor, Eamonn
ISNI:       0000 0004 7964 166X
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2018
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Introduction and Methods: Enterotoxigenic Escherichia coli (ETEC) are an important cause of diarrhoeal disease among children in low-income countries. The burden of ETEC infection has not been previously described in children in Malawi. Archived faecal samples collected from hospitalised children < 5 years of age with diarrhoea in Blantyre, Malawi over a 10-year period (1997-2007); and a comparison group without diarrhoea over a 2-year period (1997-1999) prior to rotavirus vaccine introduction were examined by conventional PCR for ETEC heat-labile (LT) and heat-stable (STh and STp) enterotoxins. As well as ETEC, noroviruses are endemic in human populations and recognised as a leading cause of acute gastroenteritis worldwide, with GII.4 norovirus strains most frequently identified. The molecular epidemiology of GII.4 norovirus strains among sporadic or community cases of gastroenteritis is poorly described, especially in resource poor settings. Current surveillance programmes are biased towards strains identified from outbreaks in high-income settings. Norovirus strains detected during studies of sporadic diarrhoeal disease in the UK and Malawi between 1993 and 2009 were characterised to better understand the distribution of GII.4 norovirus strains in the wider population. Results and Conclusions: ETEC was detected in 10.6% of children with and 7.3% of children without diarrhoea. The most prevalent circulating toxin types were STh (6.6%), followed by LT (2.1%) and STp (0.9%). ETEC infection was most prevalent in infants aged 6-11 months and co-infection with rotavirus was common. The burden of ETEC infection in young children in Malawi is significant and following the introduction of rotavirus vaccine should become a focus of diarrhoea prevention efforts. GII.4 norovirus strains of global epidemic importance have circulated in the community up to 18-years prior to their subsequent recognition as pandemic strains associated with increases in outbreaks. More inclusive surveillance programmes that comprise strains associated with sporadic cases may allow for earlier detection of emerging strains with pandemic potential and inform vaccine formulations as they become available.
Supervisor: Cunliffe, Nigel ; Iturriza-Gomara, Miren Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral