By the age of five, nearly every child in the world has been infected at least once with Rotavirus, the leading single cause of severe diarrhoea among infants and young children. With each infection, immunity develops and subsequent infections are less severe. Adults are rarely affected.
Rotavirus falls into a category defined as Food-Borne Diseases (FBD), caused by consuming foods and beverages contaminated by disease-causing microbes, pathogens or even toxic chemicals and other harmful substances. The World Health Organization estimates that half a million children die from Rotavirus infection globally.
Rotavirus infects cells that line the small intestine and produces an enterotoxin, which induces gastroenteritis, leading to severe diarrhoea and sometimes death through dehydration.
In an attempt to prevent Rotavirus in the USA, a humanbovine rotavirus vaccine, RotaTeq, was recommended for routine use among infants from November 2007 to May 2008. The results indicated a delay in onset by 2-4 months, and there was a reduction in magnitude by >50%. Although hygiene and sanitation have improved generally worldwide, Rotavirus diarrhoea has not been significantly reduced and the vaccine may be the best way to protect infants.
However, for this vaccine to become available in Trinidad and Tobago, we must determine the prevalence of this virus in our communities as this is unknown. A study on the Burden of Illness (BOI ) is currently being done to help ascertain the levels. Data from this study will help the Ministry of Health to decide on whether this vaccine should be introduced to infants as part of their routine vaccines.
The Burden of Illness (BOI ) can be defined as the incidence and prevalence of morbidity, disability and mortality associated with acute and chronic manifestations of diseases (WHO, 2006). Simply put, this is the burden associated with having an illness.
This burden may be either direct or indirect costs. Direct costs include expenditures for hospital or other institutional care, drugs, physician care, or any additional irect health expenses.
Indirect costs would be the value of economic output lost because of the illness. These would include the value of time lost, activity days lost due to short-term morbidity costs, time lost from work (perhaps loss of a workday or two) and leisure activities by family members or friends who care for the patient.
The BOI related to FBDs and specific food-borne pathogens is currently unknown in the Caribbean. To determine its extent, a Caribbean Burden of Illness Study is being conducted in seven Caribbean countries to find the prevalence and estimate the burden of acute gastroenteritis (the key syndrome related to food and water-borne infections), undifferentiated fever and fever and respiratory illnesses and the priority pathogens commonly transmitted by food.
Data obtained from Trinidad and Tobago will be presented in the larger Caribbean study. These studies form part of a larger WHO initiative to understand the global burden of food-borne diseases. It supplements ongoing proposals implemented through CAREC, including: PAHO’s regional cooperation in Food Safety and Emerging Infectious Disease program and WHO/Global SalmSurv (GSS) activities in the Caribbean.
The study in Trinidad and Tobago is now in its second year. The population survey has been completed and data analysis is in its preliminary stage. The research also aims to estimate the cost associated with food-borne illness, its causes and related effects. A cursory look at the data has revealed that the estimated direct cost associated with having mild to severe forms of gastroenteritis in Trinidad and Tobago ranged from $12-$700, with an average of $105 per case of gastroenteritis. This figure does not take into account the indirect costs.
Currently there is consistent laboratory testing at the Trinidad Public Health Laboratory for the suspected range of pathogens. This testing is scheduled to end in December 2009.
However, the study has not been all smooth sailing since the Trinidad Public Health Laboratory has not been receiving sufficient diarrhoeal stool specimens to test for the range of pathogens, although numerous efforts have been made to encourage people to visit their nearest health centre or hospital if they have signs and symptoms of gastroenteritis.
Discussions with key health representatives indicate that one of the major reasons for the diminutive number of stool specimens submitted to the lab was because people are too embarrassed to submit samples. Physicians often do not request that patients submit samples to determine the cause of their conditions, instead they prescribe medication to treat short term problems, leaving underlying causes unknown.
The only way we can find out what bugs are present in the body is if a diarrhoeal stool specimen is submitted. The information can then be used to explore risk factors for infection, identify gaps in surveillance and provide the basis for guiding appropriate prevention and control measures for food-borne. The University of the West Indies seeks the cooperation of the public to achieve the objectives of the BOI study.
If you are experiencing signs and symptoms of gastroenteritis (nausea, vomiting, diarrhoea, abdominal pain), please visit the nearest doctor, public health centre and hospital and submit a diarrhoeal sample. Containers for the collection of samples can be obtained at health centres.
The BOI study consists of two core components
A population based component: The population-based component consists of a population survey based on self-reported cases of acute gastroenteritis, acute respiratory illness and undifferentiated fever. It was administered as a retrospective population based survey with data collection via standardized questionnaires administered by trained interviewers.
A laboratory based component: The laboratorybased component includes a baseline survey of the major public microbiology labs in Trinidad and Tobago to determine laboratory testing protocols and the proportion of specimens that are tested for specific food-borne pathogens. Laboratory testing for a wide range of food-borne pathogens will be done for one year at the Trinidad Public Health Laboratory.
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