Enteric Pathogens in children under five with diarrhoea in a rotavirus vaccinated population in Coastal Ghana, 2023

BACKGROUND: Despite the introduction and wide coverage of vaccination regimes such as rotavirus vaccination globally, diarrhoea remains as a major public health problem with new studies showing an emerging pattern in its etiology. We assessed the etiology of diarrhoea in a population of children under five years appropriately vaccinated against rotavirus. METHODS: We conducted a cross-sectional study of children under five years reporting with diarrhoea at the district health facility in the Anloga district, Ghana. Stool samples of diarrhoea cases were tested for pathogens and co-infections using standard ELISA methods and TAQMAN Array Card RT-PCR Technology. The Vesikari Clinical Severity Scoring System was used to classify diarrhoea severity. Data generated was described descriptively. RESULTS: Median age was 21.5 (IQR:12,30)months, 55.3%(21/38) with being male. About half of the cases were moderate diarrhoea severity (20/38). The Rotavirus A prevalence was 2.5%. The pathogen with the highest prevalence was Enteroaggregative Escherichia coli (EAEC) (52.6%, 20/38), Shigella/ Enteroinvasive Escherichia coli (Shigella/EIEC (76.3%, 29/38), Norovirus (26.3%, 10/38) and Giardia was the main parasite identified. The rate of co-infection was high (94.7%, 36/38). Co-infections with bacteria-virus present had more moderate-severe diarrhoea cases (73.3%, 11/15). Norovirus was present in most of the severe cases (75%, 3/4). CONCLUSION: The leading diarrhoea pathogens found were EAEC, Shigella/EIEC and Norovirus. The rate of pathogen co-infection was very high with bacteria-virus related co-infections affecting diarrhoea severity. The study recommends periodic diarrhoea pathogen surveillance through Ghana Health Service collaborating with research institutions such as Noguchi Memorial Institute for Medical Research (NMIMR). Also, enhancing water, sanitation and hygiene practices at the district, community and individual levels as a means of diarrhoea prevention in the absence of additional vaccines for other diarrhoea pathogens.