{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T02:55:18Z","timestamp":1790218518231,"version":"4.1.0"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","license":[{"start":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T00:00:00Z","timestamp":1681862400000},"content-version":"vor","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["OPP1111236"],"award-info":[{"award-number":["OPP1111236"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["OPP1116751"],"award-info":[{"award-number":["OPP1116751"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,19]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>While rotavirus causes severe diarrheal disease in children aged &amp;lt;5 years, data on other viral causes in sub-Saharan Africa are limited.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In the Vaccine Impact on Diarrhea in Africa study (2015\u20132018), we analyzed stool from children aged 0\u201359 months with moderate-to-severe diarrhea (MSD) and without diarrhea (controls) in Kenya, Mali, and The Gambia using quantitative polymerase chain reaction. We derived the attributable fraction (AFe) based on the association between MSD and the pathogen, accounting for other pathogens, site, and age. A pathogen was attributable if the AFe was \u22650.5.<\/jats:p><jats:p>The severity of attributable MSD was defined by a modified Vesikari score (mVS). Monthly cases were plotted against temperature and rainfall to assess seasonality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 4840 MSD cases, proportions attributed to rotavirus, adenovirus 40\/41, astrovirus, and sapovirus were 12.6%, 2.7%, 2.9%, and 1.9%, respectively. Attributable rotavirus, adenovirus 40\/41, and astrovirus MSD cases occurred at all sites, with mVS of 11, 10, and 7, respectively. MSD cases attributable to sapovirus occurred in Kenya, with mVS of 9. Astrovirus and adenovirus 40\/41 peaked during the rainy season in The Gambia, while rotavirus peaked during the dry season in Mali and The Gambia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In sub-Saharan Africa, rotavirus was the most common cause of MSD; adenovirus 40\/41, astrovirus, and sapovirus contributed to a lesser extent among children aged &amp;lt;5 years. Rotavirus- and adenovirus 40\/41-attributable MSD were most severe. Seasonality varied by pathogen and location. Efforts to increase the coverage of rotavirus vaccines and to improve prevention and treatment for childhood diarrhea should continue.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cid\/ciad060","type":"journal-article","created":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T13:58:06Z","timestamp":1681912686000},"page":"S123-S131","source":"Crossref","is-referenced-by-count":22,"title":["Prevalence, Clinical Severity, and Seasonality of Adenovirus 40\/41, Astrovirus, Sapovirus, and Rotavirus Among Young Children With Moderate-to-Severe Diarrhea: Results From the Vaccine Impact on Diarrhea in Africa (VIDA) Study"],"prefix":"10.1093","volume":"76","author":[{"given":"Adama Mamby","family":"Keita","sequence":"first","affiliation":[{"name":"Centre pour le D\u00e9veloppement des Vaccins du Mali (CVD-Mali) , Bamako , Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanogo","family":"Doh","sequence":"additional","affiliation":[{"name":"Centre pour le D\u00e9veloppement des 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Hossain","sequence":"additional","affiliation":[{"name":"Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine , Banjul , The Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Billy","family":"Ogwel","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR) , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John B","family":"Ochieng","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR) , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joquina Chiquita M","family":"Jones","sequence":"additional","affiliation":[{"name":"Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine , Banjul , The Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed M A","family":"Zaman","sequence":"additional","affiliation":[{"name":"Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine , Banjul , The Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex O","family":"Awuor","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR) , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Juma","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR) , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilruba","family":"Nasrin","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland , USA"},{"name":"Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia , Charlottesville, Virginia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Awa","family":"Traor\u00e9","sequence":"additional","affiliation":[{"name":"Centre pour le D\u00e9veloppement des Vaccins du Mali (CVD-Mali) , Bamako , Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uma","family":"Onwuchekwa","sequence":"additional","affiliation":[{"name":"Centre pour le D\u00e9veloppement des Vaccins du Mali (CVD-Mali) , Bamako , Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Badji","sequence":"additional","affiliation":[{"name":"Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine , Banjul , The Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Golam","family":"Sarwar","sequence":"additional","affiliation":[{"name":"Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine , Banjul , The Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Antonio","sequence":"additional","affiliation":[{"name":"Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine , Banjul , The Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric R","family":"Houpt","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia , Charlottesville, Virginia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon M","family":"Tennant","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland , USA"},{"name":"Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene N","family":"Kasumba","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland , USA"},{"name":"Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie P","family":"Jamka","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland , USA"},{"name":"Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland , 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E","family":"Tate","sequence":"additional","affiliation":[{"name":"Division of Viral Diseases, US Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umesh D","family":"Parashar","sequence":"additional","affiliation":[{"name":"Division of Viral Diseases, US Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen M","family":"Neuzil","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland , USA"},{"name":"Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen L","family":"Kotloff","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of 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