(P24-071-24) Predictors of Rotavirus and Viral Diarrhea Etiology in Young Children: A Secondary Cross-Sectional Analysis of the ABCD Trial

Objectives: To identify clinical and host predictors of rotaviral and viral etiology among children with acute non bloody diarrhea who are dehydrated, moderately undernourished, and/or severely stunted in low and middle income settings.

Methods: Analysis of baseline data from the ABCD trial. ABCD was a multicountry, double blinded, randomized, placebo controlled clinical trial that assessed whether a 3 day treatment with azithromycin would reduce all cause mortality among 2-23 months old children presenting with acute non bloody diarrhea who were dehydrated and/or moderately undernourished, excluding those severely acutely malnourished. A stool sample was collected prior to antibiotic treatment from a subsample, to detect selected enteropathogens with PCR. We used log-binomial regression models to determine associations between predictors and the likelihood of the detection of rotavirus or other viral pathogens. The models were adjusted for potential confounders like site of enrollment, age, risk defining criteria, diarrhea duration, frequency of loose stools and low birth weight.

Results: Of the 8,268 children, 6,697 had a fecal sample analyzed by qPCR. In multivariable models, the association between rotavirus vaccination and prevalence of rotavirus diarrhea etiology at presentation was not statistically significant (PR 0.71; 95% CI:0.49, 1.03). Children with moderate acute malnutrition (MAM) and dehydration had higher prevalence of viral pathogen detection than those with severe stunting only (PR 1.46; 95% CI:1.12, 1.90). Further, children aged 6 - < 12 months (PR 1.43; 95% CI:1.24, 1.64) and those 12 - < 18 months (PR 1.42; 95% CI:1.23, 1.65) had a higher prevalence of viral detection than children aged 2- < 6 months. Children presenting after prolonged diarrhea had a lower likelihood of viral pathogen detection than those presenting with shorter duration8 (PR 0.3; 95% CI: 0.18-0.77) for rotavirus, (PR 0.69; 95% CI:0.50,0.96) for any virus.

Conclusions: Among 2-23-month old children presenting at health facilities with diarrhea and mortality risk, those with MAM and dehydration, those 6-18 months of age, and those with short symptom duration have the highest likelihood of viral diarrhea.

Funding Sources: Main trial was funded by Bill & Melinda Gates Foundation.