Acute diarrhea remains one of the major public health issues in a number of developing countries. According to the World Health Organization (WHO), rotavirus contributes to around 40% of hospitalizations and the main cause of severe diarrhea in under five children worldwide 1.

It is associated with the death of more than 600,000 children under the age of 5 per year worldwide, the most affected of which are malnourished infants living in disadvantaged, low-income rural areas, where access to health care is poor 1234.

Since 2006, rotavirus vaccines have been recommended for all countries by the World Health Organization (WHO). In 2009, more than 100 countries, including six with a high burden of disease (Afghanistan, Angola, Ethiopia, India, Kenya and Pakistan) introduced a rotavirus vaccine into their vaccination program 567.

The Democratic Republic of Congo (DRC) introduced the Rotasiil vaccine into its immunization schedule in 2019 1213. But few studies have assessed the impact of vaccination on the prevalence of rotavirus and the clinical profile of diarrhea. Thus this study aimed to determine the prevalence of rotavirus among children with diarrhea and the description of the sociodemographic and clinical profile of children from 0 to 5 years old with diarrhea in 4 hospitals in the DRC.

It’s a documentary, retrospective and analytical study which took into account two periods, before and after introduction of the rotasiil vaccine, i.e. from January 2017 to December 2018 and from January 2020 to December 2021. It took place in 4 hospital structures, i.e. 2 in Kinshasa, the capital of the DRC and 2 in Lubumbashi, the 2nd largest province of the country. In addition, these health structures had received support in diagnostic tools as part of rotavirus surveillance. The data was collected exhaustively and consecutively on the basis of consultation registers, patient files and laboratory registers.

All records of infants and children under 5 years of age who presented with diarrhea lasting less than 1 week were included in the study. Two stool samples were taken 2 days apart in these children, in 2 jars, within 48 hours of their admission for a SANDWICH ELISA serological test. We’re not included all the children who had not carried out the serological test or those who did not have stool results available or those whose medical records were not found. Socio-epidemiological (age, sex, origin, month of consultation) and clinical (fever, vomiting, diarrhea with its frequency, appearance and duration) data were collected. Data were analyzed using SPSS 26.0 software. Quantitative variables were summarized by the median with their interquartile spaces, categorical ones were presented as relative frequencies/percentage and Pearson's chi-square test or Fisher's test was used for the comparison of proportions. The p˂0.05 value was considered statistically significant. The study had received the approval of the ethics committee of the school of public health under the number ESP/CE/36/2022. The confidentiality of our results was guaranteed.

A total of 924, or 49.4%, of children were enrolled before the introduction of the vaccine and 948, or 50.6% after the introduction of the vaccine, giving a total of 1,872 cases. Of this number, only 1737 had taken the serological test, of which 875 (50.4%) had a positive result for rotavirus and 862 (49.6%) had a negative result.

However, from these positive results before and after vaccination, there is a reduction of 30.6% since the introduction of the Rotasiil vaccine in the DRC.

Regarding children with diarrhea according to the sites, the provincial city of Kinshasa had registered 1,360 children, i.e. 72.6% and the city of Lubumbashi recorded 512 children, i.e. 24.6%.

The median age of the patients was 8 months (6 to 12 months of interquartile space). The predominant age range was 6 to 11 months. (Table 1)

The socio-demographic data were presented according to the periods of the study (Table 2).

The male sex was predominant with 1061 cases (56.7%) against 811 (43.3%) of female sex. The sex ratio was 1.3 in favor of boys.

The results showed a significant association with age and Kinshasa city, while gender had no significant statistical value.

In order to highlight the seasonality of the disease, the frequency of patients was presented monthly during the 2 periods of the study, namely, before and after vaccination. The figure 1 below shows the trend.

We note that before the introduction of the vaccine, the frequency generally decreased from January to December, while the opposite trend was observed after the introduction of the Rotasiil vaccine.

As for the clinical characteristics, in our series, diarrhea, vomiting and fever are the dominant symptoms in all children. Moderate to severe diarrhea being found in the majority of cases 88.5%, vomiting in 73.7% of cases and fever in 73.9% of cases.

The association between clinical characteristics and vaccination is presented in Table 3.

Note that children before vaccination were 11 times more likely to have diarrhea than after the vaccine. And the risk of having diarrhea between 3-10 times was 3 times, even 9-10 times greater before than after the introduction of the vaccine.

The risk of having an episode of vomiting was 9 times greater before vaccination than after. And the risk of fever was twice as great before the introduction of the vaccine as after it. The risk of having a positive result was twice as great before the introduction of the vaccine as after. (Table 3).

Acute diarrhea remains one of the major public health issues in a number of developing countries. According to the World Health Organization (WHO), rotavirus contributes to around 40% of hospitalizations and the main cause of severe diarrhea in under five children worldwide. The objective was to determine the prevalence of rotavirus and the sociodemographic and clinical profile among children with diarrhea in 4 hospitals in the DRC. To achieve this, we conducted the study of certain socio-demographic parameters and prevalence.

The Democratic Republic of Congo, like many other countries on the continent, have introduced the vaccine against Rotavirus (Rotasiil) into their vaccination schedule. At the end of this study, we noted a reduction in frequency due to diarrhea unlike previous years, this is probably attributable to the presence of the vaccine and the age group under 12 months pays the greatest burden. of this pathology.

The authors declare that they have no competing financial interests or known personal relationships which might appear to influence the work reported in this article.

1. Freddy Mboko Byamungu : design, writing of the work and data collection,

2. LoukiaPaizanosAketi: supervision and writing of the work,

3. Joseph Diayisu Shiku: work supervision,

4. Dr Joëlle Nzuzi Bemba: support for data collection,

5. Dr Rosette KevaaniLepira: support for data collection,

6. Dr Irène Kifutu Matula: support for data collection,

7. Éric TshitonaKaluli: support for data collection.

We also appreciate the contribution of all the sentinel teams (nurses, laboratories and data managers) who not only allow the implementation of these surveillance activities in the field which have made the data available to us.

We would also like to thank the INRB team who contributed to making the database available to us, but also the families of the children for their passage through the care structures contributed to obtaining this data.