Nosocomial rotavirus gastroenteritis in a neonatal nursery.
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Rotavirus Infections
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Актуальність. В Україні щорічно реєструється більше 50 тисяч захворювань на гостру кишкову інфекцію (ГКІ) у дітей. Статистичні дані щодо ротавірусної інфекції не відповідають дійсності через низьку можливість лабораторної діагностики в лікувальних закладах. Мета дослідження: визначити рівень навантаження ротавірусної інфекції, провести аналіз і дати характеристику ротавірусної інфекції дітей віком до 5 років, яких госпіталізували в два інфекційні стаціонари (Київ, Одеса), за період спостереження 2006–2015 роки. Матеріал та методи. Дослідження проводилося за стандартним протоколом, затвердженим Всесвітньою організацією охорони здоров’я. Визначення тяжкості перебігу захворювання проводилося за допомогою бальної шкали оцінки тяжкості клінічних проявів ротавірусного гастроентериту Vesikari. Результати. За період з грудня 2006 по грудень 2015 року було взято під спостереження 20 932 дитини віком до 5 років, яких госпіталізували в інфекційні відділення м. Києва і м. Одеси з діагнозом «гострий гастроентерит/гостра кишкова інфекція» і які відповідали критеріям включення в дослідження. Обстежено на ротавірус 18 384 (87,33 %) дитини віком до 5 років, тобто переважна більшість дітей, які надходили в стаціонар з ГКІ. Протягом усіх років спостереження причиною майже половини госпіталізацій дітей до 5-річного віку була ротавірусна інфекція. Звернуло на себе увагу, що в окремі роки в Києві частота госпіталізацій через ротавірусну інфекцію збільшувалася, навіть до 70 %. В Україні серед 6 країн Європейського регіону, що входять до глобальної мережі епіднагляду за ротавірусною інфекцією (Global Rotavirus Surveillance Network), спостерігалася найвища частота ротавірусної діареї серед госпіталізованих дітей до 5 років. При середній частоті в регіоні 24 % в Україні вона досягала 41 %. У всі роки спостереження половина випадків ротавірусної інфекції, що була причиною госпіталізації, припадала на перші 2 роки життя. У всі роки в обох центрах визначалися переважно 4 генотипи ротавірусів: G1P[8], G2P[4], G3P[8], G4P[8]. Генотип G9P[8] займав досить значні позиції в Києві, але були роки, коли він зовсім не визначався як в Києві, так і в Одесі. Цей генотип ротавірусу описано в складі типових комбінацій G та Р ротавірусів, що уражають людину у близько 90 % усіх випадків ротавірусної інфекції на багатьох територіях земної кулі. Відмічалася зміна лідерства окремих генотипів описаних вище ротавірусів за роками. При ротавірусній інфекції вірогідно більшою є частота епізодів діареї та блювання, тривалість блювання у днях також є довшою, ніж при ротанегативних ГКІ. Явища дегідратації також були тяжчими у групі ротавіруспозитивних дітей. Висновки. Ротавірусна інфекція впродовж 10 років спостереження в Україні незмінно залишалася основною причиною госпіталізації дітей віком до 5 років з ГКІ. ГКІ ротавірусної етіології характеризуються значно більш тяжкими проявами, ніж ГКІ, при яких ротавірус було виключено. Суттєвих змін у генотипах за цей період не було, лише періодично спостерігалася зміна домінуючого штаму. Отримані дані обґрунтовують введення універсальної вакцинації проти ротавірусної інфекції в Україні.
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Universal rotavirus vaccination with RotaTeq was introduced in Israel in December 2010. We examined hospitalization rates of children under 5 years of age due to all-cause and rotavirus gastroenteritis, both before and 3 years after universal introduction of the vaccination. An ongoing hospital-based surveillance network that was established in November 2007, accessed information regarding hospitalization of children due to gastroenteritis (n = 6205) in 3 hospitals in northern Israel, with an annual average of about 60,000 children under 5 years of age living in the catchment area of these hospitals. Stool samples were tested for rotavirus by immunochromatography. Compared to the period preceding implementation of the universal rotavirus vaccination (2008–2010), hospitalizations due to rotavirus gastroenteritis in children <5 years of age decreased significantly, by 55% (95% CI 43%-67%) during the period of universal vaccination (2011–2013), a decrease that was sustained throughout the 3 year period. This reduction was greater in children aged 0–23 months (60–61%) than in toddlers aged 24–59 months (36%). A 32% (95% CI 21%-45%) decrease in the incidence of all-cause gastroenteritis was also observed. During the period preceding universal vaccination, rotavirus diarrhea showed typical winter seasonality, with highest incidence in December. However, the winter peak was substantially blunted during the period of universal immunization. Surveillance of rotavirus gastroenteritis should continue to assess the long-term impact of such a program. Our findings are of relevance to high and middle-income countries considering the introduction of a universal rotavirus immunization program.
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SUMMARY Rotavirus infections are the main cause of gastroenteritis in infants and children and it is expected that by the age of 5 years, nearly every child will have experienced at least one episode of rotavirus gastroenteritis. While severe cases are hospitalized, milder disease is either treated at home or by the GP, and as such the true prevalence of rotavirus infection in the community, and the burden of disease, is unknown. This paper reports the results of a cost-of-illness study which was conducted alongside a structured community surveillance study. Forty-eight percent of our sample was found to have rotavirus acute gastroenteritis; and the average total cost of a child presenting with rotavirus gastroenteritis ranged between £59 and £143 per episode, depending on the perspective. Given the prevalence and severity of the disease, the estimated burden of rotavirus gastroenteritis to society is £11.5 million per year.
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Rotavirus is the most common cause of severe gastroenteritis in children worldwide. This retrospective, cross-sectional study was undertaken in a sentinel hospital that provides the only pediatric beds for the local population with an average of 4,400 children aged <5 years and determined the incidence of rotavirus hospitalizations. Medical charts that recorded acute gastroenteritis cases occurring in children aged <5 years living in the cites of Yuri-Honjo or Nikaho, Akita, Japan between 2001 and 2011 were retrieved and examined to enumerate rotavirus antigen-positive hospitalizations. Of the 1,596 acute gastroenteritis cases retrieved, antigen detection was performed in 834 cases, and 387 were positive; hence, the crude annual incidence rate of rotavirus hospitalizations was 8.8 per 1,000 person-years. The adjusted annual incidence rate of rotavirus hospitalizations was 13.7 per 1,000 person-years when untested samples collected during the peak season were extrapolated to the same rotavirus detection proportion as the tested samples (58.9%). We confirmed a high incidence of rotavirus hospitalizations in Akita Prefecture and revealed a considerable degree of annual fluctuation in the rotavirus hospitalization rates, which exceeded the degree of stochastic fluctuation. Thus, caution must be exercised when interpreting the impact of a rotavirus vaccine on the reduction of the number of rotavirus hospitalizations.
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During a one year period, 2.179 stool specimen coming from 1.608 children attending our Hospital, were reviewed. These children were both with or without gastrointestinal symptomatology. Rotavirus determination by an ELISA method and routine stool culture were performed to every specimen. Rotavirus incident in the symptomatic group is 27,61%, meanwhile bacterial pathogens represent a 27,29%. It is studied the seasonal variation of virus emission and its distribution depending on children age. According to those appreciations, we think that the method applied in our study is important in order to determine the causal agent of many infantile gastroenteritis.
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• The incidence of rotavirus gastroenteritis in infants and children that required admission to the hospital was estimated for a defined population of approximately 105,000 individuals, including 29,000 children aged 15 years or younger whose primary health care was provided by Group Health Association, Inc, a health maintenance organization in the Washington, DC, area. From January 1977 through March 1979, almost all infants and children in this age group who required hospitalization for gastroenteritis were studied for evidence of infection with human rotavirus (HRV) and other agents. On the average, one in 272 (3.7/1,000) infants less than 12 months old and one in 451 (2.2/1,000) children aged 13 through 24 months were hospitalized for HRV disease each winter. The incidence of rotavirus gastroenteritis requiring hospitalization declined precipitously in children after the second birthday and such illness was not detected in children aged 5 years or older. The role of other agents in acute gastroenteritis requiring hospitalization was minimal, compared with that of rotavirus. (Am J Dis Child134:777-779, 1980)
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Rotavirus is a major cause of infantile gastroenteritis worldwide and remains a common cause of hospitalizations in developed countries. The study aimed to assess the hospitalizations due to rotavirus gastroenteritis in Israel and their characteristics.A retrospective review of the records of children < 18 years hospitalized in six medical centers in Israel between April 2004 and March 2006 with acute gastroenteritis (AGE) and stool positive for rotavirus. Children with nosocomial infections, immune deficiency or under immunosuppressive therapy were excluded.During the study period, 1912 children were hospitalized with AGE due to rotavirus, of whom 1719 were included in this study. The peak rate of admission due to rotavirus was in November and December, when 34% of the admissions for AGE were caused by rotavirus, and the lowest rate was in August (7%, p < 0.0001). Annually, rotavirus caused 18.4% and 2.8% of the hospitalization for AGE and of all pediatric hospitalizations, respectively. The mean age on admission was 14 months (median 12 months) and the mean hospitalization--3.9 days. According to the annual pediatric statistics in Israel for 2004, the estimated annual rotavirus-associated hospitalization in Israel is 3816, with 14,692 hospitalization days.Rotavirus gastroenteritis is an important cause for hospitalizations and complications in children < 5 years in Israel, stressing the need for safe and efficacious vaccines to reduce the burden of the infection.
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Objective of this study was to provide data on hospitalizations for rotavirus gastroenteritis (RVGE) in Ferrara, Italy. The study was conducted analyzing the hospital discharge forms of all children admitted to the Pediatric Department of the University of Ferrara, Arcispedale Sant'Anna, from January 2001 through December 2005. The database was searched for all gastrointestinal diseases and in particular RVGE. During the period under study 3277 children, of which 2038 <60 months of age, were hospitalized; 247 children < 5 years old were admitted for acute gastroenteritis and 89 (4.4% of all and 36% of gastroenteritis-related hospitalizations) had rapid screening tests positive for rotavirus. A seasonal pattern was observed for RVGE with an increase in winter and early spring. The average length of hospital stay was 5.7 days. The median cost of each hospitalized case of RVGE ranged between 1417 and 1595 Euros. The present research confirms that rotavirus gastroenteritis represents an important cause of hospitalization in children and is responsible for significant costs for the Public Health Care System. An effective vaccination program could significantly reduce the incidence of hospitalization and the associated costs.
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Background: Few prospective cohort studies have estimated the overall impact of severe rotavirus gastroenteritis (RVGE) leading to hospitalization on families and society. We assessed human and economic resources needed to care for an affected average child aged <5 years in Sweden.Methods: The study was conducted in Astrid Lindgren Children's Hospital which serves approximately 14% of all Swedish children <5 years of age. All children admitted with acute gastroenteritis in the study period were tested for rotavirus. Health care consumption was collected prospectively and publically available unit costs used to calculate direct costs. Non-medical and indirect costs were collected in interviews with families using a standardized questionnaire during the hospital stay and approximately 14 days post-discharge.Results: 144/206 children (70%) with laboratory-confirmed RVGE were included. The median age was 14 months. The average total cost per hospitalized child was €3894, of which €2169 (56%) was due to direct healthcare-related costs (including Emergency Department visits and in-patient care), €104 (2%) to non-medical direct costs and €1621 (42%) to indirect costs due to productivity loss. Carers of children with severe RVGE were absent from work on average five days per study child: four days during hospitalization of affected child and one day due to gastroenteritis in the carer.Conclusions: Costs for RVGE are dominated by direct costs which are similar to some other countries in Europe, but indirect costs due to productivity loss are also important, and should be considered in decisions to introduce rotavirus vaccines into national vaccination programmes.
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