Prevalence of rotavirus-induced diarrhea among children under 5 years in Ilorin, Nigeria

Diarrhoea disease is an important cause of morbidity and mortality in Nigerian children and rotavirus has been identified as an important causative agent among children below 5 years. We determined the prevalence of rotavirus-induced diarrhoea among under-5 s by electrophenotyping. Stool samples were collected from eligible subjects who presented with acute diarrhoea. The samples were processed for viral studies by electrophenotyping. Among the 299 subjects recruited, 55.9% were positive for rotavirus. Eighty percent of the recruited patients were below 24 months. There was a significant decrease (p-value = 0.00001) in the prevalence of rotavirus among diarrhoea patients above the age of 24 months when compared with those below this age group. Rotavirus was associated with higher morbidity and mortality. We conclude that rotavirus is the most important cause of diarrhoea among children <5 years in Ilorin, Nigeria and its prevalence is highest in the first 2 years of life. Adequate rehydration should be regarded as the mainstay of management.     

Rotavirus gastroenteritis in Finland: burden of disease and epidemiological features

The burden of disease attributable to childhood rotavirus infection in Finland was assessed from data on hospital admissions for acute gastroenteritis and from reported virological diagnoses of rotavirus from 1985 to 1995. The mean number of hospitalizations (3584 annually in children under 5 y of age) corresponded to approximately 5.6% of the birth cohort. Rotavirus was estimated to be responsible for 54% of cases; accordingly, 3% of all children in Finland are hospitalized for rotavirus diarrhoea. The monthly distribution of hospitalizations for acute diarrhoea showed a similar pattern as monthly diagnoses of rotavirus, with a long epidemic period starting as early as November or December and lasting until June or even July. The prevalent rotavirus G-type throughout the study period was G1, which was detected in over 60% of the cases; however, in the season 1988-89 G4 was the prominent type. Improved case management has led to a shorter duration of hospital stay (3.3 d in 1985 vs. 2.3 d in 1995), but otherwise these was no significant trend for rotavirus gastroenteritis over the years. These findings underscore the need to control rotavirus gastroenteritis with a specific intervention, notably rotavirus vaccination.     

Rotavirus gastroenteritis in Finland: burden of disease and epidemiological features

The burden of disease attributable to childhood rotavirus infection in Finland was assessed from data on hospital admissions for acute gastroenteritis and from reported virological diagnoses of rotavirus from 1985 to 1995. The mean number of hospitalizations (3584 annually in children under 5 y of age) corresponded to approximately 5.6% of the birth cohort. Rotavirus was estimated to be responsible for 54% of cases; accordingly, 3% of all children in Finland are hospitalized for rotavirus diarrhoea. The monthly distribution of hospitalizations for acute diarrhoea showed a similar pattern as monthly diagnoses of rotavirus, with a long epidemic period starting as early as November or December and lasting until June or even July. The prevalent rotavirus G-type throughout the study period was G1, which was detected in over 60% of the cases; however, in the season 1988-89 G4 was the prominent type. Improved case management has led to a shorter duration of hospital stay (3.3 d in 1985 vs. 2.3 d in 1995), but otherwise these was no significant trend for rotavirus gastroenteritis over the years. These findings underscore the need to control rotavirus gastroenteritis with a specific intervention, notably rotavirus vaccination.     

Occurrennce and impact of community-acquired and nosocomial rotavirus infections — a hospital-based study over 10 y

The need for a rotavirus vaccine in any particular country depends primarily on the number of hospitalized cases. Since only limited data are available for Germany, we undertook a retrospective hospital-based analysis in order to gather further information. From 1987 through 1996, a total of 3618 inpatients were hospitalized with a diagnosis of gastroenteritis (ICD 9). In 892 (25%) of them the causative organism wasa rotavirus. During the same period, 1886 (out of 8383; 22%) stool speciment tested in the hospital laboratory were obtained from rotavirus-positive inpatients. In 49.2% the infection was community-acquired, and in the remainder of nosocomial origin. Infants under 4 months of age(n=709; 38%) predominated among both the nosocomial and community-acquired infections. Premature neonates made up 26% of the nosocomial, but only 2% of the community-acquired cases of diarrhoea. The winter peak (January) was most pronounced in the age group 4-12 months, but in those more than 1 y old the peak came a month later. The median hospitalization time for community-acquired cases was 4 d (mean 5.9 d).The mortality was 0.1%. Rotavirus infection must therefore be regarded as a considerable burden, particularly with regard to infants and young children. Furthermore, the morbidity due to nosocomial infection with the rotavirus, analysed here in a long-term observational study, is unexpectedly high. □ Hospital-based study, nosocomial infection, rotavirus     

Occurrence and impact of community-acquired and nosocomial rotavirus infections--a hospital-based study over 10 y

The need for a rotavirus vaccine in any particular country depends primarily on the number of hospitalized cases. Since only limited data are available for Germany, we undertook a retrospective hospital-based analysis in order to gather further information. From 1987 through 1996, a total of 3618 inpatients were hospitalized with a diagnosis of gastroenteritis (ICD 9). In 892 (25%) of them the causative organism was a rotavirus. During the same period, 1886 (out of 8383; 22%) stool specimens tested in the hospital laboratory were obtained from rotavirus-positive inpatients. In 49.2% the infection was community-acquired, and in the remainder of nosocomial origin. Infants under 4 months of age (n = 709: 38%) predominated among both the nosocomial and community-acquired infections. Premature neonates made up 26% of the nosocomial, but only 2% of the community-acquired cases of diarrhoea. The winter peak (January) was most pronounced in the age group 4-12 months, but in those more than 1 y old the peak came a month later. The median hospitalization time for community-acquired cases was 4 d (mean 5.9 d). The mortality was 0.1%. Rotavirus infection must therefore be regarded as a considerable burden, particularly with regard to infants and young children. Furthermore, the morbidity due to nosocomial infection with the rotavirus, analysed here in a long-term observational study, is unexpectedly high.     

An estimate of the proportion of diarrhoeal disease episodes seen by general practitioners attributable to rotavirus in children under 5 y of age in England and Wales

Mean weekly incidence rates for a 4-week period of new episodes of infectious intestinal disease (IID) and laboratory reports of faecal isolations in children under 5 y of age presenting in general practice were used to estimate the incidence of IID due to rotavirus infection in England and Wales. Between January 1992 and December 1996, a total of 92452 new episodes of IID were seen at sentinel general practices and reported to the Royal College of General Practitioners (RCGP) Research Unit in Birmingham, UK. Of these 32% (29592) were in children under 5 y of age. During the same period the Communicable Disease Surveillance Centre (CDSC) in London, UK received 159532 reports of faecal identifications in children under 5 y of age; 69219 (43%) of these were due to rotavirus. By modelling RCGP data and laboratory reports, the proportion of episodes attributable to rotavirus infection was estimated to be 29% (95% CI: 24% to 34%). By extrapolation of RCGP data it was estimated that rotavirus accounted for 762000 of new episodes of IID nationally in children under 5 y of age between January 1992 and December 1996. Implementation of a rotavirus vaccination programme could substantially reduce the incidence of childhood diarrhoea.     

Rotavirus infection among children with diarrhoea in Italy

Despite the absence of a nationwide surveillance system for rotavirus infection, relevant information concerning the epidemiology of this pathogen in Italy can be obtained from hospitalbased studies carried out since the early 1980s on patients with acute diarrhoea. A review of morethan 50 papers and congress proceedings published in both international and national literature indicates that rotavirus is the most important cause of diarrhoea in Italy among young children requiring hospitalization, with a prevalence ranging from approximately 20% to 40% in different studies. Infection is predominant among children aged 6-24 months, although cases are also common in younger children and in children 2-3y of age. Despite differences among studies in geographical area, years and age group under investigation, an increase in rotavirus cases is consistently reported in the winter months, with a peak in February through April. Although a few studies have been conducted in non-hospitalized patients, rotavirus infection is significantly less frequent among outpatients with enteritis than among inpatients. Most circulating rotavirus strainstyped from 1981 to 1992 belong to serotype 1 and, to a lesser extent, 4. However, untypable rotavirus strains have been found in these years, with prevalences up to 27%, suggesting a possible spread of non-serotype 1 through 4 strains. □ Diagnosis, diarrhoea, epidemiology, rotavirus, serotype     

Diarrhoea-related morbidity and rotavirus infection in France

To assess the importance of diarrhoea in France and, specifically, rotavirus-related diarrhoea among children, we reviewed data obtained from three complementary sources: (1) general practitioner (GP) sentinel surveillance; (2) hospital discharge data from paediatric hospitals; and (3) laboratory based surveillance. The GP sentinel network is based on 500 physicians who electronically notify new cases of eight illnesses, including diarrhoea, each week. It was estimated that about 3.3 million patients seek medical attention for diarrhoea from their GP each year, with a winter outbreak associated with an increased rate of isolation of rotavirus. A national system of hospital discharge diagnosis was used to estimate the burden of diarrhoeal morbidity in two paediatric wards in Tours, France. Between 1994 and 1996, 1164 patients under 15 y of age (9.7% of all admissions) were admitted for diarrhoea, of whom 83% were reported as having viral gastroenteritis; 14.3% were dehydrated and 52% were under 1y old. Hospital admissions had a seasonal pattern similar to notifications from sentinel GP for children under 5 y old. A centralized laboratory surveillance network representing 17 of the 22 French regions describes a rotavirus outbreak each winter that is concomitant of outbreaks detected by the GP sentinel network and seen in hospitals. Most of the isolates (98%) identified through this surveillance system are among children under 5y of age. All the data reviewed in this study indicate that the epidemiology of rotavirus diarrhoea in France fits well with what has been reported in other developed countries.     

An estimate of the proportion of diarrhoeal disease episodes seen by general practitioners attributable to rotavirus in children under 5 y of age in England and Wales

Mean weekly incidence rates for a 4-week period of new episodes of infectious intestinal disease (IID) and laboratory reports of faecal isolations in children under 5 y of age presenting in general practice were used to estimate the incidence of IID due to rotavirus infection in England and Wales. Between January 1992 and December 1996, a total of 92452 new episodes of IID were seen at sentinel general practices and reported to the Royal College of General Practitioners (RCGP) Research Unit in Birmingham, UK. Of these 32% (29592) were in children under 5 y of age. During the same period the Communicable Disease Surveillance Centre (CDSC) in London, UK received 159532 reports of faecal identifications in children under 5 yof age; 69219 (43%) of these wer due to rotavirus. By modelling RCGP data and laboratory reports, the proportion of episodes attributable to rotavirus infection was estimated to be 29% (95% CI: 24% to 34%). By extrapolation of RCGP data it was estimated that rotavirus accounted for 762000 of new episodes of IID nationally in children under 5 y of age between January 1992 and December 1996. Implementation of a rotavjrus vaccinatio programme could substantially reduce the incidence of childhood diarrhoea. □ General practice, rotavirus     

Diarrhoea-related morbidity and rotavirus infection in France

To assess the importance of diarrhoea in France and, speecifically, rotavirus-related diarrhoea among children, we reviewed data obtained from three complementary sources; (1) general practitioner (GP) sentinel surveillance; (2) hospital discharge data from paediatric hospitals; and (3) laboratory based surveillance. The GP sentinel network is based on 500 physicians who electronically notify new cases of eight illnesses, including diarrhoea, each week. It was estimated that abour 3.3 million patients seek medical attention for diarrhoea from their GP each year, with a winter outbreak associated with an increased rate of isolation of rotavirus. A national system of hospital discharge diagnosis was used to estimate the burden of diarrhoeal morbidity in two paediatric wards in Tours, France. Between 1994 and 1996, 1164 patients under 15 y of age (9.7% of all admissions) were dehydrated and 52% were under 1 y old. Hospital admissions had a seasonal pattern similar to notifications from sentinel GP for children under 5 y old. A centralized laboratory surveillance network representing 17 of the 22 French regions describes a rotavirus outbreak each winter that is concomitant of outbreaks detected by the GP sentinel network and seen in hospitals. Most of the isolates (98%) identified through this surveillance system are among children under 5 y of age. All the data reviewed in this study indicate that the epidemiology of rotavirus diarrhoea in France fits well with what has been reported in other developed countries. □ Diarrhoea, general practice, hospitalization, rotavirus     

Rotavirus as an important cause of diarrhoea in a hospital for children in Dammam, Saudi Arabia

A major cause of morbidity and mortality among children in developing countries is acute diarrhoea and rotavirus, a reovirus-like agent, is found to be a leading causative agent. We report here the incidence of rotavirus infection among infants and young children with gastro-enteritis treated at the Children's Hospital in Dammam, Kingdom of Saudi Arabia. One hundred and fifty children, aged between 1 and 60 months, suffering from diarrhoeal illness, were selected as the study cohort; another 150 hospitalized children of the same age group, but not suffering from diarrhoea, served as controls. Sixty-two per cent of the study children complained of watery diarrhoea and 39% of vomiting; all had mild to moderate dehydration. Seventy-two per cent had fever and 30% associated respiratory illness. Worst affected were those 7-12 months old, among whom rotavirus was detected by ELISA techniques in 39.6%, compared with 7.5% of the control children of comparable age group. We could not detect any rotavirus from control children aged over 36 months, whereas approximately 15% of the study children in this age group yielded rotavirus from the stool. The second most common pathogen isolated was Shigella ssp. It was isolated from 18.7% of children under study as against 3% of the controls.     

Epidemiology and impact of rotavirus diarrhoea in Poland

Hospital and laboratory data were analysed in three hospitals to estimate rotavirus disease burden in 1994-96. Community acquired gastroenteritis was diagnosed in 757 children of whom 41% tested positive for rotavirus. A total of 196 children had rotavirus nosocomial infections (39% of all rotavirus community-acquired and nosocomial cases) Infants less than 24 months old and children less than 3 months old comprised 74% and 11.9% of admissions for rotavirus, respectively. Almost 94% of children with rotavirus infection had severe gastroenteritis (score 11). The annual rate of rotavirus associated hospitalization in Poland in 1996 was 3.1/1000 children under the age of 60 months and 5.2/1000 infants under 24 months of age. The mean hospital stay was 9.5 d (±9.8 d). We estimated that 8918 children under 60 months of age were hospitalized for rotavirus gastroenteritis in 1996; they accounted for 84899 inpatient days. We conclude that rotavirus is a leading aetiological agent of severe gastroenteritis in young children in Poland and that the Burden of this infection is significant. Rotavirus vaccine could significantly decrease the hospitalization rate and the financial impact of rotavirus Gastroenteritis in Poland. □ Acute diarrhoea, disease burden, epidemiology, gastroenteritis, rotavirus     

Rotavirus in Ireland: national estimates of disease burden, 1997 to 1998

BACKGROUND: We estimated the disease burden caused by rotavirus hospitalizations in the Republic of Ireland by using national data on the number of hospitalizations for diarrhea in children and laboratory surveillance of confirmed rotavirus detections. METHODS: We examined trends in diarrheal hospitalizations among children <5 years old as coded by ICD-9-CM for the period January, 1997, to December, 1998. We collated data on laboratory-confirmed rotavirus detections nationally for the same period among children <2 years old. We calculated the overall contribution of rotavirus to laboratory-confirmed intestinal disease in children <5 years old from INFOSCAN, a disease bulletin for one-third of the population. We compared data from all sources and estimated the proportion of diarrheal hospitalizations that are likely the result of rotavirus in children <5 years old. RESULTS: In children <5 years old, 9% of all hospitalizations are for diarrheal illness. In this age group 1 in 8 are hospitalized for a diarrheal illness, and 1 in 17 are hospitalized for rotavirus by 5 years of age. In hospitalized children <2 years old, 1 in 38 have a laboratory confirmed rotavirus infection. CONCLUSIONS: The disease burden of rotavirus hospitalizations is higher than in other industrialized countries. Access to comprehensive national databases may have contributed to the high hospitalization rates, as well as a greater tendency to hospitalize children with diarrhea in Ireland.     

Epidemiology of rotavirus infections in The Netherlands

This paper reviews published and unpublished data from epidemiological and virological studies or rotavirus in the Netherlands to identify gaps in our knowledg; it includes analysis of surveillance data for seasonality and age groups at risk. Rotavirus was found in approximately 5% of stool specimens from people consulting a physician for gastroenteritis, Of these cases, 38% were under 5y of age. A clear seasonality was observed, with a peak in rotavirus activity in winter and early spring, In one hospital-based study between 1976 and 1983 rotavirus was found in 30% of children under 3y of age hospitalized for gastroenteritis. In addition, nosocomial infections have been documented. Analysis of monthly data from laboratory surveillance from 1981 to 1996 showed that between 6 and 16% of stool samples tested positive for rotavirus, again with a clear seasonal distribution. A total of 98% of rotavirus strains that were typed were G-type 1-4, We conclude that more recent data about hospitalization rates are needed for a well-founded costbenefit analysis.     

Epidemiology of rotavirus infections in The Netherlands

This paper reviews published and unpublished data from epidemiological and virological studies of rotavirus in the Netherlands to identify gaps in our knowledge; it includes analysis of surveillance data for seasonality and age groups at risk. Rotavirus was found in approximately 5% of stool specimens from people consulting a physician for gastroenteritis. Of these cases, 38% were under 5 y of age. A clear seasonality was observed, with a peak in rotavirus activity in winter and early spring. In one hospital-based study between 1976 and 1983, rotavirus was found in 30% of children under 3 y of age hospitalized for gastroenteritis. In addition, nosocomial infections have been documented. Analysis of monthly data from laboratory surveillance from 1981 to 1996 showed that between 6 and 16% of stool samples tested positive for rotavirus, again with a clear seasonal distribution. A total of 98% of rotavirus strains that were typed were G-type 1-4. We conclude that more recent data about hospitalization rates are needed for a well-founded cost-benefit analysis.     

Burden of human rotavirus-associated hospitalizations in three geographic regions of Hungary

Data on hospital admissions and laboratory reports were used to estimate the number of hospitalizations of children aged 14 y or less in three geographic regions of Hungary due to group A rotavirus infection. Between January 1993 and December 1996, 9182 hospitalizations for gastroenteritis occurred, of which 1946 (21%) were associated with rotavirus infection. Most (90%) ofthe rotavirus detections were among children aged 4 y or less. By extrapolation, an estimated 5000 rotavirus-related hospitalizations (8.4/1000 children aged 4 y or less/y) occurred in Hungary during the study period. Marked seasonality of rotavirus infections was observed, with a peak of incidence from December to February. Rotaviruses with "long" RNA electropherotypes predominated each year, but in 1995/1996 20% of electropherotypes in the Budapest area were "short". Effective surveillance is required for all children hospitalized for diarrhoea as part of a rotavirus immunization program in Hungary. □ Age group, burden, electropherotypes, Hungaiy, region, rotavirus, season     

Burden of human rotavirus-associated hospitalizations in three geographic regions of Hungary

Data on hospital admissions and laboratory reports were used to estimate the number of hospitalizations of children aged 14 y or less in three geographic regions of Hungary due to group A rotavirus infection. Between January 1993 and December 1996, 9182 hospitalizations for gastroenteritis occurred, of which 1946 (21%) were associated with rotavirus infection. Most (90%) of the rotavirus detections were among children aged 4 y or less. By extrapolation, an estimated 5000 rotavirus-related hospitalizations (8.4/1000 children aged 4 y or less/y) occurred in Hungary during the study period. Marked seasonality of rotavirus infections was observed, with a peak of incidence from December to February. Rotaviruses with "long" RNA electropherotypes predominated each year, but in 1995/1996 20% of electropherotypes in the Budapest area were "short". Effective surveillance is required for all children hospitalized for diarrhoea as part of a rotavirus immunization program in Hungary.     

Incidence and estimates of the diease burden of rotavirus in Sweden

Laboratory and hospitalization data from two children's hospitals with large primary catchment areas and national laboratory and hospitalization data for children under 4 y of age with acute diarrhoea were compiled to estimate the number of hospitalizations and the cost burden associated with rotavirus diarrhoea in Sweden. According to our estimates 1500-1700 rotavirus-associated hospitalizations occur annually in Sweden in children under 4 y of age (3.7 hospitalizations/lOOO children/y). This number represents 2.3% of admissions for all diagnoses in children of this age group. The cost of these hospitalizations is 13.5–15 million Swedish crowns (US$1.8–2 million). Serotyping by PCR for two years revealed that serotype 1 (GI) was the most common (49% and 58%, respectively) identified. Serotypes 2-4 were identified in the following proportions G2 (23% and 5%), G3 (21% and 0%) and G4 (7% and 16%). The national laboratory report data for 1993-96 show that as much as 7-13% of rotavirus infections occur in elderly people. □G-typing, incidence, rotavirus     

Rotavirus hospitalisation in New Zealand children under 3 years of age

OBJECTIVE: To describe the epidemiology of severe rotavirus gastroenteritis and to estimate the hospitalisation rates of this illness in New Zealand children under 3 years of age. METHODS: Children under 3 years of age with acute diarrhoea admitted to 1 of 8 study hospitals between 1 May 1998 and 30 April 2000 were surveyed. Their socio-demographic, treatment and length-of-stay data were recorded and stool samples tested by a rotavirus-specific enzyme-linked immunoassay. National hospital discharge data for infectious diarrhoea (International Classification of Diseases, ninth revision, 003-009) were reviewed, allowing population-based estimates for rotavirus-related hospitalisation in New Zealand. RESULTS: Of 2019 enrolled children, 1138 (56.4%) provided stools for testing, and of these 485 (42.6%) tested rotavirus positive. Rotavirus detection varied significantly by age (26.8% for 0 to 5 months, 42.5% for 6 to 11 months and 52.1% for children aged 12 to 35 months; P < 0.001), and by season (51.2% in winter/spring vs. 24.5% in summer/autumn; P < 0.001). While those infected with rotavirus were more likely to be dehydrated (50.6% vs. 37.4%; P < 0.001), their median hospital stay was similar (1.0 vs. 2.0 days; P = 0.09) to other children with acute gastroenteritis. The estimated national hospitalisation rate for rotavirus diarrhoea in children under 3 years, standardised for age and season, was 634 (95% CI 597, 672) per 100,000. In New Zealand, rotaviruses result in 1 in 52 children being hospitalised by 3 years of age. CONCLUSIONS: Rotavirus diarrhoea is an important, potentially vaccine-preventable cause of hospitalisation in New Zealand children, especially during winter and spring seasons.