A prospective evaluation of community acquired gastroenteritis in paediatric practices: impact and disease burden of rotavirus infection.

AIMS: To examine the disease burden and epidemiology of community acquired rotavirus gastroenteritis in Austrian children treated in a paediatric practice. METHODS: A prospective, population based, multicentre study in four paediatric practices and two children's hospitals (Innsbruck and Leoben). Children 相似文献   

Economic impact of community- and nosocomially acquired rotavirus gastroenteritis in Austria

OBJECTIVE: To determine the average costs per child for rotavirus (RV) acute gastroenteritis from different perspectives, from the hospital's, third-party payer's, pediatrician's and family's perspectives as well as in summary from the societal one. MATERIALS AND METHODS: This cost-of-illness study is based on data collected alongside a 6-month prospective, laboratory-confirmed epidemiologic study that evaluated the disease burden of RV infection in Austrian children < or =48 months of age. The study population at risk to contract a community- and nosocomially acquired acute gastroenteritis comprised 9,687 children. All of the 51 children with community-acquired and 33 with nosocomially acquired RV acute gastroenteritis were included in this analysis. The annual costs were estimated by means of extrapolation. RESULTS: For community-acquired RV acute gastroenteritis, the average costs from the hospital's perspective were EURO (EUR) 97.8, from the third party payer's perspective 95.6 EUR, followed by 29.9 EUR and 9.8 EUR from the family's and pediatrician's perspectives, respectively. For nosocomially acquired RV acute gastroenteritis the average costs from the hospital's perspective were 1,494 EUR and from the third party payer's and family's perspectives 831 EUR and 116.8 EUR, respectively. In summary the average costs from the societal point of view for community-acquired RV acute gastroenteritis were 250 EUR and for nosocomial infections 2,442 EUR. After extrapolation the estimated total annual costs were 7.17 EUR million to 0.97 EUR million (13.6%) caused by community-acquired RV acute gastroenteritis and 6.2 EUR million (86.4%) caused by nosocomial RV acute gastroenteritis. CONCLUSION: This cost-of-illness study clearly demonstrates the great impact of RV acute gastroenteritis, mainly of nosocomially acquired infection, on medical health care costs in Austria. To cut costs efforts in disease prevention should be encouraged.     

The impact of childhood acute rotavirus gastroenteritis on the parents' quality of life: prospective observational study in European primary care medical practices

ABSTRACT: BACKGROUND: Rotavirus (RV) is the commonest cause of acute gastroenteritis in infants and young children worldwide. A Quality of Life study was conducted in primary care in three European countries as part of a larger epidemiological study (SPRIK) to investigate the impact of paediatric rotavirus gastroenteritis (RVGE) on affected children and their parents. METHODS: A self-administered questionnaire was linguistically validated in Spanish, Italian and Polish. The questionnaire was included in an observational multicentre prospective study of 302 children aged <5 years presenting to a general practitioner or paediatrician for RVGE at centres in Spain, Italy or Poland. RV infection was confirmed by polymerase chain reaction (PCR) testing (n = 264). The questionnaire was validated and used to assess the emotional impact of paediatric RVGE on the parents. RESULTS: Questionnaire responses showed that acute RVGE in a child adversely affects the parents' daily life as well as the child. Parents of children with RVGE experience worry, distress and impact on their daily activities. RVGE of greater clinical severity (assessed by the Vesikari scale) was associated with higher parental worries due to symptoms and greater changes in the child's behaviour, and a trend to higher impact on parents' daily activities and higher parental distress, together with a higher score on the symptom severity scale of the questionnaire. CONCLUSIONS: Parents of a child with acute RVGE presenting to primary care experience worry, distress and disruptions to daily life as a result of the child's illness. Prevention of this disease through prophylactic vaccination will improve the daily lives of parents and children.     

Unexpectedly high burden of rotavirus gastroenteritis in very young infants

Background  

The highest incidence of rotavirus gastroenteritis has generally been reported in children 6-24 months of age. Young infants are thought to be partially protected by maternal antibodies acquired transplacentally or via breast milk. The purpose of our study was to assess the age distribution of children with confirmed community-acquired rotavirus gastroenteritis presenting to an urban referral hospital.     

The epidemiology and disease burden of rotavirus infection in the Salento peninsula, Italy

The aim of this study was to delineate the epidemiology of rotavirus gastroenteritis in the Salento peninsula, Italy. The study lasted a year and included the gathering of data on hospitalizations for enteritis caused by rotaviruses in the pediatric wards of seven hospitals in the Province of Lecce. During 2004, 7,938 children were hospitalized; 973 of them had gastroenteric symptoms and 202 were positive for rotavirus. The percentage of admissions to hospital was high in autumn and at the beginning of spring. The highest incidence of the disease was observed in children aged between 1 and 2 years, especially males. The morbidity of diarrhea caused by rotavirus followed a seasonal pattern and a distribution in terms of age group and sex that were in line with what has been seen in other geographical areas. In conclusion, on the basis of the data gathered in this study, the cases of acute gastroenteritis seem to represent an important cause of hospitalization in the Salento peninsula.     

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.     

Prospective study of the burden of rotavirus gastroenteritis in Danish children and their families

This was the first study to characterize the total burden of rotavirus gastroenteritis (RVGE) at both hospital and general physician (GP) clinics in Denmark, and also the first to confirm rotavirus (RV) as the leading cause of acute gastroenteritis (GE) among children <5 years in GP clinics nationwide. Several aspects of RVGE were reported, including the impact of RVGE on family life by changes in HRQoL and by the number of days absent from day care. RV was detected in 225 (63.6%) children, and the median number of days absent from day care was 5 days. In 43.0% of the families, at least one family member, a total of 170 individuals, experienced symptoms of acute GE. Reduced health-related quality of life was observed both among children and parents. Our data suggested that RVGE indirectly as well as directly is a major public health burden in Denmark and comparable with data from other European countries.     

Intestinal and serum immune response to a naturally acquired rotavirus gastroenteritis in children

Seventeen children (mean age: 2.0 years, range: 36 days-8 years) hospitalized with acute gastroenteritis were investigated. Thirteen children had a rotavirus infection while four did not. Rotavirus serum IgA as well as ScIg, i.e., antirotavirus immunoglobulin containing secretory component, increased rapidly after rotavirus infection. While rotavirus IgA persisted in serum for at least 6 months, rotavirus ScIg disappeared from serum in less than 4 months. Rotavirus IgG could be detected in serum during the early stage of the infection and was still high after 6 months. The patients with nonrotavirus acute gastroenteritis did not show any of the above-mentioned serological hallmarks of those with rotavirus infection. The amounts of rotavirus ScIg found in serum about 1 week after the infection correlated to the amounts of rotavirus ScIg in duodenal fluid. Six months after the infection, rotavirus IgA was found in the feces of the majority of the patients while rotavirus ScIg could be detected only in one patient. The amounts of rotavirus IgA in sera and intestinal secretions showed identical patterns in the acute phase of the disease as well as after recovery. The same applied to rotavirus ScIg. These findings could be useful in future evaluations of vaccines and immunity against rotavirus infections.     

Estimates of economic burden of providing inpatient care in childhood rotavirus gastroenteritis from Malaysia

AIM: To estimate the cost of an episode of inpatient care and the economic burden of hospitalisation for childhood rotavirus gastroenteritis (GE) in Malaysia. METHODS: A 12-month prospective, hospital-based study on children less than 14 years of age with rotavirus GE, admitted to University of Malaya Medical Centre, Kuala Lumpur, was conducted in 2002. Data on human resource expenditure, costs of investigations, treatment and consumables were collected. Published estimates on rotavirus disease incidence in Malaysia were searched. Economic burden of hospital care for rotavirus GE in Malaysia was estimated by multiplying the cost of each episode of hospital admission for rotavirus GE with national rotavirus incidence in Malaysia. RESULTS: In 2002, the per capita health expenditure by Malaysian Government was US$71.47. Rotavirus was positive in 85 (22%) of the 393 patients with acute GE admitted during the study period. The median cost of providing inpatient care for an episode of rotavirus GE was US$211.91 (range US$68.50-880.60). The estimated average cases of children hospitalised for rotavirus GE in Malaysia (1999-2000) was 8571 annually. The financial burden of providing inpatient care for rotavirus GE in Malaysian children was estimated to be US$1.8 million (range US$0.6 million-7.5 million) annually. CONCLUSION: The cost of providing inpatient care for childhood rotavirus GE in Malaysia was estimated to be US$1.8 million annually. The financial burden of rotavirus disease would be higher if cost of outpatient visits, non-medical and societal costs are included.     

Impact of acute rotavirus gastroenteritis on pediatric outpatient practices in the United States

OBJECTIVES: The objectives of this study were to determine the presenting symptoms, healthcare utilization, and lost time from work and day care associated with acute rotavirus gastroenteritis. METHODS: During the winter to spring seasons of 2002-2003 or 2003-2004, children <36 months of age presenting with acute gastroenteritis to urban and suburban pediatric outpatient practices affiliated with 5 academic centers across the United States were enrolled in similarly designed studies. The case definition required >or=3 watery or looser-than-normal stools and/or forceful vomiting within a 24-hour period beginning 相似文献   

Epidemiologic patterns of diarrheal disease in Argentina: estimation of rotavirus disease burden

BACKGROUND: Information on the burden of diarrheal diseases and rotavirus diarrheal diseases would help define strategies for management and prevention and clarify the potential benefits of candidate vaccines. This report of our study of the epidemiology of rotavirus diseases in Argentina analyzes the burden of rotavirus diarrhea, based on those studies and national statistics of diarrhea-associated medical visits, hospital discharges and deaths. METHODS: Information of diarrhea-associated medical visits, hospital discharges and deaths were provided by the Argentine Health Ministry. Estimation of rotavirus disease burden was performed using the percentage of rotavirus identification from previous reports.RESULTS: The incidence of diarrhea-associated medical visits (1999) was 14 times greater for ages 0 to 4 years than for ages of > or =5 years. Diarrhea-associated hospital discharges (0 to 4 years of age) decreased between 1981 and 1995 from 1.3 per 100 to 0.9 per 100 person-years) and diarrheal deaths (<2 years of age) decreased by a factor of 4 between 1985 and 1999 (64.7 per 100 000 to 16.1 per 100 000 person-years). Frequency of diarrheal deaths, hospital discharges and medical visits were highest in some of the northern Argentine provinces (26.2, 14.7 and 5.9 times greater, respectively, than in the lower risk areas of the country). We estimated that 1 in 2 children born in 1995 visited a public hospital, 1 in 12 required hospitalization, 1 in 1599 died of diarrheal diseases before their fifth year of life; 1 in 6, 1 in 35 and 1 in 4169 of those, respectively, died as a result of rotavirus diarrhea before their third year of life. CONCLUSIONS: The number of preventable diarrhea-associated and rotavirus-associated hospitalizations and deaths in Argentina is significant. The lack of rotavirus diagnostic capability in Argentine hospitals has resulted in underestimation of the disease burden of this virus. A rotavirus vaccine would have the potential to avoid thousands of hospitalizations and dozens of deaths, especially in the poor high risk Argentine provinces.     

Prospective study of nosocomial rotavirus infection in a paediatric hospital

Abstract Hospital-acquired enteric infections, particularly those due to rotavirus, were investigated by studying 220 patients under 3 years of age who were admitted without gastroenteritis to two paediatric general medical wards during a 10 month period. Faecal specimens were collected within 48 h of admission and then daily until the patients were discharged. Samples were also collected after discharge if patients developed enteric symptoms within 2 days of discharge. Fourteen per cent (31 of 220) of patients acquired rotavirus infections while in hospital, 23% (seven of 30) excreted rotavirus only after discharge; 29% of patients infected with rotavirus were asymptomatic (nine of 31). Acquisition of rotavirus infection was most prevalent during the months May-August, with a prevalence of 34% (12 of 35) in May. Hospitalization was prolonged in those patients who acquired rotavirus (11.1 days compared with 8.0 days, P < 0.05). This study highlights the importance of rotavirus as a cause of hospital cross-infection, particularly in the very young patient, and emphasizes the need for further assessment of factors involved in its acquisition. In order to determine correctly the incidence of hospital-acquired illness, it is essential to follow patients after discharge from hospital. This study reinforces the importance of developing preventive measures in order to reduce the frequency of this illness.     

Prospective study of nosocomial rotavirus infection in a paediatric hospital

Hospital-acquired enteric infections, particularly those due to rotavirus, were investigated by studying 220 patients under 3 years of age who were admitted without gastroenteritis to two paediatric general medical wards during a 10 month period. Faecal specimens were collected within 48 h of admission and then daily until the patients were discharged. Samples were also collected after discharge if patients developed enteric symptoms within 2 days of discharge. Fourteen per cent (31 of 220) of patients acquired rotavirus infections while in hospital, 23% (seven of 30) excreted rotavirus only after discharge; 29% of patients infected with rotavirus were asymptomatic (nine of 31). Acquisition of rotavirus infection was most prevalent during the months May-August, with a prevalence of 34% (12 of 35) in May. Hospitalization was prolonged in those patients who acquired rotavirus (11.1 days compared with 8.0 days, P less than 0.05). This study highlights the importance of rotavirus as a cause of hospital cross-infection, particularly in the very young patient, and emphasizes the need for further assessment of factors involved in its acquisition. In order to determine correctly the incidence of hospital-acquired illness, it is essential to follow patients after discharge from hospital. This study reinforces the importance of developing preventive measures in order to reduce the frequency of this illness.     

The health and economic burden of rotavirus disease in Belgium

For health economic evaluations of rotavirus vaccination, estimates of the health and cost burden of rotavirus are required. Due to differences in health care systems and surveillance organisations, this is difficult to achieve by imputing estimates from one country to others. This study aimed to estimate the burden of rotavirus disease in Belgium. In children younger than 7 years of age, rotavirus is predicted to account annually for about 5,600 hospitalisations (676:100,000 children); 26,800 outpatient, general practitioner and paediatrician visits; and about 44,600 episodes for which no medical care is sought. This burden is estimated to represent direct costs of 7.7 million € and indirect costs of 12.8 million €. Rotavirus disease causes a substantial health and economic burden in Belgium.