Effect of breast-feeding on morbidity in rotavirus gastroenteritis

Fifty infants less than 1 year of age with rotavirus gastroenteritis were studied with regard to the protective effect of breast-feeding. The initial incidence of breast-feeding was 64% in the patients infected with rotavirus and 70% in a matched control population. Seven patients were breast-fed at the time of infection, 25 patients had stopped breast-feeding prior to infection, and 18 patients were exclusively formula-fed. There were no significant differences between groups in the average age of infection, mean duration of diarrhea, mean number of bowel movements in 24 hours, or in the frequency of fever or irritability. The only apparent difference between groups was that the frequency of vomiting was significantly decreased in the breast-fed children. The results of this study suggest that breast-feeding offers little protection against rotavirus gastroenteritis.     

Overview of rotavirus infections in Korea

Rotavirus is the most common cause of acute watery diarrhea in young Korean children. Rotavirus vaccine will soon be available, and information is urgently required about the serotype distribution of recent epidemics and clinical characteristics of rotavirus infection in Korean children before the implementation of a vaccination program against rotavirus. We reviewed published studies of the past 20 years, carried out on Korean children with rotavirus gastroenteritis. Rotavirus was estimated to be responsible for 46% of 4668 hospitalized Korean children with acute gastroenteritis. Rotavirus gastroenteritis was most prevalent among children aged 6-24 months, which accounted for 84% of all cases. Asymptomatic rotavirus infection was common. Rotavirus was one of the most commonly identified enteric pathogens in nosocomial diarrhea. Vomiting, respiratory symptoms and fever were prominent symptoms in rotavirus gastroenteritis. Transient elevation of liver enzymes, pulmonic infiltration and rarely afebrile convulsion were also observed. The epidemic peak, which occurred in November of the last 15 years, has been moving toward late winter and early spring in recent years. No apparent cause has been found to explain this alteration of peak seasonality. All serotyping studies in Korea for the past 10 years until 1997 revealed that G1 was most prevalent (45-81%). Interestingly, the predominant G serotype of the recent outbreaks in 1998 and 1999 was not G1 but G4. Approximately 95% of rotavirus isolates in recent outbreaks belonged to serotype G1, 2, 3 or 4.     

Multicenter prospective study analysing the role of rotavirus on acute gastroenteritis in Spain

Background: Paediatric rotavirus gastroenteritis is the most frequent cause of acute gastroenteritis (AGE) in children up to 5 years of age worldwide. Aim: To analyse the clinical characteristics of AGE caused by rotavirus comparing to AGE caused by other agents. Methods: The study was conducted in 30 health‐care centers in Spain (25 hospitals and five primary centers) between January and March 2006. Children with AGE up to 2 years of age were included. Stool samples were analysed using immunochromatographic test to identify rotavirus infection. Clinical and epidemiological data were analysed. Results: A total of 1192 children were enrolled (mean age: 11.2 months). Fever, Vomiting, weakness and dehydration were more frequent in rotavirus‐positive AGE cases. Severity score was higher and hospitalization was likely in AGE caused by rotavirus. Family AGE illness was more frequent in children with rotavirus‐positive AGE. Breastfeeding was found as a protective factor against Rotavirus AGE. Conclusion: Rotavirus is the primary causal agent of AGE in children under 2 years of age in Spain, causing more severe symptoms and more hospital admissions than other causal agents. Our data support the interest of the introduction of the available rotavirus vaccines in the Spanish immunization schedule.     

Epidemiological changes in rotavirus gastroenteritis in children under 5 years of age after the introduction of rotavirus vaccines in Korea

Rotavirus gastroenteritis is the leading cause of severe acute gastroenteritis in children worldwide and is associated with high hospitalization and mortality rates in children younger than 5 years of age. Vaccination is necessary to prevent rotavirus infection. Two live attenuated and orally administered rotavirus vaccines became commercially available in Korea. The aim of this study is to describe epidemiological changes in rotavirus gastroenteritis after the introduction of rotavirus vaccines in Korea. The medical records of 11,199 children younger than 5 years of age and hospitalized for acute gastroenteritis from August 2007 to July 2010 in eight Korean hospitals were reviewed. Rotavirus was detected in stool samples obtained from 2,959 children (26.42 %). The authors evaluated the percentage of rotavirus gastroenteritis among all acute gastroenteritis hospitalizations in eight hospitals located in different geographical areas and analyzed epidemiological changes in rotavirus gastroenteritis according to age, geographical area, and season. According to the findings, the percentage of rotavirus gastroenteritis showed a decrease in children eligible for vaccination during the study period. After introduction of the vaccine, reduced rates of rotavirus detection were observed in all of the geographical areas, and the greatest reduction was observed in Seoul. In Seoul, there was a marked delay of the rotavirus season. Conclusion: Epidemiologic changes in Korea after the introduction of rotavirus vaccine are consistent with changes observed in other countries.     

Gastroentérites à rotavirus dans un hôpital pédiatrique au cours de cinq années consécutives

Rotavirus is the major cause of gastroenteritis in children and the main cause of hospital acquired-infection in paediatric unit. We report the epidemiology of gastroenteritis in our hospital during five consecutive years. Rotavirus was involved in 13% of the patients. Seasonal peaks were observed in January and 45.8% of the patients were less than 6 month old. The rotavirus infection was hospital-acquired in 1/3 of the cases. During the winter period, the incidence of rotavirus nosocomial infection was 4.4%.     

Conquering rotavirus: From discovery to global vaccine implementation

Rotavirus, the commonest cause of severe dehydrating gastroenteritis world‐wide, was discovered less than 50 years ago. It causes about 450 000 deaths per year in children <5 years of age and hospitalises millions more. Rotavirus vaccines have been shown to have a major impact on hospital admissions due to rotavirus gastroenteritis and all‐cause gastroenteritis and reduce mortality in developing countries. In Australia, there has been a 71% decrease in rotavirus hospitalisations in children 0–5 years of age. From the discovery of rotavirus as the major causative agent for severe gastroenteritis, through vaccine development and vaccine post‐marketing surveillance activities, Australian scientists and clinicians have played a significant role in the global effort to reduce the burden of rotavirus infection.     

Recommendations for the use of rotavirus vaccines in infants

Rotavirus infection occurs in the majority of healthy children before five years of age, and is the most common diarrheal illness associated with hospitalization. The majority of children present with symptoms of vomiting, diarrhea and fever. As a result, rotavirus gastroenteritis is responsible for greater morbidity than other common childhood diarrheal illnesses. The highest risk of severe disease is in children younger than two years of age. It is estimated that one in 20 children will require an emergency department visit. In addition to community-acquired infections, hospital-acquired infections are also significant. There are currently two licensed rotavirus vaccines in Canada. Both vaccines are administered orally and are highly effective against severe disease and hospitalization. Large pre- and postmarketing studies have shown no increased risk of intussusception with the current rotavirus vaccines. The present statement provides information concerning the clinical disease and rotavirus vaccines in Canada.     

Hospital surveillance of rotavirus infection and nosocomial transmission of rotavirus disease among children in Guinea-Bissau

BACKGROUND: Vaccination against rotavirus is protective against severe disease. Surveillance of rotavirus infection in developing countries might direct vaccination policy more efficiently. METHODS: We implemented WHO's generic protocols for hospital-and community-based surveillance of rotavirus gastroenteritis. From April 2001 to May 2002, and from January 2003 to June 2003, we conducted hospital surveillance for rotavirus infection at the only pediatric ward in the capital of Guinea-Bissau. Children less than 5 years of age admitted with diarrhea or developing diarrhea during hospitalization were enrolled in the study. Rotavirus infection was detected in the feces samples using an ELISA assay. Rectal swabs were also obtained and its use was validated against stool specimen. RESULTS: During the surveillance period, 161 cases of rotavirus infection were registered. During the season, rotavirus accounted for 35% of all hospitalized diarrhea cases. The rate of nosocomial disease was 1.6 per 1000 child-days (95% confidence interval [CI] = 1.02-2.51) with high rates for children aged 12 to 23 months of age (rate: 3.09; 95% CI = 1.47-6.48). Most of the rotavirus cases (93%) were in children less than 2 years of age and only 10 children aged less than 3 months were infected. Fever (risk ratio (RR) 1.56; 95% CI = 1.16-2.10) and vomiting (RR 1.38; 95% CI = 1.11-1.73) were more common in patients with rotavirus than in patients with nonrotavirus diarrhea. The case-fatality was 8%. Results from stool samples and rectal swabs were concordant in 96% of the pairs. Rectal swabs increased the detection of rotavirus cases by 6% and deaths by 33% over stool sample results. CONCLUSION: Rotavirus infections were confined to a 4-month period each year. It is an important cause of childhood diarrhea with high case-fatality ratio in Guinea-Bissau. The use of rectal swab appeared to increase the detection rate of rotavirus infection and the case-fatality rate. The high rate of nosocomial infections in hospitalized children emphasizes the need for prevention of disease.     

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     

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   

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 > or =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.     

Rotavirus vaccines: an update

PURPOSE OF REVIEW: Rotavirus infection is the most common cause of severe diarrhea disease in infants and young children worldwide and has a major global impact on childhood morbidity and mortality. Vaccination is the only control measure likely to have a significant impact on the incidence of severe dehydrating rotavirus disease. RECENT FINDINGS: Rotavirus disease prevention efforts suffered a great setback in 1999 with the withdrawal of the RRV-TV vaccine less than a year after its introduction. Several new rotavirus vaccine candidates have now been developed and are undergoing clinical trials. SUMMARY: New safe and effective rotavirus vaccines offer the best hope of reducing the toll of acute rotavirus gastroenteritis in both developed and developing countries.     

Diarrhea caused by Shigella, rotavirus, and Giardia in day-care centers: prospective study

We conducted a 19-month prospective study of children attending 20-day-care centers to determine the occurrence, causes, and transmission of gastroenteritis among children, staff, and family members. Nine centers had 15 outbreaks of diarrhea involving 195 patients. An enteropathogen was identified in all outbreaks. Shigella was detected in five outbreaks, rotavirus in two, giardia in one, and in the remaining seven multiple enteropathogens were identified. Rotavirus and Giardia occurred only in children less than 3 years of age; shigellosis occurred at all ages. In six DCC 68 single cases of diarrhea were not associated with an outbreak; an enteropathogen was identified in only three (4%) persons. Thirty-four family members (11%) developed diarrhea associated with the occurrence of gastroenteritis in children in six DCC evaluated for this problem. Secondary attack rates of diarrhea in families according to organisms identified in the DCC outbreaks were: Shigella 26%, rotavirus 15%, and G. lamblia 17%. DCC may play an important role in the epidemiology and transmission of gastroenteritis in the United States.     

Rotaviruses in infants with diarrhea studied by viral RNA electrophoresis in Ankara, Turkey

Incidence of rotavirus in children under 2 years of age, admitted to 2 children's hospitals i n Ankara, Turkey, from July 1984-June 1985 was measured using viral RNA electrophoresis in agarose gels. 375 children were selected at random from over 14,000 diarrhea admissions, and their stool specimens taken on admission were compared to those of 333 children without diarrhea. 61 (16.3%) of the diarrhea cases had detectable rotavirus, compared to 0% in controls. Bacteriologic tests for salmonella, Shigella and Campylobacter jejuni were positive for 51 (13.6%) of the diarrhea patients and 1.8% of controls. 1 child had both rotavirus and Salmonella. Rotavirus infection was highest in November- March, peaking in December. Bacterial diarrhea was prevalent in the summer. This pattern is typical of a temperate climate, although in developed countries bacterial gastroenteritis is not as prevalent. Since there are about 2340 diarrhea admissions annually for rotavirus in Ankara, from a population of 2,700,000, rotavirus vaccination seems appropriate.     

多重感染致儿童急性腹泻病的多中心临床研究

目的 观察急性腹泻患儿中单一感染与混合感染的发病率,比较单一和多个病原体感染患儿的临床表现.方法 采用回顾性研究方法,选择年龄1个月～14岁诊断急性腹泻病的患儿4728例作为观察对象.单一感染组和混合感染组患儿均进行大便常见病原体检测,包括轮状病毒(rotavirus,RV)、肠道腺病毒(enteric adenovirus,EAdV)、诺如病毒(norovirus,NV)抗原以及常见肠道致病菌的培养、分离鉴定.同时观察患儿病情的严重程度,包括腹泻持续时间和频率,发热、呕吐持续时间以及脱水的程度.结果 4 728例患儿中有一种及一种以上病原体感染的有3 595例(76.0％),实验室检测未发现病原体感染的患儿有1 133例(24.0％).其中RV感染有1 889例(40.0％),EAdV有412例(8.7％),NV感染有309例(6.5％),大肠埃希菌(VTEC) 274例(5.8％),沙门菌属276例(5.8％),肺炎克雷伯菌感染123例(2.6％),志贺菌78例(1.6％),金黄色葡萄球菌70例(1.5％)和产气荚膜杆菌126例(2.7％).其中1370例(29.0％)腹泻患儿存在混合感染,以RV合并NV感染150例(3.2％)及RV与产气荚膜菌混合感染127例(2.7％)为最常见.混合感染所致的儿童急性腹泻较单一感染临床表现更加严重,差异有统计学意义(P＜0.05).结论 轮状病毒仍是儿童急性腹泻最常见的病原体,其次为NV、EAdV、沙门菌属及VTEC.混合感染中轮状病毒合并诺如病毒感染最常见.在病毒与细菌混合感染时,VTEC与各类病毒合并感染发生率最高.多种病毒感染与单一病毒感染腹泻患儿比较,呕吐持续时间和脱水程度较严重,而发热及腹泻持续时间、腹泻频率则无明显差异.病毒合并细菌感染与单一病毒感染和单一细菌感染腹泻患儿的临床表现比较,混合感染患儿发热、呕吐及腹泻持续时间长,腹泻、脱水程度都更加严重.     

Astrovirus,adenovirus, and rotavirus in hospitalized children: prevalence and association with gastroenteritis

BACKGROUND: Agents of viral gastroenteritis such as astrovirus, rotavirus, and adenovirus are common pediatric pathogens accounting for many physician visits, hospital admissions, and nosocomial infections. Previous hospital-based prevalence studies have examined mainly symptomatic children. PURPOSE: To evaluate the prevalence of astrovirus, rotavirus, and adenovirus infections among hospitalized children less than 6 years of age, regardless of symptoms, and determine association with gastroenteritis. METHODS: From September 1998 to June 2000, stool specimens were collected twice weekly from children less than five years of age admitted to two wards in a tertiary-care children's hospital. A total of 480 samples were obtained from 309 hospitalizations. Stools were examined using antibody-based ELISA for astrovirus, rotavirus, and adenovirus. Clinical data was abstracted from patient records. RESULTS: Twenty one percent of the children had gastroenteritis symptoms at some point during their hospitalizations (43% were hospital acquired). Astrovirus was detected in 5.2% of all children compared to 6.8% with rotavirus and 0.8% with adenovirus serotypes 40 or 41. Nosocomial acquisition was common. Seventy five percent of astrovirus infections and 90% rotavirus infections were symptomatic. Astrovirus infections were significantly more likely to occur in younger infants and in children with compromised immunity. Rotavirus infections were significantly more likely to cause dehydration. In a three-year passive surveillance of gastroenteritis at the hospital, astrovirus and rotavirus infections peaked simultaneously in winter months. CONCLUSIONS: Rotavirus and astrovirus are common symptomatic infections on pediatric wards and contribute greatly to inpatient morbidity. Adenoviruses played a limited role in gastroenteritis in hospitalized children in this study.     

Child rotavirus infection in association with acute gastroenteritis in two Chinese sentinel hospitals

Rotavirus gastroenteritis is an important pediatric disease in China. In a survey of rotavirus infection at two sentinel hospitals in China (Beijing Friendship Hospital and Changchun Children's Hospital), 296 cases were detected. A total of 283 (95.6%) cases of rotavirus infection occurred in children under 5 years of age. Serotype G1 (62%) was most prevalent followed by G2 (28.5%), G3 (5%) and G4 (2%). Mixed infections (n = 8, 3%) were rate, and 16 isolates (5.5%) remained non-typeable. A consistent epidemic occurred during the winter. Rotavirus was responsible for about 61.8% of diarrhea-related hospitalizations in children under 5 years of age, with a mean hospital stay of 5.6 days (1.0-21 days). The estimated rate of rotavirus-attributed hospitalizations was 16/1000 children under 5 years of age per year. Rotavirus-related death is rare in Changchun and Beijing. The present findings suggest that a rotavirus vaccine for the prevention of severe disease and a reduction of treatment costs would be of significant benefit to China.     

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 ⩽ 48 months of age presenting with gastroenteritis during a six month period of rotavirus peak between December 1997and May 1998 were included. Prospective testing of stool samples for rotavirus was performed using ELISA.
RESULTS—A total of 6969 children were enrolled; 171 (2.4%) had community acquired gastroenteritis. Of 144 children who could be included in further analysis, 49 (34%; median age 16.7 months) were rotavirus positive, and 95 (66%; median age 17.0 months) were rotavirus negative. Three of the rotavirus positive children (median age 14.6 months) were hospitalised. The severity of rotavirus positive gastroenteritis was significantly higher than that of rotavirus negative gastroenteritis. The incidence of community acquired gastroenteritis was 4.67 per 100 children per year, and of rotavirus positive gastroenteritis 1.33 per 100 children per year.
CONCLUSION—Rotavirus is a relevant cause of community acquired gastroenteritis in children aged 4 years and younger treated by a paediatrician. The data can be used as a basis for developing strategies to prevent infection.

     

A prospective study of acute diarrhoea in Finnish children from birth to 2 1/2 years of age

To determine the incidence, clinical significance and etiology of acute diarrhoea in early childhood, a cohort of 336 children were followed from birth to the age of 24-32 (mean 26) months. More than half (55%) of the children had no diarrhoea, 26% had one episode and 19% had two or more episodes of diarrhoea during follow-up; altogether 248 episodes of diarrhoea were detected. Rotavirus was by far the most common (26%) identified pathogen; adenoviruses were detected in 4% and bacterial pathogens (EPEC, Salmonellae, Yersiniae) in 4% of the cases. Two thirds of the episodes remained etiologically unresolved. Rotavirus diarrhoea was significantly more severe than diarrhoea due to other causes; 75% of severe episodes of diarrhoea were associated with rotavirus. About two thirds of the infants were breast-fed over 6 months; breast-feeding for less than 6 months was associated with a higher incidence of rotavirus diarrhoea between 7-12 months of age but not thereafter. About three quarters of the children were cared for at home beyond 12 months of age; those at home had a lower rate of rotavirus diarrhoea than those at day-care centers.