Two new rotavirus vaccines are expected to be introduced in the European Union (EU) in coming years. A human rotavirus vaccine has already been licensed in several countries worldwide, and a pentavalent bovine vaccine has been submitted for licensure in the United States and the EU. Few data exist on the burden of rotavirus disease and its associated costs within the EU. To estimate the burden of rotavirus disease in the EU, we adapted a model based on the approach developed by the Centers for Disease Control and Prevention to the European situation and applied it to recent population and mortality data from European countries. Country-specific estimates were added to obtain a global estimate of rotavirus episodes treated at home, clinic visits, hospitalization and death. We estimate that 3.6 million episodes of rotavirus disease occur annually among the 23.6 million children younger than 5 years of age in the EU. Every year, rotavirus accounts for 231 deaths, >87,000 hospitalizations and almost 700,000 outpatient visits. Rotavirus disease constitutes a large public health burden in the EU. Except for deaths, the burden of disease is not dissimilar to that in the developing world. Country-specific studies are required to more accurately understand the burden of disease caused by rotavirus. With the introduction of new rotavirus vaccines in sight, rotavirus gastroenteritis may be regarded as the single most frequent vaccine-preventable disease among children in the EU.

Burden of rotavirus disease in European Union countries.

The data currently available on the epidemiology, severity and economic burden of nosocomial rotavirus (RV) infections in children younger than 5 years of age in the major European countries are reviewed. In most studies, RV was found to be the major etiologic agent of pediatric nosocomial diarrhea (31-87%), although the number of diarrhea cases associated with other virus infections (eg, noroviruses, astroviruses, adenoviruses) is increasing quickly and almost equals that caused by RVs. Nosocomial RV (NRV) infections are mainly associated with infants 0-5 months of age, whereas community-acquired RV disease is more prevalent in children 6-23 months of age. NRV infections are seasonal in most countries, occurring in winter; this coincides with the winter seasonal peak of other childhood virus infections (eg, respiratory syncytial virus and influenza viruses), thus placing a heavy burden on health infrastructures. A significant proportion (20-40%) of infections are asymptomatic, which contributes to the spread of the virus and might reduce the efficiency of prevention measures given as they are implemented too late. The absence of effective surveillance and of reporting of NRV infections in any of the 6 countries studied (France, Germany, Italy, Poland, Spain and the United Kingdom) results in severe underreporting of NRV cases in hospital databases and therefore in limited awareness of the importance of NRV disease at country level. The burden reported in the medical literature is potentially significant and includes temporary reduction in the quality of children's lives, increased costs associated with the additional consumption of medical resources (increased length of hospital stay) and constraints on parents'/hospital staff's professional lives. The limited robustness and comparability of studies, together with an evolving baseline caused by national changes in health care systems, do not presently allow a complete and accurate overview of NRV disease at country level to be obtained. RV is highly contagious, and the efficiency of existing prevention measures (such as handwashing, isolation and cohorting) is variable, but low at the global level because of the existence of numerous barriers to implementation (eg, lack of staff, high staff turnover, inadequate hospital infrastructure). Prevention of RV infection by mass vaccination could have a positive impact on the incidence of NRV by reducing the number of children hospitalized for gastroenteritis, therefore reducing the number of hospital cross-infections and associated costs.

Nosocomial rotavirus infection in European countries: a review of the epidemiology, severity and economic burden of hospital-acquired rotavirus disease.

Rotavirus affects 95% of children worldwide by age 5 years and is the leading cause of severe dehydrating diarrhea. The objective of this review was to estimate the burden of rotavirus gastroenteritis (RVGE) in the Western European pediatric population. A comprehensive literature search (1999-2010) was conducted in PubMed and other sources (CDC; WHO, others). Data on the epidemiology and burden of RVGE among children < 5 years-old in Western Europe --including hospital-acquired disease--were extracted. 76 studies from 16 countries were identified. The mean percentage of acute gastroenteritis (AGE) cases caused by rotavirus ranged from 25.3%-63.5% in children < 5 years of age, peaking during winter. Incidence rates of RVGE ranged from 1.33-4.96 cases/100 person- years. Hospitalization rates for RVGE ranged from 7% to 81% among infected children, depending on the country. Nosocomial RVGE accounted for 47%-69% of all hospital-acquired AGE and prolonged hospital stays by 4-12 days. Each year, RVGE incurred $0.54- $53.6 million in direct medical costs and $1.7-$22.4 million in indirect costs in the 16 countries studied. Full serotyping data was available for 8 countries. G1P[8], G2P[4], G9P[8], and G3P[8] were the most prevalent serotypes (cumulative frequency: 57.2%- 98.7%). Serotype distribution in nosocomial RVGE was similar. This review confirms that RVGE is a common disease associated with significant morbidity and costs across Western Europe. A vaccine protecting against multiple serotypes may decrease the epidemiological and cost burden of RVGE in Western Europe.

/pdf/burden-of-community-acquired-and-nosocomial-rotavirus-4kjo02ffas.pdf

Burden of community-acquired and nosocomial rotavirus gastroenteritis in the pediatric population of Western Europe: a scoping review

Rotaviruses are a major cause of hospitalizations for acute gastroenteritis in developed countries. This review shows the burden of rotavirus disease in <5-year-old children in Europe. An estimated 72000–77000 hospitalizations for community-acquired rotavirus disease occur annually in the 23 million under-fives living in the European Union (EU-25), with a median cost of €1417 per case. Annual hospitalization incidence rates range from 0·3 to 11·9/1000 children <5 years old (median 3/1000). The median proportion of hospital-acquired rotavirus disease among all cases of hospitalization for rotavirus disease is estimated to be 21%. Countries of the EU-25 require information on the burden of rotavirus disease to support introduction of rotavirus vaccines. Data on cases treated at home, medical visits, and emergency wards as well as rotavirus-associated deaths are limited. To fully evaluate the impact and effectiveness of rotavirus vaccination programmes in Europe, additional epidemiological studies will be critical and desirable.

REVIEW ARTICLE The paediatric burden of rotavirus disease in Europe

BACKGROUND AND OBJECTIVES: Nosocomial rotavirus (nRV) infections represent an important part of rotavirus (RV)-associated morbidity. The incidence of nRV influences the estimated total RV disease burden, an important determinant of cost-effectiveness of RV vaccination programs. Our aim is to summarize the existing evidence and produce reliable estimates of nRV incidence, in pediatric settings in Europe and North America.

METHODS: We searched electronic databases for studies on nRV incidence among pediatric inpatients. To ascertain complete case reporting, only studies describing active nRV surveillance in their methodology were included. Random effects meta-analysis was performed. Meta-regression was used to obtain results adjusted for important study characteristics.

RESULTS: Twenty surveillance studies met the quality criteria for inclusion. The pooled unadjusted nRV incidence was 2.9 per 100 hospitalizations (95% confidence interval [CI]: 1.6–4.4). Incidence was significantly influenced by studies' seasonality-months (RV epidemic season only or year-round) and the age range of included patients. Highest nRV incidence was found for children <2 years of age, hospitalized during the epidemic months (8.1/100 hospitalizations; 95% CI: 6.4–9.9). The adjusted year-round nRV incidence estimate without age restriction was 0.4/100 hospitalizations (95% CI: 0.1–2.1) and 0.7 (95% CI: 0.0–1.8) for children <5 years of age.

CONCLUSIONS: This is the first meta-analysis to summarize results of surveillance studies on nRV incidence. nRV is an important problem among hospitalized infants during the winter months. The lower season and age-adjusted nRV incidence estimate seems more appropriate for application in population-based burden of disease analysis.

* Abbreviations:
 CI — : confidence interval
 nRV — : nosocomial rotavirus
 RV — : rotavirus

Nosocomial rotavirus infections: a meta-analysis.

Suivi prospectif des diarrhées nosocomiales dans 28 services de pédiatrie du quart Sud-Est de la France au cours d'un trimestre d'hiver

The aim of this study was to evaluate the risk of hospital-acquired diarrhoea during an epidemic period through a prospective multicentre observational study. A systemic investigation of the hospital-acquired diarrhoea (occurring at least 48 h after hospital admission) was conducted through a standardised questionnaire from January to March 1999 in patients of 5 years old or less hospitalised in 28 wards (620 beds) belonging to 20 hospitals located in the south-east part of France. Overall, 241 cases of hospital-acquired diarrhoea were collected, corresponding to a prevalence of 3.3% (3.6% after exclusion of patients admitted for diarrhoea) and a density of incidence of 0.81 per 100 days of hospitalisation. The mean stay duration of hospital-infected patients was greater than 10 days, versus 3.9 days for the other children (P < 0.001). A readmission was required in 27% of the infected children. Rotavirus was involved in 97.8% of microbiologically documented cases (88%). In 50% of the cases, the hospital-acquired diarrhoea was seen in patients with bronchiolitis. Contact isolation measures were

Suivi prospectif des diarrhées nosocomiales dans 28 services de pédiatrie du quart Sud-Est de la France au cours d'un trimestre d'hiver Prospective follow-up of hospital-acquired diarrhoea in 28 paediatric wards of the south-east part of France during a winter season

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Suivi prospectif des diarrhées nosocomiales dans 28 services de pédiatrie du quart Sud-Est de la France au cours d'un trimestre d'hiver

Suivi prospectif des diarrhées nosocomiales dans 28 services de pédiatrie du quart Sud-Est de la France au cours d'un trimestre d'hiver Prospective follow-up of hospital-acquired diarrhoea in 28 paediatric wards of the south-east part of France during a winter season