Background A substantial number of surveillance studies have documented rotavirus prevalence among children admitted for dehydrating diarrhea. We sought to establish global seasonal patterns of rotavirus disease before the introduction of widespread vaccination. Methods We reviewed studies of rotavirus detection in children with diarrhea published since 1995. We assessed potential relationships between seasonal prevalence and locality by plotting the average monthly proportion of diarrhea cases positive for rotavirus according to geography, country development and latitude. We used linear regression to identify variables that were potentially associated with the seasonal intensity of rotavirus. Results Among a total of 99 studies representing all 6 geographic regions of the world, patterns of year-round disease were more evident in low- and low-middle income countries compared with upper-middle and high-income countries where disease was more likely to be seasonal. The level of country development was a stronger predictor of strength of seasonality (P = 0.001) than geographic location or climate. However, the observation of distinctly different seasonal patterns of rotavirus disease in some countries with similar geographic location, climate and level of development indicate that a single unifying explanation for variation in seasonality of rotavirus disease is unlikely. Conclusion While no unifying explanation emerged for varying rotavirus seasonality globally, the country income level was somewhat more predictive of the likelihood of having seasonal disease than other factors. Future evaluation of the effect of rotavirus vaccination on seasonal patterns of disease in different settings may help understand factors that drive the global seasonality of rotavirus disease.

/pdf/global-seasonality-of-rotavirus-disease-24cqyb85ue.pdf

Global seasonality of 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

Resume Contexte. – Rotavirus est le germe le plus souvent incrimine dans les diarrhees aigues graves de l'enfant. L'impact des infections a rotavirus (morbidite et mortalite) n'est pas precisement connu dans les pays temperes et plus particulierement en France. Objectifs. – L'objectif de cette etude est de determiner la morbidite, la mortalite et les couts engendres par l'infection a rotavirus en France. Methodes. – Les enfants sont suivis de la naissance jusqu'a l'âge de cinq ans par un modele de l'infection a rotavirus dans un formalisme d'arbre de decision (i.e. modele de Markov), alimente par des donnees d'observation nationales et des donnees disponibles dans la litterature. L'incidence des diarrhees aigues a rotavirus a ete determinee en fonction de l'âge, des saisons et de l'allaitement. Resultats. – L'infection a rotavirus serait chaque annee responsable de 300 000 episodes de diarrhee aigue chez les enfants de moins de cinq ans en France, 138 000 consultations en ville, 18 000 hospitalisations et de neuf deces. Le cout direct annuel de l'infection est estime a 28 millions d'euros pour le systeme de sante. Conclusion. – Ce travail souligne l'impact important des diarrhees aigues a rotavirus chez les enfants de moins de cinq ans en France en termes de morbidite et de couts engendres pour le systeme de soins. Dans la perspective de la commercialisation d'un nouveau vaccin, le modele qui a ete elabore au cours de ce travail pourra etre utilise pour evaluer l'efficacite, le cout et le cout–efficacite d'un programme vaccinal en France.

Morbidité et coût des infections à rotavirus en France

On 24 August 2008, an outbreak alert regarding cases of acute gastroenteritis in Podgorica triggered investigations to guide control measures. From 23 August to 7 September, 1699 cases were reported in Podgorica (population 136 000) and we estimated the total size of the outbreak to be 10 000-15 000 corresponding to an attack rate of approximately 10%. We conducted an age- and neighbourhood-matched case-control study, microbiologically analysed faecal and municipal water samples and assessed the water distribution system. All cases (83/83) and 90% (80/90) [corrected] of controls drank unboiled chlorinated municipal water [matched odds ratio (mOR) 11.2, 95% confidence interval (CI), 1.6-infinity]. Consumption of bottled water was inversely associated with illness (mOR 0.3, 95% CI 0.1-0.8). Analyses of faecal samples identified six norovirus genotypes (21/38 samples) and occasionally other viruses. Multiple defects in the water distribution system were noted. These results suggest that the outbreak was caused by faecally contaminated municipal water. It is unusual to have such a large outbreak in a European city especially when the municipal water supply is chlorinated. Therefore, it is important to establish effective multiple-barrier water-treatment systems whenever possible, but even with an established chlorinated supply, sustained vigilance is central to public health.

/pdf/massive-outbreak-of-viral-gastroenteritis-associated-with-1oi196jc5c.pdf

Massive outbreak of viral gastroenteritis associated with consumption of municipal drinking water in a European capital city

Burden of rotavirus disease and cost-effectiveness of universal vaccination in the Province of Genoa (Northern Italy).

Data on the burden of rotavirus gastroenteritis in Europe are needed to help understand the potential impact of introducing new rotavirus vaccines. As part of prospective observational study (Rotavirus gastroenteritis Epidemiology and Viral types in Europe Accounting for Losses in Public Health and Society Study, REVEAL) conducted in 2004–2005 in seven European countries, we studied, the characteristics of acute gastroenteritis and rotavirus gastroenteritis in children less than 5 years in primary care, emergency room and hospital settings (Padova, Italy). A total of 757 children with acute gastroenteritis were included and enzyme-linked immunoabsorbent assay (ELISA) results were available for 725 cases. The overall estimated annual incidence for rotavirus gastroenteritis was 4.7%. Overall, rotavirus gastroenteritis was estimated to account for 43.6% of acute gastroenteritis cases. Among children with acute gastroenteritis (AGE) aged 6–23 months, 61.2% were rotavirus positive. Rotavirus gastroenteritis (RVGE) was responsible for 68.8% of hospitalizations, 61% of emergency consultations, and 33% of primary care consultations. The most prevalent serotype was G9 (84.4%) followed by G1 (11.8%). The relative risk for rotavirus gastroenteritis of being referred to hospital after an initial consultation in primary care was 3.37 (95% CI: 1.77–6.43) and 3.38 (95% CI: 2.28–5.01) for emergency room referral. Children with rotavirus gastroenteritis generally had more severe disease than children with rotavirus-negative gastroenteritis. Rotavirus accounts for a significant proportion of acute gastroenteritis cases in children less than 5 years in Italy, many of whom require frequent primary care consultations, or care in emergency room or hospital settings.

/pdf/prospective-study-of-the-burden-of-acute-gastroenteritis-and-2zqhdddu9q.pdf

Prospective Study of the Burden of Acute Gastroenteritis and Rotavirus Gastroenteritis in Children Less Than 5 Years of Age, in Padova, Italy

Background
Rotavirus gastroenteritis (RVGE) has a major impact in terms of morbidity in Italy. Comprehensive data on the economic impact are needed in order to evaluate the cost-effectiveness of a Rotavirus (RV) vaccination program.

Costi della gastroenterite da rotavirus acquisita in comunità in età pediatrica a Padova in Italia

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Prospective Study of the Burden of Acute Gastroenteritis and Rotavirus Gastroenteritis in Children Less Than 5 Years of Age, in Padova, Italy

Costi della gastroenterite da rotavirus acquisita in comunità in età pediatrica a Padova in Italia