The potential effects of rotavirus and cholera immunization (with an improved vaccine) on diarrhea morbidity and mortality among young children are reviewed using data from field studies and theoretical calculations. In developing countries rotavirus may be responsible for about 6% of all diarrhea episodes and 20% of all diarrhea deaths in children under 5 years of age. In industrial countries these proportions may be higher. Rotavirus immunization may reduce overall diarrhea morbidity rates by 2-3% and diarrhea mortality rates by 6-10% among children under 5 years of age in developing countries depending on vaccine efficacy and program coverage. The impact of improved cholera vaccines depends on the prominence of cholera as a cause of diarrhea and this varies greatly from country to country. Taking the extreme example of Bangladesh where cholera is endemic and may account for about 0.4% of all diarrhea episodes and 8% of all diarrhea deaths in children under 5 years of age cholera immunization might reduce overall diarrhea morbidity rates by 0.06-0.13% and diarrhea mortality rates by 1-2% among these children. The similar incidence rates in industrial and developing countries suggest that rotavirus diarrhea may not be controlled by improvements in water supply sanitation or hygiene. Control may depend upon the widespread of an effective vaccine. (author)

Interventions for the control of diarrhoeal diseases among young children: rotavirus and cholera immunization.

https://mmbr.asm.org/content/mmbr/48/2/157.full.pdf

Human viral gastroenteritis.

Objectives This report describes clinical signs of rotavirus infection (RVI) among neonates admitted to a neonatal intensive care unit (NICU), compares these signs between term and preterm neonates and assesses the seasonal distribution of RVI in the NICU with that of the community. Methods After an initial prevalence study of 28 days, a prospective longitudinal study in the NICU was conducted. During the next 48 months from December 1, 1991 to November 30, 1995, term and preterm NICU patients were evaluated daily for pre-defined deviations in their baseline gastrointestinal status. Fecal specimens of neonates who fulfilled the entry criteria were tested for rotavirus by a monoclonal antibody-based enzyme immunoassay and by immunoelectron microscopy. Demographic and outcome data for these neonates were collected. In addition data assessing RVI in the community were collected during this period. Results The prevalence of RVI among NICU patients was 18.4%. Of 194 neonates included in the longitudinal study, 95 had RVI. Neonates with RVI differed from those without RVI with respect to frequent stooling (P = 0.0005), higher percentage of bloody mucoid stools (P = 0.003) and higher percentage of watery stools (P = 0.023). The odds of these three clinical outcomes were approximately 2.5 times higher in neonates with RVI than in neonates without RVI. Among neonates included in the study advanced necrotizing enterocolitis occurred at the same rate (15%) among those with and without RVI. Comparisons between term and preterm neonates with RVI showed that frequent stooling (P = 0.003) and watery stools (P = 0.0001) occurred more often among term neonates, whereas bloody mucoid stools (P = 0.001), abdominal distention (P = 0.03) and intestinal dilatation (P = 0.016) were more common in preterm neonates. The seasonal distribution of RVI in NICU paralleled its distribution in the community. Conclusion RVI appears prevalent in the NICU setting. An absence of watery stools in a neonate should not preclude consideration of RVI when evaluating gastrointestinal signs among neonates. The clinical spectrum of RVI differs in term and preterm infants.

Clinical manifestations of rotavirus infection in the neonatal intensive care unit.

During February and March 1984, 207 fecal samples from infants and children with gastroenteritis were tested for rotavirus with four techniques: two enzyme immunoassays (Rotazyme; Abbott Laboratories, North Chicago, Ill., and Enzygnost-Rotavirus; Calbiochem-Behring, La Jolla, Calif.) and two latex agglutination tests (Rotalex; Orion Research, Inc., Cambridge, Mass., and Slidex Rota-Kit; Biomerieux). All stool samples were also tested for yeasts and bacterial pathogens. Electron microscopy was used to investigate discrepant results. We found 47% positive samples with Enzygnost-Rotavirus, 38% with Rotazyme, 37% with Slidex Rota-Kit, and 34% with Rotalex. No specimen was found positive by Rotazyme only or Slidex Rota-Kit only. On the contrary, 12 samples which were positive with Enzygnost-Rotavirus only and 3 which were positive with Rotalex only were not confirmed as positive by electron microscopy. Both enzyme immunoassays gave 6% equivocal results; Slidex Rota-Kit gave significantly fewer equivocal results than did Rotalex: 2.9% versus 9.7% (P less than 0.01). The sensitivity and specificity of latex tests compared favorably with that of enzyme immunoassays. Latex agglutination tests can be performed by unskilled personnel and are rapid and relatively cheap. They appear to be very suitable for routine laboratory work and may prove useful for large-scale screening in developing countries.

Direct appraisal of latex agglutination testing, a convenient alternative to enzyme immunoassay for the detection of rotavirus in childhood gastroenteritis, by comparison of two enzyme immunoassays and two latex tests.

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. Children presenting to The Children's Hospital of Philadelphia with acute gastroenteritis have been monitored for the presence of rotavirus antigen in the stool by ELISA (followed by genotyping if ELISA-positive) since the 1994-95 epidemic season. Over the last 12 rotavirus seasons prior to the introduction of the pentavalent rotavirus vaccine in 2006, stool specimens from 1646 patients tested positive for community-acquired rotavirus infection. Gender or age was not recorded in 6 and 5 cases, respectively. Overall, 58% of the cases occurred in boys. G1 was the predominant VP7 serotype, accounting for 72% of cases. The median (IQR) age was 11 (5-21) months. A total of 790 (48%) cases occurred in children outside the commonly quoted peak age range, with 27% in infants 24 months of age. A total of 220 (13%) cases occurred during the first 3 months of life, and the highest number of episodes per month of age [97 (6%)] was observed during the second month of life. The incidence of community-acquired rotavirus gastroenteritis monitored over 12 seasons in the prevaccine era at a major university hospital was nearly constant for each month of age during the first year of life, revealing an unexpectedly high incidence of symptomatic rotavirus disease in infants <3 months old. A sizeable fraction of cases occurred in children too young to have been vaccinated according to current recommendations.

/pdf/unexpectedly-high-burden-of-rotavirus-gastroenteritis-in-51ow4enr9c.pdf

Unexpectedly high burden of rotavirus gastroenteritis in very young infants

An enzyme immunoassay was used to detect rotavirus in the stools of 176 pediatric patients presenting with gastroenteritis. The highest incidence of rotavirus infection was found among patients less than 1 year of age. In contrast to previously reported studies, 23% of neonates with gastroenteritis had rotavirus in their stools. This relatively easy and rapid method was helpful in the management of pediatric patients with gastroenteritis.

Incidence of rotavirus infection in different age groups of pediatric patients with gastroenteritis.

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Incidence of rotavirus infection in different age groups of pediatric patients with gastroenteritis.