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Gönüllü E, Soysal A, Yıldız İ, Karaböcüoğlu M. Impact of self-financed rotavirus vaccination on acute gastroenteritis in young children in Turkey. Hum Vaccin Immunother 2021; 17:510-516. [PMID: 32702249 DOI: 10.1080/21645515.2020.1776043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Rotavirus (RV) vaccines have been available in Turkey since 2006. These vaccines are not funded by the National Health System, so consequently their coverage rate in children has reached only 13-18%. We conducted a retrospective record review including all children ≤60 months of age presenting to study hospitals with suspected or clinical acute gastroenteritis (AGE) between 2012 and 2018. During the study, 109,605 children ≤60 months of age were admitted to pediatric out-patient clinics and pediatric emergency room, of which 15,501 (14%) were diagnosed with AGE. Incidence of RV-positive AGE decreased from 4.47 per 1,000 children in 2012 to 2.48 per 1,000 in 2018. A total of 4,805 (31%) such children were hospitalized with RV-positive AGE, a decrease from 1.9 per 1,000 children in 2012 to 0,45 per 1,000 in 2018. The length of hospital stays (LOS) of RV-positive AGE was 2.47 ± 1.15 days compared to LOS of RV-negative AGE 1.59 ± 1.17 days (p < .001). The overall cost of RV-positive AGE ($335 ± 200) was higher than that for RV-negative AGE ($280 ± 148) cases (p = .015). Vaccine effectiveness against any case of RV-positive AGE was 75,1% (95% CI: 65-86%). Despite the low level of vaccine coverage, the introduction of RV vaccination had a positive impact on the incidence of RV-positive AGE and related hospitalizations in young children.
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Affiliation(s)
- Erdem Gönüllü
- Clinic of Pediatrics, Ataşehir Memorial Hospital , Istanbul, Turkey
| | - Ahmet Soysal
- Clinic of Pediatrics, Ataşehir Memorial Hospital , Istanbul, Turkey
| | - İsmail Yıldız
- Clinic of Pediatrics, Şişli Memorial Hospital , Istanbul, Turkey
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Ledent E, Arlegui H, Buyse H, Basile P, Karkada N, Praet N, Nachbaur G. Benefit Versus Risk Assessment of Rotavirus Vaccination in France: A Simulation and Modeling Analysis. BioDrugs 2018; 32:139-152. [PMID: 29589230 PMCID: PMC5878204 DOI: 10.1007/s40259-018-0273-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction Two vaccines against rotavirus gastroenteritis (RVGE) in young children, Rotarix and RotaTeq, have been available in Europe since 2006. Vaccination against rotaviruses significantly reduces the burden of RVGE, but it is also associated with a very small increased risk of intussusception. In a benefit–risk analysis, the prevented RVGE burden is weighed against the possible excess of intussusception. Purpose The aim was to compare the estimated benefits and risks of Rotarix vaccination in France. Methods We estimated the benefits (vaccine-preventable RVGE hospitalizations and deaths) and risks (vaccine-caused intussusception hospitalizations and deaths) following two doses of Rotarix in a birth cohort of 791,183 followed for 3–5 years in France. We used data from peer-reviewed clinical and epidemiological studies or publications, and government statistics. Results Within the total number of French children below 5 years of age, we estimate vaccination could prevent a median 11,132 [95% credible interval (CI) 7842–14,408] RVGE hospitalizations and 7.43 (95% CI 3.27–14.68) RVGE deaths. At the same time, vaccination could cause an average of 6.86 (95% CI 2.25–38.37) intussusception hospitalizations and 0.0099 (95% CI 0.0024–0.060) intussusception deaths in the entire French birth cohort of infants below 1 year of age. Therefore, for every intussusception hospitalization and every intussusception death caused by vaccination, 1624 (95% CI 240–5243) RVGE hospitalizations and 743 (95% CI 93–3723) RVGE deaths are prevented, respectively, by vaccination. Conclusions The vaccine-prevented RVGE hospitalizations and deaths (benefit) greatly outweigh the excess potentially vaccination-related cases of intussusception (risk), indicating a favorable benefit–risk balance for Rotarix in France. Electronic supplementary material The online version of this article (10.1007/s40259-018-0273-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Hugo Arlegui
- Clinical Research, NPI and Academic Alliances, Laboratoire GSK, Rueil-Malmaison, France
| | - Hubert Buyse
- Clinical Safety and Pharmacovigilance, GSK, Wavre, Belgium
| | - Peter Basile
- Clinical Safety and Pharmacovigilance, GSK, Wavre, Belgium
| | | | - Nicolas Praet
- Clinical Research and Development, GSK, Wavre, Belgium
| | - Gaëlle Nachbaur
- Pharmaco-Epidemiology and Health Outcomes Research, Laboratoire GSK, Rueil-Malmaison, France
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Umair M, Abbasi BH, Nisar N, Alam MM, Sharif S, Shaukat S, Rana MS, Khurshid A, Mujtaba G, Aamir UB, Zaidi SSZ. Molecular analysis of group A rotaviruses detected in hospitalized children from Rawalpindi, Pakistan during 2014. INFECTION GENETICS AND EVOLUTION 2017; 53:160-166. [DOI: 10.1016/j.meegid.2017.05.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/26/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
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Fonteneau L, Le Meur N, Cohen-Akenine A, Pessel C, Brouard C, Delon F, Desjeux G, Durand J, Kirchgesner J, Lapidus N, Lemaitre M, Tala S, Thiébaut A, Watier L, Rudant J, Guillon-Grammatico L. [The use of administrative health databases in infectious disease epidemiology and public health]. Rev Epidemiol Sante Publique 2017. [PMID: 28624133 DOI: 10.1016/j.respe.2017.03.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The public health burden resulting from infectious diseases requires efforts in surveillance and evaluation of health care. The use of administrative health databases (AHD) and in particular the French national health insurance database (SNIIRAM) is an opportunity to improve knowledge in this field. The SNIIRAM data network (REDSIAM) workshop dedicated to infectious diseases conducted a narrative literature review of studies using French AHD. From the results, benefits and limits of these new tools in the field of infectious diseases are presented. METHODS Publications identified by the members of the workgroup were collected using an analytical framework that documented the pathology of interest, the aim of the study, the goal of the developed algorithm, the kind of data, the study period, and the presence of an evaluation or a discussion of the performance of the performed algorithm. RESULTS Fifty-five articles were identified. A majority focused on the field of vaccination coverage and joint infections. Excluding vaccine coverage field, the aim of 28 studies was epidemiological surveillance. Twenty-six studies used hospital databases exclusively, 18 used ambulatory databases exclusively and 4 used both. Validation or discussion of the performed algorithm was present in 18 studies. CONCLUSIONS The literature review confirmed the interest of the French AHD in the infectious diseases field. The AHD are additional tools of the existing surveillance systems and their use will probably be more frequent in the coming years given their advantage and reliability. However, incoming users need to be assisted. Thus, the workgroup will contribute to a reasonable use of AHD and support future developments.
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Affiliation(s)
- L Fonteneau
- REDSIAM, groupe de travail infectieux, France; Santé publique France, direction des maladies infectieuses, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
| | | | - A Cohen-Akenine
- REDSIAM, groupe de travail infectieux, France; Haute Autorité de santé, Saint-Denis la Plaine, France
| | - C Pessel
- Haute Autorité de santé, Saint-Denis la Plaine, France
| | - C Brouard
- REDSIAM, groupe de travail infectieux, France; Santé publique France, direction des maladies infectieuses, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France
| | - F Delon
- REDSIAM, groupe de travail infectieux, France; Centre d'épidémiologie et de santé publique des armées, Marseille, France
| | - G Desjeux
- REDSIAM, groupe de travail infectieux, France; Caisse nationale militaire de sécurité sociale, Toulon, France
| | - J Durand
- REDSIAM, groupe de travail infectieux, France; Santé publique France, direction des maladies infectieuses, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France
| | - J Kirchgesner
- REDSIAM, groupe de travail infectieux, France; Inserm, unité mixte de recherche en santé 1136, institut Pierre-Louis d'épidémiologie et de santé publique, Paris, France
| | - N Lapidus
- REDSIAM, groupe de travail infectieux, France; Département de santé publique, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique (IPLESP UMRS 1136), Sorbonne universités, UPMC université Paris 06, hôpital Saint-Antoine, AP-HP, 75000 Paris, France
| | - M Lemaitre
- REDSIAM, groupe de travail infectieux, France; Haute Autorité de santé, Saint-Denis la Plaine, France
| | - S Tala
- REDSIAM, groupe de travail infectieux, France; Département études sur l'offre de soins, direction de la stratégie, des études et des statistiques, Caisse nationale d'assurance maladie des travailleurs salariés, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
| | - A Thiébaut
- REDSIAM, groupe de travail infectieux, France; Biostatistics, biomathematics, pharmacoepidemiology and infectious diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, université Paris-Saclay, 75000 Paris, France
| | - L Watier
- REDSIAM, groupe de travail infectieux, France; Biostatistics, biomathematics, pharmacoepidemiology and infectious diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, université Paris-Saclay, 75000 Paris, France
| | - J Rudant
- REDSIAM, groupe de travail infectieux, France; Département études de santé publique, direction de la stratégie, des études et des statistiques, Caisse nationale d'assurance maladie des travailleurs salariés, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
| | - L Guillon-Grammatico
- REDSIAM, groupe de travail infectieux, France; Service d'information médicale d'épidémiologie et d'économie de la santé, unité régionale d'épidémiologie hospitalière (UREH), université F.-abelais, CHRU de Tours, 37000 Tours, France
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Rébeillé-Borgella B, Barbier C, Moussaoui R, Faisant A, Michard-Lenoir AP, Rubio A. [Nasogastric rehydration for treating children with gastroenteritis]. Arch Pediatr 2017; 24:527-533. [PMID: 28416428 DOI: 10.1016/j.arcped.2017.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 01/09/2017] [Accepted: 03/16/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION When oral rehydration is not feasible, enteral rehydration via the nasogastric route has been the ESPGHAN recommended method of rehydration since 2008, rather than intravenous rehydration (IVR), for children with acute gastroenteritis. However, these recommendations are rarely followed in France. Since 2011, in case of failure of oral rehydration, enteral rehydration has been used as a first-line therapy in the Children's Emergency Department at the Grenoble-Alpes University Hospital. PURPOSE The aims of the study were to compare the length of the hospital stay, the duration of initial rehydration, and the incidence of complications and failure with the use of enteral nasogastric versus intravenous rehydration. METHODS This study compared two cohorts of children (<3 years of age) with mild-to-moderate dehydration caused by acute gastroenteritis and failure of rehydration via the oral route. The first group (winter 2010-2011) was managed according to the previous protocol (intravenous rehydration). The second group (winter 2011-2012) was managed according the new protocol (nasogastric tube rehydration [NGR]). The rest of the gastroenteritis management was identical in both groups. RESULTS A total of 132 children were included, 65 were treated with nasogastric tube rehydration (NGR) and 67 with intravenous rehydration. There was a significant reduction in the duration of hospitalization in the post-emergency unit in the NGR group: 23.6h vs 40.1h (P<0.05). The duration of initial rehydration was also significantly reduced (10.5h vs 22.0h). There was no significant difference regarding serious adverse events. However, the NGR group presented more mild adverse events (22 vs 7, P<0.05) and more treatment failures (15.3% vs 3%, P=0.013). CONCLUSION Nasogastric rehydration reduces the duration of rehydration and the length of the hospital stay without increasing the incidence of serious adverse events for dehydrated children hospitalized for acute gastroenteritis.
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Affiliation(s)
- B Rébeillé-Borgella
- Service d'accueil des urgences pédiatriques, clinique universitaire de pédiatrie, hôpital couple enfants, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - C Barbier
- Service d'accueil des urgences pédiatriques, clinique universitaire de pédiatrie, hôpital couple enfants, CHU de Grenoble Alpes, 38000 Grenoble, France.
| | - R Moussaoui
- Service d'accueil des urgences pédiatriques, clinique universitaire de pédiatrie, hôpital couple enfants, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - A Faisant
- Service d'accueil des urgences pédiatriques, clinique universitaire de pédiatrie, hôpital couple enfants, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - A-P Michard-Lenoir
- Service d'accueil des urgences pédiatriques, clinique universitaire de pédiatrie, hôpital couple enfants, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - A Rubio
- Service d'accueil des urgences pédiatriques, clinique universitaire de pédiatrie, hôpital couple enfants, CHU de Grenoble Alpes, 38000 Grenoble, France; Université Grenoble Alpes, 38000 Grenoble, France
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Community-Acquired Rotavirus Gastroenteritis Compared with Adenovirus and Norovirus Gastroenteritis in Italian Children: A Pedianet Study. Int J Pediatr 2016; 2016:5236243. [PMID: 26884770 PMCID: PMC4738938 DOI: 10.1155/2016/5236243] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/06/2015] [Accepted: 12/13/2015] [Indexed: 11/17/2022] Open
Abstract
Background. Rotavirus (RV) is the commonest pathogen in the hospital and primary care settings, followed by Adenovirus (AV) and Norovirus (NV). Only few studies that assess the burden of RV gastroenteritis at the community level have been carried out. Objectives. To estimate incidence, disease characteristics, seasonal distribution, and working days lost by parents of RV, AV, and NV gastroenteritis leading to a family pediatrician (FP) visit among children < 5 years. Methods. 12-month, observational, prospective, FP-based study has been carried out using Pedianet database. Results. RVGE incidence was 1.04 per 100 person-years with the highest incidence in the first 2 years of life. Incidences of AVGEs (1.74) and NVGEs (1.51) were slightly higher with similar characteristics regarding age distribution and symptoms. Risk of hospitalisation, access to emergency room (ER), and workdays lost from parents were not significantly different in RVGEs compared to the other viral infections. Conclusions. Features of RVGE in terms of hospitalisation length and indirect cost are lower than those reported in previous studies. Results of the present study reflect the large variability of data present in the literature. This observation underlines the utility of primary care networks for AGE surveillance and further studies on community-acquired gastroenteritis in children.
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Hartwig S, Uhari M, Renko M, Bertet P, Hemming M, Vesikari T. Hospital bed occupancy for rotavirus and all cause acute gastroenteritis in two Finnish hospitals before and after the implementation of the national rotavirus vaccination program with RotaTeq®. BMC Health Serv Res 2014; 14:632. [PMID: 25494641 PMCID: PMC4266892 DOI: 10.1186/s12913-014-0632-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 12/02/2014] [Indexed: 12/05/2022] Open
Abstract
Background Vaccination-impact studies of the live-attenuated pentavalent oral vaccine Rotateq® have demonstrated that the burden of rotavirus gastroenteritis has been reduced significantly after the introduction of RotaTeq® vaccination, but less is known about the benefit of this vaccination on hospital overcrowding. Methods As part of an observational surveillance conducted during the RV seasons 2000/2001 to 2011/2012, we analysed hospital discharge data collected retrospectively from two Finnish hospitals (Oulu and Tampere), concerning ICD 10 codes A00-09 (acute gastroenteritis, AGE) and A08.0 (rotaviral acute gastroenteritis RV AGE). We estimated the reduction in the number of beds occupied and analysed the bed occupancy rate, for RV AGE and all cause AGE, among 0–16 year-old children, before and after the implementation of the RV immunisation program. Results The rate of bed days occupied for RV AGE was reduced by 86% (95% CI 66%-94%) in Tampere and 79% (95% CI 47%-92%) in Oulu after RV vaccination implementation. For all cause AGE, reduction was 50% (95% CI 29% to 65%) in Tampere and 70% (95% CI 58% to 79%) in Oulu. Results were similar among 0–2 year-old children. This effect was also observed on overcrowding in both hospitals, with a bed occupancy rate for all cause AGE >25% in only 1% of the time in Tampere and 9% in Oulu after the implementation of the immunisation program, compared to 13% and 48% in the pre-vaccination period respectively. After extrapolation to the whole country, the annual number of prevented hospitalizations for all cause AGE in the post-vaccination period in Finland was estimated at 1,646 and 2,303 admissions for 0–2 and 0–16 year-old children respectively. Conclusions This study demonstrated that universal RV vaccination is associated with a clear decrease in the number of bed days and occupancy rates for RV AGE and all cause AGE. Positive consequences include increase in quality of care and a better healthcare management during winter epidemics.
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Arena C, Amoros JP, Vaillant V, Ambert-Balay K, Chikhi-Brachet R, Jourdan-Da Silva N, Varesi L, Arrighi J, Souty C, Blanchon T, Falchi A, Hanslik T. Acute diarrhea in adults consulting a general practitioner in France during winter: incidence, clinical characteristics, management and risk factors. BMC Infect Dis 2014; 14:574. [PMID: 25358721 PMCID: PMC4220050 DOI: 10.1186/s12879-014-0574-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/17/2014] [Indexed: 11/26/2022] Open
Abstract
Background Data describing the epidemiology and management of viral acute diarrhea (AD) in adults are scant. The objective of this study was to identify the incidence, clinical characteristics, management and risk factors of winter viral AD in adults. Methods The incidence of AD in adults during two consecutive winters (from December 2010 to April 2011 and from December 2011 to April 2012) was estimated from the French Sentinelles network. During these two winters, a subset of Sentinelles general practitioners (GPs) identified and included adult patients who presented with AD and who filled out a questionnaire and returned a stool specimen for virological examination. All stool specimens were tested for astrovirus, group A rotavirus, human enteric adenovirus, and norovirus of genogroup I and genogroup II. Age- and sex-matched controls were included to permit a case–control analysis with the aim of identifying risk factors for viral AD. Results During the studied winters, the average incidence of AD in adults was estimated to be 3,158 per 100,000 French adults (95% CI [2,321 – 3,997]). The most reported clinical signs were abdominal pain (91.1%), watery diarrhea (88.5%), and nausea (83.3%). GPs prescribed a treatment in 95% of the patients with AD, and 80% of the working patients with AD could not go to work. Stool examinations were positive for at least one enteric virus in 65% (95% CI [57 – 73]) of patients with AD with a predominance of noroviruses (49%). Having been in contact with a person who has suffered from AD in the last 7 days, whether within or outside the household, and having a job (or being a student) were risk factors significantly associated with acquiring viral AD. Conclusions During the winter, AD of viral origin is a frequent disease in adults, and noroviruses are most often the cause. No preventable risk factor was identified other than contact with a person with AD. Thus, at the present time, reinforcement of education related to hand hygiene remains the only way to reduce the burden of disease. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0574-4) contains supplementary material, which is available to authorized users.
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Abstract
BACKGROUND Rotavirus is the most common cause of severe gastroenteritis and dehydration in young children in both industrialized and developing countries. The anticipated introduction of rotavirus vaccine into Togo's national immunization program highlights the need for baseline data on the burden of this disease. METHODS We conducted sentinel surveillance for rotavirus gastroenteritis among children <5 years of age in Sylvanus Olympio Teaching Hospital of Lome (Togo) from February 2008 through January 2012, based on the World Health Organization's generic protocol. Rotavirus was detected in stool specimens by enzyme linked immunosorbent assay. The strain characterization by genotyping was performed at Noguchi Memorial Institute for Medical Research in Accra (Ghana) and at Medunsa campus in Pretoria (South Africa). RESULTS 803 children with acute gastroenteritis were enrolled and of which 390 (48%) were positive for rotavirus. The difference of age among children with rotavirus and nonrotavirus gastroenteritis was significant (P < 0.010) with rotavirus cases younger than nonrotavirus cases. From December to February, significantly (P < 0.002) more cases of rotavirus gastroenteritis were enrolled compared with other months of the year. Vomiting (P = 0.04) was more common in children with rotavirus than nonrotavirus gastroenteritis. The most common G-P combinations were G3P[6] (23%), G1P[8] (12%), G1P[6/8] (8%), G2P[6] (7%), G12P[6] (7%) and G3/12P[6] (6%). CONCLUSIONS The prevalence of rotavirus is high among children with acute gastroenteritis in Togo. Continued and extended rotavirus surveillance will be important to monitor changes in the epidemiology of rotavirus disease and the impact of vaccination after introduction.
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Van Trieu T, De Pontual L. [Management of acute diarrhea in children]. Presse Med 2012; 42:60-5. [PMID: 23265760 DOI: 10.1016/j.lpm.2012.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 10/02/2012] [Indexed: 11/26/2022] Open
Abstract
Diarrhea in childhood is very frequent (two episodes/year/children less of 5 years), rarely fatale (mostly mild) and not requiring additional exploration. But it can justify a hospitalization in case of dehydration (delay of care) or risk of dehydration. It is mainly of viral origin (rotavirus +++) and it has for main complication dehydration. Diagnosis and evaluation of the dehydration, in percentage of loss of weight, must be fast and lead (drive) to a premature correction of hypovolumic shock (or to an accurate fluid management). Main treatment is oral rehydration solutions (ORS), which considerably upset the morbi-mortality, associated with a premature refeeding. Breast-feeding must not be interrupted. Symptomatic treatments and especially antibiotics are not recommended. In case of failure of the rehydration by ORS, alternative is nasogastric tube or intraveinous infusion. Prevention includes essentially the respect of hygienic rules and antirotavirus vaccine.
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Affiliation(s)
- Thanh Van Trieu
- Hôpital Jean-Verdier, service de pédiatrie, 93140 Bondy cedex, France.
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Ogilvie I, Khoury H, Goetghebeur MM, El Khoury AC, Giaquinto C. Burden of community-acquired and nosocomial rotavirus gastroenteritis in the pediatric population of Western Europe: a scoping review. BMC Infect Dis 2012; 12:62. [PMID: 22429601 PMCID: PMC3342230 DOI: 10.1186/1471-2334-12-62] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 03/19/2012] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Isla Ogilvie
- BioMedCom Consultants Inc., 1405 TransCanada Highway, Suite 310, Montreal, QC, H9P 2V9, Canada
| | - Hanane Khoury
- BioMedCom Consultants Inc., 1405 TransCanada Highway, Suite 310, Montreal, QC, H9P 2V9, Canada
| | - Mireille M Goetghebeur
- BioMedCom Consultants Inc., 1405 TransCanada Highway, Suite 310, Montreal, QC, H9P 2V9, Canada
| | | | - Carlo Giaquinto
- Department of Paediatrics, University of Padua, Padua, Italy
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Effectiveness of rotavirus vaccines in preventing cases and hospitalizations due to rotavirus gastroenteritis in Navarre, Spain. Vaccine 2012; 30:539-43. [DOI: 10.1016/j.vaccine.2011.11.071] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 11/12/2011] [Accepted: 11/16/2011] [Indexed: 11/23/2022]
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Abstract
Since 1998, the French Health Insurance (NHI) system had established a national database in order to reimburse drug prescriptions. These electronical data are a considerable potential source for syndromic surveillance because of their exhaustive and regular updates. The aim of this study was to develop a method to identify acute gastroenteritis (AG) cases from drug reimbursements of the NHI database. The algorithm aimed at discriminating AG from other pathologies was determined from a sample of 206 AG prescriptions and 351 non-AG prescriptions collected in five pharmacies. The AG case identification was mainly based on the lag time between the prescription and delivery day, the occurrence of non-AG case-specific drugs, AG case-specific drug associations and treatment duration. The discriminant algorithm led to a sensitive and specific indicator of medically treated cases of AG with a time-spatial resolution power which met the need for waterborne AG surveillance.
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Kaboré H, Michel P, Levallois P, Déry P, Payment P, Lebel G. A descriptive review of selected nonviral enteric illnesses reported in children in Quebec between 1999 and 2006. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2010; 21:e92-8. [PMID: 21629612 PMCID: PMC2912104 DOI: 10.1155/2010/502682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To review the epidemiology of selected nonviral enteric illnesses reported in children in Quebec between 1999 and 2006. METHODS Incidence rates were calculated to describe age, sex, temporal and geographical characteristics of the selected nonviral enteric cases reported in children who were between zero and four years of age. Standard descriptive methods were used to analyze the temporal and geographical distributions of the incidence rates. RESULTS A total of 5068 cases were reported. Of these, three pathogens accounted for the majority of the infections: Giardia (32.52%), Salmonella (30.98%) and Campylobacter (30.82%). Salmonella was most frequent in children younger than one year of age, whereas comparable incidence rates for the three pathogens were calculated for children between one and four years of age. For Giardia, the geographical distributions showed that the highest rates were in areas with more than 100,000 inhabitants (except Montreal, Quebec); for Salmonella, the highest rates were in Montreal; and for Campylobacter, the highest rates were in areas with fewer than 10,000 inhabitants. No detectable trends were seen over the study period for the three pathogens. Seasonal summer peaks were noted for Salmonella and Campylobacter, contrasting with late summer to early autumn peaks for Giardia. CONCLUSION Findings suggest that Giardia, Salmonella and Campylobacter were the most common causes of nonviral enteric illnesses reported in children in Quebec. Giardia cases seemed to arise from different sources and transmission routes than the other two pathogens. Characteristics specific to Campylobacter infections in children, namely its predominance in areas with low population densities, and to Salmonella infections, namely predominance in the Greater Montreal area, should be further investigated to better guide prevention and control measures.
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Affiliation(s)
- Henri Kaboré
- Institut national de santé publique du Québec
- Unité de recherche en santé publique, Centre Hospitalier Universitaire de Québec, Québec
| | - Pascal Michel
- Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, Faculté de Médecine Vétérinaire, Université de Montréal, Montréal
| | - Patrick Levallois
- Institut national de santé publique du Québec
- Unité de recherche en santé publique, Centre Hospitalier Universitaire de Québec, Québec
| | - Pierre Déry
- Département de pédiatrie, Centre hospitalier universitaire de Québec, Québec
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Epidemiology of rotavirus-associated hospital admissions in the province of Ferrara, Italy. Eur J Pediatr 2009; 168:1423-7. [PMID: 19255784 DOI: 10.1007/s00431-009-0942-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Accepted: 02/04/2009] [Indexed: 10/21/2022]
Abstract
OVERVIEW Hospital discharge forms with specific codes for rotavirus gastroenteritis in children 0 to 14 years of age were reviewed in the period 2003-2005 in the province of Ferrara. RESULTS A total of 4,238 children were admitted to the pediatric departments; 151 patients were diagnosed with rotavirus gastroenteritis. The average annual rate of hospitalization for rotavirus gastroenteritis was 1.54/1,000 children <14 years of age and 2.9/1,000 children <5 years of age. Most hospitalizations (72%) involved children aged <60 months. The average length of hospital stay was about 5 days. Considering the Emilia Romagna regional reimbursement codes referable to rotavirus disease, the estimated costs of our 151 cases range from 214,033 euros to 341,832 euros. CONCLUSIONS The results of this study contribute to the awareness of rotavirus epidemiology in Italy and underline the potential impact of rotavirus vaccination in our province.
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Martin A, Batty A, Roberts J, Standaert B. Cost-effectiveness of infant vaccination with RIX4414 (Rotarix™) in the UK. Vaccine 2009; 27:4520-8. [PMID: 19446594 DOI: 10.1016/j.vaccine.2009.05.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 04/28/2009] [Accepted: 05/06/2009] [Indexed: 10/20/2022]
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17
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Bayiroğlu F, Cemek M, Çaksen H, Cemek F, Dede S. Altered Antioxidant Status and Increased Lipid Peroxidation in Children with Acute Gastroenteritis Admitted to a Pediatric Emergency Service. J Emerg Med 2009; 36:227-31. [DOI: 10.1016/j.jemermed.2007.05.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Revised: 04/01/2007] [Accepted: 05/11/2007] [Indexed: 10/22/2022]
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18
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Évaluation de la charge de travail induite aux urgences pédiatriques par les gastroentérites aiguës en période épidémique. Med Mal Infect 2008; 38:642-7. [DOI: 10.1016/j.medmal.2008.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 08/26/2008] [Accepted: 10/15/2008] [Indexed: 11/20/2022]
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19
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Huet F, Chouchane M, Cremillieux C, Aubert M, Caulin E, Pothier P, Allaert FA. [Prospective epidemiological study of rotavirus gastroenteritis in Europe (REVEAL study). Results in the French area of the study]. Arch Pediatr 2008; 15:362-74. [PMID: 18396016 DOI: 10.1016/j.arcped.2008.01.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 12/08/2007] [Accepted: 01/04/2008] [Indexed: 11/16/2022]
Abstract
PRIMARY OBJECTIVE To estimate the incidence of acute gastroenteritis (AGE) and rotavirus acute gastroenteritis (RVAGE) in children less than 5 years of age seeking medical care in primary care, emergency department, and hospital settings. SECONDARY OBJECTIVES To compare the clinical profile of RVAGE and non-RVAGE and to describe the distribution of RV serotypes among RVAGE cases. METHODS A prospective primary care, emergency ward and hospital-based observational study was conducted during 1 year in a selected city of France with 250,000 inhabitants. Children less than 5 years of age presenting with symptoms of AGE were included. Rotavirus was identified using an Elisa test in stools. RESULTS The estimated annual incidence of RVAGE was 1.56% for AGE and 0.87% for RVAGE in hospital, 5.87% for AGE and 2.65% for RVAGE in emergency-wards, 7.39% for AGE and 1.45% for RVAGE in primary care. Total incidence was 14.82% for AGE and 4.96% for RVAGE among children less than 5 years of age. RVAGE were more clinically severe than the AGE: dehydration (26.8% vs. 14.7%, p<0.0001), vomiting 84.9% vs. 60.9%, p<0.0001), fever (74.3% vs. 44.4%, p<0.0001), lethargy (84.9% vs. 70.2%, p<0.0001). G9 serotype was the most frequent serotype encountered (54.7%) during the study period followed by G3 serotype (33.6%) and G2 serotype (7.9%). CONCLUSION In this study, RVAGE, caused by serotypes G9 and G3, represented about 1/3 of AGE and were more severe than non-RV AGE with twice as high dehydration rate. These results underline the need for continued promotion on the use of oral rehydration fluids and provide some arguments on the benefits of vaccination against rotavirus and also permanent virological monitoring of circulating serotypes.
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Affiliation(s)
- F Huet
- Service de pédiatrie, CHU de Dijon, Dijon, France
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20
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Huet F, Allaert FA, Trancart A, Miadi-Fargier H, Trichard M, Largeron N. Évaluation du coût de la prise en charge pédiatrique des gastroentérites aiguës à rotavirus. Arch Pediatr 2008; 15:1159-66. [DOI: 10.1016/j.arcped.2008.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 02/07/2008] [Accepted: 04/13/2008] [Indexed: 11/16/2022]
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21
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Fau C, Billaud G, Pinchinat S, Lina B, Kaplon J, Pothier P, Derrough T, Marcelon L, Largeron N, Caulin E, Bellemin B, Cao Nong T, Gaspard C, Mamoux V, Floret D. [Epidemiology and burden of rotavirus diarrhea in day care centers in Lyon, France]. Arch Pediatr 2008; 15:1183-92. [PMID: 18456480 DOI: 10.1016/j.arcped.2008.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Accepted: 02/23/2008] [Indexed: 11/26/2022]
Abstract
Rotavirus is the main cause of severe, dehydrating diarrhoea in infants and young children. In industrialized countries, pediatric rotavirus gastroenteritis (PRGE) is responsible for high morbidity, particularly among children under 3 years of age attending day care centers (DCCs). The objectives of this study were to estimate the incidence, management and cost of PRGE in DCCs. We also described the nature of group A rotavirus genotypes. This study also compared the performance of different diagnostic techniques. The study was conducted from November 2004 to May 2005. Children aged less than 36 months, attending a participating DCC at least 4 times a week were included in the study. For any episode of acute gastroenteritis (AGE), defined as the occurrence of 3 or more watery or looser than normal stools and/or forceful vomiting within a 24 h period, a fecal specimen was tested by Elisa test IDEIA Rotavirus (Dako) and the immunochromatographic test VIKIA Rota-Adeno (BioMérieux). Sequencing by RT-PCR was performed to identify the rotavirus genotype. Among the 41 DCCs contacted, 18 (43.9%) agreed to participate. Out of 966 children, 547 attended a participating DCC at least 4 times a week and met the inclusion criteria. A total of 302 were included in the study. The clinical diagnosis of AGE was confirmed and validated, by the Elisa test, in 63 fecal specimens, of which 29 (46%) were positive for rotavirus antigen, with a predominance of P[8]G9 (86%). Our results showed good sensitivity and specificity for the VIKIA and Elisa methods when compared to RT-PCR. Among the PRGE cases, 36% were male and the median age was 12.2 months. The first rotavirus case was observed in December 2004 with a peak in January 2005. The incidence of PRGE cases was 2.2 [1.4-3.0] per 100 child-months in children aged less than 36 months of age, increasing to 3.4 per 100 child-months among children aged less than 24 months. Vomiting (P<0.0005) and behavior modification (P<0.001) were significantly more frequent for PRGE cases. A total of 85.7% PRGE cases sought medical attention. In 58.3% of these cases, at least one parent had to miss work for a mean duration of 2.1 days. The total cost of rotavirus cases seeking medical attention (with or without prescribed medication, days off work for parents or additional diaper consumption) was estimated at 275.54 euros/case. The PRGE incidence rate is similar to that estimated in European studies conducted in DDC. These findings confirm that rotavirus transmission occurs not only in DCCs but within the family. This is the first study to give an estimate of the incidence and the cost of rotavirus infection in DCCs in France.
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Affiliation(s)
- C Fau
- Médecins référents des crèches municipales de la ville de Lyon, France
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Pruvost I, Dubos F, Aurel M, Hue V, Martinot A. Valeur des données anamnestiques, cliniques et biologiques pour le diagnostic de déshydratation par diarrhée aiguë chez l’enfant de moins de 5 ans. Presse Med 2008; 37:600-9. [DOI: 10.1016/j.lpm.2007.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 10/17/2007] [Accepted: 10/24/2007] [Indexed: 11/30/2022] Open
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23
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Standaert B, Parez N, Tehard B, Colin X, Detournay B. Cost-effectiveness analysis of vaccination against rotavirus with RIX4414 in France. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2008; 6:199-216. [PMID: 19382820 DOI: 10.1007/bf03256134] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND It is estimated that annually 300 000 cases of rotavirus-induced gastroenteritis (RVGE) occur in children aged up to 5 years in France. A two-dose vaccine against rotavirus infection (RIX4414; Rotarix, GlaxoSmithKline), has been shown to be highly effective against severe RVGE. OBJECTIVE This study evaluated the cost effectiveness of general vaccination against rotavirus using RIX4414 in France. METHODS A Markov model simulated RVGE events and the associated outcomes and costs relating to general vaccination of infants against rotavirus infection using RIX4414 (Rotarix) in a birth cohort of children aged up to 5 years in France with a combined adjustment for age distribution with the seasonality of the infection. Costs and outcomes were estimated from a limited societal perspective, including direct medical costs paid out of pocket or by third-party payers, as well as the proportion of direct medical costs reimbursed by the health authorities. Indirect costs were not included in the base-case analysis. The primary outcome measure was the incremental cost per QALY. RESULTS Vaccination with RIX4414 incurred an incremental cost of 44 583 Euro per QALY at a public price of 57 Euro per vaccine dose. Univariate sensitivity analyses showed that the parameters with the largest influence on the results were the transition probabilities of severe diarrhoea, seeking medical advice and emergency visits, utility scores of diarrhoea (mild) in children and infants, and the discount rate for benefits. Probabilistic multivariate sensitivity analysis confirmed these results. The acceptability curve indicated that 94% of the results were under an informal threshold of 50 000 Euro per QALY. Comparing our results with those of a recently published study using pooled data for two rotavirus vaccine products in France, the main differences are explained by differences in model structure and in data input values. They include a different age distribution of the infection, shorter duration of the at-risk period (3 years instead of 5 years), different vaccine efficacy, different unit cost data, different disease duration, and different disutility values for the health states in the model. There is a need for agreed standards to improve comparability of results from different studies. CONCLUSIONS The results demonstrate that a generalized vaccination strategy with RIX4414 would be cost effective in France from a limited societal perspective, depending on the baseline assumptions for disease progression and on utility scores selected.
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24
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Dhont P, Trichard M, Largeron N, Rafia R, Bénard S. Burden of rotavirus gastroenteritis and potential benefits of a pentavalent rotavirus vaccination in Belgium. J Med Econ 2008; 11:431-48. [PMID: 19450097 DOI: 10.3111/13696990802306162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE AND METHODS A decision analytic model was built to assess the paediatric rotavirus gastroenteritis (RVGE) burden and potential benefits associated with the introduction of RotaTeq (pentavalent rotavirus vaccine) in Belgium. RESULTS In the absence of a rotavirus (RV) immunisation programme, paediatric RVGE was estimated to account for about 5,860 hospitalisations, 1,720 cases of nosocomial infections, 9,410 cases treated by general practitioners/paediatricians (GP/P) and 10,790 cases not seeking medical care for a birth cohort followed up to 5 years of age. Paediatric RVGE was estimated to cost about euro9.0 million from the Belgian healthcare provider perspective and euro15.3 million to society. Given a 90% RV vaccination coverage rate, the pentavalent RV vaccine would have a high impact on RV burden by preventing more than 4,850 hospitalisations, 995 cases of nosocomial infections, 7,145 cases treated by GP/P and 8,190 cases not seeking medical care, and reduce RVGE costs by euro7.1 million from the Belgian healthcare provider perspective and euro12.0 million to society.
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Affiliation(s)
- Patrick Dhont
- sanofi pasteur MSD, avenue Jules Bordet 13 Brussels 1140, Belgium
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25
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26
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Huet F, Largeron N, Trichard M, Miadi-Fargier H, Jasso-Mosqueda G. Burden of paediatric rotavirus gastroenteritis and potential benefits of a universal rotavirus vaccination programme with RotaTeq in France. Vaccine 2007; 25:6348-58. [PMID: 17629598 DOI: 10.1016/j.vaccine.2007.06.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Revised: 06/07/2007] [Accepted: 06/11/2007] [Indexed: 10/23/2022]
Abstract
This study aimed at estimating the paediatric RotaVirus GastroEnteritis (RVGE) burden in children aged up to 5 years, and at evaluating health and economic benefits of a universal infant vaccination with a pentavalent rotavirus vaccine, in France. A decision analytic model was constructed considering a cohort of French children from birth to 5 years old. In the absence of a universal rotavirus immunisation programme, the model predicts that of every new French birth cohort, 336,738 children would present a RVGE case, which would result in 33,386 hospitalisations, 14 deaths and more than 279,000 work days lost for the parents. The management of these RVGE cases would cost 63 million euro to the National Healthcare Payer and would reach up to 117 million euro when all indirect costs were included. The introduction of a universal rotavirus vaccination would avoid 249,400 RVGE cases and consequently about 25,700 hospitalisations, 6000 nosocomial infections, 81,200 emergency visits, 39,900 general practitioner or paediatrician consultations, 11 deaths and 206,700 parental work days lost. RVGE total costs would be reduced by 47 million euro for the National Healthcare Payer and by 88 million euro from the Societal perspective. Therefore, a routine universal rotavirus vaccination programme represents an opportunity to significantly reduce the high paediatric RVGE burden in France.
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Affiliation(s)
- Frédéric Huet
- Hôpital du Bocage, Service de pédiatrie, 10 boulevard du Maréchal de Lattre de Tassigny, 21000 Dijon, France
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27
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Harris JP, Jit M, Cooper D, Edmunds WJ. Evaluating rotavirus vaccination in England and Wales. Vaccine 2007; 25:3962-70. [PMID: 17395343 DOI: 10.1016/j.vaccine.2007.02.072] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 02/16/2007] [Indexed: 11/17/2022]
Abstract
Rotavirus is a major cause of gastroenteritis in young children. New vaccines for rotavirus are now available and countries need to establish the health and economic burden of rotavirus disease to assess whether vaccine introduction is advisable. This study assesses the fraction of acute gastroenteritis in children under 5 years that may be attributable to rotavirus using multiple linear regression. Results suggest around 45% of hospitalisations, 25% of GP consultations, 27% of NHS Direct calls and 20% of accident and emergency (A&E) attendances for acute gastroenteritis in this age group may be attributable to rotavirus. The annual incidence is estimated to be 4.5 hospitalisations, 9.3 A&E consultations, and 28-44 GP consultations per 1000 children under five years of age. The cost to the health service is estimated to be pound 14.2m per annum. Rotavirus vaccination has the potential to reduce this burden of disease. This study provides a sound basis on which to make this assessment and serves as a baseline against which any reductions that do occur if vaccination is introduced can be measured against.
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Affiliation(s)
- J P Harris
- Environmental and Enteric Diseases Department, Centre for Infections, Health Protection Agency, United Kingdom
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28
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Van Damme P, Van der Wielen M, Ansaldi F, Desgrandchamps D, Domingo JD, Sanchez FG, Gray J, Haditsch M, Johansen K, Lorgelly P, Lorrot M, Parez N, Reschke V, Rose M. Rotavirus vaccines: considerations for successful implementation in Europe. THE LANCET. INFECTIOUS DISEASES 2007; 6:805-12. [PMID: 17123900 DOI: 10.1016/s1473-3099(06)70657-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A group of European experts in infectious diseases and vaccinology has met on several occasions to assess the rationale for universal vaccination against rotavirus infection of infants in Europe. On the basis of the available data, we concluded that vaccination was the best approach to prevent severe rotavirus gastroenteritis, and that European countries should consider implementing rotavirus vaccination in their routine immunisation programmes. The main barrier to the implementation of rotavirus vaccination in Europe is a general lack of awareness of stakeholders, policymakers, health-care professionals, and parents about rotavirus disease and the advantages of vaccination. Further studies on the cost of the disease and the benefit of vaccination, together with raising awareness are necessary steps to ensure successful implementation of rotavirus vaccination in Europe.
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Affiliation(s)
- Pierre Van Damme
- Centre for the Evaluation of Vaccination, University of Antwerp, Belgium.
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Regagnon C, Chambon M, Archimbaud C, Charbonné F, Demeocq F, Labbé A, Aumaître O, Ughetto S, Peigue-Lafeuille H, Henquell C. Diagnostic rapide des infections à rotavirus : étude prospective comparative de deux techniques de détection d'antigènes dans les selles. ACTA ACUST UNITED AC 2006; 54:343-6. [PMID: 16481124 DOI: 10.1016/j.patbio.2005.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Accepted: 12/01/2005] [Indexed: 11/24/2022]
Abstract
The ability of two commercially available diagnosis rapid assays in detecting rotavirus antigen was compared in a prospective study conducted from September 2002 to May 2003. Five hundred and twelve faecal specimens were studied by IDEIA Rotavirus enzyme immunoassay test (EIA) and Diarlex MB immunochromatographic test (ICG). Specimens giving discrepant results were examined by electron microscopy (EM) and clinical data reconsidered. Out of 512 stool specimens, 155 (30.3%) were positive and 332 (64.8%) negative with the two assays. Discrepant results were obtained for 25 (4.88%) specimens (24 children, 1 adult), with EIA giving more positive results. The retrospective examination by EM, possible for fifteen stools on the 25 that gave discrepant results, confirmed the presence of rotavirus in 7/14 stools which were positive only by EIA and in the stool specimen that was found positive only by ICG. The 25 clinical observations re-examination showed the presence of GEA signs in all cases. The statistical analysis shows an excellent concordance between the EIA and the ICG tests (kappa = 0.89, IC(95%) = [0.85-0.93]) in spite of the underestimation of ICG test in comparison with EIA test (P < 0.0001).
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Affiliation(s)
- C Regagnon
- Service de virologie médicale, centre de biologie, CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France.
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Martinot A, Aurel M, Pruvost I, Hue V, Dubos F. L'épidémiologie clinique aux urgences peut-elle contribuer à améliorer la prise en charge des gastro-entérites aiguës du nourrisson ? Arch Pediatr 2006; 13:555-7. [PMID: 16690278 DOI: 10.1016/j.arcped.2006.03.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A Martinot
- Clinique de pédiatrie et université de Lille-II, hôpital Jeanne-de-Flandre, avenue E.-Avinée, 59037 Lille cedex, France.
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Abstract
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 72,000-77,000 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 Euro 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.
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Gleizes O, Desselberger U, Tatochenko V, Rodrigo C, Salman N, Mezner Z, Giaquinto C, Grimprel E. Nosocomial rotavirus infection in European countries: a review of the epidemiology, severity and economic burden of hospital-acquired rotavirus disease. Pediatr Infect Dis J 2006; 25:S12-21. [PMID: 16397425 DOI: 10.1097/01.inf.0000197563.03895.91] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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.
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Melliez H, Boelle PY, Baron S, Mouton Y, Yazdanpanah Y. [Morbidity and cost of rotavirus infections in France]. Med Mal Infect 2005; 35:492-9. [PMID: 16316731 DOI: 10.1016/j.medmal.2005.08.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2005] [Accepted: 08/31/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Rotavirus is the most common cause of severe diarrhea in children. Morbidity and mortality related to rotavirus infection is not well known in temperate countries in general, and in France in particular. OBJECTIVES The aim of this study was estimate the morbidity, mortality, and cost related to the rotavirus infection in France, in order to assess the potential impact of a vaccination program. METHODS A birth cohort was followed until 5 years of age using a decision tree model. Rotavirus infection incidence rates were modeled according to age, seasons, and breast-feeding status. RESULTS Based on estimates from a decision model, we found that in France, rotavirus infection was responsible for 300,000 annual episodes of acute diarrhea, 138,000 visits to general practitioners, 18,000 hospitalizations, and 9 deaths. The annual direct cost related to rotavirus infection care was estimated at 28 million euros. CONCLUSION This study demonstrates the high morbidity and cost of care associated with rotavirus infection in France. The decision tree model developed in this study could be used in the future to estimate the potential effectiveness, cost and cost-effectiveness of childhood vaccination strategies using new rotavirus vaccines.
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Affiliation(s)
- H Melliez
- Service universitaire régional de maladies infectieuses, faculté de médecine de Lille, 135, rue du Président-Coty, BP 619, 59208 Tourcoing cedex, France.
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