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Mrozek-Budzyn D, Kieltyka A, Majewska R, Augustyniak M. The effectiveness of rotavirus vaccine in preventing acute gastroenteritis during rotavirus seasons among Polish children. Arch Med Sci 2016; 12:614-20. [PMID: 27279856 PMCID: PMC4889696 DOI: 10.5114/aoms.2016.59935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/30/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Rotavirus is the main etiological cause of intestinal infections in children. Voluntary rotavirus vaccines were included in the Polish vaccination schedule in 2007. The aim of this study was to assess the effectiveness of a completed rotavirus vaccination course in preventing acute gastroenteritis in Polish infants during their first five years of life. MATERIAL AND METHODS This was a retrospective cohort study conducted in Lesser Poland (Malopolska Province). The sample population included a group of 303 children who received the completed rotavirus vaccination course and 303 children not vaccinated against rotavirus. The date of the child's acute gastroenteritis diagnosis and his or her vaccination history were extracted from the physicians' records. Each kind of diagnosed acute gastroenteritis during winter-spring rotavirus seasons was treated as the endpoint. The relative risk of having gastrointestinal infection was assessed using the hazard ratio from the Cox proportional hazards regression model. RESULTS In the examined group, 96 (15.8%) children had winter-spring gastrointestinal infections. In the non-vaccinated children, the cumulative incidence of these infections in the first 5 years of life was 20.8%, whereas in the children vaccinated with Rotarix it was only 10.9%. Those who were vaccinated with Rotarix had a 44% reduction in the risk of a winter-spring acute gastroenteritis infection compared to those not vaccinated with Rotarix (p = 0.005). Birth weight less than 2500 g increased the risk of the infection twofold and also reached statistical significance (p = 0.044). CONCLUSIONS The results showed that Rotarix is effective in preventing acute gastroenteritis in Polish children during rotavirus seasons.
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Affiliation(s)
- Dorota Mrozek-Budzyn
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Kieltyka
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Renata Majewska
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Malgorzata Augustyniak
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
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Shafi A, Farooq U, Akram K, Jaskani M, Siddique F, Tanveer A. Antidiarrheal Effect of Food Fermented by Various Strains ofLactobacillus. Compr Rev Food Sci Food Saf 2014; 13:229-239. [DOI: 10.1111/1541-4337.12056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 12/23/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Afshan Shafi
- Inst. of Food Science and Nutrition; Univ. of Sargodha; Sargodha Pakistan
| | - Umar Farooq
- Inst. of Food Science and Nutrition; Univ. of Sargodha; Sargodha Pakistan
| | - Kashif Akram
- Inst. of Food Science and Nutrition; Univ. of Sargodha; Sargodha Pakistan
| | - Mahgul Jaskani
- Inst. of Food Science and Nutrition; Univ. of Sargodha; Sargodha Pakistan
| | - Farzana Siddique
- Dept. of Food Technology; Pir Mehr Ali Shah Arid Agriculture Univ.; Rawalpindi Pakistan
| | - Amna Tanveer
- Inst. of Food Science and Nutrition; Univ. of Sargodha; Sargodha Pakistan
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A Survey on Rotavirus Associated Diarrhea in 5 Main Cities of Iran. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2013. [DOI: 10.5812/pedinfect.6431] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nosocomial Rotovirus Gastroenetrocolitis in Children Hospitalized Primarily Due to Respiratory Infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 755:267-74. [DOI: 10.1007/978-94-007-4546-9_34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bouzón-Alejandro M, Redondo-Collazo L, Sánchez-Lastres JM, Martinón-Torres N, Martinón-Sánchez JM, Martinón-Torres F. Prospective evaluation of indirect costs due to acute rotavirus gastroenteritis in Spain: the ROTACOST study. BMC Pediatr 2011; 11:81. [PMID: 21917176 PMCID: PMC3190332 DOI: 10.1186/1471-2431-11-81] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 09/14/2011] [Indexed: 01/14/2023] Open
Abstract
Background The effect of rotavirus in developed countries is mainly economic. This study aimed to assess the indirect costs induced by rotavirus acute gastroenteritis (RVAGE) in Spain. Methods A prospective observational study was conducted from October 2008 to June 2009. It included 682 children up to 5 years of age with acute gastroenteritis (AGE) who attended primary care (n = 18) and emergency room/hospital settings (n = 10), covering the regions of Galicia and Asturias (North-west Spain). All non-medical expenses incurred throughout the episode were recorded in detail using personal interviews and telephone contact. Results Among the 682 enrolled children, 207 (30.4%) were rotavirus positive and 170 (25%) had received at least one dose of rotavirus vaccine. The mean (standard deviation) indirect cost caused by an episode of AGE was estimated at 135.17 (182.70) Euros. Costs were 1.74-fold higher when AGE was caused by rotavirus compared with other etiologies: 192.7 (219.8) Euros vs. 111.6 (163.5) Euros (p < .001). The costs for absenteeism were the most substantial with a mean of 91.41 (134.76) Euros per family, resulting in a loss of 2.45 (3.17) days of work. In RVAGE patients, the absenteeism cost was 120.4 (154) Euros compared with 75.8 (123) for the other etiologies (p = .002), because of loss of 3.5 (3.6) vs 1.9 (2.9) days of work (p < .001). Meals costs were 2-fold-higher (48.5 (55) vs 24.3 (46) Euros, p < .001) and travel costs were 2.6-fold-higher (32 (92) vs 12.5 (21.1) Euros, p = .005) in RVAGE patients compared with those with other etiologies. There were no differences between RVAGE and other etiologies groups regarding costs of hiring of caregivers or purchase of material. Patients with RVAGE were admitted to hospital more frequently than those with other etiologies (47.8% vs 14%, p < .001). Conclusions Rotavirus generates a significant indirect economic burden. Our data should be considered in the decision-making process of the eventual inclusion of rotavirus vaccine in the national immunization schedule of well developed countries.
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Abstract
This is a cross-sectional and analytical-descriptive study of 511 children less than 36 months of age who were admitted to Tabriz Children's Hospital with acute gastroenteritis during a period of 2 years (from October 2007 to October 2009). Rotavirus was found in stool specimens of 284 (55.6%) of 511 children with diarrhea. Two-thirds of them were admitted during autumn and winter for a mean hospital stay of 3.1 ± 1.8 days.
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Ogilvie I, Khoury H, El Khoury AC, Goetghebeur MM. Burden of rotavirus gastroenteritis in the pediatric population in Central and Eastern Europe: serotype distribution and burden of illness. HUMAN VACCINES 2011; 7:523-33. [PMID: 21422818 DOI: 10.4161/hv.7.5.14819] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Rotaviral gastroenteritis (RVGE) is the leading cause of severe diarrhea in children under five years of age worldwide. This comprehensive review aims to estimate the burden of RVGE among children in Central and Eastern Europe. METHODS An extensive search of the biomedical literature (1999-2009) was conducted in major databases. Studies pertaining to the epidemiology and burden of rotavirus in Central and Eastern Europe were captured and data from each country was systematically extracted and compared. RESULTS This literature search captured 38 studies pertaining to RVGE infection in the region. Among children under 15 years of age, RVGE accounted for between 22.0% and 55.3% of all cases of acute gastroenteritis per year. For most countries RVGE was most common in the winter months, although it was reported year round in Bulgaria. Geographical comparison of genotyping data revealed that three genotype combinations, G1P[8], G4P[8], and G2P[4] were present in all countries for which full genotyping data was available. Genotype predominance varied on a season to season basis within each country. Only limited data was available for healthcare resource utilization, and economic burden for this region. CONCLUSIONS RVGE is a common disease associated with significant morbidity, and mortality. While three genotype combinations currently predominate in the region, the dominance of a certain serotype can change dramatically from year to year and from country to country. A vaccination program with broad serotype coverage may help to decrease the burden of RVGE in Central and Eastern Europe.
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Affiliation(s)
- Isla Ogilvie
- BioMedCom Consultants inc., Montreal, Quebec, Canada.
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Wildi-Runge S, Allemann S, Schaad UB, Heininger U. A 4-year study on clinical characteristics of children hospitalized with rotavirus gastroenteritis. Eur J Pediatr 2009; 168:1343-8. [PMID: 19205732 DOI: 10.1007/s00431-009-0934-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 01/24/2009] [Indexed: 10/21/2022]
Abstract
Rotavirus (RV) is a frequent cause of severe gastroenteritis (GE) in children. With the licensure of new RV vaccines, data on the burden of disease are important regarding immunization strategies. We reviewed the medical records of children hospitalized with RV infection in our institution between July 2002 and March 2006. Relevant data were extracted in a standardized fashion from records of hospitalized children with a positive RV antigen test in a stool sample. Severity of disease was graded by the 20-point Vesikari score. Population data were obtained from the Federal Office of Statistics. Six hundred eighty-six RVGE were identified and records of 608 hospitalizations (in 607 children) were available. In 539 (89%) cases, RVGE was the primary reason for hospitalization and 69 (11%) were nosocomial infections; yearly peaks occurred between February and May. Cumulative incidence of RVGE was 26.7/1,000 children <3 years of age. Median age of 539 children (55.6% male) with primary RVGE was 1.4 years and median stay in the hospital for both community acquired and nosocomial RVGE was 4 days (interquartile range 3-5). Thirtypercent and 94% of RV hospitalizations were in children <1 and <3 years of age, respectively. Mean Vesikari score was 15 (range 6-20; 96% >11). Intravenous fluids were administered in 378 (70%) patients, 130 (24%) patients were rehydrated via nasogastral tube, and 31 (5.7%) received rehydration by mouth. RVGE causes a substantial burden in children with an estimated risk for hospitalization due to RVGE of one in 37 children <3 years of age.
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Hospitalizations for nosocomial rotavirus gastroenteritis in a tertiary pediatric center: a 4-year prospective study. Am J Infect Control 2009; 37:465-9. [PMID: 19155098 DOI: 10.1016/j.ajic.2008.09.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Revised: 09/14/2008] [Accepted: 09/16/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although rotavirus is the most common cause of gastroenteritis worldwide, data regarding nosocomial rotavirus gastroenteritis (NRVGE) are limited. Our objectives were to study the rates, seasonality, epidemiology, and clinical features of NRVGE. METHODS This was a 4-year prospective study. RESULTS NRVGE occurred in 1% of all admissions (356/35,833), 0.8% of all hospitalization days (1164/145,595) and 0.24 cases per 100 hospitalization days. Rates of NRVGE were age-dependent, occurring in 1.8%, 1.5%, 0.3%, and 0.1% of the admissions of children age < or = 1, > 1 to 2, > 2 to 5, and > 5 years, respectively (P < .001). Of the children age > 5 years, 90% received immunosuppressive treatment or had significant underlying diseases. The number of NRVGE cases was highest in winter months, but it occurred throughout the year, and its percentage of all hospitalizations for rotavirus gastroenteritis was highest in the summer months. NRVGE occurred after a median hospitalization of 6 days, required a median hospital stay of 3 days, and warranted treatment with intravenous fluids in 67% of cases. CONCLUSION NRVGE is a significant health burden, especially in children age < or = 2 years, although it also can affect children age > 5 years with significant underlying disturbances. Vaccine prevention of rotavirus gastroenteritis also could reduce NRVGE and should be considered in cost-effectiveness analyses.
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Estimated mortality and hospital admission due to rotavirus infection in the WHO European region. Epidemiol Infect 2009; 137:607-16. [DOI: 10.1017/s0950268808001714] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYIn 2006 two rotavirus vaccines were licensed for use in young children in Europe. This study aimed to estimate the mortality and hospital admissions due to rotavirus in children aged <5 years in the WHO European region using data from routine sources and published literature. We grouped 49/52 countries in the region by their World Bank Gross National Income (GNI) per capita. We obtained for children aged <5 years: populations, hospital discharges for diarrhoeal disease, estimated mortality rates and the percentage of deaths attributable to diarrhoeal disease, from WHO data sources or published literature, and combined them to estimate country-specific diarrhoeal disease mortality. Rotavirus-attributable percentages of hospital admissions due to diarrhoeal disease were obtained through a literature search, and an income-group median applied to countries in each GNI category. In the countries we studied in the WHO European region, rotavirus infection causes an estimated 6550 deaths (range 5671–8989) and 146 287 (range 38 374–1 039 843) hospital admissions each year in children aged <5 years. Hospital admission rates were similar across income groups (medians 2·0, 2·8, 4·2 and 1·9/1000 per year in low-, lower-middle-, upper-middle- and high-income countries, respectively). Seven countries, mostly in the low- and lower-middle-income groups, accounted for 93% of estimated deaths. Disease burden varied dramatically by income level in the European region. Rotavirus vaccination in Azerbaijan, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan and Turkey could potentially prevent 80% of all regional rotavirus deaths. Data from low-income countries is still sparse, and improved disease burden studies are required to better inform regional vaccine policy.
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Yang BM, Jo DS, Kim YH, Hong JM, Kim JS. The societal cost of rotavirus infection in South Korea. KOREAN JOURNAL OF PEDIATRICS 2008. [DOI: 10.3345/kjp.2008.51.9.977] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Bong Min Yang
- School of Public Health, Seoul National University, Seoul, korea
| | - Dae Sun Jo
- Department of Pediatrics, Medical School, Chonbuk National University, Jeonju, Korea
| | - Youn Hee Kim
- School of Public Health, Seoul National University, Seoul, korea
| | - Ji Min Hong
- School of Public Health, Seoul National University, Seoul, korea
| | - Jung Soo Kim
- Department of Pediatrics, Medical School, Chonbuk National University, Jeonju, Korea
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Albano F, Bruzzese E, Bella A, Cascio A, Titone L, Arista S, Izzi G, Virdis R, Pecco P, Principi N, Fontana M, Guarino A. Rotavirus and not age determines gastroenteritis severity in children: a hospital-based study. Eur J Pediatr 2007; 166:241-7. [PMID: 16941130 DOI: 10.1007/s00431-006-0237-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Revised: 06/16/2006] [Accepted: 06/26/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND The severity of childhood gastroenteritis is generally believed to be age-related rather than aetiology-related. Rotavirus-induced gastroenteritis is more severe than gastroenteritis caused by other enteric pathogens and is also age-related. We thus addressed the question of whether the increased severity of rotavirus-induced gastroenteritis is related to age or to features intrinsic to the agent. STUDY DESIGN In this multicentre, hospital-based, prospective survey, we evaluated the severity of diarrhoea in rotavirus-positive and rotavirus-negative children up to 4 years of age. Severity was assessed with a score in four groups of age-matched children. RESULTS Rotavirus was detected in 381 of 911 children. Disease severity was evaluated in 589 cases for which clinical data were complete. The rotavirus-positive and rotavirus-negative groups differed with regards to diarrhoea duration, hospital stay, degree of dehydration and the number of episodes of vomiting. Gastroenteritis was more severe in rotavirus-positive than in rotavirus-negative children. In contrast, none of the main severity parameters differed in the four age groups, irrespective of the presence of rotavirus. CONCLUSIONS These data provide the evidence that aetiology and not age determines diarrhoeal severity. The demonstration that diarrhoea was more severe in rotavirus-positive children supports the need for a rotavirus vaccine and for studies that address the duration of vaccine protection.
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Affiliation(s)
- Fabio Albano
- Dipartimento di Pediatria, Università di Napoli Federico II, via S. Pansini 5, 80131 Naples, Italy
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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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Chandran A, Heinzen RR, Santosham M, Siberry GK. Nosocomial rotavirus infections: a systematic review. J Pediatr 2006; 149:441-7. [PMID: 17011311 DOI: 10.1016/j.jpeds.2006.04.054] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Revised: 03/16/2006] [Accepted: 04/25/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Aruna Chandran
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA
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Abstract
Probiotics, defined as microbial cell preparations or components of microbial cells that have a beneficial effect on the health and well being of the host, have traditionally been used to treat and prevent a variety of infections. Beneficial effects of probiotics in acute infectious diarrhea in children seem to be: (i) moderate; (ii) strain-dependent; (iii) dose dependent; (iv) significant in watery diarrhea and viral gastroenteritis, but non-existent in invasive, bacterial diarrhea; and (v) more evident when treatment with probiotics is initiated early in the course of disease. Three large, randomized controlled trials (RCTs) provide evidence of a very modest effect (statistically significant, but of questionable clinical importance) of some probiotic strains (Lactobaccillus GG, Lactobaccillus reuteri, Bifodobacterium lactis) on the prevention of community-acquired diarrhea. We have found conflicting evidence from four RCTs on the efficacy of Lactobacillus GG and B. bifidum and Streptococcus thermophilus in the prevention of nosocomial diarrhea in children. Two RCTs in children provide evidence of a moderate beneficial effect of Lactobacillus GG in the prevention of antibacterial-associated diarrhea (AAD), but results in adults are conflicting. Data on the efficacy of other probiotic strains in AAD in children are very limited. In conclusion, to date, the most extensively studied and best documented clinical application of probiotics in children is for the treatment of acute watery diarrhea of rotaviral or presumably viral etiology. Studies documenting effects in other types of diarrheal diseases in children are limited, although some preliminary results are promising. The effects of different probiotic microorganisms are not equal. Only very few probiotic strains have been tested rigorously in RCTs. Many questions remain to be answered. Future clinical trials should evaluate carefully selected, precisely defined probiotic strains and address clinically important endpoints.
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Affiliation(s)
- Hania Szajewska
- Department of Paediatric Gastroenterology and Nutrition, The Medical University of Warsaw, Warsaw, Poland.
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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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Abstract
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.
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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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Karadag A, Acikgoz ZC, Avci Z, Catal F, Gocer S, Gamberzade S, Uras N. Childhood diarrhoea in Ankara, Turkey: epidemiological and clinical features of rotavirus-positive versus rotavirus-negative cases. ACTA ACUST UNITED AC 2005; 37:269-75. [PMID: 15804663 DOI: 10.1080/00365540410020983] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Published reports dealing with rotavirus infections in Turkey are very scarce. This study included 1099 consecutive paediatric patients with diarrhoea, who sought care at 3 hospitals in Ankara, Turkey between 1999 and 2002 and were investigated for the presence of rotavirus antigen in faeces. Rotavirus antigen was detected by an immunochromatographic test, Simple Rotavirus (Operon, Spain). Other clinical and laboratory data were extracted from patient journals. A total of 404 (36.8%) patients were positive for rotavirus antigen. Rotavirus antigen was more frequently detected in boys than girls (40.8 vs 31.8%) and in children younger than 2 y (62.7%). The proportion of rotavirus-positive children was higher in the winter season (49.6%; November to April) and the highest proportion was observed in December (55.4%). Rotavirus-associated diarrhoea had a more severe clinical presentation than non-rotaviral diarrhoea; 55.3% of all patients who required hospitalization were rotavirus-positive. The seasonal and epidemiological characteristics of rotavirus diarrhoea in Ankara were similar to those in the USA and Europe. For reliable nationwide information about the epidemiology of rotavirus-associated disease in Turkey, more individual studies and reliable official statistics of gastroenteritis cases are needed.
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Affiliation(s)
- Ahmet Karadag
- Department of Paediatrics, Fatih University, Faculty of Medicine, Ankara, Turkey
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Fischer TK, Bresee JS, Glass RI. Rotavirus vaccines and the prevention of hospital-acquired diarrhea in children. Vaccine 2004; 22 Suppl 1:S49-54. [PMID: 15576202 DOI: 10.1016/j.vaccine.2004.08.017] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Rotavirus, the major cause of severe acute dehydrating gastroenteritis in children less than 5 years of age, is responsible for an estimated 20-50% of all hospitalizations for diarrhea and approximately 440,000 deaths annually, primarily in the developing world. Rotavirus vaccines are considered the most promising means for disease prevention. While the prime rationale for developing rotavirus vaccines has been the enormous burden of rotavirus infection leading to severe and fatal disease, a secondary benefit may be the prevention of nosocomial rotavirus diarrhea. We have reviewed the burden of intra-hospital-acquired rotavirus infections from several countries and found that in the United States alone, as many as 25% of rotavirus hospitalizations or approximately 16,000-18,000 hospitalizations each year might be due to rotavirus infections acquired within hospitals. To countries with low rotavirus-associated mortality, prevention of these infections and the resulting economic savings therefore represent an important secondary goal. Several rotavirus vaccines are in development, and two candidates are currently being tested in large-scale safety and efficacy trials. Development of safe and effective rotavirus vaccines will protect children worldwide against the severe consequences of rotavirus infections including prolonged hospitalizations for nosocomially acquired infections.
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Affiliation(s)
- Thea K Fischer
- Epidemic Intelligence Service, Epidemiology Program Office, USA.
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Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI. Global Illness and Deaths Caused by Rotavirus Disease in Children. Emerg Infect Dis 2003. [DOI: 10.3201/eid0905.020562 order by 8029-- awyx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Affiliation(s)
| | | | - Joseph S. Bresee
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark A. Miller
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Roger I. Glass
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI. Global Illness and Deaths Caused by Rotavirus Disease in Children. Emerg Infect Dis 2003. [DOI: 10.3201/eid0905.020562 order by 1-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Affiliation(s)
| | | | - Joseph S. Bresee
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark A. Miller
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Roger I. Glass
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI. Global Illness and Deaths Caused by Rotavirus Disease in Children. Emerg Infect Dis 2003. [DOI: 10.3201/eid0905.020562 order by 8029-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Affiliation(s)
| | | | - Joseph S. Bresee
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark A. Miller
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Roger I. Glass
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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25
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Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI. Global Illness and Deaths Caused by Rotavirus Disease in Children. Emerg Infect Dis 2003. [DOI: 10.3201/eid0905.020562 order by 1-- gadu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Affiliation(s)
| | | | - Joseph S. Bresee
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark A. Miller
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Roger I. Glass
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI. Global illness and deaths caused by rotavirus disease in children. Emerg Infect Dis 2003; 9:565-72. [PMID: 12737740 PMCID: PMC2972763 DOI: 10.3201/eid0905.020562] [Citation(s) in RCA: 1237] [Impact Index Per Article: 58.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
To estimate the global illness and deaths caused by rotavirus disease, we reviewed studies published from 1986 to 2000 on deaths caused by diarrhea and on rotavirus infections in children. We assessed rotavirus-associated illness in three clinical settings (mild cases requiring home care alone, moderate cases requiring a clinic visit, and severe cases requiring hospitalization) and death rates in countries in different World Bank income groups. Each year, rotavirus causes approximately 111 million episodes of gastroenteritis requiring only home care, 25 million clinic visits, 2 million hospitalizations, and 352,000-592,000 deaths (median, 440,000 deaths) in children <5 years of age. By age 5, nearly every child will have an episode of rotavirus gastroenteritis, 1 in 5 will visit a clinic, 1 in 65 will be hospitalized, and approximately 1 in 293 will die. Children in the poorest countries account for 82% of rotavirus deaths. The tremendous incidence of rotavirus disease underscores the urgent need for interventions, such as vaccines, particularly to prevent childhood deaths in developing nations.
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Affiliation(s)
- Umesh D Parashar
- Viral Gastroenteritis Section, Division of Viral and Ricksettial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop G04, Atlanta, GA 30333, USA.
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27
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Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI. Global Illness and Deaths Caused by Rotavirus Disease in Children. Emerg Infect Dis 2003. [DOI: 10.3201/eid0905.020562 order by 1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Affiliation(s)
| | | | - Joseph S. Bresee
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark A. Miller
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Roger I. Glass
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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28
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Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI. Global Illness and Deaths Caused by Rotavirus Disease in Children. Emerg Infect Dis 2003. [DOI: 10.3201/eid0905.020562 order by 8029-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Affiliation(s)
| | | | - Joseph S. Bresee
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark A. Miller
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Roger I. Glass
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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29
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Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI. Global Illness and Deaths Caused by Rotavirus Disease in Children. Emerg Infect Dis 2003. [DOI: 10.3201/eid0905.020562 and 1880=1880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Affiliation(s)
| | | | - Joseph S. Bresee
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark A. Miller
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Roger I. Glass
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Abstract
Acute gastroenteritis is one of the most common diseases in humans worldwide. Viruses are recognized as important causes of this disease, particularly in children. Since the Norwalk virus was identified as a cause of gastroenteritis, the number of viral agents associated with diarrheal disease in humans has steadily increased. Rotavirus is the most common cause of severe diarrhea in children under 5 years of age. Astrovirus, calicivirus and enteric adenovirus are also important etiologic agents of acute gastroenteritis. Other viruses, such as toroviruses, coronaviruses, picobirnaviruses and pestiviruses, are increasingly being identified as causative agents of diarrhea. In recent years, the availability of diagnostic tests, mainly immunoassays or molecular biology techniques, has increased our understanding of this group of viruses. The future development of a safe and highly effective vaccine against rotavirus could prevent, at least, cases of severe diarrhea and reduce mortality from this disease.
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Affiliation(s)
- I Wilhelmi
- Servicio de Microbiología, Instituto de Salud Carlos III, Sección de Virus Productores de Gastroenteritis, Madrid, Spain.
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31
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Cunliffe NA, Bresee JS, Hart CA. Rotavirus vaccines: development, current issues and future prospects. J Infect 2002; 45:1-9. [PMID: 12217724 DOI: 10.1053/jinf.2002.1012] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The potential benefit of safe and effective rotavirus vaccination in reducing morbidity and especially mortality from rotavirus gastroenteritis among children in developing countries has long been recognised. More recently, the focus of attention shifted to developed countries, where cost-effectiveness analyses justified the routine introduction of rotavirus vaccines into childhood immunisation schedules. The recent withdrawal in the U.S.A. of the first licensed rotavirus vaccine (the tetravalent rhesus reassortant rotavirus vaccine), following investigation into reports of intussusception among a number of vaccinees, has directed attention once more towards rotavirus vaccine use in developing countries. However, issues relating to vaccine safety, efficacy, and cost, remain to be overcome before widespread introduction of rotavirus vaccines can be anticipated.
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Affiliation(s)
- Nigel A Cunliffe
- Department of Medical Microbiology and Genito-Urinary Medicine, University of Liverpool, Duncan Building, Daulby Street, Liverpool L69 3GA, UK.
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Alcalde Martín C, Gómez López L, Carrascal Arranz M, Blanco del Val A, Marcos Andrés H, Bedate Calderón P, González Pérez A, Jiménez Mena E. Gastroenteritis aguda en pacientes hospitalizados. Estudio evolutivo de 14 años. An Pediatr (Barc) 2002. [DOI: 10.1016/s1695-4033(02)78939-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Frühwirth M, Heininger U, Ehlken B, Petersen G, Laubereau B, Moll-Schüler I, Mutz I, Forster J. International variation in disease burden of rotavirus gastroenteritis in children with community- and nosocomially acquired infection. Pediatr Infect Dis J 2001; 20:784-91. [PMID: 11734742 DOI: 10.1097/00006454-200108000-00013] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The great impact of rotavirus disease on morbidity and medical health care costs in industrialized countries together with the withdrawal of the live oral rotavirus vaccine have made a reassessment of rotavirus gastroenteritis necessary. Such a reassessment should provide sufficient data for developing alternative disease prevention strategies and for allocating resources efficiently. OBJECTIVES To compare characteristics and management of community- and nosocomially acquired rotavirus disease in Austria, Germany and Switzerland. PATIENTS AND METHODS In a prospective, population-based, trinational (Austria, Germany, Switzerland), multicenter (9 cities, 10 hospitals and 30 pediatric practices) study, a total of 174 552 children months and 78 516 hospital days were evaluated. Participants were all children 4 years of age and younger, who either presented at one of the pediatric practices with community-acquired gastroenteritis, or who had acquired gastroenteritis nosocomially. From December, 1997, to May, 1998, prospective antigen testing was done by enzyme-linked immunosorbent assay, and serotyping was done by reverse transcription polymerase chain reaction. Disease severity was scored by the Vesikari severity scale. RESULTS Rotavirus was detected in 29.5, 27 and 37.5% of children with community-acquired gastroenteritis and in 57, 69 and 49% of children with nosocomial gastroenteritis in Austria, Germany and Switzerland, respectively. Severity of community-acquired rotavirus gastroenteritis was more pronounced in Austria (median severity score, 11) than in Germany (median score, 9) or Switzerland (median score, 10). However, only 2% of Austrian and Swiss children compared with 12% of German children presented to their pediatricians more than four times. Nosocomially acquired rotavirus gastroenteritis was mildest in Austria but occurred within the shortest median duration of hospitalization (4 days vs. 5 and 7 in Germany and Switzerland, respectively). In a multivariant analysis age, family size, day care, breast-feeding and nationality were not predictive factors for enhanced risk to contract rotavirus infection. Alimentation was changed frequently; diet was used between 23 and 83%; special formulas were used between 10 and 57%. CONCLUSION The cumulative experience from three European countries suggest that rotavirus is an important cause of diarrhea in Central Europe, but significant local differences clearly demonstrate the need for obtaining national data as a reliable basis for control and prevention of the disease.
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Affiliation(s)
- M Frühwirth
- Department of Pediatrics, University Hospital Innsbruck, Innsbruck, Austria.
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Szajewska H, Kotowska M, Mrukowicz JZ, Armańska M, Mikołajczyk W. Efficacy of Lactobacillus GG in prevention of nosocomial diarrhea in infants. J Pediatr 2001; 138:361-5. [PMID: 11241043 DOI: 10.1067/mpd.2001.111321] [Citation(s) in RCA: 213] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Nosocomial diarrhea is a major problem in pediatric hospitals worldwide. We evaluated the efficacy of orally administered Lactobacillus GG (LGG) in the prevention of this disease in young children. STUDY DESIGN Eighty-one children aged 1 to 36 months who were hospitalized for reasons other than diarrhea were enrolled in a double-blind trial and randomly assigned at admission to receive LGG (n = 45) at a dose of 6 x 10(9) colony-forming units or a comparable placebo (n = 36) twice daily orally for the duration of their hospital stay. RESULTS LGG reduced the risk of nosocomial diarrhea (> or =3 loose or watery stools/24 h) in comparison with placebo (6.7% vs 33.3%; relative risk: 0.2; [95% CI: 0.06-0.6]; number needed to treat: 4 [95% CI: 2-10]). The prevalence of rotavirus infection was similar in LGG and placebo groups (20% vs 27.8%, respectively; relative risk: 0.72; 95% CI: 0.33-1.56). However, the use of LGG compared with placebo significantly reduced the risk of rotavirus gastroenteritis (1/45 [2.2%] vs 6/36 [16.7%], respectively; relative risk: 0.13; 95% CI: 0.02-0.79; number needed to treat: 7; 95% CI: 3-40). CONCLUSIONS Prophylactic use of LGG significantly reduced the risk of nosocomial diarrhea in infants, particularly nosocomial rotavirus gastroenteritis.
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Affiliation(s)
- H Szajewska
- Department of Pediatric Gastroenterology and Nutrition, The Medical University of Warsaw, Warsaw, Poland
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36
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de Wit MA, Koopmans MP, van der Blij JF, van Duynhoven YT. Hospital admissions for rotavirus infection in the Netherlands. Clin Infect Dis 2000; 31:698-704. [PMID: 11017818 DOI: 10.1086/314025] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/1999] [Revised: 02/08/2000] [Indexed: 12/25/2022] Open
Abstract
The development of a vaccine against rotavirus (RV) infection has necessitated the estimation of the number of hospitalizations for RV infection in the Netherlands. During 1998, pediatricians have reported all hospitalizations with RV infection and supplied information on the duration of admission, clinical picture, indication for admission, and treatment. Also, data from the National Disease Registry on hospitalizations for gastroenteritis (International Classification of Disease codes 006.6. 006.8, 009, and 558.9) and laboratory surveillance data for 1996-1998 were combined in a linear regression model to indirectly estimate the incidence and proportion of hospitalizations attributable to RV infection. The direct estimate of admissions for RV infection in children aged <5 years was 0.9 per 1000, and the indirect estimate was 2.7 per 1000 in 1998 (1996, 3.4; 1997, 1.6). The proportion of hospitalizations for gastroenteritis attributable to RV ranged from 32% in 1997 to 58% in 1996.
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Affiliation(s)
- M A de Wit
- Department of Infectious Diseases Epidemiology, National Institute of Public Health and the Environment, Bilthoven, the Netherlands.
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