Distribution of rotavirus VP4 genotypes and VP7 serotypes among nonhospitalized and hospitalized patients with gastroenteritis and patients with nosocomially acquired gastroenteritis in Austria

Investigation of Rotavirus with Various Methods in Children with Acute Gastroenteritis and Determination of Its Molecular Epidemiology in Kayseri Province, Turkey

BACKGROUND

In this study, the fresh stool samples from 254 children under 5 years of age with acute gastroenteritis which were delivered between October 2012 and December 2013 were collected.

METHODS

In the stool samples, rotavirus antigens were investigated using two different immunochromatographic methods which are routinely used at different times, namely the RIDA^® QUICK Rotavirus/Adenovirus Combi Test (R-Biopharm AG, Germany) and the Genx^® Rotavirus Test (Diamed-Lab, Turkey), in addition to the Rotavirus Ag (Stool) ELISA (DRG, Germany) kit. The results were compared with reverse transcriptase PCR (RT-PCR).

RESULTS

When the Genx^® Rotavirus Test and RIDA^® QUICK Rotavirus/Adenovirus Combi Test immunochromatographic methods were compared with RT-PCR, their sensitivity and specificity were found as 97.1%, 100%, and 80.4%, 72%, respectively. As to the Rotavirus Ag (Stool) ELISA method, on the other hand, its sensitivity was found to be 95.1% and its specificity was 86.5%. The most common genotype was G9P[8] (40%), which was followed by the G1P[8] (18.7%) and G3P[8] (9.6%) genotypes.

CONCLUSION

Consequently, it was revealed that the sensitivity of ELISA and immunochromatographic methods, which provide results in a short time and are used in the investigation of rotavirus antigen, was high and their specificity was low; further studies to determine the distribution of G and P genotypes will contribute to establishing strategies for vaccine development for rotavirus in the world.

Sentinel hospital-based surveillance for assessment of burden of rotavirus gastroenteritis in children in Pakistan

Objectives

To determine the burden and molecular epidemiology of rotavirus gastroenteritis in children hospitalized with severe acute watery diarrhea in Pakistan prior to introduction of rotavirus vaccine.

Methods

A cross-sectional study was carried out over a period of two years from 2006 – 2008 at five sentinel hospitals in the cities of Karachi, Lahore, Rawalpindi, and Peshawar. Stool samples collected from children under five years of age hospitalized with severe acute watery diarrhea were tested for rotavirus antigen via enzyme immunoassay (EIA) (IDEA REF K6020 Oxoid Ltd (Ely), Cambridge, United Kingdom). A subset of EIA positive stool samples were further processed for genotyping.

Results

6679 children were enrolled and stool specimens of 2039 (30.5%) were positive for rotavirus. Rotavirus positivity ranged from 16.3% to 39.4% in the 5 hospitals with highest positivity in Lahore. 1241 (61%) of all rotavirus cases were in infants under one year of age. Among the strains examined for G-serotypes, the occurrence of G1, G2, G9 and G4 strains was found to be 28%, 24%, 14% and 13%, respectively. Among P-types, the most commonly occurring strains were P6 (31.5%) followed by P8 (20%) and P4 (12%). Prevalent rotavirus genotype in hospitalized children of severe diarrhea were G1P[8] 11.6% (69/593), followed by G2P[4] 10.4% (62/593), and G4P[6] 10.1% (60/593).

Conclusions

Approximately one third of children hospitalized with severe gastroenteritis in urban centers in Pakistan have rotavirus. Introduction of rotavirus vaccine in Pakistan's national immunization program could prevent many severe episodes and diarrheal deaths.

The impact of Rotavirus mass vaccination on hospitalization rates, nosocomial Rotavirus gastroenteritis and secondary blood stream infections

Background

The aim of the study was to evaluate the effects of universal mass vaccination (UMV) against rotavirus (RV) on the hospitalization rates, nosocomial RV infections and RV-gastroenteritis (GE)-associated secondary blood stream infections (BSI).

Methods

The retrospective evaluation (2002–2009) by chart analysis included all clinically diagnosed and microbiologically confirmed RV-GE cases in a large tertiary care hospital in Austria. The pre-vaccination period (2002–2005) was compared with the recommended and early funded (2006–2007) and the funded (2008–2009) vaccination periods. Primary outcomes were RV-GE-associated hospitalizations, secondary outcomes nosocomial RV disease, secondary BSI and direct hospitalization costs for children and their accompanying persons.

Results

In 1,532 children with RV-GE, a significant reduction by 73.9% of hospitalized RV-GE cases per year could be observed between the pre-vaccination and the funded vaccination period, which was most pronounced in the age groups 0–11 months (by 87.8%), 6–10 years (by 84.2%) and 11–18 years (88.9%). In the funded vaccination period, a reduction by 71.9% of nosocomial RV-GE cases per year was found compared to the pre-vaccination period. Fatalities due to nosocomial RV-GE were only observed in the pre-vaccination period (3 cases). Direct costs of hospitalized, community-acquired RV-GE cases per year were reduced by 72.7% in the funded vaccination period. The reduction of direct costs for patients (by 86.9%) and accompanying persons (86.2%) was most pronounced in the age group 0–11 months.

Conclusions

UMV may have contributed to the significant decrease of RV-GE-associated hospitalizations, to a reduction in nosocomial RV infections and RV-associated morbidity due to secondary BSI and reduced direct hospitalization costs. The reduction in nosocomial cases is an important aspect considering severe disease courses in hospitalized patients with co-morbidities and death due to nosocomial RV-GE.

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

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.

Impact of rotavirus vaccination on hospital-acquired rotavirus gastroenteritis in children

OBJECTIVE

Data show that after the implementation of routine rotavirus vaccination for infants in the United States, community-acquired (CA) rotavirus cases declined substantially in the 2007-2008 season. The impact of community-based rotavirus vaccination on the substantial burden of hospital-acquired (HA) rotavirus has not been documented.

PATIENTS AND METHODS

We assessed CA and HA rotavirus, respiratory syncytial virus, and influenza infections at Children's Memorial Hospital for 5 winter seasons (defined as occurring from September through May) from 2003 to 2008. We also report rotavirus data from the 2008-2009 season.

RESULTS

A similar dramatic decline (>60% compared with the median of previous seasons) occurred in the rates of cases of both CA (P < .0001) rotavirus hospitalizations and HA (P < .01) rotavirus infections in the 2007-2008 season compared with previous seasons, whereas the rates of CA and HA influenza and respiratory syncytial virus, respectively, remained stable. Improvements in hand-hygiene compliance did not correlate with a reduction in the transmission rate of rotavirus in the hospital. Both CA and HA rotavirus rates remained much lower in the 2008-2009 than in the 2003-2007 seasons.

CONCLUSIONS

Community-based rotavirus vaccination is associated with a substantial reduction in the number of children who are admitted with rotavirus. These data also indicate that routine community-based rotavirus infant vaccination protects hospitalized children from acquiring rotavirus. Vaccination efforts should be encouraged as a strategy to affect the substantial burden of HA rotavirus.

Healthcare-associated viral gastroenteritis among children in a large pediatric hospital, United Kingdom

Enteric viruses introduced from the community are major causes of these illnesses.

Viruses are the major pathogens of community-acquired (CA) acute gastroenteritis (AGE) in children, but their role in healthcare-associated (HA) AGE is poorly understood. Children with AGE hospitalized at Alder Hey Children’s Hospital, Liverpool, UK, were enrolled over a 2-year period. AGE was classified as HA if diarrhea developed >48 hours after admission. Rotavirus, norovirus, adenovirus 40/41, astrovirus, and sapovirus were detected by PCR. A total of 225 children with HA-AGE and 351 with CA-AGE were enrolled in the study. HA viral gastroenteritis constituted one fifth of the diarrheal diseases among hospitalized children and commonly occurred in critical care areas. We detected >1 virus in 120 (53%) of HA-AGE cases; rotavirus (31%), norovirus (16%), and adenovirus 40/41 (15%) were the predominant viruses identified. Molecular evidence indicated rotaviruses and noroviruses were frequently introduced into the hospital from the community. Rotavirus vaccines could substantially reduce the incidence of HA-AGE in children.

Nosocomial rotavirus gastroenteritis in Spain: a multicenter prospective study

BACKGROUND

The objective of this study was to assess the incidence of nosocomial rotavirus gastroenteritis among children <2 years of age.

METHODS

We conducted a prospective active surveillance for acute gastroenteritis (AGE) in the pediatric wards of 3 representative hospitals in Valencia (Spain) from October 2006 to March 2007, among children between 1 and 23 months of age with acute diarrhea. Children were followed up for 3 days after discharge. We obtained clinical and demographic information from participants and tested their stool specimens for rotavirus.

RESULTS

A total of 1576 children were hospitalized at the 3 hospitals and 1300 (82.5%) were followed up as the study cohort. In 69 children, AGE started 48 hours after admission and were considered nosocomial infections. In 35 of the 59 cases where stool samples were obtained, rotavirus (RV) was present (59%), and in 12 of them symptoms started after discharge. The accumulated incidence of nosocomial rotavirus disease during the study period was 2.8 cases per 100 inpatients (95% CI: 1.9-3.8), and the incidence rate was 4.8 cases per 1000 hospital days (95% CI: 3.2-6.5). The most commonly found genotype in nosocomial infection was G9P[8], in 23 cases (66%), followed by G1P[8] in 4 cases (11%). The total economic cost was 883 euro per case.

CONCLUSION

Active surveillance demonstrated that the burden of nosocomial rotavirus disease is substantial, and G9P [8] was the genotype found most frequently. Following up children after discharge from hospital allowed the discovery of cases of nosocomial RVAGE which are missed in most other studies.

Hospitalizations for nosocomial rotavirus gastroenteritis in a tertiary pediatric center: a 4-year prospective study

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.

G-serotypes of group A rotaviruses in Pilsen region (Czechia)

A total of 260 feces samples from children with confirmed rotavirus infection collected during 1999-2002 were serotyped, using enzymoimmunoassay with VP7 specific monoclonal antibodies for G1-G4 serotypes. The serotypes were identified in 185 feces, i.e. 71.2 %. Individual serotypes occurred in 43, 2, 16 and 2 %; 8 % samples reacted with 2 type-specific monoclonal antibodies. The G1 serotype was prevalent over the whole period. The G3 type occurred with a statistically higher significance in children of up to 36 months (chi2 = 4.6, p = 0.028). In 4 children a different serotype was demonstrated in the first and second, or in the second and third stools, respectively. No dominant serotype was found in children with nosocomial infection.

Human rotavirus serotype G9, São Paulo, Brazil, 1996-2003

Diverse rotavirus strains are present, and frequency of G9 is high.

A total of 3,101 fecal specimens were collected during an 8-year survey for rotavirus infection in São Paulo, Brazil. Group A rotavirus was detected in 774 (25.0%) specimens. Of these, 431 strains (55.7%) were analyzed for G and P types by reverse transcription–polymerase chain reaction; G1 was the predominant serotype (68.2%), followed by G9 (17.2%), G4 (6.3%), G2 (1.2%), G3 (0.7%), mixed infection (1.8%), and untypeable (4.6%). Both rotavirus G and P types could be established in 332 strains (77.0%). We identified the 4 most common strains worldwide: P[8]G1 (66.6%), P[4]G2 (1.0%), P[8]G3 (0.6%), and P[8]G4 (7.2%). Among the single G9 strains detected, VP4 genotyping showed that P[8]G9 was the most prevalent, followed by P[4]G9 and P[6]G9. The emergence and high frequency of rotavirus G9 in São Paulo, Brazil, and other parts of the world will affect the development and evaluation of future vaccines.

A lack of significant association between the electropherotype or G-serotype of the infecting strain and disease severity of rotavirus gastroenteritis

Despite many previous studies, the question has not been settled as to whether some human rotavirus strains are more virulent than others. Since disease severity is most clearly reflected by the hospitalization status of the infected children, we examined whether there was any difference in the distribution of dominant strains between inpatient and outpatient groups. The study population comprised 763 children with acute diarrhea who were treated at a general hospital in Honjo City, Akita, Japan, during 1986-1997. Rotaviruses from stool specimens were classified into 77 electropherotypes using polyacrylamide gel electrophoresis. A single dominant strain or two co-dominant strains circulated simultaneously with some infrequent strains in most rotavirus seasons. Over the 11 rotavirus seasons, there was no significant difference in the relative frequencies of 15 rotavirus strains between the inpatient and the outpatient groups when strains of rotavirus were defined by their electropherotypes in polyacrylamide gel electrophoresis. However, infection with one G1 strain that co-dominated with a G4 strain carrying an identical electropherotype except the VP7 gene resulted in a statistically significantly reduced risk of hospitalization. There was no significant difference in the relative frequencies of four major G-serotypes or long/short RNA pattern. We conclude that the virulence or disease-causing potential of human rotavirus is not substantially different in the majority of strains.

Rotavirus types in Europe and their significance for vaccination

The degree of diversity of cocirculating human rotavirus wild-type strains is high. This article reviews the occurrence and frequency of rotavirus types in European children younger than 5 years of age during the past 10-15 years. To enable greater understanding of the overall epidemiologic situation, rotavirus types found in animals in Europe are described. In addition, rotavirus types occurring in children outside Europe are considered. Taken together, these data provide an essential background to the development of rotavirus vaccines. The different concepts of immunization with the 2 main rotavirus candidate vaccines are briefly discussed, and their potential impact on the epidemiology of cocirculating rotavirus wild-type viruses is considered. A case is made for comprehensive surveillance of cocirculating human rotavirus types in Europe after the implementation of rotavirus vaccination.

Characterisation of rotavirus strains among hospitalised and non-hospitalised children in Guinea-Bissau, 2002 A high frequency of mixed infections with serotype G8

BACKGROUND

In a previous community-based cohort study in Guinea-Bissau from 1996 to 1998, characterisation of rotavirus strains showed a high frequency of less common genotypes such as G8 and G9 and a high proportion of mixed infections.

OBJECTIVES AND STUDY DESIGN

In the present study, we examined the prevalence of rotavirus genotypes among 81 hospitalised and 23 non-hospitalised Guinean children with rotavirus associated diarrhoea during the 2002 seasonal rotavirus outbreak. G- and P-types were determined in a two-step procedure using reverse transcription followed by a standard multiplex PCR. The multiplex PCR for G-types was furthermore supplemented with a single locus PCR including the MW8 primer for the G8-genotype.

RESULTS

The dual infection G2/P[4]P[6] (24%) appeared to be the most frequent cause of rotavirus infections followed by G2P[4] (19%), G2P[6] (16%) and G8P[6] (13%). Overall 38% of the infections were mixed and 18% of the samples had the genotype G8. However, by subjecting all samples and not only the strains, which according to the standard multiplex PCR procedure were non-typeable, to a single locus G8-PCR, we found that the genotype G8 appeared in 62% of the infections, either as a single G-strain or in combination with other G-types, especially G2. Including these results, more than 63% of infections emerged as mixed. Neither genotype (including the presence of G8) nor the presence of mixed infections, seem to influence the severity of the rotavirus infection.

CONCLUSION

We found a high frequency of mixed infections especially due to G8-genotypes, which might have implications for development of rotavirus vaccine candidates for use in Africa. Our results do not suggest that a single genotype is associated with severity, but the present study is based on a modest number of samples and results should be interpreted with caution.

Serotype diversity and reassortment between human and animal rotavirus strains: implications for rotavirus vaccine programs

The development of rotavirus vaccines that are based on heterotypic or serotype-specific immunity has prompted many countries to establish programs to assess the disease burden associated with rotavirus infection and the distribution of rotavirus strains. Strain surveillance helps to determine whether the most prevalent local strains are likely to be covered by the serotype antigens found in current vaccines. After introduction of a vaccine, this surveillance could detect which strains might not be covered by the vaccine. Almost 2 decades ago, studies demonstrated that 4 globally common rotavirus serotypes (G1-G4) represent >90% of the rotavirus strains in circulation. Subsequently, these 4 serotypes were used in the development of reassortant vaccines predicated on serotype-specific immunity. More recently, the application of reverse-transcription polymerase chain reaction genotyping, nucleotide sequencing, and antigenic characterization methods has confirmed the importance of the 4 globally common types, but a much greater strain diversity has also been identified (we now recognize strains with at least 42 P-G combinations). These studies also identified globally (G9) or regionally (G5, G8, and P2A[6]) common serotype antigens not covered by the reassortant vaccines that have undergone efficacy trials. The enormous diversity and capacity of human rotaviruses for change suggest that rotavirus vaccines must provide good heterotypic protection to be optimally effective.

Characterization of rotavirus strains in a Danish population: high frequency of mixed infections and diversity within the VP4 gene of P[8] strains

We characterized the G and P types from 162 rotavirus-positive stool specimens collected from 162 persons in Denmark (134 children and 28 adults) with acute diarrhea in 1998, 2000, and 2002. Samples were obtained during outpatient consultations (73%) and from hospitalized patients (27%). Although more than 20 different G-P combinations were identified, only 52% represented the globally most common types G1P[8], G2P[4], and G4P[8]. The G9 genotype, which is emerging worldwide, was identified in 12% of all samples. Twenty-one percent of the samples were of mixed genotypic origin, which is the highest frequency reported in any European population. The standard reverse transcription-PCR methods initially failed to identify a considerable fraction of the rotavirus P strains due to mutations at the VP4 primer-binding sites of P[8] strains. The application of a degenerate P[8] primer resulted in typing of most VP4 strains. There was considerable year-to-year variation among the circulating G-P types, and whereas G1P[8] was predominant in 1998 (42% of samples) and 2002 (26%), G2P[4] was the strain that was most frequently detected in 2000 (26% of samples). Our findings might implicate challenges for rotavirus vaccine implementation in a European population and underscore the importance of extensive strain surveillance prior to, during, and after introduction of any vaccine candidate.

Global distribution of rotavirus serotypes/genotypes and its implication for the development and implementation of an effective rotavirus vaccine

A safe and effective rotavirus vaccine is urgently needed, particularly in developing countries. Critical to vaccine development and implementation is a knowledge base concerning the epidemiology of rotavirus G and P serotypes/genotypes throughout the world. The temporal and geographical distribution of human rotavirus G and P types was reviewed by analysing a total of 45571 strains collected globally from 124 studies reported from 52 countries on five continents published between 1989 and 2004. Four common G types (G1, G2, G3 and G4) in conjunction with P[8] or P[4] represented over 88% of the strains analysed worldwide. In addition, serotype G9 viruses associated with P[8] or P[6] were shown to have emerged as the fourth globally important G type with the relative frequency of 4.1%. When the global G and/or P type distributions were divided into five continents/subcontinents, several characteristic features emerged. For example, the P[8]G1 represented over 70% of rotavirus infections in North America, Europe and Australia, but only about 30% of the infections in South America and Asia, and 23% in Africa. In addition, in Africa (i) the relative frequency of G8 was as high as that of the globally common G3 or G4, (ii) P[6] represented almost one-third of all P types identified and (iii) 27% of the infections were associated with rotavirus strains bearing unusual combinations such as P[6]G8 or P[4]G8. Furthermore, in South America, uncommon G5 virus appeared to increase its epidemiological importance among children with diarrhea. Such findings have (i) confirmed the importance of continued active rotavirus strain surveillance in a variety of geographical settings and (ii) provided important considerations for the development and implementation of an effective rotavirus vaccine (e.g. a geographical P-G type adjustment in the formulation of next generation multivalent vaccines).

Characterization of rotavirus strains from hospitalized and outpatient children with acute diarrhoea in São Paulo, Brazil

From August 1994 to July 1995, 234 faecal samples from children with or without acute diarrhoea were collected and tested. The group of children with acute diarrhoea (A) was subdivided into two subgroups: subgroup A(1) was made up of children with severe diarrhoea, dehydrated and who needed hospitalization and subgroup A(2) was composed of children who only needed outpatient care. Group B was composed of children without acute diarrhoea (controls). Rotavirus was detected in 36.7% (18/49), 22.0% (15/68) and 1.7% (2/117) patients in groups A(1), A(2) and B, respectively. Of the 35 positive samples in which rotaviruses were detected the VP7 genotypes G1, G2, G3, G5 and the mixture (G2 + G5) were found in 40.0, 11.4, 11.4, 22.9 and 2.9% of the samples, respectively. Also, the VP4 genotypes P[8], P[4] and P[6] were detected in 57.1, 31.4 and 5.7%, respectively. Rotavirus VP6 subgroups I and II were detected at a frequency of 22.4 and 54.3%, respectively. Rotavirus RNA segments had short and long electrophoresis profiles in 20.0 and 51.4% of the cases, respectively. The severity of the disease was not related to a specific G and P types, subgroup or electropherotype.

Gastroenteritis aguda nosocomial e infección asintomática por rotavirus y astrovirus en niños hospitalizados

BACKGROUND

Nosocomial gastroenteritis is frequent in pediatric hospital wards. Between 20% and 50% of gastroenteritis cases caused by rotavirus and astrovirus are of nosocomial origin.

OBJECTIVE

To determine the incidence of nosocomial rotavirus and astrovirus gastroenteritis in our environment, the incidence of asymptomatic infection with these viruses, and to identify the G serotypes of the rotaviruses detected.

METHODS

We performed a prospective study of all children under 2 years of age admitted to a neonatology unit over a 1-year period who were followed-up for the presence of diarrhea and periodic study of feces to detect the presence of rotavirus and astrovirus antigens by enzyme immunoassay (EIA). Patients with gastroenteritis also underwent bacteria stool culture, adenovirus detection by EIA, calcivirus detection by polymerase chain reaction, and analysis of rotavirus G serotypes by EIA with monoclonal antibodies.

RESULTS

Of 666 children admitted without diarrhea, 60 presented nosocomial gastroenteritis (9 % of patients admitted and 1.75 per 100 days of hospital stay): 34 presented rotavirus (5 % of patients) and two presented astrovirus (0.3 % of patients). Of the 329 patients without diarrhea who were studied, viral elimination was detected in 27: rotavirus in 23 patients and astrovirus in four. Viral infection was detected on admission in 13 patients (4 %) and after 72 hours in 14 patients (4.2 %) (asymptomatic nosocomial infection). No differences in the distribution of rotavirus G serotypes were observed between community-acquired and nosocomial gastroenteritis.

CONCLUSIONS

These data confirm the importance of viral etiology in nosocomial gastroenteritis and allow us to evaluate asymptomatic fecal elimination of rotavirus as one of the factors in the transmission of this infection.

Molecular characterization of rotavirus strains from children in Toronto, Canada

BACKGROUND

Rotaviruses are the most common agents of diarrheal illness of infants and young children. Gastroenteritis caused by rotaviruses is also more likely to be associated with severe dehydration compared to other viral gastroenteritis.

OBJECTIVES

We determined the G-serotype of rotaviruses circulating in the Metro Toronto-Peel County region, during the 1997-1998 winter.

STUDY DESIGN

Stool samples were collected in Metro Toronto-Peel county region from November 1, 1997 to June 30, 1998. Rotavirus presence was demonstrated by electron microscopy and ELISA. A reverse transcription-polymerase chain reaction (RT-PCR) assay for the amplification of the near-complete RHA segment 9 of rotavirus was developed and used to determine the G-serotype by sequencing and phylogenetic analysis.

RESULTS

A total of 135 rotavirus isolates were used as templates for RT-PCR. Of these, four could not be amplified and one revealed a mixed infection. The G-serotypes could be unambiguously determined for the other isolates. Of these, 85 were of G-serotype 1, 41 of G2, 1 of G3, 1 of G4, and 2 of G9.

CONCLUSION

Our RT-PCR assay enables unambiguous determination of the G-serotype. The overall relative incidence of G-serotypes in Toronto is similar to that of other developed countries. Serotype G9 was present at low levels in Toronto.

Gastrointestinal infections

Advances in public health have reduced the risk of contracting certain enteric diseases, but many remain, and new pathogens have emerged and/or recently have been discovered. The pathogenic agents are varied and consist of a variety of bacteria and select viruses and parasites. Selected use of microbiologic assays to detect these pathogens is encouraged. When tests are ordered non-judiciously, costs rapidly accrue. The age of the patient, time of year, travel history, and clinical presentation all provide clues to the etiologic agent. Microbiologic assays should be used judiciously to confirm or exclude the likely infectious agents.

International variation in disease burden of rotavirus gastroenteritis in children with community- and nosocomially acquired infection

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.

A prospective evaluation of community acquired gastroenteritis in paediatric practices: impact and disease burden of rotavirus infection

AIMS

To examine the disease burden and epidemiology of community acquired rotavirus gastroenteritis in Austrian children treated in a paediatric practice.

METHODS

A prospective, population based, multicentre study in four paediatric practices and two children's hospitals (Innsbruck and Leoben). Children </= 48 months of age presenting with gastroenteritis during a six month period of rotavirus peak between December 1997 and May 1998 were included. Prospective testing of stool samples for rotavirus was performed using ELISA.

RESULTS

A total of 6969 children were enrolled; 171 (2.4%) had community acquired gastroenteritis. Of 144 children who could be included in further analysis, 49 (34%; median age 16.7 months) were rotavirus positive, and 95 (66%; median age 17.0 months) were rotavirus negative. Three of the rotavirus positive children (median age 14.6 months) were hospitalised. The severity of rotavirus positive gastroenteritis was significantly higher than that of rotavirus negative gastroenteritis. The incidence of community acquired gastroenteritis was 4.67 per 100 children per year, and of rotavirus positive gastroenteritis 1.33 per 100 children per year.

CONCLUSION

Rotavirus is a relevant cause of community acquired gastroenteritis in children aged 4 years and younger treated by a paediatrician. The data can be used as a basis for developing strategies to prevent infection.

Rotavirus infection as cause of tacrolimus elevation in solid-organ-transplanted children

Rotavirus (RV) is the most common cause of diarrheal illness in children. We report three solid-organ-transplanted patients in whom RV infection caused increased trough levels of the immunosuppressive macrolide tacrolimus (TAC) by mechanisms that are still under investigation. The virus was detected for longer in the feces of these patients than in infants not receiving immunosuppressive therapy. In association with short-term monitoring of blood trough levels of TAC, the dosage should be reduced early if symptoms of an acute gastroenteritis are present.