Microbiota-Derived Extracellular Vesicles as a Postbiotic Strategy to Alleviate Diarrhea and Enhance Immunity in Rotavirus-Infected Neonatal Rats

Rotavirus (RV) infection is a major cause of acute gastroenteritis in children under 5 years old, resulting in elevated mortality rates in low-income countries. The efficacy of anti-RV vaccines is limited in underdeveloped countries, emphasizing the need for novel strategies to boost immunity and alleviate RV-induced diarrhea. This study explores the effectiveness of interventions involving extracellular vesicles (EVs) from probiotic and commensal E. coli in mitigating diarrhea and enhancing immunity in a preclinical model of RV infection in suckling rats. On days 8 and 16 of life, variables related to humoral and cellular immunity and intestinal function/architecture were assessed. Both interventions enhanced humoral (serum immunoglobulins) and cellular (splenic natural killer (NK), cytotoxic T (Tc) and positive T-cell receptor γδ (TCRγδ) cells) immunity against viral infections and downregulated the intestinal serotonin receptor-3 (HTR3). However, certain effects were strain-specific. EcoR12 EVs activated intestinal CD68, TLR2 and IL-12 expression, whereas EcN EVs improved intestinal maturation, barrier properties (goblet cell numbers/mucin 2 expression) and absorptive function (villus length). In conclusion, interventions involving probiotic/microbiota EVs may serve as a safe postbiotic strategy to improve clinical symptoms and immune responses during RV infection in the neonatal period. Furthermore, they could be used as adjuvants to enhance the immunogenicity and efficacy of anti-RV vaccines.

Severe Adult Rotavirus Gastroenteritis: A Rare Case with Multi-Organ Failure and Critical Management

BACKGROUND Infectious diarrheal illnesses such as rotavirus gastroenteritis are significant contributors to childhood morbidity and mortality, especially in low socio-demographic index regions. Major advances in addressing this issue include sanitation and clean water initiatives, as well as rotavirus immunization. In Australia, a robust vaccination program has significantly reduced childhood rotavirus infections, leading to decreased hospitalizations and mortality. However, cases of adult rotavirus still occur, and although these adult patients usually do not require interventional management, it is possible for them to present critically unwell and require resuscitation. CASE REPORT A previously well 65-year-old man presented to the Emergency Department febrile and hypotensive with severe diarrhea attributed to rotavirus. Clinically, he presented with mixed hypovolemic and septic shock. Despite initial resuscitation, he had multiple severe acute end-organ complications, secondary to poor perfusion. He acquired an acute kidney injury, type-2 myocardial infarction, and ischemic hepatic injury. The mainstay of management was rapid fluid resuscitation, continuous renal replacement therapy, and monitoring in the Intensive Care Unit; however, it was crucial to empirically treat for other causes of shock. CONCLUSIONS To the best of our knowledge, there is a scarcity of reports documenting the management of severe rotavirus gastroenteritis in adults. We recommend advising elderly patients to avoid contact with individuals with diarrheal illnesses, especially rotavirus gastroenteritis. Clinicians should also promote awareness regarding the potential severity of a disease that is typically managed conservatively, and be aware that intervention can be required in severe gastroenteritis.

Study on the effectiveness and safety of Xingpi Yanger granule combined with Saccharomyces boulardii for rotavirus enteritis in children: A protocol for systematic review and meta-analysis

BACKGROUND

To systematically evaluate the effectiveness and safety of traditional Chinese medicine preparation XPYEG combined with SBI and SBI alone in the treatment of REC, and to provide the reference in drugs for the clinical treatment of children with rotavirus enteritis.

METHODS

Retrieving the English databases: PubMed, Cochrane Library and Embase; Chinese databases: CNKI, CBM and WANFANG Data. Retrieving a randomized controlled trial of XPYEG and SBI in the treatment of REC. The retrieval time is from the above database until September 2020. The retrieval strategy of combining free words and subject words is adopted, and the references included in the literature are searched manually in accordance with the literature studied in this paper and not included in the above database. Two researchers screen the literature according to the literature inclusion and exclusion criteria, extract valid data and evaluate the quality of the literature, and cross-check it. Using the RevMan 5.3 software to conduct the meta-analysis on the main outcome and secondary outcome indicators of the included literature, while assessing the evidence quality of included study.

RESULTS

The effectiveness and safety of XPYEG and SBI in the treatment of REC are presented through the main and secondary outcome indicators.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/3QSZG.

CONCLUSION

This study will conclude whether the combination of XPYEG and SBI is more effective than SBI alone in the treatment of REC, and whether the medication increases the risk of adverse reactions compared with single medication.

ETHICS AND DISSEMINATION

This study does not involve the specific patients, and all research data comes from publicly available professional literature, so an ethics committee is not required to conduct an ethical review and approval of the study.

Effect of a new Lactobacillus plantarum product, LRCC5310, on clinical symptoms and virus reduction in children with rotaviral enteritis

BACKGROUND

Rotavirus is one of the most common causes of infantile enteritis. In common enterocolitis, probiotic organisms, including Lactobacilli, are effective in treating diarrhea. A new species, Lactobacillus plantarum (LRCC5310), which was shown to inhibit the adherence and proliferation of rotavirus in the small intestine through animal experiments, was investigated for the efficacy and safety of patients with rotaviral enteritis.

METHODS

LRCC5310 (Group I) and control (Group II) groups consisting of children who were hospitalized for rotaviral enteritis were compared, and the medical records of patients (Group III) who were hospitalized for rotaviral enteritis during the same study period were retrospectively analyzed. Clinical symptoms were compared and stool samples were collected to compare changes in virus multiplication between Groups I and II.

RESULTS

Groups I, II, and III comprised 15, 8, and 27 children, respectively. There were no differences in clinical information among the groups at admission. In Group I, a statistically significant improvement was noted in the number of patients with diarrhea, number of defecation events on Day 3, and total diarrhea period as opposed to Group II (P = .033, P = .003, and P = .012, respectively). The improvement of Vesikari score in Group I was greater than that in the other groups (P = .076, P = .061, and P = .036, respectively). Among rotavirus genotypes, 9 (22.5%) strains and 8 (20.0%) strains belonged to the G9P8 and G1P8 genotypes, respectively. The virus reduction effect, as confirmed via stool specimens, was also greater in Group I. No significant side effects were noted in infants.

CONCLUSION

LRCC5310 improved clinical symptoms, including diarrhea and Vesikari score, and inhibited viral proliferation in rotaviral gastroenteritis.

Acupoint application for rotavirus diarrhea in infants and children: A protocol for systematic review and meta analysis

BACKGROUND

Diarrheal disease currently claims the lives of approximately 500,000 children each year. Rotaviruses are the pathogens primarily responsible for more severe cases and more than one-third of diarrhea-associated deaths in children under 5 years old globally. At present, commonly used drug therapies for rotavirus diarrhea in Western medicine, such as oral rehydration salts, montmorillonite, probiotics, and nitazoxanide, often cannot achieve satisfactory curative effects. Moreover, infants' and children's compliance with drugs and injections is often lower than their compliance with acupoint application therapy. A large number of studies have shown that acupoint application can increase the clinical cure rate and shorten the duration of diarrhea. However, there is a lack of systematic reviews on the safety and efficacy of acupoint application in the treatment of rotavirus diarrhea. Therefore, we will conduct a study to evaluate the safety and efficacy of acupoint application for rotavirus diarrhea in infants and children.

METHODS

We will search the relevant medical literature using PubMed, EMBASE, Web of Science, Cochrane CENTRAL, China National Knowledge Infrastructure, the Wanfang Database, the Chinese Biomedical Literature Database, and the Chinese Scientific Journal Database from inception to August 2020. Both MeSH and free text terms will be utilized to obtain the maximum numbers of papers. No language restrictions will be applied, and the publication type will be limited to randomized controlled trials. Two teams will independently review and assess the studies for inclusion in the review. RevMan V 5.0 software will be applied for data extraction. The methodological quality of the included studies will be evaluated according to the Cochrane Handbook.

RESULTS

The results of this study will be published in a peer-reviewed journal.

CONCLUSION

The conclusion of this systematic review will provide evidence regarding whether acupoint application is an effective intervention for infants and children with rotavirus diarrhea.

INPLASY REGISTRATION NUMBER

INPLASY202070123.

Association of Rotavirus Vaccination With Inpatient and Emergency Department Visits Among Children Seeking Care for Acute Gastroenteritis, 2010-2016

IMPORTANCE

Rotavirus vaccines have been recommended for universal US infant immunization for more than 10 years, and understanding their effectiveness is key to the continued success of the US rotavirus vaccine immunization program.

OBJECTIVE

To assess the association of RotaTeq (RV5) and Rotarix (RV1) with inpatient and emergency department (ED) visits for rotavirus infection.

DESIGN, SETTING, AND PARTICIPANTS

This case-control vaccine effectiveness study was performed at inpatient and ED clinical settings in 7 US pediatric medical institutions from November 1, 2009, through June 30, 2016. Children younger than 5 years seeking medical care for acute gastroenteritis were enrolled. Clinical and epidemiologic data, vaccination verification, and results of stool sample tests for laboratory-confirmed rotavirus were collected. Data were analyzed from November 1, 2009, through June 30, 2016.

MAIN OUTCOMES AND MEASURES

Rotavirus vaccine effectiveness for preventing rotavirus-associated inpatient and ED visits over time for each licensed vaccine, stratified by clinical severity and age.

RESULTS

Among the 10 813 children included (5927 boys [54.8%] and 4886 girls [45.2%]; median [range] age, 21 [8-59] months), RV5 and RV1 analyses found that compared with controls, rotavirus-positive cases were more often white (RV5, 535 [62.2%] vs 3310 [57.7%]; RV1, 163 [43.1%] vs 864 [35.1%]), privately insured (RV5, 620 [72.1%] vs 4388 [76.5%]; RV1, 305 [80.7%] vs 2140 [87.0%]), and older (median [range] age for RV5, 26 [8-59] months vs 21 [8-59] months; median [range] age for RV1, 22 [8-59] months vs 19 [8-59] months) but did not differ by sex. Among 1193 rotavirus-positive cases and 9620 rotavirus-negative controls, at least 1 dose of any rotavirus vaccine was 82% (95% CI, 77%-86%) protective against rotavirus-associated inpatient visits and 75% (95% CI, 71%-79%) protective against rotavirus-associated ED visits. No statistically significant difference during this 7-year period was observed for either rotavirus vaccine. Vaccine effectiveness against inpatient and ED visits was 81% (95% CI, 78%-84%) for RV5 (3 doses) and 78% (95% CI, 72%-82%) for RV1 (2 doses) among the study population. A mixed course of both vaccines provided 86% (95% CI, 74%-93%) protection. Rotavirus patients who were not vaccinated had severe infections 4 times more often than those who were vaccinated (74 of 426 [17.4%] vs 28 of 605 [4.6%]; P < .001), and any dose of rotavirus vaccine was 65% (95% CI, 56%-73%) effective against mild infections, 81% (95% CI, 76%-84%) against moderate infections, and 91% (95% CI, 85%-95%) against severe infections.

CONCLUSIONS AND RELEVANCE

Evidence from this large postlicensure study of rotavirus vaccine performance in the United States from 2010 to 2016 suggests that RV5 and RV1 rotavirus vaccines continue to perform well, particularly in preventing inpatient visits and severe infections and among younger children.

Talk to Patients About: Rotavirus

Rotavirus is a highly contagious viral infection that inflames the lining of the stomach and intestines, and especially affects children 2 years old and younger. In the United States, the introduction of a vaccine in 2006 helped arrest rotavirus illnesses and deaths.

Rotavirus Vaccines: Effectiveness, Safety, and Future Directions

Rotavirus is the leading cause of diarrheal death among children < 5 years old worldwide, estimated to have caused ~ 215,000 deaths in 2013. Prior to rotavirus vaccine implementation, > 65% of children had at least one rotavirus diarrhea illness by 5 years of age and rotavirus accounted for > 40% of all-cause diarrhea hospitalizations globally. Two live, oral rotavirus vaccines have been implemented nationally in > 100 countries since 2006 and their use has substantially reduced the burden of severe diarrheal illness in all settings. Vaccine efficacy and effectiveness estimates suggest there is a gradient in vaccine performance between low child-mortality countries (> 90%) and medium and high child-mortality countries (57-75%). Additionally, an increased risk of intussusception (~ 1-6 per 100,000 vaccinated infants) following vaccination has been documented in some countries, but this is outweighed by the large benefits of vaccination. Two additional live, oral rotavirus vaccines were recently licensed and these have improved on some programmatic limitations of earlier vaccines, such as heat stability, cost, and cold-chain footprint. Non-replicating rotavirus vaccines that are parenterally administered are in clinical testing, and these have the potential to reduce the performance differential and safety concerns associated with live oral rotavirus vaccines.

Therapeutic Opportunities in Intestinal Microbiota-Virus Interactions

The host microbiota has emerged a third player in interactions between hosts and viral pathogens. This opens new possibilities to use different tools to modulate the intestinal microbial composition, aimed at reducing the risk of or treating viral enteric infections.

[Not Available]

Zusammenfassung. Die häufigsten Gründe, weshalb ein Kind in der Praxis oder im Spital vorgestellt wird, sind Dehydratation und Trink-/Essensverweigerung aufgrund einer akuten Gastroenteritis (AGE). Die häufigste Ursache einer AGE ist das Rotavirus, gefolgt von Norovirus und seltenen bakteriellen Erkrankungen. Eine Erregerdiagnostik ist dabei nur selten nötig. Der Dehydratationsgrad wird vornehmlich klinisch anhand eines Dehydratations-Scores gestellt. Ziel der Dehydratationstherapie sind die rasche Rehydrierung und Wiederaufnahme von Flüssigkeit und Nahrung durch das Kind. Eine Rehydratationstherapie (RT) sollte wenn immer möglich per os oder per Magensonde stattfinden und nur in schweren Fällen intravenös. Bei einem prolongierten Verlauf sind weitere Abklärungen beim gastroenterologischen Spezialisten empfehlenswert.

Rotavirus infection in children as of today (literature review)

INTRODUCTION

Urgency of the issue of rotavirus infection (RV) is stipulated by a special place in the structure of morbidity and mortality among young children. According to the data provided by WHO, 180 million diarrheal diseases with rotavirus etiology are registered every year. The aim of this article is to examine of current views on diagnosis and management of rotavirus infection in children.

MATERIAL AND METHODS

The data of scientific literatures with the use of bibliosemantic method of study became the material for research.

REVIEW

The urgent approaches to diagnosis and management of rotavirus infection in children is reflected in the article.

CONCLUSIONS

The specific prophylaxis is recommended in order to prevent these infection. Apply monovalent vaccine, which has cross protection against different strains (G1, G2, G3, G4 and G9), and use pentavalent liquid vaccine containing G serotypes are recommended. It has cross-protection against different strains.

Modulation of microbiota as treatment for intestinal inflammatory disorders: An uptodate

Alterations of intestinal microflora may significantly contribute to the pathogenesis of different inflammatory and autoimmune disorders. There is emerging interest on the role of selective modulation of microflora in inducing benefits in inflammatory intestinal disorders, by as probiotics, prebiotics, synbiotics, antibiotics, and fecal microbiota transplantation (FMT). To summarize recent evidences on microflora modulation in main intestinal inflammatory disorders, PubMed was searched using terms microbiota, intestinal flora, probiotics, prebiotics, fecal transplantation. More than three hundred articles published up to 2015 were selected and reviewed. Randomized placebo-controlled trials and meta-analysis were firstly included, mainly for probiotics. A meta-analysis was not performed because of the heterogeneity of these studies. Most of relevant data derived from studies on probiotics, reporting some efficacy in ulcerative colitis and in pouchitis, while disappointing results are available for Crohn's disease. Probiotic supplementation may significantly reduce rates of rotavirus diarrhea. Efficacy of probiotics in NSAID enteropathy and irritable bowel syndrome is still controversial. Finally, FMT has been recently recognized as an efficacious treatment for recurrent Clostridium difficile infection. Modulation of intestinal flora represents a very interesting therapeutic target, although it still deserves some doubts and limitations. Future studies should be encouraged to provide new understanding about its therapeutical role.

Dietary Lactobacillus rhamnosus GG Supplementation Improves the Mucosal Barrier Function in the Intestine of Weaned Piglets Challenged by Porcine Rotavirus

Lactobacillus rhamnosus GG (LGG) has been regarded as a safe probiotic strain. The aim of this study was to investigate whether dietary LGG supplementation could alleviate diarrhea via improving jejunal mucosal barrier function in the weaned piglets challenged by RV, and further analyze the potential roles for apoptosis of jejunal mucosal cells and intestinal microbiota. A total of 24 crossbred barrows weaned at 21 d of age were assigned randomly to 1 of 2 diets: the basal diet and LGG supplementing diet. On day 11, all pigs were orally infused RV or the sterile essential medium. RV infusion increased the diarrhea rate, increased the RV-Ab, NSP4 and IL-2 concentrations and the Bax mRNA levels of jejunal mucosa (P<0.05), decreased the villus height, villus height: crypt depth, the sIgA, IL-4 and mucin 1 concentrations and the ZO-1, occludin and Bcl-2 mRNA levels of jejunal mucosa (P<0.05), and affected the microbiota of ileum and cecum (P<0.05) in the weaned pigs. Dietary LGG supplementation increased the villus height and villus height: crypt depth, the sIgA, IL-4, mucin 1 and mucin 2 concentrations, and the ZO-1, occludin and Bcl-2 mRNA levels of the jejunal mucosa (P<0.05) reduced the Bax mRNA levels of the jejunal mucosa (P<0.05) in weaned pigs. Furthermore, dietary LGG supplementation alleviated the increase of diarrhea rate in the weaned pigs challenged by RV (P<0.05), and relieve the effect of RV infection on the villus height, crypt depth and the villus height: crypt depth of the jejunal mucosa (P<0.05), the NSP4, sIgA, IL-2, IL-4, mucin 1 and mucin 2 concentrations of jejunal mucosa (P<0.05), the ZO-1, occludin, Bax and Bcl-2 mRNA levels of the jejunal mucosa (P<0.05), and the microbiota of ileum and cecum (P<0.05) in the weaned pigs challenged by RV. These results suggest that supplementing LGG in diets alleviated the diarrhea of weaned piglets challenged by RV via inhibiting the virus multiplication and improving the jejunal mucosal barrier function, which was possibly due to the decreasing apoptosis of jejunal mucosal cells and the improvement of intestinal microbiota.

[Effect of ingested immunoglobulin on sIgA expression in pediatric rotavirus enteritis]

OBJECTIVE

To identify the effects of ingested anti-rotavirus immunoglobulin on enteric expressions of SIgA in pediatric rotavirus enteritis.

METHODS

In this randomized, placebo controlled clinic trial, 100 patients of pediatric rotavirus enteritis who simultaneously received fluid replacement as basic therapy, were randomly divided into control and immunoglobulin treated groups. The patients in experimental group were given "ingested antirotavirus IgY". Stool sample was collected at day 1, 3, 5, 7, 9 and 11, the level of fecal SIgA was quantifies by radioimmunoassay kit, and fecal rotavirus shedding was detected by double-sandwich ELISA.

RESULTS

The frequency of diarrhea in immunoglobulin group was obviously less than that in control group (P<0.05). The mean course of diarrhea was (4.5 +/- 0.92) d in immunoglobulin group, and (5.8 +/- 1.68) d in control group (P=0.015). The fecal SIgA level in immunoglobulin group was higher than that in control group(P<0.05). The doubling time of SIgA level was the 3rd d in immunoglobulin group, and the 5th d in control group. The fecal rotavirus shedding in immunoglobulin group was obviously lower than that in control group (P < 0.05).

CONCLUSION

Ingested anti-rotavirus immunoglobulin could promote the expression of enteric SIgA to remove rotavirus, achieving the benefit to release diarrhea in pediatric rotavirus enteritis.

Viral infection. Prevention and cure of rotavirus infection via TLR5/NLRC4-mediated production of IL-22 and IL-18

Activators of innate immunity may have the potential to combat a broad range of infectious agents. We report that treatment with bacterial flagellin prevented rotavirus (RV) infection in mice and cured chronically RV-infected mice. Protection was independent of adaptive immunity and interferon (IFN, type I and II) and required flagellin receptors Toll-like receptor 5 (TLR5) and NOD-like receptor C4 (NLRC4). Flagellin-induced activation of TLR5 on dendritic cells elicited production of the cytokine interleukin-22 (IL-22), which induced a protective gene expression program in intestinal epithelial cells. Flagellin also induced NLRC4-dependent production of IL-18 and immediate elimination of RV-infected cells. Administration of IL-22 and IL-18 to mice fully recapitulated the capacity of flagellin to prevent or eliminate RV infection and thus holds promise as a broad-spectrum antiviral agent.

HSV-1 amplicon vectors as genetic vaccines

HSV-1 amplicon vectors have been used as platforms for the generation of genetic vaccines against both DNA and RNA viruses. Mice vaccinated with such vectors encoding structural proteins from both foot-and-mouth disease virus and rotavirus were partially protected from challenge with wild-type virus (D'Antuono et al. Vaccine 28: 7363-7372, 2010; Laimbacher et al. Mol Ther 20: 1810-1820, 2012), indicating that HSV-1 amplicon vectors are attractive tools for the development of complex and safe genetic vaccines. This chapter describes the use of HSV-1 amplicon vectors that encode individual or multiple viral structural proteins from a polycistronic transgene cassette in mammalian cells. More precisely, amplicon vectors that encode multiple structural viral proteins support the in situ production of viruslike particles (VLPs) in vector-infected cells. The expression of the viral genes is confirmed by Western blot and immune fluorescence analysis, and the generation of VLPs in vector-infected cells is demonstrated by electron microscopy.

Septicemia following rotavirus gastroenteritis

BACKGROUND

Rotavirus gastroenteritis is a prevalent childhood illness rarely complicated by secondary bacterial sepsis. Although there are case reports of septicemia after rotavirus infection, there are no recent reviews on this topic.

OBJECTIVES

To add new cases of septicemia after rotavirus to the literature, review the few cases of septicemia after rotavirus that have been reported, calculate the incidence of septicemia in children hospitalized for rotavirus gastroenteritis, and discuss the characteristics of septicemia after rotavirus infection and implications for current pediatric practice.

METHODS

We identified children whose illness was complicated by septicemia from among all hospitalizations at our facility for rotavirus gastroenteritis from May 1999 through May 2010. We also review the few cases reported in the English literature.

RESULTS

We identified two cases of septicemia from among 632 hospitalizations for rotavirus gastroenteritis in this time period, for an incidence rate of 0.32%, which is comparable to other estimates in the English literature. The typical course for cases of bacterial superinfection involves a second peak of high fever; other clinical signs are variable.

CONCLUSIONS

Septicemia after rotavirus gastroenteritis is a rare but dangerous entity. Early identification of a child developing bacterial superinfection after rotavirus, as in any case of sepsis, is of the utmost importance, as is obtaining blood cultures in a child with a rotavirus infection and a second fever spike.

A comparison of healthcare resource use for rotavirus and RSV between vulnerable children with co-morbidities and healthy children: a case control study

OBJECTIVE

To quantify the differences in hospital length of stay (LOS) and cost between healthy and vulnerable children with cystic fibrosis (CF), insulin-dependent diabetes mellitus (IDDM), cancer, and epilepsy who contract rotavirus (RVGE) or respiratory syncytial virus (RSV).

METHODS

Hospital Episode Statistics (HES) data were collected for England, for children <5 years old, admitted between April 2001 and March 2008, using ICD-10 codes for RVGE and RSV. Cases were identified as having RVGE and/or RSV plus CF, IDDM, cancer, or epilepsy. Healthy controls had RVGE and/or RSV only, additional controls had eczema only. Cost, hospital LOS, and demographics were collected.

RESULTS

Four hundred and eighty-six (0.5%) cases and 101,784 (99.5%) healthy controls were admitted with RVGE or RSV, with 17,420 eczema controls. RVGE was present in 153 (31.5%) cases and 7532 (7.4%) healthy controls, and RSV in 333 (68.5%) cases and 94,252 (92.6%) healthy controls. Cases were older (1.1 years, SD = 1.3 years), had greater LOS (9.9 days, SD = 19.9), and cost more (£3477, SD = £7765) than healthy controls (age = 0.2, SD = 0.5, p < 0.001; LOS = 1.9 days, SD = 3.1, p < 0.001; cost = £595, SD = £727, p < 0.001). Cost for cases was 6-times greater than healthy controls (p < 0.001). Controls had a 0.3 day greater LOS (p < 0.001) with RSV, but a £17 (p = 0.085) lower mean cost than RVGE.

CONCLUSION

RVGE and RSV are more serious diseases in vulnerable children, requiring more intense resource use. The importance of preventing infection in vulnerable children is underlined by hygiene and appropriate isolation and vaccination strategies. When universal vaccination is under consideration, as for rotavirus vaccines, evaluation of a vaccination programme should consider the potentially positive impact on vulnerable children.

LIMITATIONS

Limitations of the study include a dependency on accurate coding, an expectation that patients are identified through laboratory testing, and the possibility of unidentified underlying conditions affecting the burden.

[Using meglumine acridonacetate for the treatment of gastroenteritis caused by rotavirus in children]

The study was aimed at an analysis of the influence of meglumine acridonacetate--the inductor of endogenous interferon synthesis--on the clinical course of gastroenteritis caused by rotavirus in children. A group of 100 patients aged from 3 months to 14 years were involved on retrospective comparative randomized study. The obtained data showed the advantages of meglumine acridonacetate administration during early terms of treatment of the gastroenteritis caused by rotaviruses. This treatment leads to fast regression of the main clinical symptoms such as fever, diarrhea, and intoxications, which results in reduction of the clinical course duration.

Oral immunoglobulin for the treatment of rotavirus diarrhea in low birth weight infants

BACKGROUND

Rotavirus infection is the most common neonatal nosocomial viral infection. It is a major health problem worldwide. Epidemics with the newer P(6)G9 strains have been reported in neonatal units globally. These strains can cause severe symptoms in most infected infants. Infection control measures become necessary and the utilization of hospital resources increase. Local mucosal immunity in the intestine to rotavirus is important in the resolution of infection and protection against subsequent infections. Boosting local immunity by oral administration of anti-rotaviral immunoglobulin preparations might be a useful strategy in treating rotaviral infections, especially in low birth weight babies.

OBJECTIVES

To determine the effectiveness and safety of oral immunoglobulin preparations for the treatment of rotavirus diarrhea in hospitalized low birth weight infants (birth weight less than 2500 g)

SEARCH STRATEGY

Electronic databases including The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2004), MEDLINE, EMBASE and CINAHL, Biological Abstracts (BIOSIS) were searched by the strategy outlined in the protocol. Science Citation Index search for all articles that referenced Barnes 1982 were searched. The proceedings of the Pediatric Academic Societies published online at 'Abstracts Online' were searched. Ongoing registered trials at www.clinicaltrials.gov and www.controlled-trials.com were searched. Authors prominent in the field were contacted for any unpublished articles and more information on published articles was sought. Reference lists of identified clinical trials and personal files were also reviewed. The above search was updated in July 2011.

SELECTION CRITERIA

The criteria used to select studies for inclusion were: 1) DESIGN: randomized or quasi-randomized controlled trials 2) Hospitalized low birth weight infants with rotavirus diarrhea 3) INTERVENTION: Oral immunoglobulin preparations compared to placebo or no intervention 4) At least one of the following outcomes were reported: All cause mortality during hospital stay, mortality due to rotavirus infection during hospital stay, duration of diarrhea, need for rehydration, duration of viral excretion, duration of infection control measures, length of hospital stay in days, recurrent diarrhea or chronic diarrhea

DATA COLLECTION AND ANALYSIS

The two reviewers were to independently abstract data from eligible trials. No data were available for analysis.

MAIN RESULTS

No eligible randomized controlled trials were found.

AUTHORS' CONCLUSIONS

No randomized controlled trials that assessed the effectiveness or safety of oral immunoglobulin preparations for the treatment of rotavirus diarrhea in hospitalized low birth weight infants were found. Clinical trials that address the issue of oral immunoglobulin treatment of rotavirus infection are needed.

[Application of clinical pathways in children with Rotavirus enteritis]

OBJECTIVE

Clinical pathways are standardized, multidisciplinary, integrated management plans. This study aimed to evaluate the efficacy of clinical pathways in children with Rotavirus enteritis.

METHODS

Seventy-one children with Rotavirus enteritis were treated according to the clinical pathways. Seventy-five children with Rotavirus enteritis who received routine therapy and nursing interventions served as the control group. The clinical efficacies were compared between the two groups.

RESULTS

The average hospitalization duration was shortened, the hospitalization costs were reduced and the parents' satisfaction rate increased in the observed group compared with the control group (P<0.05).

CONCLUSIONS

The use of clinical pathways may decrease the hospitalization duration and costs and improve the quality of nursing care and the parents' satisfaction rate in children with Rotavirus enteritis.

Characteristics of rotavirus gastroenteritis in hospitalized children in Israel

BACKGROUND

Diarrhea is a leading cause of child mortality worldwide. Rotavirus is one of the most common causes of severe diarrhea and dehydration in children.

OBJECTIVES

To compare the demographic, clinical and laboratory characteristics of patients with rotavirus gastroenteritis to those with other causes of gastroenteritis.

METHODS

The medical records of children aged 0-18 years hospitalized with acute gastroenteritis in our facility between 1 January 2004 and 31 March 2006 were retrieved. Patients with rotavirus gastroenteritis were compared with patients who were rotavirus negative.

RESULTS

The study group comprised 533 patients; 202 tested positive for rotavirus and 331 tested negative. Compared to patients with rotavirus-negative gastroenteritis, patients with rotavirus-positive gastroenteritis had a higher incidence of vomiting (185/202 vs. 212/331, 92% vs. 64%, P < 0.001), lethargy (67/202 vs. 51/331, 33% vs. 15%, P < 0.001), and dehydration (81/202 vs. 78/331, 40% vs. 24%, P < 0.001). The need for intravenous rehydration therapy and the duration of hospitalization were higher in patients with rotavirus gastroenteritis.

CONCLUSIONS

Vomiting and dehydration are more common in hospitalized children with rotavirus gastroenteritis than in children with gastroenteritis due to other causes.

Burden of disease and costs of treating rotavirus diarrhea in Mexican children for the period 2001-2006

OBJECTIVES

To estimate the health impact and the costs of treatment associated with rotavirus diarrhea in six yearly cohorts (2001-2006) of Mexican infants.

METHODS

The perspective of study is from the health care system. We estimated the effect of rotavirus diarrhea on disability adjusted life years (DALYS) and diarrhea treatment costs in hypothetical cohorts of infants who are followed from birth up to five years of age beginning in years from 2001 to 2006. We used information from administrative databases on mortality and health care from the National System of Information on Health and from the Mexican Institute for Social Security to feed a decision analysis to project the burden of disease and costs of treatment.

RESULTS

Estimates of DALYS were 19,426 in 2001 and decreased by 28.9% for 2006 meanwhile costs of treatment were relatively constant, estimated at US$ 38.7 million and increased only by 5%.

CONCLUSION

Rotavirus diarrhea in Mexican children is a major disease burden, presenting significant treatment costs. Rotavirus diarrhea mortality is decreasing; however this has not led to a steady decrease in treatment costs in the 6 years period of analysis. A sensitivity analysis showed that incidences of rotavirus diarrhea as well as the parameters associated with health-care access were the main factors, which had a significant effect on the projected burden of disease and costs.

[Rotavirus infections]

Rotaviruses are genetically highly variable, non-enveloped viruses with a double-stranded, segmented ribonucleic acid genome. They are a major cause of gastroenteritis worldwide. In children aged less than 5 years, they are the most frequent agent of severe acute diarrheal illnesses. In less developed countries, rotavirus diseases are one of the most frequent causes of death in infants and little children. Typically, symptomatic rotavirus diseases in infants (<5 years) and the elderly (>70 years) arise with sudden onset of watery diarrhoea with high risk of dehydration, accompanied by vomiting and, in several cases, unspecific respiratory symptoms such as cold and sore throat. In adults aged less than 70 years, illnesses due to rotavirus appear generally mild or as travel diarrhoea. Although rotavirus infections are considered to by systemic, extraintestinal manifestations such as rotavirus central nervous system diseases are relatively rare. Rotaviruses are transmitted primarily from person-to-person by the faecal-oral route. Treatment of rotavirus diarrhoea is usually symptomatic and comprises a sufficient fluid and electrolyte substitution. Although nitazoxanide and some other drugs show high efficacy against rotavirus in vitro and in vivo, there is currently no recommended specific antiviral therapy. For prophylaxis, special attention should be paid to adequate hygienic rules. Because of the high stability of rotaviruses to changing environmental conditions, disinfection should be performed applying disinfectants with proven activity against rotaviruses. In Germany, two efficient and secure live vaccines against rotaviruses have been approved. Their application, however, is not generally recommended.

Burden on UK secondary care of rotavirus disease and seasonal infections in children

OBJECTIVE

Rotavirus is a common infection affecting children under 5 years, which leads to a significant disease burden. This burden is potentially exacerbated by the seasonality of rotavirus, particularly in the context of the seasonality of other common childhood infections. The primary study objective was to describe the pattern and burden of seasonal infections amongst children under 5 years of age with particular attention placed on rotavirus and other gastrointestinal infections.

METHODS

A retrospective analysis of all routine inpatient data relating to selected seasonal infections in the UK was conducted between 2001/02 and 2007/08 using data from Capse Healthcare Knowledge Systems (CHKS, England, Northern Ireland and Wales) and Information Services Division (ISD, Scotland). Admissions with selected diagnoses were extracted based on International Classification of Diseases (ICD)-10 coding. All episodes were processed using a HRG grouper and costs applied according to the NHS National Tariff.

RESULTS

In the financial year 2007/08, the total number of admissions in the UK for children under 5 years for the selected seasonal infections was 64,879 of which 32,126 admissions were associated with gastrointestinal infections including rotavirus gastroenteritis (RVGE). Seasonal peaks of gastrointestinal infections and RVGE occurred in the spring quarter and respiratory syncytial virus (RSV) and influenza in the winter quarter. Admissions for gastrointestinal infection including RVGE accounted for 35 003 bed days with 9922 due to RVGE. The total cost for admissions involving a diagnosis of seasonal infection was £56 million. Of this, it was estimated that infections with an ICD-10 classification of rotavirus represented a cost of £8.6 million.

CONCLUSION

Rotavirus contributes to the significant burden that seasonal infections place on inpatient paediatric resources during the winter and spring months. This study may be limited by issues of clinical coding and the infrequency of confirmatory microbiological testing in real-world practice. Vaccination might be considered as a means of reducing this clinical and economic burden particularly where long-term effectiveness and ease of administration are proven.

[Molecular epidemiology of rotavirus among children under 5 years old hospitalized for diarrhea in China]

OBJECTIVE

To study molecular epidemiology of Rotavirus among children under 5 years of age in china.

METHODS

Stool specimens were collected from 4047 inpatients under 5 years of age with diarrhea in our 9 hospital-based surveillance sites from January 2006 to December 2007 following the WHO Rotavirus surveillance protocol. Rotavirus were detected by ELISA, Further strain characterization of rotavirus was carried out with RT-PCR.

RESULTS

A total of 4047 stool samples were collected and 3862 of total stools were tested among which 1700 was positive. The Rotavirus positive rate is 44.0%. A peak admission of rotavirus diarrhea was observed from November to next January. More than 95.4% of viral diarrhea patients occurred in their first 2 years. The incidence rates of rotavirus diarrhea were highest in 12-17 months of age. The most common rotavirus strain was P[8]G3(58.3%); followed by P[8] G1(22.1%), P[4]G1 (3.0%), P[8]G9 (2.4%). G4 was not detected in this study. The four common strains were 80.8% in the world.

CONCLUSION

Rotavirus diarrhea was an important infectious disease among children under 5 years of age in China. Safe and effective rotavirus vaccines for the prevention of rotavirus diarrhea and reduction of treatment costs are of significant importance to China.

Clinical application of rapid assay of interleukin-6 in influenza-associated encephalopathy

The characteristics of influenza-associated encephalopathy is the high mortality and nimble progress with coma which appears in general cases within 48 hours. Most of patients show no abnormalities in the standard blood checks on admission or in early stage. In this study we investigated if a rapid assay of interleukin (IL)-6 is useful in influenza-associated encephalopathy in early stages. The levels of IL-6 in patients with influenza-associated encephalopathy did not show any significant difference compared with those in patients with febrile convulsion and rotavirus-associated convulsion. However the levels of IL-6 in severe cases were significantly higher than those of mild cases with influenza-associated encephalopathy. Consequently the rapid assay of serum IL-6 is useful to evaluate and decide the therapies.

Rotavirus vaccines and pathogenesis: 2008

PURPOSE OF REVIEW

Rotaviruses cause life-threatening gastroenteritis in children throughout the world. The burden of disease has resulted in the development of two live, attenuated vaccines that are now licensed in many countries. This review summarizes new data on these vaccines, their effectiveness, and remaining challenges including new data on the rotavirus enterotoxin, a potential antiviral target.

RECENT FINDINGS

Live attenuated rotavirus vaccines are used to protect infants against severe rotavirus-induced gastroenteritis and, RotaTeq, a pentavalent bovine-based vaccine, and, Rotarix, a monovalent human rotavirus, are now currently licensed in many countries. Initial results of the licensed RotaTeq vaccine have been promising in the USA and results of immunogenicity and efficacy in developing countries are expected soon. However, universal vaccine implementation is challenging due to age limitations on administration of these vaccines. Chronic rotavirus infections in immunocompromised children may remain a problem and require the development of new treatments including antiviral drugs. Increasing data on the mechanisms of action of the rotavirus enterotoxin highlight this pleiotropic protein as a good target as well as a unique calcium agonist.

SUMMARY

Rotavirus is now a commonly occurring vaccine-preventable disease among children in developed countries and hopefully this also will soon be true for developing countries. Future studies will determine whether other methods of prevention, such as nonreplicating vaccines and antiviral drugs, will be needed to treat disease in immunocompromised children.

Resource utilization and costs of treating severe rotavirus diarrhea in young Mexican children from the health care provider perspective

BACKGROUND

Rotavirus is the most common cause of severe diarrhea in infants. The economic costs of treating severe rotavirus can be quite significant and are important to include in any evaluation of prevention programs. The aim of this study was to determine utilization of health care resources and costs incurred due to severe diarrhea associated with rotavirus infection in Mexican children < 5 years of age.

MATERIAL AND METHODS

The costs of rotavirus infection evaluated in this observational study consisted of hospital, emergency room care and out-patient visit expenses at three hospitals of the Mexican Institute of Social Security throughout 1999-2000. Service costs were estimated from costs of care for rotavirus versus non-rotavirus diarrhea obtained through a follow-up study data of 383 children and administrative records.

RESULTS

Diarrhea cases due to rotavirus infection comprised 36% of the sample. Participants with rotavirus diarrhea spent an average of 3.2 days in the hospital, 5.9 hours in the emergency room, and had 1.3 visits to an outpatient physician's office. Some differences in the consumption of health care were found between rotavirus and non-rotavirus diarrhea cases, although the mean costs of rotavirus and nonrotavirus cases were not significantly different. The mean cost per case of severe rotavirus diarrhea was estimated to be US $936. The total cost of treating severe rotavirus diarrhea, including 5,955 rotavirus hospitalizations for 2004, was estimated at US $5.5 million.

CONCLUSION

Health care costs due to treatment for severe rotavirus diarrhea are a significant economic burden to the Mexican Social Security system.

Prospective study of the burden of acute gastroenteritis and rotavirus gastroenteritis in children less than 5 years of age, in Padova, Italy

BACKGROUND

Data on the burden of rotavirus gastroenteritis in Europe are needed to help understand the potential impact of introducing new rotavirus vaccines.

MATERIALS AND METHODS

As part of prospective observational study (Rotavirus gastroenteritis Epidemiology and Viral types in Europe Accounting for Losses in Public Health and Society Study, REVEAL) conducted in 2004--2005 in seven European countries, we studied, the characteristics of acute gastroenteritis and rotavirus gastroenteritis in children less than 5 years in primary care, emergency room and hospital settings (Padova, Italy).

RESULTS

A total of 757 children with acute gastroenteritis were included and enzyme-linked immunoabsorbent assay (ELISA) results were available for 725 cases. The overall estimated annual incidence for rotavirus gastroenteritis was 4.7%. Overall, rotavirus gastroenteritis was estimated to account for 43.6% of acute gastroenteritis cases. Among children with acute gastroenteritis (AGE) aged 6-23 months, 61.2% were rotavirus positive. Rotavirus gastroenteritis (RVGE) was responsible for 68.8% of hospitalizations, 61% of emergency consultations, and 33% of primary care consultations. The most prevalent serotype was G9 (84.4%) followed by G1 (11.8%). The relative risk for rotavirus gastroenteritis of being referred to hospital after an initial consultation in primary care was 3.37 (95% CI: 1.77-6.43) and 3.38 (95% CI: 2.28-5.01) for emergency room referral. Children with rotavirus gastroenteritis generally had more severe disease than children with rotavirus-negative gastroenteritis.

CONCLUSION

Rotavirus accounts for a significant proportion of acute gastroenteritis cases in children less than 5 years in Italy, many of whom require frequent primary care consultations, or care in emergency room or hospital settings.

Gastroenteritis by rotavirus in Spanish children. Analysis of the disease burden

Rotavirus is one of the most common causes of gastroenteritis worldwide. With the commercialisation of effective rotavirus vaccines in Europe in sight, it is necessary to provide studies which evaluate the disease burden. The aim of this study is two-fold, on one hand, to determine the burden of the rotavirus disease in Spanish children under the age of five, and on the other, to estimate the economic cost of these hospitalizations. The study was undertaken during a 5 year period (2000-2004). The rotavirus hospitalization rate was determined using the Minimum Basic Data Set of the national hospital discharge register. The observed data were compared with those expected by applying a model developed by the Centers for Disease Control and Prevention (CDC) adapted for European Countries. The financial expense of these hospitalizations was estimated. Of all admissions coded as gastroenteritis, 31.6% were due to rotavirus. The hospitalization rate by rotavirus was 480 cases per 100,000 children under five. These data are within the confidence range proposed by the adapted CDC model. The financial expense due to hospitalizations reaches 123,262 euros yearly in a Spanish University Hospital. In conclusion, rotavirus contributes significantly to the hospitalization of acute gastroenteritis. The rate of hospitalization by rotavirus is higher compared to other studies carried out in Spain. In view of future commercialisation of rotavirus vaccines, more in-depth analysis considering direct and indirect costs are necessary.

[Rotavirus infections in children]

Rotaviruses are the most common cause of acute diarrhoea in children. The disease often leads to hospitalization; it is also a source of intrahospital infections. In the last 10 years in Poland the incidence of rotavirus infections increased more than twofold In this study we analyse the etiopathogenesis, epidemiology, clinical course, diagnostic methods, treatment and prevention of rotavirus infections.

[Hospitalizations associated with rotavirus gastroenteritis in Israel--a retrospective study]

BACKGROUND

Rotavirus is a major cause of infantile gastroenteritis worldwide and remains a common cause of hospitalizations in developed countries. The study aimed to assess the hospitalizations due to rotavirus gastroenteritis in Israel and their characteristics.

METHODS

A retrospective review of the records of children < 18 years hospitalized in six medical centers in Israel between April 2004 and March 2006 with acute gastroenteritis (AGE) and stool positive for rotavirus. Children with nosocomial infections, immune deficiency or under immunosuppressive therapy were excluded.

RESULTS

During the study period, 1912 children were hospitalized with AGE due to rotavirus, of whom 1719 were included in this study. The peak rate of admission due to rotavirus was in November and December, when 34% of the admissions for AGE were caused by rotavirus, and the lowest rate was in August (7%, p < 0.0001). Annually, rotavirus caused 18.4% and 2.8% of the hospitalization for AGE and of all pediatric hospitalizations, respectively. The mean age on admission was 14 months (median 12 months) and the mean hospitalization--3.9 days. According to the annual pediatric statistics in Israel for 2004, the estimated annual rotavirus-associated hospitalization in Israel is 3816, with 14,692 hospitalization days.

CONCLUSIONS

Rotavirus gastroenteritis is an important cause for hospitalizations and complications in children < 5 years in Israel, stressing the need for safe and efficacious vaccines to reduce the burden of the infection.

Rotavirus enteritis in solid organ transplant recipients: an underestimated problem?

BACKGROUND

Diarrhea in solid organ transplantation can be a complication with a high morbidity and mortality. Rotavirus (RV) infection normally occurs in children up to 3 years of age and often presents with severe diarrhea; however, it can also affect adults. We investigated the prevalence and outcome of RV infections in both adult and pediatric patients after solid organ transplantation.

PATIENTS AND METHODS

Retrospective analysis of RV-related enteritis in solid organ transplant recipients with a minimum of a 1-year follow-up from a single center between 2000 and 2004.

RESULTS

Within our cohort of 1303 solid organ transplants, RV infection was observed in 19 patients (1.5%); 14 of these were liver recipients. Infection was most prevalent among pediatric liver recipients, with 52% (11/21) of the children affected. Five adults acquired the infection during their initial hospitalization. Two adult patients had to be readmitted following late-onset RV infection. In all cases, infection was self-limiting, but led to prolonged hospitalization because of significant loss of fluids and electrolytes.

CONCLUSIONS

RV enteritis is a common infection in pediatric solid organ recipients but may also affect adult patients.

Estimates of economic burden of providing inpatient care in childhood rotavirus gastroenteritis from Malaysia

AIM

To estimate the cost of an episode of inpatient care and the economic burden of hospitalisation for childhood rotavirus gastroenteritis (GE) in Malaysia.

METHODS

A 12-month prospective, hospital-based study on children less than 14 years of age with rotavirus GE, admitted to University of Malaya Medical Centre, Kuala Lumpur, was conducted in 2002. Data on human resource expenditure, costs of investigations, treatment and consumables were collected. Published estimates on rotavirus disease incidence in Malaysia were searched. Economic burden of hospital care for rotavirus GE in Malaysia was estimated by multiplying the cost of each episode of hospital admission for rotavirus GE with national rotavirus incidence in Malaysia.

RESULTS

In 2002, the per capita health expenditure by Malaysian Government was US$71.47. Rotavirus was positive in 85 (22%) of the 393 patients with acute GE admitted during the study period. The median cost of providing inpatient care for an episode of rotavirus GE was US$211.91 (range US$68.50-880.60). The estimated average cases of children hospitalised for rotavirus GE in Malaysia (1999-2000) was 8571 annually. The financial burden of providing inpatient care for rotavirus GE in Malaysian children was estimated to be US$1.8 million (range US$0.6 million-7.5 million) annually.

CONCLUSION

The cost of providing inpatient care for childhood rotavirus GE in Malaysia was estimated to be US$1.8 million annually. The financial burden of rotavirus disease would be higher if cost of outpatient visits, non-medical and societal costs are included.

[Administration of probiotic lactobacilli to children with gastrointestinal problems: there is still little evidence]

Probiotics are defined as 'live micro-organisms that confer a health benefit on the host if administered in adequate amounts'. There are only limited data in the literature regarding the efficacy and safety of lactobacilli for various gastrointestinal indications in children. Lactobacillus rhamnosus GG (LGG) has no added value in the treatment of children with functional constipation. Lactobacilli do seem to be effective in rotavirus diarrhoea. They seem safe and shorten the duration of the diarrhoea by about 1 day. For the prevention of infectious diarrhoea, lactobacilli are only moderately effective and the clinical relevance is unclear. There is 1 controlled study in which LGG had a preventive effect on the development of atopic eczema (but not of allergy to cow's milk) in newborn infants.

Use of formative research in developing a knowledge translation approach to rotavirus vaccine introduction in developing countries

BACKGROUND

Rotavirus gastroenteritis is the leading cause of diarrheal disease mortality among children under five, resulting in 450,000 to 700,000 deaths each year, and another 2 million hospitalizations, mostly in the developing world. Nearly every child in the world is infected with rotavirus at least once before they are five years old. Vaccines to prevent rotavirus or minimize its severity are now becoming available, and have already been introduced into the public vaccine programs of several Latin American countries. The World Health Organization (WHO) has made rotavirus vaccine introduction in developing countries a high priority. The WHOs Guidelines for Vaccine Introduction indicates that a key determinant to achieving vaccine introduction is the public health priority of the disease, suggesting that where the disease is not a priority uptake of the vaccine is unlikely. WHO recommends conducting a qualitative analysis of opinions held by the public health community to determine the perceptions of the disease and the priority given to the vaccine.

METHODS

This paper presents the formative research results of a qualitative survey of public health providers in five low- and middle-income countries to determine if and to what degree rotavirus is perceived to be a problem and the priority of a vaccine. Open-ended surveys were carried out through focus group discussions and one-on-one interviews.

RESULTS

Researchers discovered that in all five countries knowledge of rotavirus was extremely low, and as a result was not considered a high priority. However, diarrhea among young children was considered a high priority among public health providers in the three poorest countries with relatively high levels of child mortality: India, Indonesia, and Nicaragua.

CONCLUSION

In the poorest countries, advocacy and communication efforts to raise awareness about rotavirus sufficient for prioritization and accelerated vaccine introduction might benefit from a knowledge translation approach that delivers information and evidence about rotavirus through the broader context of diarrheal disease control, an existing priority, and including information about other new interventions, specifically low-osmolarity oral rehydration solution and zinc treatment.

Acute childhood diarrhoea in northern Ghana: epidemiological, clinical and microbiological characteristics

Background

Acute diarrhoea is a major cause of childhood morbidity and mortality in sub-Saharan Africa. Its microbiological causes and clinico-epidemiological aspects were examined during the dry season 2005/6 in Tamale, urban northern Ghana.

Methods

Stool specimens of 243 children with acute diarrhoea and of 124 control children were collected. Patients were clinically examined, and malaria and anaemia were assessed. Rota-, astro-, noro- and adenoviruses were identified by (RT-) PCR assays. Intestinal parasites were diagnosed by microscopy, stool antigen assays and PCR, and bacteria by culturing methods.

Results

Watery stools, fever, weakness, and sunken eyes were the most common symptoms in patients (mean age, 10 months). Malaria occurred in 15% and anaemia in 91%; underweight (22%) and wasting (19%) were frequent. Intestinal micro-organisms were isolated from 77% of patients and 53% of controls (P < 0.0001). The most common pathogens in patients were rotavirus (55%), adenovirus (28%) and norovirus (10%); intestinal parasites (5%) and bacteria (5%) were rare. Rotavirus was the only pathogen found significantly more frequently in patients than in controls (odds ratio 7.7; 95%CI, 4.2–14.2), and was associated with young age, fever and watery stools. Patients without an identified cause of diarrhoea more frequently had symptomatic malaria (25%) than those with diagnosed intestinal pathogens (12%, P = 0.02).

Conclusion

Rotavirus-infection is the predominant cause of acute childhood diarrhoea in urban northern Ghana. The abundance of putative enteropathogens among controls may indicate prolonged excretion or limited pathogenicity. In this population with a high burden of diarrhoeal and other diseases, sanitation, health education, and rotavirus-vaccination can be expected to have substantial impact on childhood morbidity.

Clinical consequences of rotavirus acute gastroenteritis in Europe, 2004-2005: the REVEAL study

BACKGROUND

The availability of comprehensive, up-to-date epidemiologic data would improve the understanding of the disease burden and clinical consequences of rotavirus gastroenteritis (RVGE) in Europe.

METHODS

During the 2004-2005 season, a prospective, multicenter, observational study was conducted in children <5 years of age in primary care, emergency department, and hospital settings in selected areas of Belgium, France, Germany, Italy, Spain, Sweden, and the United Kingdom. The clinical consequences of acute gastroenteritis (AGE) and RVGE were estimated.

RESULTS

The estimated percentage of children with rotavirus-positive AGE admitted to a hospital was 10.4%-36.0%, compared with 2.1%-23.5% of children with rotavirus-negative AGE. In France, Germany, Italy, Spain, and the United Kingdom, the relative risk of hospitalization was statistically significantly higher for children with rotavirus-positive AGE than for those with rotavirus-negative AGE. Children with rotavirus-positive AGE were more likely to have lethargy, fever, vomiting, and dehydration, and, therefore, more severe disease than were children with rotavirus-negative AGE. Dehydration was up to 5.5 times more likely in children with rotavirus-positive AGE than in those with rotavirus-negative AGE.

CONCLUSIONS

Rotavirus-positive AGE is more severe, causes more dehydration, and results in more emergency department consultations and hospitalizations than does rotavirus-negative AGE. Variations in the management of RVGE seen across study areas could be explained by differences in health care systems. Routine rotavirus vaccination of infants could significantly reduce the substantial burden of RVGE and would have major benefits for potential patients, their families, and health care providers.

[Role of rotavirus non-structural protein 4 in causing of acute gastroenteritis]

Rotaviruses belong to the family Reoviridae, genus Rotavirus with several types that are important for human and animal medicine. Rotavirus genome is consisted of 11 segments of double-stranded RNA, which code the synthesis of structural (VP) and non-structural proteins (NSP). The virus genome is enclosed in the three-layer capsid. Protein of the middle layer (VP6) is responsible for group specificity, and two proteins of the external capsid layer (VP7 and VP4) are responsible for belonging of rotaviruses group A to different sero/genotypes, in further text G and P. These two important antigen proteins stimulate an organism to produce specific neutralizing antibodies. Today, there are overall 15 G and 23 P serotypes of rotaviruses known and discovered so far. It infects humans, with 10 G and 11 P serotypes of rotaviruses discovered, with the most frequent presence of group A of serotypes G1 to G4, and serotypes P4 and P8, respectively. The most frequently found serotype among them is G1. According to recent reports, rotaviruses are still one of the most important causes of acute gastroenteritis in the population of young children, with endemic distribution in all geographic regions. Annually, around 50,000 of rotavirus-infected individuals are hospitalized in USA and around 80,000 in Europe. Compared to other pathogens, rotaviruses are present in causing of acute diarrheas in children in 30-40 % of cases. In children younger than 5, around 136 millions of gastroenteritis cases with rotavirus etiology are registered annually. Out of this number, 111 millions are treated at homes, 25 millions ask for medical consultations, 2 millions are hospitalized, and around 440,000 die.