Published online December 1, 2008
PEDIATRICS Vol. 122 No. 6 December 2008, pp. 1235-1243 (doi:10.1542/peds.2007-3378)

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ARTICLE

Active, Population-Based Surveillance for Severe Rotavirus Gastroenteritis in Children in the United States

Daniel C. Payne, PhD, MSPH^a, Mary Allen Staat, MD, MPH^b, Kathryn M. Edwards, MD^c,d,e, Peter G. Szilagyi, MD, MPH^f, Jon R. Gentsch, PhD^g, Lauren J. Stockman, MPH^a,h, Aaron T. Curns, MPH^a, Marie Griffin, MD, MPH^c,d,e, Geoffrey A. Weinberg, MD^f, Caroline B. Hall, MD^f, Gerry Fairbrother, PhD^b, James Alexander, MD^a, Umesh D. Parashar, MBBS, MPH^a

^a Epidemiology Branch
^g Gastroenteritis and Respiratory Viruses Laboratory Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, Georgia
^b Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
^c Departments of Pediatrics
^d Medicine
^e Preventive Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
^f Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
^h Atlanta Research and Education Foundation, Decatur, Georgia

OBJECTIVES. Routine vaccination of US infants against rotavirus was implemented in 2006, prompting the Centers for Disease Control and Prevention New Vaccine Surveillance Network to begin population-based acute gastroenteritis surveillance among US children <3 years of age. This surveillance system establishes baseline estimates of rotavirus disease burden and allows for the prospective monitoring of rotavirus vaccination impact.

METHODS. Eligible children with acute gastroenteritis (3 episodes of diarrhea and/or any vomiting in a 24-hour period) who were hospitalized, were seen in emergency departments, or visited selected outpatient clinics in 3 US counties during the period of January through June 2006 were enrolled. Epidemiological and clinical information was obtained through parental interview and medical chart review, and stool specimens were tested for rotavirus with enzyme immunoassays. Rotavirus-positive specimens were genotyped by using reverse transcription-polymerase chain reaction assays.

RESULTS. Stool specimens were collected from 516 of the 739 enrolled children with acute gastroenteritis (181 inpatient, 201 emergency department, and 134 outpatient) and 44% tested positive for rotavirus (227 of 516 specimens). The most common strain was P[8]G1 (84%), followed by P[4]G2 (5%) and P[6]G12 (4%). None of the 516 children had received rotavirus vaccine. The rotavirus detection rate was 50% for hospitalized acute gastroenteritis cases, 50% for emergency department visits, and 27% for outpatient visits. Rotavirus-related acute gastroenteritis cases were more likely than non–rotavirus-related acute gastroenteritis cases to present with vomiting, diarrhea, fever, and lethargy. Directly calculated, population-based rates for rotavirus hospitalizations and emergency department visits were 22.5 hospitalizations and 301.0 emergency department visits per 10 000 children <3 years of age, respectively. A sentinel outpatient clinic visit rate of 311.9 outpatient visits per 10 000 children <3 years of age was observed.

CONCLUSIONS. Population-based, laboratory-confirmed rotavirus surveillance in the final rotavirus season before implementation of the US rotavirus vaccine program indicated a considerable burden of disease on the US health care system.

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Key Words: rotavirus • acute gastroenteritis • disease burden • population-based surveillance

Abbreviations: CDC—Centers for Disease Control and Prevention • NVSN—New Vaccine Surveillance Network • AGE—acute gastroenteritis • ED—emergency department • EIA—enzyme immunoassay • RT—reverse transcription • PCR—polymerase chain reaction • CI—confidence interval • NHAMCS—National Hospital Ambulatory Medical Care Survey

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Accepted Mar 10, 2008.

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