Published online March 2, 2009
PEDIATRICS Vol. 123 No. 3 March 2009, pp. e393-e400 (doi:10.1542/peds.2008-2088)

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ARTICLE

Hospital-Based Surveillance to Estimate the Burden of Rotavirus Gastroenteritis Among European Children Younger Than 5 Years of Age

Johannes Forster, MD^a, Alfredo Guarino, MD^b, Nathalie Parez, MD, PhD^c, Fernando Moraga, MD^d, Enriqueta Román, PhD^e, Olivier Mory, MD^f, Alberto E. Tozzi, MD^g, Ana López de Aguileta, MD^h, Ulrich Wahn, MDⁱ, Clive Graham, MBBS, MRCP, MRCPath^j, Reinhard Berner, MD^k, Titus Ninan, FRCP, FRCPCH^l, Celia Barberousse, MSc^m, Nadia Meyer, MD^m, Montse Soriano-Gabarró, MD, MSc^m and the Rotavirus Study Group

^a St Josefskrankenhaus, Kinderabteilung St Hedwig, Freiburg, Germany
^b Department of Pediatrics, University "Federico II," Naples, Italy
^c Service des Urgences Pédiatriques, Hôpital d'enfants Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
^d Service of Pediatrics, Hospital Vall d'Hebrón, Barcelona, Spain
^e Service of Pediatrics, Hospital de Fuenlabrada, Madrid, Spain
^f Service de Pédiatrie, Hôpital Nord, CHU de St-Etienne, St-Etienne, France
^g Epidemiology Unit, Bambino Gesu' Hospital, Rome, Italy
^h Service of Pediatrics, Hospital General de Vic, Barcelona, Spain
ⁱ Department for Pediatric Pneumology and Immunology, Charité Berlin, Berlin, Germany
^j Department of Microbiology, Birmingham Children's Hospital NHS Trust, Birmingham, United Kingdom
^k Centre for Pediatrics and Adolescent Medicine, University Medical Centre, Freiburg, Germany
^l Department of Paediatrics, Heart of England NHS Trust Foundation, Birmingham, United Kingdom
^m GlaxoSmithKline Biologicals, Rixensart, Belgium

OBJECTIVES. Rotavirus is the leading cause of acute gastroenteritis requiring hospitalization in young children. Data on the burden of rotavirus gastroenteritis are needed to guide recommendations for rotavirus vaccine use. This study was undertaken to estimate the burden of rotavirus gastroenteritis in European children <5 years of age.

METHODS. This prospective, study was conducted in 12 hospitals in France, Germany, Italy, Spain, and the United Kingdom. A sample of all children aged <5 years presenting to emergency departments or hospitalized because of community-acquired acute gastroenteritis was enrolled for parental interview and stool collection. Acute gastroenteritis was defined as diarrhea (3 loose stools per 24 hours) for <14 days. Rotavirus was detected by enzyme-linked immunosorbent assay and typed by reverse-transcriptase polymerase chain reaction.

RESULTS. Between February 2005 and August 2006, 3734 children with community-acquired acute gastroenteritis were recruited and retained for analysis (55.9% via the emergency department, 41.8% hospitalized). Of the 2928 community-acquired acute gastroenteritis cases for which stool samples were available, 43.4% were rotavirus-positive by enzyme-linked immunosorbent assay (32.8% emergency department, 56.2% hospitalized). Of these rotavirus gastroenteritis cases 80.9% occurred in children aged <2 years and 15.9% among infants aged <6 months. Acute gastroenteritis was more severe in rotavirus-positive subjects (Vesikari score 11 in 53.3% compared with 31.0% of rotavirus-negative subjects). All 1271 rotavirus-positive strains were genotyped (G1P[8]: 40.3%; G9P[8]: 31.2%; G4P[8]: 13.5%; G3P[8]: 7.1%).

CONCLUSIONS. Rotavirus gastroenteritis places high demands on European health care systems, accounting for 56.2% of hospitalizations and 32.8% of emergency department visits because of community-acquired acute gastroenteritis in children aged <5 years. Most community-acquired rotavirus gastroenteritis occurs in children aged <2 years, and a high proportion occurs in infants aged <6 months. Cases were also observed among very young infants <2 months of age. Rotavirus vaccination is expected to have a major impact in reducing morbidity and the pressure on hospital services in Europe.

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Key Words: rotavirus • gastroenteritis • children • epidemiology • surveillance and monitoring

Abbreviations: AGE—acute gastroenteritis • ED—emergency department • ELISA—enzyme-linked immunosorbent assay • SHRIK—Surveillance for Hospitalized Rotavirus Infections in Kids • RT-PCR—reverse-transcriptase polymerase chain reaction • CI—confidence interval

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Accepted Dec 4, 2008.

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