PEDIATRICS Vol. 122 No. 6 December 2008, pp. 1235-1243 (doi:10.1542/peds.2007-3378)
ARTICLE |
Active, Population-Based Surveillance for Severe Rotavirus Gastroenteritis in Children in the United States
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
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ABSTRACT |
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 TOP ABSTRACT METHODSRESULTSDISCUSSIONREFERENCES |
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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.
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
In 2006, a new vaccine for the prevention of acute gastroenteritis (AGE) caused by rotavirus (RotaTeq; Merck, Whitehouse Station, NJ) was licensed in the United States and was recommended by the US Advisory Committee for Immunization Practices and the American Academy of Pediatrics for routine immunization of all US children.1 This decision was based in part on the considerable burden of rotavirus-related AGE on the US health care system,2–7 primarily assessed through large linked databases (eg, national hospital discharge data) and the use of indirect approaches to estimate the proportion of AGE events attributable to rotavirus. Because limited population-based, laboratory-confirmed, active surveillance data on severe rotavirus existed,8 the Centers for Disease Control and Prevention (CDC) New Vaccine Surveillance Network (NVSN) undertook such an effort. This surveillance is needed to assess the effectiveness of vaccination through prospective, direct monitoring of the burden of disease caused by rotavirus and the genotypes of circulating rotavirus strains. This article presents the results from the first season of AGE surveillance through NVSN, which was also the final rotavirus season before widespread implementation of the US rotavirus vaccine program.
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METHODS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
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The NVSN conducted prospective, population-based, AGE surveillance in 3 US counties from January 1, 2006, through June 30, 2006. Surveillance was conducted in hospitals, emergency departments (EDs), and outpatient clinics, with institutional review board approval from the CDC and each participating NVSN site. These NVSN sites include Vanderbilt University Medical Center (Davidson County, Tennessee), Cincinnati Children's Hospital Medical Center (Hamilton County, Ohio), and the University of Rochester Medical Center (Monroe County, New York).
Children 14 days to 3 years of age were considered eligible for enrollment if they presented to these health care facilities with AGE, defined as 3 loose stools and/or 1 episode of vomiting within 24 hours. They were required to be residents of the specified counties, to have experienced onset of their gastroenteritis AGE symptoms 
10 days before seeking health care, and to have informed consent from a parent or guardian. Children were ineligible if they had a noninfectious disease cause, were immunocompromised, were enrolled previously with the same episode of gastroenteritis, or were transferred from another hospital after an admission of >48 hours. Children who were enrolled as ED patients and then experienced escalation to inpatient status during surveillance hours were categorized as hospitalized.
A standardized questionnaire administered to the consenting parent or guardian collected demographic, medical history, and socioeconomic data, and medical chart reviews ascertained clinical data and vaccination status. We attempted to collect a whole stool sample within 14 days after disease onset, and specimens were tested by using a commercial rotavirus enzyme immunoassay (EIA). EIA-positive specimens were analyzed by the CDC for determination of rotavirus genotypes, through multiplex, reverse transcription (RT)-polymerase chain reaction (PCR) methods and nucleotide sequencing.9–12 Statistical analyses were conducted by using SAS 9.1 (SAS Institute, Cary, NC). Comparisons were made by using Pearson's 
2 test and Student's t test.
Participating NVSN hospitals capture >95% of all pediatric hospital admissions in their respective counties. These 3 counties include 
85 000 children <3 years of age. Population-based hospitalization rates were calculated as the weighted number of AGE hospitalizations with laboratory-confirmed rotavirus divided by the number of children within the age cohort in the county population (as determined in the 2000 US Census), multiplied by 10 000. Weights were calculated to account for the number of days when AGE surveillance was conducted, the proportion of eligible children enrolled in the study, and the different specimen collection rates at the NVSN sites. The 95% confidence intervals (CIs) were determined by using 1000 bootstrap samples for each rate, with the resulting 2.5th and 97.5th percentile values as the lower and upper limits, respectively, of the CIs.13
Population-based ED rotavirus visit rates were estimated by correcting the number of AGE-related ED visits among children <3 years of age for the 24-hour surveillance periods, to account for the days that surveillance was not conducted in a given week and to account for the estimated ED visit proportions at the NVSN ED facilities in the 3 counties (Davidson County, Tennessee, 54% at Vanderbilt University Medical Center ED; Hamilton County, Ohio, 95% at Cincinnati Children's Hospital Medical Center ED; Monroe County, New York, 70% at Strong Memorial ED and 25% at Rochester General ED). The weighted totals according to month were multiplied by the monthly proportion of rotavirus-positive specimens among study participants at each NVSN ED, to obtain the estimated number of rotavirus-related ED visits.14 Population-based ED rates were calculated by using the method described for the population-based hospitalization rates.
For comparison with our NVSN rotavirus-related ED rates, we calculated rotavirus-related ED visit rates indirectly by using National Hospital Ambulatory Medical Care Survey (NHAMCS) data. All NHAMCS ED visits attributable to AGE among children <3 years of age between January 1 and June 30 were identified for 2003 through 2005.15 These ED visits were identified by selecting International Classification of Diseases, Ninth Revision, Clinical Modification codes for AGE in any 1 of the 3 physician diagnosis fields. SEs for the weighted estimates were calculated by using SUDAAN 9.0 (Research Triangle Institute, Research Triangle Park, NC). The weighted estimate of AGE visits among children <3 years of age was multiplied by the proportion of rotavirus-positive specimens observed at the NVSN sites during the coinciding period of January 1 to June 30, 2006, to obtain the estimated number and US rate of ED visits attributable to rotavirus-related AGE. The National Center for Health Statistics bridged-race intercensal estimates of US children <3 years of age for 2003 through 2005 were used as the denominators in our rate calculations.16
Outpatient NVSN data are sentinel and not population-based, as are our ED and hospitalization data, but they represent an important component of the estimated burden of severe rotavirus gastroenteritis. We approximated a rotavirus outpatient rate for the United States by multiplying the proportion of laboratory-confirmed rotavirus outpatient visits from our 6-month period (January through June) of NVSN AGE surveillance by the number of outpatient visits (NHAMCS, 2003–2005) plus medical office visits (National Ambulatory Medical Care Survey, 2003–2005) among US children <3 years of age in January through June. We then calculated the US rate by using the same method as used for the US ED rates. All rates were annualized as visits per 10 000 children per year except for monthly rates, which are reported according to 10 000 child-years. Extrapolations to the US population were calculated by applying NVSN rates to the annual US birth cohort of 4 million.
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RESULTS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
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Study Group
Of 1042 inpatient, ED, and outpatient children screened for participation in this study, 838 (80%) were determined to be eligible. We obtained consent for 729 of those children (87%), who were then enrolled as NVSN AGE surveillance study subjects. Stool specimens were collected from 516 (71%) of the 729 study participants, that is, 181 from the inpatient setting, 201 from EDs, and 134 from sentinel outpatient clinics (Fig 1). None of these children had received rotavirus vaccine.
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Comparison of Study Participants
Stool specimens were more likely to be collected from hospitalized enrolled subjects (91%) than from ED and outpatient enrolled subjects (61% and 66%, respectively; P < .001). Enrolled study participants were statistically similar to nonenrolled subjects with respect to provider type, age, and gender, but significant differences were observed with respect to ethnicity; 27% of nonenrolled subjects were Hispanic, compared with 12% of enrolled study participants (P < .001), and 18% of nonenrolled subjects were uninsured, compared with 6% of enrolled study participants (P < .001). Reasons for nonenrollment included the following: parent or guardian refusal, non–English-speaking, no parent or legal guardian available, and patient discharged before enrollment.
Rotavirus Detection Through EIA
Across all surveillance sites and all provider settings, 44% of NVSN stool specimens (227 of 516 specimens) tested positive for rotavirus. Rotavirus detection rates for AGE inpatient and ED visits were both 50% and the outpatient clinic detection rate was 27%, which was statistically lower (P < .001). The proportions of inpatient, ED, and outpatient specimens that tested positive for rotavirus were not statistically different across the 3 surveillance sites (inpatient: P = .668; ED: P = .259; outpatient: P = .068) (Table 1).
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Rotavirus-positive subjects were statistically different from rotavirus-negative subjects with respect to age group (P < .001) and insurance status (P < .001) (Table 2). The mean age of rotavirus-positive children was 13.6 months (SD: 8.2 months), compared with a mean age of 11.7 months (SD: 9.4 months) for rotavirus-negative children. Stool specimens from children 6 to 12 months of age were statistically more likely to test positive for rotavirus than were those from infants <6 months of age (43% vs 31%; P = .013). Rotavirus-positive subjects were more likely to be privately insured than were rotavirus-negative patients (37% vs 20%). No statistical differences in rotavirus EIA results according to race (P = .196), ethnicity (P = .207), or gender (P = .918) were observed.
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Rotavirus-Related Hospitalization Rate
The estimated rotavirus-related hospitalization rate was 22.5 admissions per 10 000 children <3 years of age in the 3 surveillance counties, with a 95% CI of 19.2 to 25.7 admissions per 10 000 children. Rotavirus hospitalization rates varied according to NVSN site, with 23.1 admissions per 10 000 children <3 years of age (95% CI: 17.2–28.7 admissions per 10 000 children) in Davidson County, Tennessee (Vanderbilt), 30.9 admissions per 10 000 children <3 years of age (95% CI: 24.6–36.9 admissions per 10 000 children) in Hamilton County, Ohio (Cincinnati), and 11.8 admissions per 10 000 children <3 years of age (95% CI: 8.1–15.1 admissions per 10 000 children) in Monroe County, New York (Rochester) (Fig 2).
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According to age category, the weighted hospitalization rates for rotavirus were lowest for children 30 to 36 months of age (7.1 admissions per 10 000 children) and highest for children 12 to 18 months of age (42.5 admissions per 10 000 children) (Fig 3). Comparatively, the 30- to 36-month-old category also had the lowest hospitalization rate for rotavirus-negative AGE (7.0 admissions per 10 000 children), but hospital rates for infections with nonrotavirus pathogens peaked in the first 6 months of life (54.7 admissions per 10 000 children). The hospitalization rate attributed to rotavirus was highest during the months of February (70.3 admissions per 10 000 child-years), March (111.3 admissions per 10 000 child-years), and April (46.9 admissions per 10 000 child-years), whereas the surveillance months of January, May, and June averaged 13.8 admissions per 10 000 child-years (Fig 4).
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Rotavirus-Related ED and Outpatient Visit Rates
In active, population-based, NVSN surveillance, 301.0 per 10 000 children <3 years of age had ED visits attributable to rotavirus-related AGE. Our directly obtained rate was higher than the 3-year average rate we calculated from NHAMCS data (171.7 ED visits per 10 000 children <3 years of age for January to June, 2003–2005; 95% CI: 136.5–207.0 ED visits per 10 000 children). Between 2005 and 2003, single-year national ED rates from NHAMCS data ranged from 140.0 ED visits per 10 000 children (95% CI: 78.7–201.2 ED visits per 10 000 children) to 205.9 ED visits per 10 000 children (95% CI: 136.7–275.1 ED visits per 10 000 children). NVSN ED rates for rotavirus-related AGE among children <3 years of age varied across the NVSN sites, that is, 357.3 ED visits per 10 000 children for Davidson County, Tennessee, 401.5 ED visits per 10 000 children for Hamilton County, Ohio, and 131.1 ED visits per 10 000 children for Monroe County, New York (Fig 2). Consistent with the seasonal pattern for rotavirus hospitalizations, the ED visit rate for rotavirus-related AGE was highest during the months of February (858.3 ED visits per 10 000 children), March (1557.1 ED visits per 10 000 children), and April (727.0 ED visits per 10 000 children), compared with an average rate of 156.7 ED visits per 10 000 children for January, May, and June (Fig 4). Among NVSN sentinel outpatient clinics, the rate of outpatient visits attributable to rotavirus gastroenteritis was 311.9 outpatient visits per 10 000 children <3 years of age (95% CI: 199.0–424.9 outpatient visits per 10 000 children).
Rotavirus Severity
Rotavirus-related AGE symptoms were generally more serious than non–rotavirus-related AGE symptoms and were more likely to include vomiting (95% vs 79%; P < .001), diarrhea (92% vs 84%; P = .006), fever (78% vs 63%; P = .001), and lethargy (53% vs 27%; P < .001). The average number of vomiting episodes per day was higher for rotavirus-related AGE cases, compared with non–rotavirus-related AGE cases (7.5 vs 5.6 episodes per day; P < .001), as was the average number of diarrheal episodes per day (9.0 vs 6.4 episodes per day; P = .001). Symptoms of AGE illness for rotavirus-positive and rotavirus-negative AGE surveillance subjects are illustrated in Fig 5 (it should be noted that fever was not a surveillance inclusion requirement). More than 70% of rotavirus-positive subjects had combined symptoms of diarrhea, vomiting, and fever, compared with 42% of rotavirus-negative AGE surveillance subjects. A rotavirus-positive presentation of diarrhea alone was rare (0.4%), but this symptom was present alone for 8% of the rotavirus-negative surveillance subjects. No deaths occurred among our surveillance subjects.
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Strain Detection
Among the 225 rotavirus-positive specimens submitted to the CDC for strain identification with RT-PCR techniques, the most prevalent strain observed was genotype P[8]G1 (189 specimens, 84.0%), followed distantly by P[4]G2 (11 specimens, 4.9%) and P[6]G12 (8 specimens, 3.6%). P[6]G1 was detected less commonly (4 specimens, 1.8%), and 1 observation (0.4%) was noted for each of the following: P[8]G2, P[8]G12, P[6]G9, and P[4]G1. Four percent of our sample had mixed rotavirus infections with >1 genotype (Fig 6).
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DISCUSSION |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
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This study clearly illustrates the substantial health burden of rotavirus-related AGE among US children and the potential benefits of vaccination. Laboratory-confirmed rotavirus infections accounted for 50% of all AGE hospitalizations and ED visits and 27% of AGE outpatient visits during our 6 months of active surveillance. With extrapolation of our population-based findings from these 3 counties to US children <3 years of age for the purpose of comparison, our overall hospitalization rate of 22.5 hospitalizations per 10 000 children would translate to
27 000 rotavirus hospitalizations per year and our ED rate of 301.0 ED visits per 10 000 children would translate to >361 000 ED visits per year. Our sentinel outpatient clinic rate of 311.9 visits per 10 000 would approximate 374 000 outpatient visits per year attributable to rotavirus-related AGE among US children <3 years of age. With application to a US birth cohort of 4 million, each year rotavirus-related AGE would be expected to cause 1 in 150 US children <3 years of age to be hospitalized and 1 in 11 to visit either an ED or an outpatient clinic (Fig 7). Furthermore, children with rotavirus-related AGE exhibited symptoms (diarrhea, vomiting, fever, and lethargy) with significantly greater frequency and intensity than did those with non–rotavirus-related AGE, which emphasizes the severity and health burden of this disease. More than 8 in 10 of our patients with laboratory-confirmed rotavirus, all of whom were unvaccinated in this baseline surveillance year, were >6 months of age, when the rotavirus vaccine series would be completed, which indicates that an effective vaccine should prevent a substantial proportion of severe rotavirus-related disease.
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Our finding that 50% of children <3 years of age who were hospitalized for AGE in January to June had laboratory-confirmed rotavirus demonstrates, as suspected, that the rotavirus-specific International Classification of Diseases, 9th Revision, Clinical Modification code likely captures only a fraction of all rotavirus-related hospitalizations. Previous studies using health care utilization data reported substantially smaller proportions (12%–20%) of AGE hospital discharges coded as rotavirus.17,18 However, Staat et al,8 in direct surveillance of children <5 years of age hospitalized with AGE, noted a rotavirus detection rate of 56% during the rotavirus season, and Canadian surveillance indicated that
40% of ED visits attributable to AGE during the winter rotavirus season are rotavirus-positive.19 Our rotavirus detection rates are consistent with both of those studies. Our report that 27% of sentinel outpatient AGE visits among children <3 years of age were attributable to laboratory-confirmed rotavirus infection is lower than the value of 40% reported by Coffin et al20 but still indicates a sizeable burden of rotavirus in pediatric outpatient practices, similar to national burden estimates produced by Parashar et al.1
When we extrapolated our active, population-based, surveillance data to US children <3 years of age, we noted that our estimation of rotavirus-attributable US hospitalization rates, although substantial, was lower than recent indirect measures from national data sets, which calculated rates for US children <5 years of age of 47 000 to 67 000 hospitalizations per year4,5,18,21; the age difference would be expected to result in NVSN hospitalization rates 10% to 15% lower than these national values. Some of the variation might be explained by the underlying assumptions used for national data set analyses, such as assumptions regarding the proportions of medically attended AGE cases that are rotavirus-positive. Nonetheless, our measure of rotavirus hospitalization burden seems to be considerably offset by our estimated finding of 361 000 US ED visits per year attributable to rotavirus, a figure higher than existing national estimates (205 000–272 000 ED visits per year1). In our own comparison, our NVSN rate for rotavirus-attributable ED visits was higher than indirect ED rates we calculated from the most recently available national data for children <3 years of age (NHAMCS, January to June, 2003–2005), although there was substantial fluctuation in national rates over this 3-year period (140.0–205.9 ED visits per 10 000 children <3 years of age). Our single-year observations from NVSN data might reflect the considerable annual rate fluctuations seen on the national level or might indicate other health care utilization dynamics, such as possible substitution of disease burden between hospital and ED health care settings at NVSN sites. Hospital and ED rates varied substantially according to NVSN site, but the ratios of ED rates to hospital rates remained similar (ED rates 11–15 times higher than hospitalization rates). It is notable that the rates of ED visits and outpatient clinic visits attributable to rotavirus-related AGE were similar, and our data portray rotavirus as posing a very large and typically underappreciated burden of disease in the ED setting. Overall, these data confirm that disease rates for population-based rotavirus surveillance in both hospital and ED health care settings is needed to gauge fully the burden of severe rotavirus-related AGE, and they suggest that additional study of rotavirus-related ED burden is warranted.
Approximately 96% of the circulating strains we detected had either a G or P antigen directly included in Merck's pentavalent rotavirus vaccine RotaTeq, the current, US-licensed, rotavirus vaccine. A monovalent rotavirus vaccine which obtained US licensure in 2008, Rotarix (GlaxoSmithKline Biologicals, Rixensart, Belgium), contains a single attenuated human rotavirus strain (P[8]G1) that was directly observed in 84% of our specimens and corresponded to either a G or P antigen for 91% of our circulating strains. Some degree of protection against severe infection by other rotavirus types has been indicated in clinical trials.22
Compared with US national laboratory rotavirus strain surveillance results from 1996–1999,23 we more frequently detected the strain P[8]G1 (84.0% vs 75.5%). We found a comparatively smaller proportion of P[4]G2 (4.9% vs 10.9%). Of the strains usually described as "uncommon" in the United States, we reported fewer P[6]G9-positive test results (0.4% vs 3.2%), but otherwise our results were comparable to national surveillance data. We detected 2 strains that have been hypothesized to represent globally emerging serotypes, on the basis of increasing detection in recent years,11,24 that is, P[8]G12 (0.4%) and P[6]G12 (3.6%). The single case of P[8]G12 was observed in Hamilton County, Ohio (Cincinnati), and P[6]G12 cases were observed in all 3 surveillance areas. Children for whom mixed rotavirus infections were detected (4.0%) might have had concomitant acute rotavirus infections or, perhaps an acute rotavirus infection combined with rotaviral shedding from an earlier infection. Continued surveillance is necessary to measure trends in circulating rotavirus strains from year to year, to monitor for possible changes resulting from implementation of vaccination, and to assess the effectiveness of vaccination against different strains.
Some limitations should be considered in the interpretation of our findings. First, this report summarizes results from only 1 season of AGE surveillance. Considerable geographic and temporal variations in rotavirus activity are known to occur,25,26 and we observed this apparent natural variability across the 3 surveillance sites. It remains to be seen how the impact of widespread vaccination may modify this geographic and temporal phenomenon in future rotavirus seasons. Second, although we conducted population-based surveillance in counties located in Southern, Midwestern, and Northeastern states, extrapolations to the US population have been used for comparative purposes, and these locations may not be representative of the entire US population. Compared with the US population of children <3 years of age from the 2000 US Census, the 85 000 children living in the 3 NVSN counties were similar in distribution according to age, gender, and white race. However, children in these NVSN catchment areas were less likely to be Hispanic (6% in the NVSN areas, compared with 20% in the United States) and were more likely to be black (27% in the NVSN areas, compared with 14% in the United States). Third, study enrollment was limited to children whose parent or guardian consented to the study in English. The difference in enrollment according to Hispanic ethnicity that we observed led us to develop a Spanish-language consent form and interview, to facilitate inclusion of non–English-speaking Hispanic parents or guardians in future surveillance. Fourth, because of logistic constraints, we conducted surveillance during 6 calendar months encompassing the winter season, when rotavirus is usually most prevalent. On the basis of the historical seasonal patterns of rotavirus disease in the United States, we are confident that we captured the vast majority of rotavirus cases at these 3 surveillance sites, although our rotavirus-related AGE rates are likely underestimated if we failed to capture cases outside the surveillance period. Fifth, our demonstration of disease severity did not include a clinical assessment of dehydration status.
By August 2008, >21 million doses of rotavirus vaccine had been distributed throughout the United States.27 As the proportion of US infants vaccinated for rotavirus increases, our NVSN surveillance platform continues to collect prospective epidemiological, clinical, and laboratory data in hospital and ED settings and in sentinel outpatient clinics. Using parental interviews, medical chart abstractions, laboratory confirmation of rotavirus disease status, and identification of rotavirus genotypes by using RT-PCR, NVSN is uniquely prepared to monitor the impact of vaccination on epidemiological and clinical disease trends, to detect changes in circulating viral genotypes, and to make robust assessments of population-based postmarketing vaccine effectiveness.
During this last rotavirus season prior to the widespread implementation of the US rotavirus vaccine program, NVSN surveillance directly confirms the rotavirus-related AGE has a significant health burden among US children. This provides important baseline information on the epidemiological and clinical features of severe rotavirus-related AGE, should allow assessment of the impact of vaccination in the future.
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ACKNOWLEDGMENTS |
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We extend special acknowledgment to Elizabeth Teel and Jennifer Hull (CDC), who performed the rotavirus genotyping, to Dr Marika Iwane (CDC), for NVSN methodologic and technical expertise, and to the NVSN site coordinators for AGE surveillance, Diane Kent (Vanderbilt University Medical Center), Michol Holloway (Cincinnati Children's Hospital Medical Center), and Dr Gerry Loftus (University of Rochester School of Medicine and Dentistry), who managed study enrollment, data collection, and laboratory coordination at the NVSN sites.
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FOOTNOTES |
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Accepted Mar 10, 2008.
Address correspondence to Daniel C. Payne, PhD, MSPH, Epidemiology Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS-A34, Atlanta, GA 30333. E-mail: dvp6{at}cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
The authors have indicated they have no financial relationships relevant to this article to disclose.
| What's Known on This Subject The US rotavirus disease burden is estimated to be high, but estimates are based largely on indirect data. We know of no other prospective, population-based surveillance for rotavirus in multiple US counties.
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| What This Study Adds Our work presents the disease burden and characteristics of severe rotavirus illness in the last season before the widespread uptake of rotavirus vaccine, providing important baseline measurements.
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PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics
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