Impact of Rotavirus Vaccination on Hospital-Acquired Rotavirus Gastroenteritis in Children

Division of Infectious Diseases, Department of Pediatrics, Children’s Memorial Hospital, Chicago, Illinois 60614, USA.
PEDIATRICS (Impact Factor: 5.47). 02/2011; 127(2):e264-70. DOI: 10.1542/peds.2010-1830
Source: PubMed


Data show that after the implementation of routine rotavirus vaccination for infants in the United States, community-acquired (CA) rotavirus cases declined substantially in the 2007-2008 season. The impact of community-based rotavirus vaccination on the substantial burden of hospital-acquired (HA) rotavirus has not been documented.
We assessed CA and HA rotavirus, respiratory syncytial virus, and influenza infections at Children's Memorial Hospital for 5 winter seasons (defined as occurring from September through May) from 2003 to 2008. We also report rotavirus data from the 2008-2009 season.
A similar dramatic decline (>60% compared with the median of previous seasons) occurred in the rates of cases of both CA (P < .0001) rotavirus hospitalizations and HA (P < .01) rotavirus infections in the 2007-2008 season compared with previous seasons, whereas the rates of CA and HA influenza and respiratory syncytial virus, respectively, remained stable. Improvements in hand-hygiene compliance did not correlate with a reduction in the transmission rate of rotavirus in the hospital. Both CA and HA rotavirus rates remained much lower in the 2008-2009 than in the 2003-2007 seasons.
Community-based rotavirus vaccination is associated with a substantial reduction in the number of children who are admitted with rotavirus. These data also indicate that routine community-based rotavirus infant vaccination protects hospitalized children from acquiring rotavirus. Vaccination efforts should be encouraged as a strategy to affect the substantial burden of HA rotavirus.

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    • "In order to assess the impact of vaccines on circulation of wild type strains, long-term surveillance for group-A RV infections and strains have been conducted in several countries [9] [10] [11]. In India epidemiological, clinical and virological features of RV infections occurring among children (<5 years) with acute gastroenteritis have been well studied [12] [13] [14]. "
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    ABSTRACT: Background Group-A Rotavirus (RV) is the main causative agent of acute gastroenteritis in children < 5 years of age. Its role as a pathogen in adults needs to be monitored. The aim of this study was to characterise the group-A RV strains that cause infections of acute gastroenteritis in adolescents and adults and determine the temporal variations in the circulating strains during 2008–2012 in continuation of an earlier study conducted in 2004–2007, in Pune, India. Methods A total of 371 stool samples were tested by RV antigen capture ELISA. VP4, VP6, VP7 and NSP4 genes of all of the RV strains detected in the study were analysed using reverse transcription PCR, multiplex PCR and sequencing. Results Group-A RV was detected in 9.4% (35/371) of the stool samples examined in the study period. The frequency of detection of RV was found to decline from 18.0% (16/90) in 2008 to 3.8% (2/52) in 2012. Of the 6 strains typed for both VP7 and VP4 genes, G2P[4], G1P[8] and G9P[4] were detected in 3, 1 and 2 samples, respectively. Sequencing and phylogenetic analysis of the VP4, VP6, VP7 and NSP4 genes revealed an infrequently reported NSP4-E6 genotype and circulation of heterogenous [G2 (lineage IIC and IID), G9 (lineage 3), P[4] (lineage P[4]-5), P[8] (lineage P[8]-3), VP6 I1 / I2 and NSP4 E2] genotypes/lineages in the RV strains. Analysis of linkage within these genes showed concordance (G2-P[4]-I2-E2) and discordance (G9-P[4]-I2-E6), equally. The sequences of amplified VP6 (n = 20) and NSP4 (n = 2) genes from G and P nontypeable RV strains (80.0%, 28/35) were most homologous to human group-A RV strains. Conclusion The study underscores the significant temporal variations in RV strains, identifies circulation of intergenogroup reassortants among adolescent and adult patients with acute gastroenteritis and emphasizes the need for continued surveillance and whole genome analysis of emerging rotavirus strains.
    Full-text · Article · Aug 2014 · Vaccine
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    • "However, epidemiological studies since 1997 based on a sentinel system showed that fluctuations of RV-GE numbers were always less than the decrease observed since introduction of UMV [5]. An unrecognized change in the prevention of pathogen transmission was excluded in our study, as similar hygienic rules and introduction of nurses, parents and visiting persons were applied during the whole study period, interventions which have been shown to be crucial in reduction of transmission [20]. "
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    ABSTRACT: Background The aim of the study was to evaluate the effects of universal mass vaccination (UMV) against rotavirus (RV) on the hospitalization rates, nosocomial RV infections and RV-gastroenteritis (GE)-associated secondary blood stream infections (BSI). Methods The retrospective evaluation (2002–2009) by chart analysis included all clinically diagnosed and microbiologically confirmed RV-GE cases in a large tertiary care hospital in Austria. The pre-vaccination period (2002–2005) was compared with the recommended and early funded (2006–2007) and the funded (2008–2009) vaccination periods. Primary outcomes were RV-GE-associated hospitalizations, secondary outcomes nosocomial RV disease, secondary BSI and direct hospitalization costs for children and their accompanying persons. Results In 1,532 children with RV-GE, a significant reduction by 73.9% of hospitalized RV-GE cases per year could be observed between the pre-vaccination and the funded vaccination period, which was most pronounced in the age groups 0–11 months (by 87.8%), 6–10 years (by 84.2%) and 11–18 years (88.9%). In the funded vaccination period, a reduction by 71.9% of nosocomial RV-GE cases per year was found compared to the pre-vaccination period. Fatalities due to nosocomial RV-GE were only observed in the pre-vaccination period (3 cases). Direct costs of hospitalized, community-acquired RV-GE cases per year were reduced by 72.7% in the funded vaccination period. The reduction of direct costs for patients (by 86.9%) and accompanying persons (86.2%) was most pronounced in the age group 0–11 months. Conclusions UMV may have contributed to the significant decrease of RV-GE-associated hospitalizations, to a reduction in nosocomial RV infections and RV-associated morbidity due to secondary BSI and reduced direct hospitalization costs. The reduction in nosocomial cases is an important aspect considering severe disease courses in hospitalized patients with co-morbidities and death due to nosocomial RV-GE.
    Full-text · Article · Mar 2013 · BMC Infectious Diseases
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    ABSTRACT: To determine the prevalence and epidemiological characteristics of rotavirus among adults admitted to the hospital with diarrhea that have bacterial stool cultures sent. The prevalence of rotavirus was determined by Rotaclone EIA in samples submitted for bacterial stool culture from adults requiring hospitalization at Northwestern Memorial Hospital, Chicago from December 01, 2005-November 30, 2006. Rotavirus was detected in 2.9% of eligible bacterial stool cultures. A bacterial pathogen (e.g., Salmonella, Shigella, Campylobacter) was identified in 3.3%. Bacterial stool pathogens were more common from June-October while rotavirus was 2.4 times more common than all bacterial pathogens from February-May. Adults in whom rotavirus was detected were older (p < 0.05) and more often immunosuppressed (p < 0.02), particularly with HIV (p < 0.04) compared to individuals from whom bacteria were isolated. The duration of hospitalization and the number of invasive procedures performed in those with rotavirus and bacterial diarrhea were comparable. In the era immediately prior to widespread rotavirus vaccination of children, rotavirus was as commonly detected from adults admitted to the hospital with diarrhea as are the bacterial gastroenteritis pathogens. Rotavirus is particularly prevalent from February-May (as in children) and in immunosuppressed or older adults.
    Full-text · Article · Sep 2011 · The Journal of infection
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