Hospital-based surveillance to estimate the burden of rotavirus gastroenteritis in children below five years of age in Romania

Abstract

Introduction: Rotavirus (RV) is a leading cause of acute gastroenteritis (AGE), affecting 95% of children below five years of age.

Methods: In this prospective, multi-center study, children below five years of age who were hospitalized or those who visited the emergency room (ER) due to AGE or who developed AGE at least 48 hours after hospitalization (nosocomial infection) and had a RV-positive stool sample were included (n=1,222). RV-positive samples were genotyped by reverse-transcriptase polymerase chain reaction.

Results: RV test results were available for 1,212 children (hospitalizations [n=677], ER visits [n=398] and nosocomial AGE cases [n=137]). Proportions of rotavirus gastroenteritis (RVGE) hospitalizations and ER visits were 51.70% (350/677; 95%CI: 47.86-55.52) and 36.18% (144/398; 95%CI: 31.45-41.12), respectively. Overall, 45.95% (494/1075) of all community-acquired AGE cases were due to RV. High numbers of RVGE cases were recorded between January and March. Most common genotypes were G9P[8] (34.27%) followed by G4P[8] (25.83%) and G1P[8] (23.02%). Of all community-acquired RVGE cases, the highest number of cases was observed in children aged 12-23 months. Median duration of hospitalization among RV-positive subjects was six days (range: 2-31 days). Incidence of nosocomial RVGE was 0.52 (95%CI: 0.45-0.60) cases per 1,000 child-days hospitalization. Median duration for additional hospitalization due to nosocomial RVGE was five days (range: 1-10). The highest burden of nosocomial RVGE was observed in children aged 12-23 months (42.34%, 58/137). Our findings confirm a high burden of acute RVGE disease in Romania and provide useful data to support the implementation of RV vaccination in Romania.

Trial registration: NCT01253967.

Keywords: Romania; Rotavirus; acute gastroenteritis; epidemiology; incidence; nosocomial.

Conflict of interest statement

Conflicts of interest Ioana Alina Anca has been the principal investigator in clinical studies supported by GlaxoSmithKline (GSK) group of companies, Ferring, Apogepha and Institut de Recherche Pierre Fabre, and scientific consultant to GSK group of companies, Wyeth, Teva, Reckitt-Benckiser, Astra Zeneca and Nestle. She received sponsorship from GSK group of companies, Wyeth and Nestle to attend scientific meetings. Florentina Ligia Furtunescu received funds from GlaxoSmithKline group of companies for organizing the e-database, data analysis and writing of the study report. All other authors, except for Katsiaryna Holl who is an employee of GlaxoSmithKline group of companies, have declared no conflicts of interest.

Figures

Figure 1.. Subjects per subgroup.

ER emergency room; GE gastroenteritis; RV rotavirus.

Figure 2.. Age distribution of RVGE cases in community-acquired AGE hospitalizations and ER visits.

AGE acute gastroenteritis; ER emergency room; RVGE rotavirus gastroenteritis.

Figure 3.. Occurrence of rotavirus gastroenteritis (RVGE) cases by month in Romania, 2008–09

Figure 4.. Genotype distributions in rotavirus gastroenteritis (RVGE) cases in Romania, 2008–09