Hospital based surveillance of rotavirus gastroenteritis in children

Abstract

Background: Rotavirus (RV) is the single most common cause of severe gastroenteritis (GE) in children aged <5 years worldwide. Data on the burden and epidemiology of RV disease in Lebanon is limited. Therefore, this study aimed to determine the attributable fraction (AF) of RV as the etiologic agent of GE, RV strain distribution and seasonality of RVGE in children aged <5 years in Lebanon. Methods: This multicenter, hospital-based surveillance conducted between May 2007 and May 2008, enrolled children <5 years hospitalized with GE episodes. Stool samples were tested for the presence of RV by enzyme immuno assay (EIA). RV positive samples were genotyped by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). Seasonality of RVGE cases was recorded during the study period. Severity of the RVGE episodes was measured using the Vesikari scale, where a score of ≥11 was considered severe. Results: Of the 534 children enrolled in this study, 491 (91.9%) were included in the final analysis in the according-to-protocol cohort; 27.7% (136/491) of subjects were RV positive, 71.5% (351/491) were RV negative and 0.8% (4/491) had unknown RV status. Of the RV positive subjects, 75% (102/136) of cases were seen in children <2 years of age. Although RVGE cases occurred throughout the year, the peak season was observed between December 2007 and March 2008 (65.4%; 89/136). Severe GE cases observed before hospitalization was 79.4% (108/136) in RV positive and 76.1% (267/351) in RV negative subjects (p = 0.44). G4 (36.9%) and P[8]WT (77.7%) were the most common RV types detected among RV positive samples that were genotyped (N = 130). Conclusion: The data generated from this first burden of disease study in Lebanon showed that the AF of Rotavirus in children <5 years of age corresponded to 27.7% of hospitalized GE. Most of the RV cases (75%) were in children aged <2 years. These baseline epidemiology data might guide policy makers in initiating nationwide public health strategies, including vaccination to reduce the RV disease burden in Lebanese children <5 years of age.