The burden of rotavirus gastroenteritis and hospital-acquired rotavirus gastroenteritis among children aged less than 6 years in Japan: a retrospective, multicenter epidemiological survey

Hitoshi Tajiri,Kosuke Ushijima,Gunasekaran Ramakrishnan,Hisashi Kawashima,Ayano Inui,Yoshihito Higashidate,Tomoko Takano,Kimie Yamamoto,Katsiaryna Holl,Toshihiro Ohura,Yuriko Takeuchi,Shigeru Toyoda,Mats Rosenlund

doi:10.1186/1471-2431-13-83

Abstract

BackgroundRotavirus is a leading worldwide cause of acute gastroenteritis in young children. This retrospective hospital-based study assessed the burden of rotavirus gastroenteritis in children younger than 6 years in Japan.MethodsChildren admitted to eight hospitals for acute gastroenteritis between 2008 and 2009 were identified from hospital admission databases. Diagnosis of acute gastroenteritis/rotavirus gastroenteritis and hospital-acquired rotavirus gastroenteritis was confirmed based on either the International Classification of Diseases and Related Health Problems 10th revision (ICD10) codes (intestinal infectious diseases [AA00-AA09] and rotavirus gastroenteritis [A08.0]) or from rapid rotavirus diagnostic test results.ResultsOf 13,767 hospitalized children, 11.9% (1,644), 4.8% (665) and 0.6% (81) were diagnosed with acute gastroenteritis, rotavirus gastroenteritis and hospital-acquired rotavirus gastroenteritis, respectively. Among acute gastroenteritis hospitalizations, 40.5% (665/1,644; ICD10 and rapid test) and 57.7% (645/1,118; rapid test only) were confirmed as rotavirus positive. Of 1,563 children with community-acquired acute gastroenteritis, 584 (37.4%) cases were confirmed as rotavirus positive. The median durations of hospitalization for all and community-acquired rotavirus gastroenteritis were 5.0 days (range: 2.0−133.0 days) and 5.0 days (range: 2.0-34.0 days), respectively. Among rotavirus gastroenteritis hospitalizations, 12.2% (81/665) of cases were hospital-acquired and the median duration of hospitalization was 10.0 days (range: 2.0-133.0 days). The median duration of additional hospitalization due to hospital-acquired rotavirus gastroenteritis was 3.0 days (range: 0–14 days). The overall incidence rate of hospital-acquired rotavirus gastroenteritis was 1.0 per 1,000 children hospital-days. The number of rotavirus gastroenteritis cases peaked between February and May in both 2008 and 2009, and the highest number of cases was reported in March 2008 (21.8%; 145/665). The highest number of rotavirus gastroenteritis hospitalizations (24.1%; 160/665) was observed in children aged 12–18 months. The proportion of hospital-acquired rotavirus gastroenteritis was higher in children aged below 18 months as compared to children at least 18 months of age (0.94 [95% CI: 0.71-1.21] vs. 0.39 [95% CI: 0.25-0.58]) and for children hospitalized for at least 5 days compared to those hospitalized for less than 5 days (0.91 [95% CI: 0.72-1.14] vs. 0.15 [95% CI: 0.05-0.32]).ConclusionsBoth community- and hospital-acquired rotavirus gastroenteritis are significant public health problems in Japan. Data from this study justify the need for the introduction and implementation of rotavirus vaccination in the Japanese national immunization program.Trial registrationClinicalTrials.gov, NCT01202201

Highlights

Rotavirus is a leading worldwide cause of acute gastroenteritis in young children
Data from this study justify the need for the introduction and implementation of rotavirus vaccination in the Japanese national immunization program
The objectives of this study were to estimate the burden of overall acute GE, RVGE and hospital-acquired RVGE in hospitalized children younger than 6 years of age, as well as to assess the age and seasonal distributions; and duration of hospitalization and additional hospitalization associated with hospital-acquired RVGE

Summary

Introduction

Rotavirus is a leading worldwide cause of acute gastroenteritis in young children. This retrospective hospital-based study assessed the burden of rotavirus gastroenteritis in children younger than 6 years in Japan. A previous study conducted in Japan reported an overall incidence of outpatient visits of 11 cases per 100 personyears due to RVGE in children less than 6 years of age; the highest incidence (27 cases per 100 person-years) was observed in infants [2]. In another single-center study conducted between 2008 and 2010 in Kyoto, the proportion of children aged below 5 years diagnosed with RVGE was reported to be 56% [3]. In Japan, RVGE is a common cause of acute GE hospitalizations whether community- or hospital-acquired and results in significant clinical and economic burden [5]

Objectives

Methods

Results

Discussion

Conclusion