Diarrhea-associated Hospitalizations Research Articles

Spatiotemporal analysis of diarrhea-related hospitalizations of children in Brazil's Midwest region from 2011 to 2020.

To examine spatiotemporal variability and identify clustering patterns of hospitalization rates for diarrhea in children younger than five years in Mato Grosso, Brazil, from 2011 to 2020. An ecological study was conducted using hospitalization records associated with diarrhea from the Brazilian Hospital Information System/Unified Health System. The relative risk of hospitalization for diarrhea in each municipality was calculated using SaTScan software considering a statistical significance level of 5% and 999 Monte Carlo replications. A total of 13,315 diarrhea-associated hospitalizations for 5-year-old children were recorded. From 2011 to 2020, the annual rates for hospitalizations related to diarrhea decreased from 8.50 to 3.45/1,000 live births among children younger than one year and from 4.99 to 1.57 for children aged 1-4 years. Clusters of municipalities with high relative risk for hospitalizations due to diarrhea, statistically significant, predominated in the North, Northeast, and Southwest health administrative macro-regions of Mato Grosso for both age groups until 2016. From 2016 to 2020, clusters of the lowest relative risk were identified in the North and Center South health administrative macro-regions for children younger than five years. Results showed that hospitalization rates for diarrhea in children younger than five years reduced with the presence of low-risk clusters in Mato Grosso in the final years of the study. Public health surveillance should incorporate spatial analysis to investigate the diarrhea-related morbidity.

Rotavirus Genotypes in Hospitalized Children With Acute Gastroenteritis Before and After Rotavirus Vaccine Introduction in Blantyre, Malawi, 1997-2019.

BackgroundRotavirus vaccine (Rotarix [RV1]) has reduced diarrhea-associated hospitalizations and deaths in Malawi. We examined the trends in circulating rotavirus genotypes in Malawi over a 22-year period to assess the impact of RV1 introduction on strain distribution.MethodsData on rotavirus-positive stool specimens among children aged <5 years hospitalized with diarrhea in Blantyre, Malawi before (July 1997–October 2012, n = 1765) and after (November 2012–October 2019, n = 934) RV1 introduction were analyzed. Rotavirus G and P genotypes were assigned using reverse-transcription polymerase chain reaction.ResultsA rich rotavirus strain diversity circulated throughout the 22-year period; Shannon (H′) and Simpson diversity (D′) indices did not differ between the pre- and postvaccine periods (H′ P < .149; D′ P < .287). Overall, G1 (n = 268/924 [28.7%]), G2 (n = 308/924 [33.0%]), G3 (n = 72/924 [7.7%]), and G12 (n = 109/924 [11.8%]) were the most prevalent genotypes identified following RV1 introduction. The prevalence of G1P[8] and G2P[4] genotypes declined each successive year following RV1 introduction, and were not detected after 2018. Genotype G3 reemerged and became the predominant genotype from 2017 onward. No evidence of genotype selection was observed 7 years post–RV1 introduction.ConclusionsRotavirus strain diversity and genotype variation in Malawi are likely driven by natural mechanisms rather than vaccine pressure.

Taking gastro-surveillance into the 21st century

Enteric viruses, particularly rotaviruses and noroviruses, are leading causes of gastroenteritis worldwide. Human rotaviruses are ubiquitous and globally almost every child has been infected by 3–5 years of age. Noroviruses affect people of all ages and is the leading cause of foodborne outbreaks. Rota- and noroviruses account for ˜40% and ˜17% of diarrhea-associated hospitalizations, and ˜200,000 deaths annually respectively, with most deaths occurring in developing countries. Two rotavirus vaccines have currently been implemented in ˜95 countries and several norovirus vaccine candidates are currently in development and/or clinical testing.Surveillance of enteric viruses is an important part of outbreak investigations as well as pre- and post-vaccine impact studies but is even in developed countries often limited to investigation of sporadic cases or comprehensive outbreaks. Conventional methods for enteric virus detection and subtyping relies on standard RT-PCR methods, supplemented with Sanger-sequencing. However, for viruses with even moderate mutationrates, PCR-based-typing of only limited parts of the virus genome is challenging and requires regular update of primers. Full-genomecharacterization technologies based on sequence independent methods based on next generation sequencing (NGS), have demonstrated great potential for enteric virus detection and/or typing in both clinical and environmental samples. However, cost-benefits must balance for such methods to be widely accepted for public health purposes.In Europe as also globally, routine use of NGS-methods for surveillance of enteric viruses is currently limited to few national public health laboratories. What important lessons can be learned from these and what is the future of NGS-based surveillance?

Cost of rotavirus diarrhea for programmatic evaluation of vaccination in Vietnam.

BackgroundRotavirus is the most common etiology of diarrhea-associated hospitalizations and clinic visits in Vietnamese children < 5 years old. To estimate the economic burden of rotavirus-associated formal healthcare encounters, an economic study was conducted.MethodsA cost-of-illness study was performed from a societal perspective. Data were collected from children below the age of five years who presented to a clinic or hospital with symptoms of acute gastroenteritis (AGE). Patient-specific information on resource use and cost was obtained through caregiver interviews and medical chart review. Costs are presented in 2014 US dollar ($).ResultsA total of 557 children with symptoms of AGE were enrolled from March through June 2009, with mean age of 16.5 months. Of the 340 outpatients and 217 admitted patients enrolled, 41 % tested rotavirus positive. It was found that, from a societal perspective, the mean total cost of AGE was $175. Costs of patients with and without rotavirus were $217 and $158, respectively. From multiple regression analysis, it was found that rotavirus infection, patient age and receiving oral rehydration solution before visiting health facility had significant effect on the costs.ConclusionsThis study clearly demonstrated substantial economic burden of AGE including rotavirus disease. They were significantly greater than the previously reported cost estimates in Vietnam. These updated costs of illness result in more favorable vaccine cost-effectiveness than in previous economic evaluations.

Hospitalizations and Deaths Because of Respiratory and Diarrheal Diseases Among Haitian Children Under Five Years of Age, 2011-2013.

Respiratory and diarrheal diseases are leading causes of morbidity and mortality among children younger than 5 years in developing countries. Data on the burden of these diseases in Haiti are scarce. We conducted a retrospective review of hospital admission registries during January 1, 2011-December 31, 2013 for children younger than 5 years in 6 hospitals in Haiti. We recorded the number of all-cause, respiratory and diarrheal disease admissions and deaths by epidemiologic week and age. A total of 31,565 hospital admissions and 1763 deaths were recorded among children aged <5 years during the study period. Respiratory diseases accounted for 9183 (29%) hospitalizations and 301 (17%) deaths. Children aged 6-23 months had the highest percentage of hospitalizations attributable to respiratory diseases (38%), whereas children aged 36-47 months had the highest proportion of deaths attributable to respiratory diseases (37%). Respiratory disease hospitalizations followed a bimodal seasonal pattern, with peaks during May-June and October-December. Diarrheal diseases accounted for 8063 (26%) hospitalizations and 224 (13%) deaths. Children aged 6-11 months had the highest percentage of diarrhea-associated hospitalizations (39%) and deaths (29%). Diarrheal disease admissions peaked in January-April before the rainy season. Respiratory and diarrheal diseases contributed to more than half of hospitalizations and almost a third of deaths in children younger than 5 years in Haiti. These data are essential to assess the impact of pneumococcal and rotavirus vaccines and other interventions in Haiti.

Hospitalizations and Deaths Caused by Diarrhea in Children Five Years Old and Younger at Four Hospitals in Haiti, 2010–2012

Worldwide, diarrhea is a major contributor to morbidity and mortality in children; however, there are few data on the burden of diarrheal disease in Haiti. We conducted a retrospective review of hospital discharge registries from 2010 to 2012 in the pediatric wards of four Haitian hospitals and recorded the number of all-cause hospitalizations and deaths as well as diarrheal hospitalizations and deaths by age (≤ 2 and 3-5 years) and epidemiological week. Diarrhea was associated with 3,582 (33.7%) of 10,621 hospitalizations and 62 (11.5%) of 540 in-hospital deaths in children ≤ 5 years old. Of these children, 88.5% and 96.8%, respectively, were among children ≤ 2 years old. The highest proportions of diarrhea-associated hospitalizations occurred from January to April. At four Haitian hospitals over a 3-year period, during which time a major epidemic of cholera occurred, diarrheal disease in children ≤ 5 years was a major contributor to pediatric hospitalizations and mortality.

Impact of Rotavirus Vaccine on Diarrhea-Associated Disease Burden Among American Indian and Alaska Native Children

Beginning in 2006, the Indian Health Service (IHS) began rotavirus vaccination of American Indian and Alaska Native (AI/AN) infants. To assess vaccine impact, we examined trends in IHS diarrhea-associated hospitalization and outpatient visits among AI/AN children in the pre- and postrotavirus vaccine era. Diarrhea-associated hospitalizations and outpatient visits among AI/AN children <5 years of age during 2001 through 2010 were examined by gender, age group, and region for prevaccine years 2001-2006 and postvaccine years 2008, 2009, and 2010. To account for secular declining trends observed in prevaccine years, expected diarrhea-associated hospitalization and outpatient rates for postvaccine years were generated by using Poisson regression analysis of the 2001-2006 annual rates. Coverage with at least 1 dose of rotavirus vaccine among AI/AN infants aged 3 to 5 months in the first half of 2008, 2009, and 2010 ranged from 48% to 80% in various IHS regions. The prevaccine average annual diarrhea-associated hospitalization rates among AI/AN children <5 years of age was 63 per 10 000 persons (range: 57-75 per 10 000), and declined to 39, 31, and 27 per 10 000 in 2008, 2009, and 2010, respectively. Observed 2008, 2009, and 2010 rates were 24%, 37%, and 44% lower than expected rates, respectively. Decreases in diarrhea-associated hospitalizations and outpatient visits were observed in all IHS regions. Diarrhea-associated hospitalization and outpatient visit rates among AI/AN children have declined after implementation of rotavirus vaccination in AI/AN populations.

G2 as an emerging rotavirus strain in pediatric gastroenteritis in southern Italy

Human rotaviruses (HRVs) represent a major cause of acute gastroenteritis in children worldwide. It is estimated that they are responsible for a large number of diarrhea-associated hospitalizations in childhood each year. In Italy, limited data are available on the patterns of distribution of HRV G and P types. We report here the results of 2 years of rotavirus strain surveillance among children with severe gastroenteritis diagnosed in the town of Portici, Campania, southern Italy. A total of 421 stool specimens from children between 6 months and 5 years of age and presenting acute diarrhea were collected and tested by routine diagnostic tests for HRV, adenovirus, astrovirus, norovirus, and common bacterial pathogens. The laboratory results showed that 110 of the 225 (26.1%) virus-positive samples contained HRVs. The different G and P rotavirus genotypes were analyzed by polymerase chain reaction (PCR). Among the VP7 genotypes identified, G1 and G2 were predominant, with percentages of 48.2 and 30.9%, respectively. G4, G9, and G10 were detected in a minority of cases. Among the VP4 genotypes, P[8] occurred the most frequently (56.4%), followed by P[4] (31.8%), and only a few P[10] and P[11] at percentages of 1.8 and 0.9%, respectively. Our epidemiological data of HRV strains will contribute to assessing the magnitude of the problem of HRV in the south of Italy.

Diarrhea-associated hospitalizations among US children over two rotavirus seasons after vaccine introduction

Child: Care, Health and DevelopmentVolume 37, Issue 2 p. 306-307 Diarrhea-associated hospitalizations among US children over two rotavirus seasons after vaccine introduction Richard Reading, Richard ReadingSearch for more papers by this author Richard Reading, Richard ReadingSearch for more papers by this author First published: 14 February 2011 https://doi.org/10.1111/j.1365-2214.2010.01206_5.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume37, Issue2March 2011Pages 306-307 RelatedInformation

Reduction of Diarrhea-associated Hospitalizations Among Children Aged &lt;5 Years in Panama Following the Introduction of Rotavirus Vaccine

In March 2006, rotavirus vaccine (Rotarix, RV1) was introduced into the Panamanian national immunization program. We assessed the effect of vaccine on diarrhea-associated hospitalizations among young Panamanian children. We obtained monthly numbers of diarrhea-associated hospitalizations among children aged ≤ 5 years during 2003 and 2008 from 5 health regions in Panama, representing 53% of the birth cohort. We compared the number of diarrhea-associated hospitalizations during the postvaccine years of 2007 and 2008 with the prevaccine mean numbers 2003-2005 among children < 1 year and those 1 to 4 years of age. Administrative data were used to estimate national rotavirus vaccine coverage. During prevaccine years, diarrhea-associated hospitalizations among children < 5 years in the 5 regions averaged 4057 annually. After the vaccine introduction, a decrease in diarrhea-associated hospitalizations of 22% (898 fewer) occurred in 2007 and 37% (1502 fewer) in 2008. Greater reductions were observed during January through June, the months presumed to have high rotavirus activity in prevaccine years (33% reduction in 2007 and 58% in 2008, compared with prevaccine mean). Reduction estimates were similar among infants and those aged 1-4 years of age, even though only 25% of the latter group was likely to have received vaccine by early 2008. Estimated coverage with ≥ 1 dose of rotavirus vaccine among infants increased from 63% at the end of 2006 to 94% at the end of 2008. RV1 appears to have had a substantial impact on diarrhea-associated hospitalizations among young children in Panama.

Racial disparities in diarrhea-associated hospitalizations among children in five US States, before and after introduction of rotavirus vaccine

Racial differences in diarrheal disease have not been systematically examined, and the impact of rotavirus vaccine on these differences has not been assessed. We compared diarrhea-associated hospitalizations by race/ethnicity among children <5 years pre- (2000–2006) and post- (2007 and 2008) rotavirus vaccine introduction in five US states. Pre-vaccine hospitalization rates were greater among whites versus blacks and Hispanics. However, black (versus non-black) infants <6 months and white (versus non-white) children ≥1 year had higher rates. In 2008, racial disparities for children 12–35 months resolved, but higher hospitalization rates among black infants <6 months persisted, highlighting the need for timely vaccination.

Reduction in hospitalizations for diarrhea and rotavirus infections in New York state following introduction of rotavirus vaccine

Objectives To monitor trends and costs of diarrhea and rotavirus-associated hospitalizations in New York before and after rotavirus vaccine implementation in 2006. To examine rotavirus test results from sentinel hospital-associated laboratories. Methods Hospital discharge data and laboratory rotavirus testing data were analyzed for children 1 month up to 18 years of age for 10 sentinel and all statewide hospitals from January 1, 2003 through December 31, 2008. Results Among children 1–23 months of age, a 40% reduction in diarrhea-associated hospitalizations and 85% decrease in rotavirus-coded hospitalizations at the 10 sentinel hospitals was observed in 2008 compared with the average of pre-vaccine seasons from 2003 through 2006. For both sentinel and statewide hospitals, the percent of diarrhea admissions due to rotavirus was reduced at least 83% among children 1–23 months (vaccine eligible) and 70% for older unimmunized children. Statewide hospital costs for rotavirus hospitalizations in children <2 years of age were reduced $10 million. Sentinel hospital laboratory data validated the declining trends seen in hospitalizations. Conclusions In 2008, New York hospital data showed significant reductions in rotavirus hospitalizations and costs among children aged 1–23 months who were eligible for vaccine. Reductions also occurred among unimmunized older children suggesting the importance of continue monitoring in future seasons to fully assess vaccine impact.

Rotavirus vaccines for the developing world

The authors discuss the most relevant information in the field of rotavirus vaccines published from October 2007 to June 2009; new information on the virus, host response and disease burden that relate to our understanding of vaccine mechanisms and impact are discussed. The review will focus on the role of the vaccines for the developing world but this does not preclude the relevance of these vaccines for children living in the industrialized world. Immune mechanisms involved in rotavirus-associated immunity potentially relevant for vaccine-associated immunity continue to be identified including anti-NSP4 antibodies, cellular and mucosal mechanisms. Rotavirus-associated disease burden is high, causing approximately 40% of diarrhea-associated hospitalizations in children less than 5 years of age worldwide; G12, G8 and P[6] antigenic types emerging in developing countries are increasing in prevalence and may share worldwide circulation with the other five more common serotypes. The two currently available vaccines, based on different immune concepts, (VP7/VP4 homotypic specificity for RotaTeq vs. homotypic and heterotypic specificity for Rotarix) have demonstrated high and sustained efficacy in middle and high-income countries. Recent efficacy and effectiveness studies demonstrate acceptable protection levels in the poorest countries of the world against most antigenic types, leading to universal vaccine recommendation. Postlicensure surveillance has not detected any signal of increased risk for intussusception in children vaccinated with any of the two vaccines. Rotavirus vaccines are well tolerated and provide adequate protection against moderate to severe disease in high, middle and low-income regions. Partnerships between governments, industry, and funding agencies will now be urgently needed to promote vaccine use, especially in the less privileged countries of the world.

Diarrhea-Associated Hospitalizations and Outpatient Visits Among American Indian and Alaska Native Children Younger Than Five Years of Age, 2000–2004

Diarrhea accounts for many hospitalizations and outpatient clinic visits among children. American Indian and Alaska Native (AI/AN) children have experienced a greater infectious disease burden compared with the general U.S. population of children, although diarrhea-associated hospitalization rates have declined among AI/AN children. Hospital discharge and outpatient visit records with a diagnosis indicating a diarrhea-associated diagnosis were evaluated for AI/AN children <5 years of age, using the 2000-2004 Indian Health Service Direct and Contract Health Service Inpatient Data and outpatient visit data from the Indian Health Service National Patient Information Reporting System, and for the general U.S. population of children <5 years of age using the Kids' Inpatient Database for 2003 and National Ambulatory data for 2000-2004. For 2000-2004, the diarrhea-associated hospitalization rate was similar for AI/AN children and U.S. children <5 years of age (65.9 and 79.3 of 10,000, respectively), but the rate among AI/AN infants was nearly twice the rate among U.S. infants (262.6 and 154.7 of 10,000, respectively). The rate of diarrhea-associated outpatient visits among AI/AN children was higher than for U.S. children (2255.4 versus 1647.9 of 10,000, respectively), as a result of the high rate among AI/AN infants compared with U.S. infants (6103.5 and 2956.3 of 10,000, respectively). Although the diarrhea-associated hospitalization rate in AI/AN children <5 years old has declined to levels comparable with that of all U.S. children, the rate for AI/AN in infants remains higher than for U.S. infants. The diarrhea-associated outpatient visit rate for AI/AN children was higher than for U.S. children. Ongoing evaluation of hospitalization and outpatient data is important to understand the impact of rotavirus vaccine among AI/AN children.

Incidence and Cost of Rotavirus Hospitalizations in Denmark

In anticipation of licensure and introduction of rotavirus vaccine into the western market, we used modeling of national hospital registry data to determine the incidence and direct medical costs of annual rotavirus-associated admissions over >11 years in Denmark. Diarrhea-associated hospitalizations coded as nonspecified viral or presumed infectious have demonstrated a marked winter peak similar to that of rotavirus-associated hospitalizations, which suggests that the registered rotavirus-coded admissions are grossly underestimated. We therefore obtained more realistic estimates by 2 different models, which indicated 2.4 and 2.5 (for children <5 years of age) and 4.9 and 5.3 (for children <2 years of age) rotavirus-associated admissions per 1,000 children per year, respectively. These admissions amount to associated direct medical costs of US $1.7-1.8 million per year. Using 2 simple models to analyze readily available hospital discharge data resulted in more consistent and reliable estimates.

Diarrhea- and Rotavirus-Associated Hospitalizations Among Children Less Than 5 Years of Age: United States, 1997 and 2000

A new rotavirus vaccine may be licensed in the United States in early 2006. Estimates of the burden of severe rotavirus disease, particularly hospitalizations, will help evaluate the potential benefits of a national rotavirus immunization program. The Kids' Inpatient Database, a robust sample of 10% of the uncomplicated births and 80% of other pediatric discharges was used to estimate the number and rate of diarrhea- and rotavirus-associated hospitalizations among US children <5 years of age in 1997 and 2000. In 1997 and 2000, diarrhea was coded in 13% of all childhood hospitalizations, for an estimated cumulative incidence of 1 diarrhea hospitalization per 23 to 27 children by age 5. Most diarrhea-associated hospitalizations (62%) were coded as unspecified etiology, and 35% as viral. Rotavirus was the most common pathogen recorded for 18% and 19% of diarrhea-associated hospitalizations in 1997 and 2000, respectively. Diarrhea-associated hospitalizations coded as unspecified or viral exhibited a marked winter peak similar to that of hospitalizations coded as rotavirus, suggesting that the rotavirus-specific code captures a fraction of all rotavirus hospitalizations. Using indirect methods, we estimated that rotavirus was associated with 51142-60155 and 46839-56820 hospitalizations in 1997 and 2000, respectively. By these estimates, rotavirus is associated with 4% to 5% of all childhood hospitalizations, and 1 in 67 to 1 in 85 children will be hospitalized with rotavirus by 5 years of age. Diarrhea is an important cause of hospitalization in US children, and rotavirus is the most important etiology. Disease burden estimates have remained stable during the past decade. An effective rotavirus vaccine will likely reduce substantially the burden of severe rotavirus disease, estimated to account for 4% to 5% of all hospitalizations and approximately 30% of hospitalizations for watery diarrhea among children <5 years of age.

Incidence of Severe Rotavirus Diarrhea in New Delhi, India, and G and P Types of the Infecting Rotavirus Strains

A total of 62,475 children <5 years old from a defined population of approximately 500,000 children and adults from slums in New Delhi, India, were assessed for 1 year by means of passive surveillance, to identify children who were hospitalized for diarrhea. The incidence of severe rotavirus diarrhea was estimated, and the G and P types of the infecting rotavirus strains were determined and were correlated with the clinical severity of diarrhea. Of 584 children who were hospitalized with diarrhea, 137 (23.5%) had rotavirus detected in stool specimens (incidence of rotavirus diarrhea-associated hospitalizations, 337 hospitalizations/100,000 children <5 years of age). Most cases of diarrhea (98%) occurred during the first 2 years of life, peaking at 9-11 months of age. Rotavirus-associated diarrhea occurred year-round but was predominant in winter. Among the strains that could be G-typed, G1 was the most common serotype, followed by G9 and G2; 10% of cases of diarrhea were due to mixed G-type infections. Common strains identified in the present surveillance study were P[8]G1, P[4]G2, P[8]G9, P[6]G1, P[6]G9, and P[6]G3. Children infected with G1 strains had a greater risk of developing more-severe cases of diarrhea than did children infected with other rotavirus strains (odds ratio, 2.95; 95% confidence interval, 1.3-6.67).

Molecular genotyping of Irish rotavirus strains.

Rotavirus is the primary etiological agent of gastroenteritis in infants and young children worldwide. In developing countries, it is estimated that rotavirus is responsible for one-third of all diarrhea-associated hospitalizations and 873,000 deaths annually. In industrialized countries, where mortality from rotavirus is low, infection is widespread, and nearly all children experience an episode of rotavirus diarrhea in the first 3-5 yr of life. Rotaviruses have important antigenic specificities including serogroup and serotype, and all viruses are classified accordingly. They are divided into seven morphologically indistinguishable but antigenically defined serogroups, delineated A through G. The human infecting rotaviruses include groups A, B, and C, and it is well documented that group A rotaviruses are the major causative agents of diarrheal diseases in children. They are responsible for 125 million cases of diarrhea annually. Within each serogroup, distinct serotypes exist. In group A rotavirus, serotype is specified by two viral proteins, VP4 and VP7. The neutralizing antibody response that is evoked by the antigenic determinants on VP4 and VP7 play an important role in protective immunity. The rotavirus genome consists of 11 double-stranded (ds) RNA segments, and each genomic segment encodes a different protein. A dual system of reporting rotavirus serotype exists because the VP4 and VP7 proteins are encoded by different genes and thus can segregate independently. The serotypes derived from VP7 are defined as G-serotypes. Currently 14 G-serotypes have been identified, and only 10 of these have been recovered from humans. The predominating G-types worldwide are G1, G2, G3, and G4, with G1 being the most prevalent type. Serotypes G5, G6, G8-G10, and G12 are rarely identified in humans and are usually recovered from animals. However, some of these unconventional types are now being frequently reported in humans, including G5, G8, and G9.

Disease burden and risk factors for hospitalizations associated with rotavirus infection among children in New York State, 1989 through 2000.

To examine trends in hospitalizations for pediatric diarrhea, ascertain the disease burden and risk factors for hospitalizations associated with rotavirus and assess the accuracy of coding for rotavirus hospitalizations in New York State. For 1989 through 2000, data were obtained for all diarrhea-associated hospitalizations in New York State among children 1 month through 4 years of age. Characteristics of patients hospitalized with rotavirus were compared with those for hospitalizations with diarrhea from other causes. Medical charts coded as rotavirus diarrhea were reviewed for patients who were discharged during 1997 to determine whether these diagnoses were supported with laboratory results. Diarrhea was reported as a discharge diagnosis in approximately 13% of all hospitalizations for an annual incidence of 83 per 10 000 children. Viruses were the most common etiologic agents reported. Since 1993, when a rotavirus-specific code was introduced, rotavirus infection was coded for 8.7% of all diarrhea-associated hospitalizations. A total of 136 patients with diarrhea died during their hospitalization (hospital fatality rate, 1.6 per 1000), and the 12 deaths among patients with rotavirus had a distinct winter pattern. During 1997 only 46% of the hospitals reporting diarrhea in children used the specific code for rotavirus, and 12% of hospitals reported rotavirus in >30% of all diarrhea-associated hospitalizations. Infants <4 months of age were more likely than older children to be nosocomially infected with rotavirus and had a higher proportion of congenital malformations. In New York State diarrhea is a common hospital discharge diagnosis and contributes approximately 13% of all hospitalizations among children <5 years of age. When hospitals with maximum recording were used as a reference point, >30% of diarrhea hospitalizations were recorded as likely the result of rotavirus.

Epidemiologic patterns of diarrheal disease in Argentina: estimation of rotavirus disease burden.

Information on the burden of diarrheal diseases and rotavirus diarrheal diseases would help define strategies for management and prevention and clarify the potential benefits of candidate vaccines. This report of our study of the epidemiology of rotavirus diseases in Argentina analyzes the burden of rotavirus diarrhea, based on those studies and national statistics of diarrhea-associated medical visits, hospital discharges and deaths. Information of diarrhea-associated medical visits, hospital discharges and deaths were provided by the Argentine Health Ministry. Estimation of rotavirus disease burden was performed using the percentage of rotavirus identification from previous reports. The incidence of diarrhea-associated medical visits (1999) was 14 times greater for ages 0 to 4 years than for ages of > or =5 years. Diarrhea-associated hospital discharges (0 to 4 years of age) decreased between 1981 and 1995 from 1.3 per 100 to 0.9 per 100 person-years) and diarrheal deaths (<2 years of age) decreased by a factor of 4 between 1985 and 1999 (64.7 per 100 000 to 16.1 per 100 000 person-years). Frequency of diarrheal deaths, hospital discharges and medical visits were highest in some of the northern Argentine provinces (26.2, 14.7 and 5.9 times greater, respectively, than in the lower risk areas of the country). We estimated that 1 in 2 children born in 1995 visited a public hospital, 1 in 12 required hospitalization, 1 in 1599 died of diarrheal diseases before their fifth year of life; 1 in 6, 1 in 35 and 1 in 4169 of those, respectively, died as a result of rotavirus diarrhea before their third year of life. The number of preventable diarrhea-associated and rotavirus-associated hospitalizations and deaths in Argentina is significant. The lack of rotavirus diagnostic capability in Argentine hospitals has resulted in underestimation of the disease burden of this virus. A rotavirus vaccine would have the potential to avoid thousands of hospitalizations and dozens of deaths, especially in the poor high risk Argentine provinces.