Active, Population-Based Surveillance for Severe Rotavirus Gastroenteritis in Children in the United States

TLDR

Routine rotavirus vaccination of US infants began in 2006, prompting the CDC New Vaccine Surveillance Network to initiate population‑based acute gastroenteritis surveillance among children under three years of age. The surveillance system was designed to establish baseline rotavirus disease burden estimates and to prospectively monitor the impact of vaccination. Children under three with acute gastroenteritis (≥3 diarrheal episodes or vomiting in 24 h) were enrolled from hospitals, emergency departments, and outpatient clinics in three US counties; data were collected via parental interview and chart review, and stool specimens were tested for rotavirus by enzyme immunoassays and genotyped by RT‑PCR. Among 516 stool specimens, 44 % tested positive for rotavirus, predominantly P[8]G1 (84 %); detection rates were 50 % for hospitalized and ED cases and 27 % for outpatient visits, with rotavirus cases more likely to present vomiting, diarrhea, fever, and lethargy, yielding population‑based rates of 22.5 hospitalizations and 301.0 ED visits per 10,000 children under three, indicating a substantial burden.

Abstract

Routine vaccination of US infants against rotavirus was implemented in 2006, prompting the Centers for Disease Control and Prevention New Vaccine Surveillance Network to begin population-based acute gastroenteritis surveillance among US children<3 years of age. This surveillance system establishes baseline estimates of rotavirus disease burden and allows for the prospective monitoring of rotavirus vaccination impact.Eligible children with acute gastroenteritis (>or=3 episodes of diarrhea and/or any vomiting in a 24-hour period) who were hospitalized, were seen in emergency departments, or visited selected outpatient clinics in 3 US counties during the period of January through June 2006 were enrolled. Epidemiological and clinical information was obtained through parental interview and medical chart review, and stool specimens were tested for rotavirus with enzyme immunoassays. Rotavirus-positive specimens were genotyped by using reverse transcription-polymerase chain reaction assays.Stool specimens were collected from 516 of the 739 enrolled children with acute gastroenteritis (181 inpatient, 201 emergency department, and 134 outpatient) and 44% tested positive for rotavirus (227 of 516 specimens). The most common strain was P[8]G1 (84%), followed by P[4]G2 (5%) and P[6]G12 (4%). None of the 516 children had received rotavirus vaccine. The rotavirus detection rate was 50% for hospitalized acute gastroenteritis cases, 50% for emergency department visits, and 27% for outpatient visits. Rotavirus-related acute gastroenteritis cases were more likely than non-rotavirus-related acute gastroenteritis cases to present with vomiting, diarrhea, fever, and lethargy. Directly calculated, population-based rates for rotavirus hospitalizations and emergency department visits were 22.5 hospitalizations and 301.0 emergency department visits per 10 000 children<3 years of age, respectively. A sentinel outpatient clinic visit rate of 311.9 outpatient visits per 10,000 children<3 years of age was observed.Population-based, laboratory-confirmed rotavirus surveillance in the final rotavirus season before implementation of the US rotavirus vaccine program indicated a considerable burden of disease on the US health care system.