Burden of Nosocomial and Community-Acquired Rotavirus Gastroenteritis in Children

Abstract

Background: This study aimed to evaluate the demographic and clinical characteristics, seasonal distribution, vaccination status, and complications of rotavirus gastroenteritis (RVGE) in children, as well as the frequency and clinical features of nosocomial RVGE. Methods: This retrospective study included pediatric patients aged 1 month to 18 years who were diagnosed with RVGE at a tertiary university pediatric hospital in Türkiye over a five-year period. The diagnosis of RVGE was based on the detection of rotavirus antigen in stool samples. Data on demographics, hospitalization, nosocomial status, complications, seasonal distribution, and vaccination status were obtained from hospital records, and vaccination status was confirmed via caregiver interviews. Nosocomial RVGE was defined as symptom onset ≥48 hours after admission or within 72 hours of discharge. Results: A total of 391 children were diagnosed with RVGE; 227 (58.1%) were outpatients and 164 (41.9%) were hospitalized. Nosocomial infection occurred in 60 (15.3%) of all RVGE cases, corresponding to 36.6% of hospitalized RVGE cases. The median age was 11 months (1–52) for outpatients, 10 months (1–61) for inpatients, and 5 months (1–40) for nosocomial cases. RVGE was most frequently observed in winter (36.6%). Complications occurred in 123 (31.5%) patients, the most common was dehydration, followed by bacteremia, pneumonia, seizures, and elevated liver enzymes. Only 8 children (2%) were vaccinated against rotavirus. Conclusion: Rotavirus remains a significant cause of gastroenteritis and hospitalization in children, particularly among the unvaccinated. The high rate of nosocomial transmission highlights the need for strengthened infection control practices and consideration of routine rotavirus vaccination in national immunization programs.

Keywords

• Rotavirus
• gastroenteritis
• children
• vaccination
• nosocomial infection

Çocuklarda Nozokomiyal ve Toplum Kökenli Rotavirüs Gastroenteritinin Yükü

Abstract

Giriş: Bu çalışmada, çocuklarda rotavirüs gastroenteritinin (RVGE) demografik ve klinik özellikleri, mevsimsel dağılımı, aşılanma durumu ve komplikasyonları ile hastane kökenli RVGE sıklığı ve klinik özelliklerinin değerlendirilmesi amaçlandı. Yöntemler: Bu retrospektif çalışmaya, beş yıllık bir süre boyunca Türkiye’deki üçüncü basamak bir üniversite çocuk hastanesinde RVGE tanısı alan, 1 ay ile 18 yaş aras pediatrik hastalar dâhil edildi. RVGE tanısı, dışkı örneklerinde rotavirüs antijeninin saptanmasına dayandırıldı. Demografik veriler, hastaneye yatış durumu, nozokomiyal durum, komplikasyonlar, mevsimsel dağılım ve aşılama durumu ile ilgili veriler hastane kayıtlarından elde edildi ve aşılama durumu, bakım verenlerle yapılan görüşmeler yoluyla doğrulandı. Nosokomiyal RVGE, semptomların yatıştan sonraki ≥48 saat içinde veya taburcu olduktan sonraki 72 saat içinde başlaması olarak tanımlandı. Bulgular: Toplam 391 çocukta RVGE saptandı; bunların 227’si (%58,1) ayaktan, 164’ü (%41,9) yatarak tedavi edildi. Tüm RVGE olgularının 60’ında (%15,3) nozokomiyal enfeksiyon vardı; bu, yatan RVGE olgularının %36,6’sına karşılık gelmekteydi. Ortanca yaş, ayaktan hastalarda 11 ay (1–52), yatanlarda 10 ay (1–61) ve nozokomiyal olgularda 5 ay (1–40) idi. En sık kış mevsiminde (%36,6) görüldü. Toplam 123 hastada (%31,5) komplikasyon gelişti; en yaygın komplikasyon dehidratasyondu, bunu bakteriyemi, pnömoni, nöbet ve karaciğer enzim yüksekliği izlendi. Sadece 8 çocuk (%2) rotavirüs aşılıydı. Sonuç: Rotavirüs, özellikle aşısız çocuklarda, gastroenterit ve hastaneye yatışların önemli bir nedenidir. Nozokomiyal bulaşın yüksek oranı, enfeksiyon kontrol önlemlerinin güçlendirilmesi ve rotavirüs aşısının ulusal bağışıklama programına dahil edilmesinin önemini vurgulamaktadır.

Keywords

• Rotavirüs
• gastroenterit
• çocuk
• aşılama
• nozokomiyal enfeksiyon

References

1. 1.Cortese MM. Rotavirus. In Long SS, Prober CG,Fischer M, Kimerlin DW eds. Principles and Practiceof Pediatric Infectious Diseases. 6th ed. Philadelphia:Elsevier, 2023: p.1141-44.
2. 2.Cortese MM, Parashar UD; Centers for DiseaseControl and Prevention (CDC). Prevention ofrotavirus gastroenteritis among infants andchildren: recommendations of the AdvisoryCommittee on Immunization Practices (ACIP).MMWR Recomm Rep. 2009; 58(RR-2): 1-25.
3. 3.Parashar UD, Hummelman EG, Bresee JS, MillerMA, Glass RI. Global illness and deaths caused byrotavirus disease in children. Emerg Infect Dis.2003; 9(5): 565-72.
4. 4.World Health Organization. Rotavirus vaccines.WHO position paper - July 2021. Wkly Epidemiol rec2021:96:301. Available from:https://www.who.int/publications/i/item/WHO-WER9628. Accessed June 02 2025.
5. 5.Du Y, Chen C, Zhang X, et al. Global burden andtrends of rotavirus infection-associated deaths from1990 to 2019: an observational trend study. Virol J.2022; 19(1):166.
6. 6.Hallowell BD, Chavers T, Parashar U, Tate JE.Global Estimates of Rotavirus HospitalizationsAmong Children Below 5 Years in 2019 and Currentand Projected Impacts of Rotavirus Vaccination. JPediatric Infect Dis Soc. 2022; 11(4):149-158.
7. 7.International Vaccine Access Center. Availablefrom: http://view-hub.org. Accessed January 03,2023.
8. 8.Tapisiz A, Bedir Demirdag T, Cura Yayla BC, et al.Rotavirus infections in children in Turkey: Asystematic review. Rev Med Virol. 2019; 29(1):e2020.

9. 9.Böncüoğlu E, Kıymet E, Şahinkaya Ş, et al. U􀇆çüncübasamak bir çocuk hastanesi yanık ünitesindemeydana gelen rotavirüs salgınının incelenmesi. JPediatr Inf. 2023; 17(1): 35-9.
10. 10.Arbanas I, Monescu V, Dragomir N, et al. A 7-YearSurvey (2015-2021) in One Pediatric Hospital(Brasov, Romania) on Rotavirus GastroenteritisSpecified as Community- or Hospital-AcquiredInfection in Young Children. Trop Med Infect Dis.2023; 8(12): 509.
11. 11.Gleizes O, Desselberger U, Tatochenko V, et al.Nosocomial rotavirus infection in Europeancountries: a review of the epidemiology, severityand economic burden of hospital-acquired rotavirusdisease. Pediatr Infect Dis J 2006; 25: S12-2.
12. 12.Bruijning-Verhagen P, Quach C, Bonten M.Nosocomial rotavirus infections: a meta-analysis.Pediatrics. 2012; 129(4): e1011-9.
13. 13.Ardura-Garcia C, Kreis C, Rakic M, et al. Rotavirusdisease and health care utilisation among childrenunder 5 years of age in highly developed countries:A systematic review and meta-analysis. Vaccine.2021; 39(22): 2917-28.
14. 14. Nitsch-Osuch A, Kuchar E, Kosmala A, Zycinska K,Wardyn K. Nosocomial rotavirus gastroenterocolitisin a large tertiary paediatric hospital in Warsaw,2006-2010. Arch Med Sci. 2013; 9(3): 493-8.
15. 15.Stefkovicová M, Simurka P, Juracková L,Hudecková H, Mad'ar R. Nosocomial rotaviralgastroenteritis in paediatric departments. Cent Eur JPublic Health. 2008; 16(1): 12-6.
16. 16.Ruiz-Contreras J, Alfayate-Miguelez S, Carazo-Gallego B, et al. Rotavirus gastroenteritis hospitalizations in provinces with different vaccination coverage rates in Spain, 2013-2018. BMC Infect Dis. 2021; 21(1): 1138.
17. 17.Burke RM, Tate JE, Barin N, et al. Three Rotavirus Outbreaks in the Postvaccine Era - California, 2017.MMWR Morb Mortal Wkly Rep. 2018; 67(16): 470-2.
18. 18.Aldemir Koçabaş B, Karbuz A, Özdemir H, et al.Complications with rotavirus: A single centerexperience. Turkish Journal of Pediatrics. 2016; 58:602–8.
19. 19.Johansen K, Hedlund KO, Zweygberg-Wirgart B,Bennet R. Complications attributable to rotavirus-induced diarrhoea in a Swedish paediatricpopulation: report from an 11-year surveillance.Scand J Infect Dis. 2008; 40(11-12): 958-64.
20. 20.Ogilvie I, Khoury H, Goetghebeur MM, El KhouryAC, Giaquinto C. Burden of community-acquired andnosocomial rotavirus gastroenteritis in the pediatricpopulation of Western Europe: a scoping review.BMC Infect Dis. 2012; 12: 62.
21. 21.Festini F, Cocchi P, Mambretti D, et al.Nosocomial Rotavirus Gastroenteritis in pediatricpatients: a multi-center prospective cohort study.BMC Infect Dis. 2010; 10: 235.
22. 22.Gosselin V, Généreux M, Gagneur A, Petit G.Effectiveness of rotavirus vaccine in preventingsevere gastroenteritis in young children accordingto socioeconomic status. Hum Vaccin Immunother.2016; 12(10): 2572-9.
23. 23.Payne DC, Englund JA, Weinberg GA, et al.Association of Rotavirus Vaccination with Inpatientand Emergency Department Visits Among ChildrenSeeking Care for Acute Gastroenteritis, 2010-2016.JAMA Netw Open. 2019; 2(9): e1912242.
24. 24.Burnett E, Parashar U, Tate J. Rotavirus Vaccines:Effectiveness, Safety, and Future Directions.Paediatr Drugs. 2018; 20(3): 223-33.
25. 25.Gönüllü E, Soysal A, Yıldız İ, Karaböcüoğlu M.Impact of self-financed rotavirus vaccination onacute gastroenteritis in young children in Turkey.Hum Vaccin Immunother. 2021; 17(2): 510-6.
26. 26.Mai CTN, Ly LTK, Doan YH, et al. Prevalence andCharacterization of Gastroenteritis Viruses amongHospitalized Children during a Pilot RotavirusVaccine Introduction in Vietnam. Viruses. 2023;15(11): 2164.
27. 27.Camilloni B, Alunno A, Nunzi E, et al. Hospital-acquired rotavirus acute gastroenteritis in 10consecutive seasons in Umbria (Italy). J Med Virol.2020; 92(12): 3202-8.