Rotavirus vaccines and the prevention of hospital-acquired diarrhea in children
Section snippets
Rotavirus (RV) infection and transmission
Rotavirus (RV) is the major cause of severe acute gastroenteritis in infants and young children and is responsible for 20–50% of hospitalizations for diarrhea worldwide [1], [2]. Virtually all children are infected before their third birthday, and even in industrialized countries with good standards of hygiene and clean food and water, RV remains the most common cause of diarrhea-associated hospitalizations among young children, suggesting that the virus can be spread effectively by means other
RV disease burden
The burden of RV disease among children in developing countries differs greatly from that among children in the United States (Fig. 1). The clinical spectrum of RV infection in young infants (<3 months) ranges from asymptomatic infections, to mild to severe diarrhea, sometimes with dehydration requiring oral or intravenous rehydration in clinics or in hospitals. Worldwide, all children, whether living in developed or developing countries, are infected with RV during their first few years of
The burden of hospital-acquired RV disease
The proportion of hospital discharges for RV diarrhea that might be attributed to nosocomial infections has not been fully assessed. We conducted a MEDLINE search of studies in English published before November 2003, using the keywords “nosocomial infection and RV” and “intra-hospital infection and RV”. We identified 209 studies from both developed and developing countries by using the search term “nosocomial” and 26 studies using the search term “intra-hospital”. From this group of studies, we
Current strategies to prevent RV transmission
Given the difficulty in interrupting transmission of RV in the community and in outbreak settings such as hospitals and day care centers, prevention of the spread of RV has rested upon immune approaches, both active immunization and the passive administration of immunoglobulins. Passive immunotherapy (by oral administration of antibodies), has been of limited use among low birth infants [15] and other special populations, so most attention has been placed upon active immunization with live oral
Future directions and public health considerations
The experience of the past two decades has proved that RV disease can be prevented through vaccination with live oral vaccines. This should be one of the most cost-effective strategies to reduce childhood diarrhea-associated morbidity and mortality. A secondary goal of particular interest in countries with low mortality is the prevention of nosocomially acquired RV disease, as this likely would mean major savings for national health budgets. Little new data are available concerning the efficacy
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