Elsevier

Vaccine

Volume 22, Supplement 1, 6 December 2004, Pages S49-S54
Vaccine

Rotavirus vaccines and the prevention of hospital-acquired diarrhea in children

https://doi.org/10.1016/j.vaccine.2004.08.017Get rights and content

Abstract

Rotavirus, the major cause of severe acute dehydrating gastroenteritis in children less than 5 years of age, is responsible for an estimated 20–50% of all hospitalizations for diarrhea and approximately 440,000 deaths annually, primarily in the developing world. Rotavirus vaccines are considered the most promising means for disease prevention. While the prime rationale for developing rotavirus vaccines has been the enormous burden of rotavirus infection leading to severe and fatal disease, a secondary benefit may be the prevention of nosocomial rotavirus diarrhea. We have reviewed the burden of intra-hospital-acquired rotavirus infections from several countries and found that in the United States alone, as many as 25% of rotavirus hospitalizations or approximately 16,000–18,000 hospitalizations each year might be due to rotavirus infections acquired within hospitals. To countries with low rotavirus-associated mortality, prevention of these infections and the resulting economic savings therefore represent an important secondary goal. Several rotavirus vaccines are in development, and two candidates are currently being tested in large-scale safety and efficacy trials. Development of safe and effective rotavirus vaccines will protect children worldwide against the severe consequences of rotavirus infections including prolonged hospitalizations for nosocomially acquired infections.

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

References (47)

  • M. Ramachandran et al.

    Molecular characterization of serotype G9 rotavirus strains from a global collection

    Virology

    (2000)
  • C. Noone et al.

    Hospital acquired rotaviral gastroenteritis in a general paediatric unit

    J Hosp Infect

    (1983)
  • S.M. Cook et al.

    Global seasonality of rotavirus infections

    Bull World Health Organ

    (1990)
  • N.A. Cunliffe et al.

    Epidemiology of rotavirus diarrhoea in Africa: a review to assess the need for rotavirus immunization

    Bull World Health Organ

    (1998)
  • D.O. Matson et al.

    Impact of rotavirus infection at a large pediatric hospital

    J Infect Dis

    (1990)
  • M.J. Ryan et al.

    Hospital admissions attributable to rotavirus infection in England and Wales

    J Infect Dis

    (1996)
  • A.J. Ratner et al.

    Nosocomial rotavirus in a pediatric hospital

    Infect Control Hosp Epidemiol

    (2001)
  • M.A. Widdowson et al.

    An outbreak of diarrhea in a neonatal medium care unit caused by a novel strain of rotavirus: investigation using both epidemiologic and microbiological methods

    Infect Control Hosp Epidemiol

    (2002)
  • P.H. Dennehy

    Transmission of rotavirus and other enteric pathogens in the home

    Pediatr Infect Dis J

    (2000)
  • L.M. Edmonson et al.

    Report of a rotavirus outbreak in an adult nursing home population

    J Am Med Dir Assoc

    (2000)
  • G.A. Gellert et al.

    An outbreak of acute gastroenteritis caused by a small round structured virus in a geriatric convalescent facility

    Infect Control Hosp Epidemiol

    (1990)
  • Kapikian A, Chanock R, Knipe D, Howley P, editors. Fields Virology, Philadelphia: Lippincott Williams & Wilkins; 2001;...
  • S.A. Sattar et al.

    Chemical disinfection of non-porous inanimate surfaces experimentally contaminated with four human pathogenic viruses

    Epidemiol Infect

    (1989)
  • Cited by (98)

    • Rotavirus Gastroenteritis Outbreaks in a neonate intermediate care unit: Direct detection of rotavirus from a computer keyboard and mouse

      2019, Journal of Microbiology, Immunology and Infection
      Citation Excerpt :

      Rotavirus is also one of the common pathogens of HAI. A review article published in 2004 reported that an average of 27% (range 14–51%) of rotavirus hospitalizations were nosocomial in nature.19 In Taiwan, Tai et al. reported that three-quarters of the infants with rotavirus infections hospitalized in neonatal care units in a tertiary teaching hospital in northern Taiwan during 2008–2010 acquired their infection in the hospital, and more than 60% of the patients were preterm infants.3

    • Rotavirus Infection. An Update on Management and Prevention

      2012, Advances in Pediatrics
      Citation Excerpt :

      During these outbreaks toys, food preparation areas, and toilet facilities are usually heavily contaminated with rotaviruses. Rotavirus is also a common hospital-acquired infection on pediatric wards in the winter months [16]. These infections result in prolonged hospital stays and increased medical costs.

    View all citing articles on Scopus
    View full text