Article title: “Decline in rotavirus hospitalizations following the first three years of vaccination in Castile-La Mancha, Spain”
Authors: Olga Redondo, Rosa Cano, and Lorena Simón
Journal: Human Vaccines & Immunotherapeutics
Bibliometrics: Volume 11, Issue 03, pages 769–775
DOI: 10.1080/21645515.2015.1009339
An incorrect version of Figure 1 was printed in the article and caused errors in the text of the article.
The correct version of Figure 1 can be found below:
Figure 1. Counting of hospital admissions by IAGE of typified and non-typified etiology. Source: MBDS. CLM, Spain. 2003-09. * * MBDS: Minimum Basic Data Set (ICD9-CM codes: International Classification of Diseases, Clinical Modification). CLM: Castile-La Mancha. ARGE: acute rotavirus gastroenteritis. PrincD.: principal diagnosis. SecD.: secondary diagnosis. Y: years old. IAGE: infectious acute gastroenteritis. Salm. spp.: Salmonella spp. C.jejuni: Campylobacter jejuni.a Bacterial or parasitic AGE (001-005, 006-007, and 008.0-008.5), and viral (008.6 to 008.8); excluding principal diagnosis of localized salmonella infection (003.21-003.24) and amebic abscess (006.3-006.6). b AGE “of undetermined etiology” (009.0 to 009.3), “Unspecified noninfectious AGE” (558.9), or “Diarrhea” (787.91). c In children under 5 years of age, 10 records that were codified with PrincD of non-typified AGE (6 with 558.9 and 4 with 009.0 or 009.3) had a specific SecD of Salmonella spp. and another 4 (3 with 558.9 and 1 with 009.0), had a SecD of Campylobacter jejuni. d Overall infectious specified AGE: PrincD of infectious AGE of typified etiology and non-typified AGE with SecD of infectious AGE.
The first, second, and third paragraphs of the Results section should be as follows:
Eight records in the Minimum Basic Data Set (MBDS) with a diagnosis of localized salmonella infection (003.21–003.24) and 4 with a diagnosis of amebic abscess (006.3–006.6) were excluded, leaving 22,998 records. A total of 5,012 cases of infectious AGE were identified through the principal diagnosis, including undetermined or cause-unspecified AGE and diarrheal syndromes with a specific secondary diagnosis of infectious AGE (Fig. 1). The total estimated cases of acute rotavirus gastroenteritis (ARGE) consisted of 1,640 records with a 008.61 diagnosis, to which we added another 17 after assigning the 008.61 code to cases with an original principal diagnosis coded as 009.0, 558.9, or 787.91, but which were linked to a secondary diagnosis coded as 008.61 (Fig. 1).
We calculated that 33% (1,657/5,012) of all hospital admissions due to cause-specific infectious AGE between 2003 and 2009 in CLM were caused by rotavirus. The median number of hospital discharges due to rotavirus was 203 (Interquartile range (IQR): 190-263) per year in children under 5 years of age, which represents 2% (1,623/85,042) of hospital admissions for any cause and 60% (1,623/2,682) of those caused by infectious AGE in this age group (Fig. 1 and Table 1). Salmonellosis accounted for 15% [(394+10)/2,682] and campylobacteriosis for 7% [(193+4)/2,682] of all hospitalizations coded as cause-specific infectious AGE in children under 5 (Fig. 1). Ninety-eight percent of rotavirus hospitalizations occurred in this age group, with 84% occurring in children under 2 y of age (Fig. 1 and Table 1). The frequency of concomitant AGE in children under 5 was 2%; the most common cause was adenovirus (70%), followed by Campylobacter jejuni (19%).
A total of 25 readmissions were due to “the same process” of ARGE, as defined in Methods section,19 with none occurring in 2008 or 2009. Only 5 readmissions due to different processes from the original diagnosis were documented; all occurred in different years. Mortality of infectious AGE requiring admission was 8‰ (38/5,012); no deaths were caused by rotavirus.
The second paragraph of the Discussion section should be as follows:
We found wide variability in the rate of RH under 5 y of age (144.27–395.53 per 105), somewhat lower than that described for Spain as a whole between 2003–08 (105.31– 462.11 per 105).20 In fact, the prevalence of RH compared to that of total hospitalizations for typified or non-typified AGE in children under 5 was somewhat lower than the national prevalence rates (26.9% vs. 28.4%). In Europe, rotavirus represents 14% to 54% of all admissions for AGE in this group.4,6,21 This variability constitutes a limitation when making comparisons and is most likely due to differences in study design, coding methods, access to health care, disease management, data sources, coverage and representativeness of surveillance systems, and the years and geographic areas included. Moreover, rotavirus possesses significant genetic diversity that can cause changes in its antigenicity and pathogenic ability.22 Anyway, this observed variability, which was even further influenced by the introduction of the new vaccines,23 results in different clinical effects over the years in various geographic areas.24-27
The sixth paragraph of the Discussion section should be as follows:
This research was carried out from the MBDS, a nationwide database. This is a compulsory data source that is retrospectively constructed with every hospitalization episode in Spain. Many studies have been conducted from it. A major limitation is that MBDS is not intended for surveillance of infectious diseases. Although the main reason for hospital discharges has previously been used to assess the burden of disease, some studies show an underestimation when MBDS is used.2,35 In fact, 71% (12,503/17,415) of the records coded with a principal diagnosis of AGE correspond to non-typified AGE (54% under 5 years) (Fig. 1). The 558.9 code is usually used to encode non-typified diarrhea at discharge, even without knowing whether these cases are infectious. Similar results on incidence categorized by age group in ARGE and non-typified AGE (Table 1) described previously36 suggest that many cases of non-typified AGE could be attributed to rotavirus, a hypothesis bolstered by the similarities observed in the seasonality of AGE, which is different when caused by Salmonella or Campylobacter than when due to rotavirus (Fig. 3). In addition, in 2007–09, cases of non-typified AGE fell by 22% in children under 5 (p<0.001), a greater decrease than that of rotavirus. About 28% of ARGE is underdiagnosed through MBDS.37 Besides, microbiological data depends on the diagnostic practices and availability of techniques in hospitals and MBDS does not collect cases from the emergency room. Finally, MBDS does not include the patterns of administered vaccines.
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