Burden of severe rotavirus disease leading to hospitalization assessed in a prospective cohort study in Sweden

Abstract

Background: The aim of this prospective cohort study was to estimate the burden of severe disease caused by rotavirus-induced gastroenteritis in Swedish children aged < 5 y. Methods: Rotavirus-positive children admitted to hospitals serving 3 geographical regions with 155,838 children aged < 5 y, were offered inclusion in this 1-year study. Rotavirus strains identified were genotyped using multiplex PCR. Disease progression was documented through interviews and chart reviews. Results: In total, 604 children with rotavirus-induced gastroenteritis were included in the study. Forty-nine of 604 (8.1%) fulfilled the criteria for nosocomial infection. The minimum incidence was 388 per 100,000, with significant variability between study regions, ranging from 280 to 542 per 100,000. In all regions, the peak season occurred in February–April, but the season start varied, with first cases observed in October in the eastern region and December in the northern region. Genotypes identified differed between the regions: G1[P8] was most prevalent in all regions (77%), while the most varied pattern was observed in the western region, with G1[P8] observed in 61%, G4[P8] in 13%, G9[P8] in 10%, G2[P4] in 8%, and G3[P8] in 8% of the children. The median age of hospitalized children was 14 months and the median total duration of diarrhoea was 6.9 days. Sixty-eight percent reported a temperature > 38.5°C upon admission. Complications occurred in > 10% of the children, with hypertonic dehydration (32/604) and seizures (10/604) occurring most frequently. Conclusions: Rotaviruses may cause severe febrile acute gastroenteritis leading to dehydration requiring acute rehydration in hospital. In addition, further complications occurred in > 10% of hospitalized children.

Keywords::

• Rotavirus
• incidence
• hospitalization
• complication
• genotype

Acknowledgements

We wish to thank the families who gave their time to answer questions on the case report forms, the study nurses Jens Olsson, Kristina Engström, Barbro Österlin, Josefin Karlsson, Marie Pettersson, Karin Hassler, Lena Harrysson, Margareta Bäckman, and Mariana Åhfeldt who conducted the interviews, and Bo Ötlund for project management.

Declaration of interest statement: The authors declare no financial or personal relationships with other people or organizations other than as follows: The study was organized in a private–public partnership between the Swedish Institute for Communicable Disease Control (SMI), GlaxoSmithKline, and Sanofi Pasteur MSD. The study protocol was developed by investigators at SMI and the 4 study centres.