Enteropathogens and other factors associated with severe disease in children with acute watery diarrhea in Lima, Peru

To evaluate enteropathogens and other factors associated with severe diseas e in children with diarrhea, 381 children <5 years of age with diarrhea and moderate to severe dehydration (in-patients) and 381 age-, sex-, and date- of-visit-matched children with mild diarrhea (outpatients) presenting to a hospital in Peru, were studied. Rotavirus was detected in 52% of the in-pat ients and 35% of the out-patients (odds ratio [OR] = 2.3, 95% confidence in terval [95% CI] = 1.6-3.2); 95% of the rotaviruses among in-patients were o f serotypes G1-G4. The risk of severe diarrhea was particularly great in ch ildren who were not exclusively breast-fed in early infancy and who also la cked piped water in their homes (for children with both characteristics OR = 6.8, 95% CI = 3.6-12.8). The high prevalence of rotavirus and its associa tion with severe diarrhea underscores the need for rotavirus vaccines. Inte rventions to educate mothers and improve access to safe water should augmen t the impact of rotavirus vaccines in preventing severe diarrhea.