Rotavirus-associated diarrhea in outpatient settings and child care centers

Objectives: To determine the prevalence of rotavirus infection in outpatien t and child care center (CCC) settings during the seasonal rotavirus outbre ak and to describe associated health care utilization. Design: Prospective, multisite cohort study in various ambulatory settings. Settings and Participants: Participants were children with diarrhea (1) pre senting to hospital emergency departments (EDs) and receiving intravenous ( IV; n=8) or oral (n=1) hydration, (2) seen in pediatric practices (n=4), or (3) attending CCCs (n=19) between No -vember 1, 1997, and June 30, 1998. P rospective centralized resting of stool samples for rotavirus was performed using enzyme-linked immunosorbent assay and electron microscopy. Study nur ses administered follow-up parent questionnaires for rotavirus-positive chi ldren. Main Outcome Measure: Prevalence of rotavirus-associated diarrhea. Results During the 8-month study, rotavirus was identified in 92 children w ith diarrhea: ED-IV, 20 (44%) of 45; ED-oral, 9 (47%) of 19; pediatric prac tices, 30 (20%) of 147; and CCCs, 33 (18%) of 186. Of 226 children with dia rrhea in pediatric practices, all 5 who progressed to ED-IV hydration or ho spitalization were tested, and 3 (60%) were rotavirus positive. Of 211 chil dren in CCCs with diarrhea, 84% who required no health care visits were tes ted, and of these 10% were positive; of 56 who went on to require a health care visit and 8 who required ED-IV hydration or hospitalization, all were tested, and 27% and 75%, respectively, were rotavirus positive. Among 16 ch ildren with rotavirus followed up with ED-IV hydration, 4 (25%) returned an d were hospitalized. Maximal health care intervention among 29 children wit h rotavirus enrolled ill, pediatric practices included 22 (76%) seeing the pediatrician only, 5 (17%) seeking further care in the ED, 1 (3%) receiving further ED-IV hydration, and 1 (3%) being hospitalized briefly. Maximal he alth care intervention for 33 children with rotavirus enrolled in CCCs incl uded 13 (39%) who did not visit a physician, 11 (33%) who did, 3 (9%) who s ought care in the ED, 1 (3%) who received ED-IV hydration, and 5 (15%) who were hospitalized. In CCCs, rates of diarrhea per 100 child-months of obser vation were as follows: ages 0 to 23 months, 6.6 episodes, ages 24 to 35 mo nths, 1.9 episodes; and 3 years and older, 0.07 episodes; rates of rotaviru s-associated diarrhea were as follows: ages 0 to 23 months, 1.1 episodes (2 8 of 2547); ages 24 to 35 months, 0.23 episodes (5 of 2185); and 3 years an d older, 0 episodes (0 of 4124). Conclusion: Across a variety of outpatient and CCC settings, rotavirus is a n important cause of diarrhea and a major cause of health care utilization.