International variation in disease burden of rotavirus gastroenteritis in children with community- and nosocomially acquired infection

Background. The great impact of rotavirus disease on morbidity and medical health care costs in industrialized countries together with the withdrawal of the live oral rotavirus vaccine have made a reassessment of rotavirus ga stroenteritis necessary. Such a reassessment should provide sufficient data for developing alternative disease prevention strategies and for allocatin g resources efficiently. Objectives. To compare characteristics and management of community- and nos ocomially acquired rotavirus disease in Austria, Germany and Switzerland. Patients and methods. In a prospective, population-based, trinational (Aust ria, Germany, Switzerland), multicenter (9 cities, 10 hospitals and 30 pedi atric practices) study, a total of 174 552 children months and 78 516 hospi tal days were evaluated. Participants were all children 4 years of age and younger, who either presented at one of the pediatric practices with commun ity-acquired gastroenteritis, or who had acquired gastroenteritis nosocomia lly. From December, 1997, to May, 1998, prospective antigen testing was don e by enzyme-linked immunosorbent assay, and serotyping was done by reverse transcription polymerase chain reaction. Disease severity was scored by the Vesikari severity scale. Results. Rotavirus was detected in 29.5, 27 and 37.5% of children with comm unity-acquired gastroenteritis and in 57, 69 and 49% of children with nosoc omial gastroenteritis in Austria, Germany and Switzerland, respectively. Se verity of community-acquired rotavirus gastroenteritis was more pronounced in Austria (median severity score, 11) than in Germany (median score, 9) or Switzerland (median score, 10). However, only 2% of Austrian and Swiss chi ldren compared with 12% of German children presented to their pediatricians more than four times. Nosocomially acquired rotavirus gastroenteritis was mildest in Austria but occurred within the shortest median duration of hosp italization (4 days vs. 5 and 7 in Germany and Switzerland, respectively). In a multivariant analysis age, family size, day care, breast-feeding and n ationality were not predictive factors for enhanced risk to contract rotavi rus infection. Alimentation was changed frequently; diet was used between 2 3 and 83%; special formulas were used between 10 and 57%. Conclusion. The cumulative experience from three European countries suggest that rotavirus is an important cause of diarrhea in Central Europe, but si gnificant local differences clearly demonstrate the need for obtaining nati onal data as a reliable basis for control and prevention of the disease.