Nosocomial Rotavirus Gastroenteritis: Is There a Role for Targeted Immunization?

Background: The prominent role of rotavirus (RV) as a pathogen in nosocomial gastrointestinal infections in pediatric settings has been recognized for several years. Although RV is now a vaccine-preventable disease, there is currently no publicly-funded vaccination program in Canada.

Objective: (i) To determine the burden of disease and characteristics of patients experiencing symptomatic nosocomial RV gastroenteritis (nRV)  and  (ii) to translate this knowledge to support decision-making on potential  vaccination strategies.

Methods: We performed a retrospective cohort study through chart review of all cases of nRV over a 10-year period (April 1997 – March 2007) in a Canadian tertiary pediatric hospital. Cases were identified using data collected by the hospital’s active prospective surveillance program for nosocomial infections. Demographic data, admission diagnoses, and data on underlying medical conditions, disease symptoms, date of onset and treatment received were recorded. Descriptive statistics were used.

Results: Two hundred fourteen cases of nRV were detected. The median length of stay in hospital was 23 days (range: 4-2251), with symptoms starting between day 3-10 in the majority of cases (range: 3-1326). Disease occurred in all age groups (7 days to 17 years old, median: 8 months), with 35% of cases in children aged 2 to 6 months. A chronic underlying medical condition was present in 57%. In 41 % of cases, the condition was present during the perinatal period (prematurity or low birth weight 28%). There were 32 patients hospitalized  since birth. Of the remaining 182 patients, 101 (55%)  had a history of previous hospitalization. This proportion was  higher among those with perinatal pathology (73%). Diarrhea lasted on average 4.7 days (range 1- 21). Fever and vomiting were present in 55% and 56% of patients respectively. Sixty-two percent of patients required rehydration, either oral (14%)  intravenous (IV)  (33%) or both (14%).  For those who required an IV exclusively for rehydration, the mean duration of IV catheterization was 3.2 days. Readmission because of nRV was necessary in 26 patients (12%) whose onset of symptoms occurred after discharge. Conclusions: nRV is predominantly a disease of children who require recurrent and prolonged hospitalizations. Underlying medical conditions were present in the majority of patients and in most cases from early on in life. Disease burden is significant with nearly half requiring IV hydration. A targeted immunization program providing RV vaccine for vulnerable patient groups identified during the first weeks of life, such as premature and low birth-weight infants and infants with congenital pathology, could be an interesting strategy.