title: Hospital-based surveillance to estimate the burden of rotavirus gastroenteritis among European children younger than 5 years of age.
abstract: OBJECTIVE
  Rotavirus is the leading cause of acute gastroenteritis requiring hospitalization in young children. Data on the burden of rotavirus gastroenteritis are needed to guide recommendations for rotavirus vaccine use. This study was undertaken to estimate the burden of rotavirus gastroenteritis in European children <5 years of age.
  
  
  METHODS
  This prospective, study was conducted in 12 hospitals in France, Germany, Italy, Spain, and the United Kingdom. A sample of all children aged <5 years presenting to emergency departments or hospitalized because of community-acquired acute gastroenteritis was enrolled for parental interview and stool collection. Acute gastroenteritis was defined as diarrhea (>/=3 loose stools per 24 hours) for <14 days. Rotavirus was detected by enzyme-linked immunosorbent assay and typed by reverse-transcriptase polymerase chain reaction.
  
  
  RESULTS
  Between February 2005 and August 2006, 3734 children with community-acquired acute gastroenteritis were recruited and retained for analysis (55.9% via the emergency department, 41.8% hospitalized). Of the 2928 community-acquired acute gastroenteritis cases for which stool samples were available, 43.4% were rotavirus-positive by enzyme-linked immunosorbent assay (32.8% emergency department, 56.2% hospitalized). Of these rotavirus gastroenteritis cases 80.9% occurred in children aged <2 years and 15.9% among infants aged <6 months. Acute gastroenteritis was more severe in rotavirus-positive subjects (Vesikari score >/= 11 in 53.3% compared with 31.0% of rotavirus-negative subjects). All 1271 rotavirus-positive strains were genotyped (G1P[8]: 40.3%; G9P[8]: 31.2%; G4P[8]: 13.5%; G3P[8]: 7.1%).
  
  
  CONCLUSIONS
  Rotavirus gastroenteritis places high demands on European health care systems, accounting for 56.2% of hospitalizations and 32.8% of emergency department visits because of community-acquired acute gastroenteritis in children aged <5 years. Most community-acquired rotavirus gastroenteritis occurs in children aged <2 years, and a high proportion occurs in infants aged <6 months. Cases were also observed among very young infants <2 months of age. Rotavirus vaccination is expected to have a major impact in reducing morbidity and the pressure on hospital services in Europe.
authors.affiliation: MSc, 89 Rue de l'Institut, 1330 Rixensart, Belgium. montse.soriano@gskbio.com.
authors.forename: Johannes
authors.initials: J
authors.lastname: Forster
authors.forename: Alfredo
authors.initials: A
authors.lastname: Guarino
authors.forename: Nathalie
authors.initials: N
authors.lastname: Parez
authors.forename: Fernando
authors.initials: F
authors.lastname: Moraga
authors.forename: Enriqueta
authors.initials: E
authors.lastname: Román
authors.forename: Olivier
authors.initials: O
authors.lastname: Mory
authors.forename: Alberto E
authors.initials: AE
authors.lastname: Tozzi
authors.forename: Ana López
authors.initials: AL
authors.lastname: de Aguileta
authors.forename: Ulrich
authors.initials: U
authors.lastname: Wahn
authors.forename: Clive
authors.initials: C
authors.lastname: Graham
authors.forename: Reinhard
authors.initials: R
authors.lastname: Berner
authors.forename: Titus
authors.initials: T
authors.lastname: Ninan
authors.forename: Celia
authors.initials: C
authors.lastname: Barberousse
authors.forename: Nadia
authors.initials: N
authors.lastname: Meyer
authors.forename: Montse
authors.initials: M
authors.lastname: Soriano-Gabarró
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000821:virology; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005060:Europe; D005243:Feces / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000821:virology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D011159:Population Surveillance; D011446:Prospective Studies; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000821:virology; D012621:Seasons; D014600:Utilization Review