Rotavirus disease in Germany--a prospective survey of very severe cases.
OBJECTIVE
Rotavirus (RV) gastroenteritis is a notifiable disease in Germany. The reports to the authorities contain few data concerning the severity of disease. The aims of this study were to determine incidence and outcome of very severe cases of RV disease.


METHODS
Cases of very severe RV disease were collected by the German Paediatric Surveillance Unit for rare diseases (Erhebungseinheit für seltene pädiatrische Erkrankungen in Deutschland) using anonymous questionnaires based on hospitalized patients between April 2009 and March 2011. Inclusion criteria were detection of RV antigen in feces, patient aged 0-16 years and 1 or more of the following criteria: intensive care treatment, hypernatremia or hyponatremia (>155 mmol/L or <125 mmol/L), clinical signs of encephalopathy (somnolence, seizures, apnea) and RV-associated death.


RESULTS
During 2 years, 130 cases of very severe RV disease were reported, 101 of 130 were verified. Seventeen patients had nosocomial infection, of whom 14 were neonates in intensive care. Among those, 12 infants had verified or suspected necrotizing enterocolitis. Eighty-four community-acquired cases were reported, median age was 10.5 months (0-108 months). The median hospital stay was 6 days, and 48 patients needed intensive care treatment. Among children less than 5 years of age, the yearly incidence of community-acquired very severe RV disease was 1.2 of 100,000 (95% confidence interval: 0.9-1.4/100,000). A total of 26 of 84 and 10 of 84 patients had severe hypernatremia or hyponatremia, respectively, and 58 of 84 patients had signs of encephalopathy. Three deaths were reported (1 nosocomial and 2 community acquired).


CONCLUSIONS
RV infection in Germany can have a life-threatening course. A substantial number are nosocomial infections.
HELIOS Klinikum Krefeld, Zentrum für Kinder- und Jugendmedizin, Lutherplatz 40, 47805 Krefeld, Germany. sonu.shai@helios-kliniken.de
Sonu
S
Shai
Ruy
R
Perez-Becker
Carl-Heinz Wirsing
CH
von König
Rüdiger
R
von Kries
Ulrich
U
Heininger
Johannes
J
Forster
Hans-Iko
HI
Huppertz
Reinhard
R
Roos
Ulrich
U
Göbel
Tim
T
Niehues
D017714:Community-Acquired Infections / Q000453:epidemiology / Q000821:virology; D003422:Critical Care; D003428:Cross Infection / Q000453:epidemiology / Q000821:virology; D003681:Dehydration / Q000453:epidemiology / Q000821:virology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012400:Rotavirus Infections / Q000453:epidemiology*; D012621:Seasons; D012640:Seizures / Q000453:epidemiology / Q000821:virology