title: Burden of Rotavirus Disease in Norway: Using National Registries for Public Health Research.
abstract: BACKGROUND
  Norway introduced routine rotavirus immunization for all children born on or after September 1, 2014. We estimated the healthcare burden of all-cause gastroenteritis and rotavirus disease in children <5 years old to establish the prevaccine baseline and support the ongoing immunization program.
  
  
  METHODS
  We examined national registry data on gastroenteritis-associated primary care consultations and hospitalizations for 2009-2013 and data on all deaths in children <5 years old reported during 2000-2013. We also established rotavirus hospital surveillance from February 2014 through January 2015.
  
  
  RESULTS
  Before vaccine introduction, 114.5 cases per 1000 children <5 years old were treated in primary care and 11.8 children per 1000 were hospitalized with gastroenteritis annually. During hospital surveillance, rotavirus was detected in 65% (95% confidence interval: 60-70) of inpatient gastroenteritis cases. We estimated that 4.0 inpatient and 2.3 outpatient cases per 1000 children were seen in hospital with rotavirus disease annually, suggesting that 1 in 32 children was hospitalized by age 5. Additional 30.6 rotavirus cases per 1000 children consulted primary care annually or 1 in every 7 children by the age of 5 years. Rotavirus-associated mortality was estimated at 0.17 deaths per 100,000 children <5 years old, corresponding to 1 death every second year.
  
  
  CONCLUSIONS
  Rotavirus remains the primary cause of severe gastroenteritis in children in Norway. The unique population-based registers, in combination with an established rotavirus surveillance platform, provide a well-suited setting to evaluate the impact of rotavirus vaccination.
authors.affiliation: From the *Department of Infectious Disease Epidemiology, †Department of Vaccines, ‡Department of Virology, Norwegian Institute of Public Health, Oslo, Norway; §Department of Pediatrics, ¶Department of Microbiology, Oslo University Hospital, Oslo, Norway; ‖Department of Pediatrics, **Department of Clinical Microbiology, Østfold Hospital Trust, Fredrikstad, Norway; ††Department of Pediatrics, St. Olavs University Hospital, Trondheim, Norway; ‡‡Norwegian University of Science and Technology, Trondheim, Norway; §§Department of Medical Microbiology, St. Olavs University Hospital, Trondheim, Norway; ¶¶Department of Pediatrics, and ‖‖Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Tone
authors.initials: T
authors.lastname: Bruun
authors.forename: Beatriz Valcarcel
authors.initials: BV
authors.lastname: Salamanca
authors.forename: Terese
authors.initials: T
authors.lastname: Bekkevold
authors.forename: Kirsti
authors.initials: K
authors.lastname: Vainio
authors.forename: Moustafa
authors.initials: M
authors.lastname: Gibory
authors.forename: Kirsti Egge
authors.initials: KE
authors.lastname: Haugstad
authors.forename: Astrid
authors.initials: A
authors.lastname: Rojahn
authors.forename: Kirsti
authors.initials: K
authors.lastname: Jakobsen
authors.forename: Gunnar
authors.initials: G
authors.lastname: Størvold
authors.forename: Anette
authors.initials: A
authors.lastname: Lunde
authors.forename: Ketil
authors.initials: K
authors.lastname: Størdal
authors.forename: Anita
authors.initials: A
authors.lastname: Kanestrøm
authors.forename: Magnhild Owesen
authors.initials: MO
authors.lastname: Eidem
authors.forename: Henrik
authors.initials: H
authors.lastname: Døllner
authors.forename: Lars Høsøien
authors.initials: LH
authors.lastname: Skanke
authors.forename: Svein Arne
authors.initials: SA
authors.lastname: Nordbø
authors.forename: Heidi Christin
authors.initials: HC
authors.lastname: Sivertsen
authors.forename: Ann Marit
authors.initials: AM
authors.lastname: Gilje
authors.forename: Elisebet
authors.initials: E
authors.lastname: Haarr
authors.forename: Elmira
authors.initials: E
authors.lastname: Flem
mesh_terms: D002675:Child, Preschool; D017281:Cost of Illness; D005260:Female; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D008297:Male; D009026:Mortality; D009664:Norway / Q000453:epidemiology; D011320:Primary Health Care; D062486:Public Health Surveillance; D012017:Referral and Consultation; D012042:Registries; D012401:Rotavirus; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000517:prevention & control; D022243:Rotavirus Vaccines; D018571:Sentinel Surveillance; D014611:Vaccination
chemical_list: D022243:Rotavirus Vaccines