title: Multicenter prospective study on the burden of rotavirus gastroenteritis in children less than 3 years of age in Spain.
abstract: BACKGROUND
  Rotavirus is acknowledged as an important cause of paediatric gastroenteritis worldwide. In Spain, comprehensive data on the burden of rotavirus disease was lacking.
  
  
  METHODS
  A prospective, multicenter, observational study was carried out, during the winter season, from October to April 2014 in selected areas of Spain (Catalonia, Basque Country, Andalusia) to estimate the frequency and characteristics of acute gastroenteritis (AGE) and rotavirus gastroenteritis (RVGE) in children ≤3 years of age seeking medical care in primary care and emergency department centres.
  
  
  RESULTS
  Of the 1087 episodes of AGE registered, 33.89 % were RVGE positive. The estimated incidence of RVGE, was 40.3 (95 % CI 36.1-44.8) episodes per 10,000 child-months in children ≤ 3 years of age and the 5-month (December-April) seasonal RVGE incidence rate was 2.01 [1.81-2.24] per 100 children. No vaccination and attending a day care centre were the main risk factors for RV infection. RVGE infected children presented more frequently with fever (63.9 % vs. 45.1 %, p = 0.009), vomiting (61.2 % vs. 44.3 %, p = 0.015), suffered more dehydration, and were hospitalised and went to the emergency room more often (41.7 % vs. 15.7 %, p <0.001) than non-RVGE infected ones. Children were usually more tired (77.5 % vs. 54.2 %, p <0.001), tearful, (47.2 % vs. 34.8 %, p <0.001), and easily irritated (76.5 % vs. 59.8 %, p <0.001), and parents were more concerned (41.7 % vs. 15.7 %, p <0.001) and suffered more working rhythm disturbances (39.0 % vs. 22.9 %, p <0.001). The cost for families of RVGE cases was significantly higher than the cost of non-RVGE infected ones (47.3 vs 36.7 euros, p = 0.011). Vaccinated children suffered less clinical symptoms and no hospitalization. Therefore, vaccination decreases the psychosocial stressors caused by the disease in the family.
  
  
  CONCLUSIONS
  Rotavirus infections are responsible for a substantial proportion of AGE cases in children ≤3 years of age in Spain attended at primary care visits. RVGE episodes are associated with greater clinical severity, greater alterations in the child´s behaviour, and higher parental distress. The outcomes of the present study recommend that routine rotavirus vaccination in infants ≤3 years of age could considerably reduce the serious burden of this potentially serious childhood disease.
authors.affiliation: Unidad de Infectología Pediátrica, Hospital de Basurto, Universidad del País Vasco (UPV/EHU), Avenida de Montevideo 18, 48013, Bilbao, Vizcaya, Spain. javier.aristeguifernandez@osakidetza.eus.
authors.forename: J
authors.initials: J
authors.lastname: Arístegui
authors.affiliation: Pediatría, CAP Roquetes Canteres, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Ferrer
authors.affiliation: Pediatría, Instituto Hispalense de Pediatría,, Sevilla, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Salamanca
authors.affiliation: Unidad de Infectología Pediátrica, Hospital de Basurto, Universidad del País Vasco (UPV/EHU), Avenida de Montevideo 18, 48013, Bilbao, Vizcaya, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Garrote
authors.affiliation: Unidad de Infectología Pediátrica, Hospital de Basurto, Universidad del País Vasco (UPV/EHU), Avenida de Montevideo 18, 48013, Bilbao, Vizcaya, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Partidas
authors.affiliation: Medical Department. Sanofi Pasteur MSD, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: San-Martin
authors.affiliation: OXON Epidemiology, Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: San-Jose
mesh_terms: D002675:Child, Preschool; D017281:Cost of Illness; D005260:Female; D005500:Follow-Up Studies; D005759:Gastroenteritis / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011320:Primary Health Care; D011446:Prospective Studies; D012307:Risk Factors; D012400:Rotavirus Infections / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology
keywords: Burden; Gastroenteritis; Primary care; Rotavirus; Spain