Rotavirus-associated diarrhea in outpatient settings and child care centers. The Greater Toronto Area/Peel Region PRESI Study Group. Pediatric Rotavirus Epidemiology Study for Immunization
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Published on: January 28, 2019
E L Ford-Jones1, E Wang, M Petric
1The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Ontario, Canada. lee.ford-jones@sickkids.on.ca
Insights
Rotavirus is a significant cause of diarrhea in children across outpatient and child care settings, leading to substantial healthcare use. This study highlights its prevalence during outbreaks and its impact on healthcare utilization.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Public Health
Background:
- Rotavirus is a leading cause of severe diarrheal disease in infants and young children globally.
- Understanding rotavirus prevalence in various community settings is crucial for public health interventions.
Purpose of the Study:
- To determine the prevalence of rotavirus infection in outpatient and child care center (CCC) settings during a seasonal outbreak.
- To describe the associated healthcare utilization patterns for rotavirus-infected children.
Main Methods:
- A prospective, multisite cohort study was conducted in ambulatory settings, including emergency departments (EDs), pediatric practices, and CCCs.
- Stool samples from children with diarrhea were tested for rotavirus using enzyme-linked immunosorbent assay and electron microscopy.
- Follow-up questionnaires were administered to parents of rotavirus-positive children.
Main Results:
- Rotavirus was identified in 92 children with diarrhea across different settings, with prevalence rates ranging from 18% in CCCs to 47% in EDs receiving oral hydration.
- Children in CCCs aged 0-23 months had the highest rates of diarrhea and rotavirus-associated diarrhea.
- Significant healthcare utilization was observed, including pediatrician visits, ED visits, IV hydration, and hospitalizations, particularly for younger children.
Conclusions:
- Rotavirus is a significant contributor to childhood diarrhea and healthcare utilization in outpatient and child care settings.
- The findings underscore the importance of rotavirus prevention and management strategies in community-based healthcare.
Objectives:
To determine the prevalence of rotavirus infection in outpatient and child care center (CCC) settings during the seasonal rotavirus outbreak and to describe associated health care utilization.
Design:
Prospective, multisite cohort study in various ambulatory settings.
Settings And Participants:
Participants were children with diarrhea (1) presenting to hospital emergency departments (EDs) and receiving intravenous (IV; n = 8) or oral (n = 1) hydration, (2) seen in pediatric practices (n=4), or (3) attending CCCs (n = 19) between November 1, 1997, and June 30, 1998. Prospective centralized testing of stool samples for rotavirus was performed using enzyme-linked immunosorbent assay and electron microscopy. Study nurses administered follow-up parent questionnaires for rotavirus-positive children.
Main Outcome Measure:
Prevalence of rotavirus-associated diarrhea.
Results:
During the 8-month study, rotavirus was identified in 92 children with diarrhea: ED-IV, 20 (44%) of 45; ED-oral, 9 (47%) of 19; pediatric practices, 30 (20%) of 147; and CCCs, 33 (18%) of 186. Of 226 children with diarrhea in pediatric practices, all 5 who progressed to ED-IV hydration or hospitalization were tested, and 3 (60%) were rotavirus positive. Of 211 children in CCCs with diarrhea, 84% who required no health care visits were tested, and of these 10% were positive; of 56 who went on to require a health care visit and 8 who required ED-IV hydration or hospitalization, all were tested, and 27% and 75%, respectively, were rotavirus positive. Among 16 children with rotavirus followed up with ED-IV hydration, 4 (25%) returned and were hospitalized. Maximal health care intervention among 29 children with rotavirus enrolled in pediatric practices included 22 (76%) seeing the pediatrician only, 5 (17%) seeking further care in the ED, 1 (3%) receiving further ED-IV hydration, and 1 (3%) being hospitalized briefly. Maximal health care intervention for 33 children with rotavirus enrolled in CCCs included 13 (39%) who did not visit a physician, 11 (33%) who did, 3 (9%) who sought care in the ED, 1 (3%) who received ED-IV hydration, and 5 (15%) who were hospitalized. In CCCs, rates of diarrhea per 100 child-months of observation were as follows: ages 0 to 23 months, 6.6 episodes; ages 24 to 35 months, 1.9 episodes; and 3 years and older, 0.07 episodes; rates of rotavirus-associated diarrhea were as follows: ages 0 to 23 months, 1.1 episodes (28 of 2547); ages 24 to 35 months, 0.23 episodes (5 of 2185); and 3 years and older, 0 episodes (0 of 4124).
Conclusion:
Across a variety of outpatient and CCC settings, rotavirus is an important cause of diarrhea and a major cause of health care utilization.
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