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Clinical presentations of rotavirus infection among hospitalized children
Mary Allen Staat1, Parvin H Azimi, Tamas Berke
1Division of Infectious Disease, Children's Hospital Medical Center, Cincinnati, OH 45229, USA. staam0@chmcc.org
Insights
Rotavirus (RV) causes severe childhood gastroenteritis. This study found RV detection highest when diarrhea, vomiting, and fever occurred together, suggesting a broader symptom spectrum in hospitalized children.
Area of Science:
- Pediatric infectious diseases
- Gastroenterology
- Virology
Background:
- Rotaviruses (RVs) are a leading cause of severe gastroenteritis in children.
- Limited data exists on the full range of clinical presentations of rotavirus disease requiring hospitalization.
Purpose of the Study:
- To define the clinical spectrum of rotavirus-associated hospitalizations in children.
- To include children with short-stay visits in the characterization.
Main Methods:
- Active surveillance for rotavirus disease in children aged 15 days to 4 years admitted with diarrhea, vomiting, and/or fever.
- Surveillance conducted at three children's hospitals from November 1997 to June 1998.
- Stool specimen testing for rotavirus using enzyme immunoassay.
Main Results:
- Rotavirus was detected in 31% of 763 tested children.
- RV detection was highest (56%) when diarrhea, vomiting, and fever were present concurrently.
- RV detection was lower with two symptoms (38% DV, 19% DF, 13% VF) or a single symptom (3% D, 11% V, 6% F).
- Nine percent of children without initial diarrhea excreted RV, and those developing diarrhea during hospitalization were more likely to have rotavirus.
Conclusions:
- Rotavirus detection rates correlate with the number of symptoms present.
- The clinical presentation of rotavirus disease in hospitalized children may be more diverse than previously understood.
Background:
Although rotaviruses (RVs) are the most common cause of severe gastroenteritis in children, there is a lack of information detailing the spectrum of clinical manifestations of RV disease resulting in hospitalization.
Objective:
To characterize the clinical spectrum of RV-associated hospitalizations, including short stay visits in children.
Methods:
Active RV disease surveillance was conducted at three children's hospitals Sundays through Thursdays in children 15 days through 4 years of age admitted with diarrhea (D), vomiting (V) and/or unexplained fever (F) between November, 1997, and June, 1998. Stool specimens were collected and tested for RV by enzyme immunoassay.
Results:
Of the 862 children enrolled, 763 (88%) had a stool specimen tested for RV. Overall 31% of children excreted RV. RV excretion was highest when all 3 symptoms (D, V and F) occurred in the same child (56%), lower when 2 symptoms occurred together (38% DV; 19% DF; 13% VF) and lowest when each symptom occurred alone (3% D; 11% V; 6% F). Nine percent of the children without diarrhea excreted RV. Children admitted without diarrhea were more likely to have rotavirus if they developed diarrhea during their hospitalization.
Conclusions:
RV detection was greatest when diarrhea, vomiting and fever occurred together and lowest when each symptom occurred alone. The spectrum of symptoms of rotavirus disease in children at the time of admission to the hospital or short stay unit may be broader than previously recognized.