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Temporal Changes in Pediatric Gastroenteritis after Rotavirus Vaccination in Quebec
Margaret K Doll1, Arnaud Gagneur, Bruce Tapiéro
1From the *McGill University, Montreal, Quebec, Canada; †Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada; ‡Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada; §Laboratoire de santé publique du Québec (LSPQ), Sainte-Anne-de-Bellevue, Montreal, Quebec, Canada; ¶McGill University Health Center Vaccine Study Center - MUHC Research Institute, Montreal, Quebec, Canada; and ‖The Montreal Children's Hospital, Montreal, Quebec, Canada.
Insights
Norovirus infections were more common than rotavirus in children seeking emergency care, but rotavirus cases were more severe. This study compared the burden and clinical outcomes of pediatric gastroenteritis post-vaccination.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Public Health Surveillance
Background:
- Rotavirus and norovirus are leading causes of pediatric gastroenteritis.
- The study examines the etiological burden and clinical severity of gastroenteritis following rotavirus vaccination in Quebec.
- Post-implementation analysis of a publicly funded rotavirus vaccination program.
Purpose of the Study:
- To compare the relative burden of pediatric gastroenteritis by etiology (rotavirus vs. norovirus).
- To assess the clinical severity of rotavirus and norovirus cases.
- To evaluate the impact of rotavirus vaccination on gastroenteritis epidemiology.
Main Methods:
- Prospective, active surveillance of acute gastroenteritis in children (8 weeks to <3 years).
- Data collection included demographics, clinical history, and stool samples.
- Stool samples were tested for rotavirus, norovirus, and sapovirus; clinical outcomes were compared by etiology.
Main Results:
- Norovirus (25.5%) was more prevalent than rotavirus (20.4%) among eligible patients.
- Rotavirus prevalence decreased relative to norovirus in the second year post-vaccination implementation.
- Rotavirus cases showed higher rates of fever, dehydration, hospitalization, and more diarrheal episodes.
Conclusions:
- Norovirus infections were more prevalent in hospitalized or emergency care pediatric gastroenteritis cases.
- Rotavirus infections, though less prevalent, were associated with greater clinical severity.
- Findings highlight the continued importance of norovirus and the clinical impact of rotavirus.
Background:
Rotavirus and norovirus are among the leading causes of pediatric gastroenteritis. We examined the relative burden of pediatric gastroenteritis by etiology and compared the clinical severity of rotavirus and norovirus cases after the November 2011 implementation of publicly funded rotavirus vaccination program in Quebec.
Methods:
Prospective, active surveillance for acute gastroenteritis among children aged 8 weeks to less than 3 years of age was implemented at 3 hospitals. Participant demographics, clinical histories and stools were collected; stools were tested for rotavirus, norovirus and sapovirus. Risk and absolute differences of several clinical severity outcomes were compared by etiology with adjustment for patient age.
Results:
From February 2012 to May 2014, 734 eligible active surveillance patients were recruited, and stools from 705 (96.0%) were tested and included in study analyses. Of these, 20.4% [95% confidence interval (CI): 16.5-24.3%] were rotavirus positive and 25.5% (95% CI: 21.3-29.8%) were norovirus positive, representing a difference of 5.1% (95% CI: 0.1-10.1%). When stratified by year, rotavirus and norovirus prevalence were similar from June 2012 to May 2013, but rotavirus prevalence was 21.4% (95% CI: 14.3-28.5%) lower than norovirus from June 2013 to May 2014. On average, rotavirus patients were more likely to be febrile, dehydrated, hospitalized and report more diarrheal episodes at the height of illness in comparison with norovirus patients of the same age.
Conclusions:
Norovirus infections were more prevalent than rotavirus infections among pediatric gastroenteritis cases hospitalized or seeking emergency care. Rotavirus cases were, on average, more clinically severe than norovirus cases among participants of the same age.
