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Rotavirus in infant-toddler day care centers: epidemiology relevant to disease control strategies
A V Bartlett1, R R Reves, L K Pickering
1Program in Infectious Diseases and Clinical Microbiology, University of Texas Medical School, Houston 77030.
Insights
Rotavirus (RV) causes frequent diarrhea in day care centers (DCCs), often in outbreaks with single strains, mirroring community spread. Asymptomatic RV infections are also common in young children attending DCCs.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Epidemiology
Background:
- Diarrhea is a common illness in young children, particularly those attending day care centers (DCCs).
- Rotavirus (RV) is a significant cause of gastroenteritis in infants and toddlers.
- Understanding RV transmission dynamics in congregate settings like DCCs is crucial for public health interventions.
Purpose of the Study:
- To investigate the incidence and characteristics of diarrhea and rotavirus infections in children attending DCCs.
- To compare RV occurrence in DCCs with that in a pediatric clinic population.
- To identify the strains responsible for RV outbreaks in DCCs and understand infection patterns.
Main Methods:
- A 15-month prospective longitudinal study in Houston DCCs and a pediatric clinic.
- Monitoring diarrhea episodes and rotavirus infections.
- Utilizing polyacrylamide gel electrophoresis for rotavirus RNA genome pattern analysis of outbreak strains.
Main Results:
- Rotavirus accounted for 10% of total diarrhea episodes, rising to 50% in winter.
- The annual rate of RV infection in DCCs was 0.55 episodes per child-year, with diarrhea in 40%.
- Nine of 45 DCC diarrhea outbreaks were RV-associated, often involving a single dominant strain within a center.
Conclusions:
- Diarrhea caused by rotavirus is prevalent in children in DCCs and frequently occurs in outbreaks.
- RV outbreaks in DCCs are often caused by a single strain and parallel community disease patterns.
- Asymptomatic rotavirus infection is common in children attending DCCs.
Abstract:
A 15-month prospective longitudinal study of diarrhea and rotavirus (RV) infection was conducted concurrently in infants and toddlers in day care centers (DCCs) and in a large pediatric clinic in Houston. The mean number of children in the DCCs was 223; the diarrhea rate during the first 12 months was 2.62 episodes per child-year. Rotavirus accounted for approximately 10% of the total episodes of diarrhea in the pediatric clinic and DCC populations, but 50% during the winter months. The occurrence of RV in the DCCs paralleled that seen in the pediatric clinic. The annual rate of RV infection in DCCs was 0.55 episodes per child-year, with diarrhea occurring in only 40% of the episodes (0.22 episodes per child-year). There were 45 diarrhea outbreaks in DCCs, for a mean of 3.8 per center per year; nine of these outbreaks were associated with RV. Polyacrylamide gel electrophoresis of RNA genome patterns of RV strains from eight of these outbreaks showed that in seven outbreaks a single strain was identified in children in that DCC, whereas multiple strains were identified simultaneously in the community. The age distributions of symptomatic and asymptomatic RV infections in DCC study children were not significantly different. In symptomatic RV-infected children in DCCs, 42% had RV identified in stool specimens within 2 days before diarrhea occurred. Thirty-eight DCC children had more than one episode of RV infection, but only five had two symptomatic RV infections. Diarrhea caused by RV is common in children in DCCs, often occurs in outbreaks due to the same strain, and parallels disease in the community; asymptomatic RV infection is also common in children in DCCs.