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Perinatal risk factors for infant hospitalization with viral gastroenteritis
R D Newman1, J Grupp-Phelan, D K Shay
1Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.
Insights
A new rotavirus vaccine is available, but a focused policy for high-risk infants is unlikely to prevent most hospitalizations. Low birth weight and premature infants show higher risk for viral gastroenteritis and rotavirus hospitalization.
Area of Science:
- Pediatric Infectious Diseases
- Vaccinology
- Public Health Policy
Background:
- Rotavirus is a leading cause of viral gastroenteritis (GE) in infants.
- A tetravalent rotavirus vaccine is now available in the United States.
Purpose of the Study:
- To identify specific infant groups at high risk for hospitalization due to viral GE and rotavirus.
- To evaluate the potential for a focused rotavirus vaccine policy targeting high-risk infants.
Main Methods:
- Population-based case-control study using linked birth and hospital discharge data (1987-1995).
- Included 1606 infants hospitalized for viral GE and 8084 non-hospitalized controls.
- Analyzed maternal and infant characteristics associated with GE hospitalization.
Main Results:
- Very low birth weight (<1500g) infants had the highest risk (OR 2.6).
- Other risk factors included male gender, maternal smoking, unmarried status, Medicaid insurance, and young maternal age.
- Infants born in Q4, to Asian mothers, or to mothers >34 years had reduced risk.
Conclusions:
- A focused rotavirus vaccination policy is unlikely to prevent the majority of infant GE hospitalizations.
- The safety of rotavirus vaccination in low birth weight and premature infants requires further investigation due to their elevated risk.
Context:
A tetravalent vaccine against rotavirus, the most commonly identified etiologic agent of viral gastroenteritis (GE), has recently been licensed for use in the United States.
Objective:
To evaluate whether specific groups of infants might be at sufficiently high risk to warrant a focused rotavirus vaccine policy, we investigated perinatal risk factors for hospitalization with viral GE and rotavirus in the first year of life.
Design:
Population-based, case-control study.
Setting:
Washington State linked birth certificate and hospital discharge abstracts from 1987 through 1995.
Patients:
Infants, 1 through 11 months of age, hospitalized for viral GE (N = 1606) were patients in this study. Control subjects were 8084 nonhospitalized infants, frequency-matched to patients on year of birth.
Primary Outcome Measure:
Maternal and infant characteristics associated with infant hospitalization for viral GE.
Results:
We found a significant association between birth weight and the risk for hospitalization. Very low birth weight infants (<1500 g) were at the highest risk (odds ratio [OR] 2.6; 95% confidence interval [CI]: 1.6,4.1);, low birth weight infants (1500-2499 g), at intermediate risk (OR 1.6; 95% CI: 1.3,2.1); and large infants (>4000 g), at reduced risk (OR 0.8; 95% CI: 0.6,0.9). Other characteristics associated with GE hospitalization were male gender (OR 1.4; 95% CI: 1.3,1.6); maternal smoking (OR 1.2; 95% CI: 1.1,1. 4); unmarried mother (OR 1.2; 95% CI: 1.1,1.4); Medicaid insurance (OR 1.4; 95% CI: 1.3,1.7); and maternal age <20 years (OR 1.2; 95% CI: 1.0,1.5). Infants born October through December were at decreased risk for hospitalization (OR 0.8; 95% CI: 0.7,0.9), as were infants born to Asian mothers (OR 0.5; 95% CI: 0.3,0.7), and infants born to mothers >34 years of age (OR 0.7; 95% CI: 0.6,0.9). Using these factors, the area under a receiver operating characteristic curve was 0.63. Therefore, to achieve a sensitivity of 90% in identifying high-risk infants, specificity would fall to 10%. Subanalyses of children admitted for viral GE during the peak of the Northwest rotavirus season (January to March) and children with confirmed rotavirus infection demonstrated similar risk factors and receiver operating characteristic curves.
Conclusion:
We conclude that a focused rotavirus vaccination policy using readily identifiable potential high-risk groups would be unlikely to prevent most infant hospitalizations associated with rotavirus infection. However, the safety of rotavirus vaccine in low birth weight and premature infants must be established, because these children appear to be at greater risk for hospitalization with viral GE and rotavirus.