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June 2000

Hospitalization for Community-Acquired, Rotavirus-Associated Diarrhea: A Prospective, Longitudinal, Population-Based Study During the Seasonal Outbreak

Author Affiliations

From Division of Infectious Diseases and Laboratory Medicine, The Hospital for Sick Children (Drs Ford-Jones, Wang, and Petric) and the Departments of Pediatrics (Drs Ford-Jones and Wang), Laboratory Medicine (Dr Petric), and Biostatistics (Dr Corey and Mr Moineddin), University of Toronto, and the Ontario Public Health Laboratory (Dr Fearon), Toronto, Ontario.

Arch Pediatr Adolesc Med. 2000;154(6):578-585. doi:10.1001/archpedi.154.6.578

Objectives  To determine the age-specific hospitalization rate for rotavirus-associated diarrhea in Canadian children during the seasonal outbreak, and to characterize children and their households, for assessment of the need for a rotavirus vaccine.

Design  Prospective multisite cohort study.

Settings and Participants  Children with an admission diagnosis of diarrhea admitted to 18 hospitals serving 132 study census tracts of a major urban region, from November 1, 1997, through June 30, 1998. Prospective centralized testing of stools was performed; research nurses administered a follow-up questionnaire to parents.

Main Outcome Measure  Age-specific diarrhea and rotavirus-associated hospitalization rates.

Results  Of 224,160 children younger than 5 years, the diarrhea hospitalization rate was 4.8 in 1000 (n=1086) during the seasonal epidemic. Based on testing of 65% of the hospitalized children, the rotavirus-associated diarrhea hospitalization rate was 1.3 in 1000; the cumulative incidence to 5 years of age was 1 in 160. Rotavirus-associated diarrhea was reported in 37% of the 1001 hospitalized children undergoing testing inside and outside of the census tracts; in children aged 6 to 35 months, this rose to more than 70% during April and May. Ages of children with rotavirus-associated diarrhea were 0 to 2 months (2%), 3 to 5 months (5%), 6 to 23 months (60%), 24 to 35 months (15%), and 36 months or older (19%). Of children aged 0 to 5 and 6 to 11 months, 4 (19%) of 21 and 6 (10%) of 59, respectively, had been born prematurely; 20 (24%) of 83 younger than 1 year were breastfed at the time of illness. Of children younger than 36 months, 77% were cared for in their homes; 13%, in family day care homes; and 8%, in child care centers. The mean (± SD) duration of rotavirus hospitalization based on hospital records and parental questioning was 2.4±1.7 and 3.1±1.6 days, respectively; it was significantly longer (P≤.001) in children with an underlying medical condition. One child required intensive care unit hospitalization. Diarrhea occurred concurrently in 74% of household contacts younger than 3 years; 38%, aged 3 to 18 years; and 29%, older than 18 years. Seventy-six percent of parents were married. Household incomes in Canadian dollars in the 81% reporting were less than $20,000 in 20%, $20,000 to $60,000 in 44%, and greater than $60,000 in 36%. Ethnicity was reported as 53% white, 15% black, 10% Asian, 12% East Indian, and 11% other.

Conclusions  Based on testing of 65% of children with diarrhea, rotavirus resulted in hospitalization in a minimum of 1 in 160 children by 5 years of age during the seasonal outbreak. Had 100% of young children with diarrhea undergone testing, the extrapolated cumulative incidence of rotavirus-associated diarrhea by 5 years of age may have been 1 in 106.