kjpid Korean Journal of Pediatric Infectious Diseases Korean J Pediatr Infect Dis 1226-3923 2289-0343 The Korean Society of Pediatric Infectious Diseases 10.14776/kjpid.2014.21.3.174 kjpid-21-174 Original Article Clinical and Epidemiological Study of 1,165 Hospitalized Cases of Rotaviral Gastroenteritis Before and After the Introduction of Rotavirus Vaccine, 2006–2013 SohnTae-YoungM.D. LeeChan-JaeM.D. KimYoon-JooM.D. KangMin-JaeM.D. KimSung-HyeM.D. LeeSo-YeonM.D. LeeDae-HyoungM.D. LeeHae-RanM.D. KimKwang-NamM.D. Department of Pediatrics, Hallym University Medical Center, Gyeonggi, Korea 01 2014 20 01 2014 21 3 174 180 03042014 11072014 14072014 Copyright © 2014 The Korean Society of Pediatric Infectious Diseases 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

This study was performed to assess the clinical and epidemiological changes after the introduction of the rotavirus vaccine in Korea, as well as to determine the efficacy of the rotavirus vaccine among hospitalized rotaviral gastroenteritis patients over the past two years. Methods: We analyzed yearly and seasonal patterns of 1,165 inpatients who were hospitalized for rotaviral gastroenteritis under the age of 5 years between 2006 and 2013. We also conducted a survey among 460 gastroenteritis patients who were hospitalized between 2012 and 2013 regarding the rotavirus vaccination and the symptoms of gastroenteritis. Among those individuals surveyed, clinical indices were analyzed for 124 patients who were tested positive for the rotavirus antigen. Results: The incidence of Rotaviral gastroenteritis have decreased significantly by year 2010. After the introduction and widespread dissemination of the rotavirus vaccine, the onset of the disease and the seasonal peak have been delayed. Overall, the vaccinated group showed a lower rate of positivity than the unvaccinated group. Among the hospitalized rotaviral gastroenteritis patients, the vaccinated group had a shorter hospitalization period, less severe clinical symptoms of gastroenteritis, and better laboratory test results. Conclusions: After introduction of the rotavirus vaccine in Korea, there were two main trends observed: 1) the overall level of disease incidence was reduced; 2) the severity of rotaviral gastroenteritis cases also decreased. Based on this data, more children should receive vaccination in order to prevent the rotavirus infection and decrease the severity of rotaviral gastroenteritis.

 Rotavirus Gastroenteritis Vaccine Epidemiology References Bern C Martines J Zoysa I Glass RI The magnitude of the global problem of diarrheal disease: a ten-year update Bull World Health Organ 199270 70514 Centers for Disease Control and Prevention Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Recomm Rep 200958 125 Parashar UD Hummelman EG Bresee JS Miller MA Glass RI Global illness and deaths caused by rotavirus disease in children Emerg Infect Dis. 20039 56572 Ramig RF Pathogenesis of intestinal and systemic rotavirus infection J Virol 200478 1021320 World Health Organization Rotavirus vaccines: WHO position Paper Wkly Epidemiol Rec 199974 3340 Nakagomi O Cunliffe NA Rotavirus vaccines: entering a new stage of deployment Curr Opin Infect Dis 200720 5017 Heaton PM Goveia MG Miller JM Offit P Clark HF Development of a pentavalent rotavirus vaccine against prevalent serotypes of rotavirus gastroenteritis J Infect Dis 2005192 S1721 Park SE Rotavirus vaccine J Korean Med Assoc 200851 13743 Desai R Oliveira LH Parashar UD Lopman B Tate JE Patel MM Reduction in morbidity and mortality from childhood diarrhoeal disease after species A rotavirus vaccine introduction in Latin America – a review Mem Inst Oswaldo Cruz 2011106 90711 Tate JE Cortese MM Payne DC Curns AT Yen C Esposito DH Uptake, impact, and effectiveness of rotavirus vaccination in the United States: review of the first 3 years of postlicensure data Pediatr Infect Dis J 201130 S5660 Buttery JP Lambert SB Grimwood K Nissen MD Field EJ Macartney KK Reduction in rotavirus-associated acute gastroenteritis following introduction of rotavirus vaccine into Australia's National Childhood vaccine schedule Pediatr Infect Dis J 201130 S259 Richardson V Hernandez-Pichardo J Quintanar-Solares M Esparza-Aguilar M Johnson B Gomez-Altamirano CM Effect of rotavirus vaccination on death from childhood diarrhoea in Mexico N Engl J Med 2010362 299305 Lanzieri TM Costa I Shafi FA Cunha MH OrtegaBarria E Linhares AC Trends in hospitalizations from all-cause gastroenteritis in children younger than 5 years of age in Brazil before and after human rotavirus vaccine introduction, 1998–2007 Pediatr Infect Dis J 201029 6735 Lanzieri TM Linhares AC Costa I Kolhe DA Cunha MH Ortega-Barria E Impact of rotavirus vaccination on childhood deaths from diarrhea in Brazil Int J Infect Dis 201115 e20610 Sá fadi MA Berezin EN Munford V Almeida FJ de Moraes JC Pinheiro CF Hospital-based surveillance to evaluate the impact of rotavirus vaccination in Sã o Paulo, Brazil Pediatr Infect Dis J 201029 101922 Choi UY Lee SY Ma SH Jang YT Kim YJ Kim HM Epidemiological changes in rotavirus gastroenteritis in children under 5 years of age after the introduction of rotavirus vaccines in Korea Eur J Pediatr 2013172 94752 Centers for Disease Control and Prevention Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Recomm Rep 200655 113 Tate JE Panozzo CA Payne DC Patel MM Cortese MM Fowlkes AL Decline and change in seasonality of US rotavirus activity after the introduction of rotavirus vaccine Pediatrics 2009124 46571 Ruiz-Palacios GM Pé rez-Schael I Velá zquez FR Abate H Breuer T Clemens SC Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis N Engl J Med 2006354 1122 Kirkwood CD Boniface K Barnes GL Bishop RF Distri-bution of rotavirus genotypes after introduction of rotavirus vaccines, Rotarix® and RotaTeq®, into the National Immunization Program of Australia Pediatr Infect Dis J 201130 S4853 Korea Centers for Disease Control and Prevention 2012 Korea national immunization survey Available at http://www.cdc.go.kr Figures and Tables

Annual percentage of rotaviral gastroenteritis patients out of all gastro-enteritis patients (2006–2013).

Monthly incidence rate of rotaviral gastroenteritis:(A) 2006–2009, (B) 2010–2013.

Baseline Demographic and Clinical Comparison between the Vaccinated Group and Unvaccinated Group for Rotaviral Gastroenteritis　

  Vaccinated (n=52) Unvaccinated (n=72) P
Age (months) 23.8±14.4 30.2±16.3 0.03
Sex ratio (M:F) 60:40 56:44 0.65
Hospitalization (d) 4.1±1.2 5.0±1.7 <0.001
Fever (n, %)∗ 30 (57.7%) 61 (84.7%) <0.001
Vomit (n, %) 43 (82.7%) 69 (95.8%) 0.02
Diarrhea ≥5 times/d (n, %)† 16 (30.8%) 35 (48.6%) 0.046

Cases that showed tympanic membrane temperature ≥38℃.

Cases that had maximum number of diarrhoeic episodes ≥5 times/day.

Laboratory Results in the Vaccinated Group and Unvaccinated Group for Rotaviral Gastroenteritis

　 Vaccinated (n=52) Unvaccinated (n=72) P
WBC (/µ L) 11,046±5,044 11,969±6,801 0.41
Neutrophil (/µ L) 6,482±4,103 8,279±6,094 0.07
Lymphocyte (/µ L) 3,407±2,324 2,621±2,606 0.09
ESR (mm/hr) 12.9±9.6 10.2±10.1 0.14
CRP (mg/L) 12.6±25.4 13.4±18.0 0.83
Glucose (mg/dL) 79.1±17.2 75.9±22.3 0.38
Hypoglycemia (n, %)∗ 6 (11.5%) 18 (25.0%) 0.06
Uric acid (mg/dL) 6.2±2.5 7.3±2.7 0.03
Hyperuricemia (n, %)† 24 (46.2%) 45 (62.5%) 0.07
BUN (mg/dL) 12.4±3.9 14.2±5.6 0.04
>20 mg/dL (n, %)‡ 1 (1.9%) 12 (16.7%) 0.01
Creatinine (mg/dL) 0.24±0.06 0.26±0.07 0.12
AST (IU/L) 48.8±34.7 46.1±10.2 0.53
ALT (IU/L) 31.5±39.7 24.9±9.2 0.17
Na (mmol/L) 136.8±2.6 135.9±3.3 0.11
K (mmol/L) 4.3±0.5 4.2±0.4 0.16
Abnormal electrolytes (n, %)∫ 9 (17.3%) 23 (31.9%) 0.07
Total CO2 (mmol/L) 15.9±3.1 14.6±3.1 0.02
Urine specific gravity 1.014±0.010 1.018±0.010 0.02
Stool occult blood (ng/mL) 11.5±73.3 5.4±18.0 0.50

Abbreviations: WBC, white blood cell; ESR, erythrocyte sedimentation rate; CRP, c-reactive protein; BUN, blood urea nitrogen; AST, aspartate aminotransferase; ALT, alanine aminotransferase; Na, sodium; K, potassium; CO2, carbon dioxide.

Cases that showed glucose <60 mg/dL.

Cases that showed uric acid >5.8 mg/dL.

Cases that showed BUN >20 mg/dL.

Cases that showed Na <135 mmol/L, Na >145 mmol/L, K <3.5 mmol/L, K >5.0 mmol/L over 12 months or K >6.0 mmol/L under 12 months.