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Sohn, Lee, Kim, Kang, Kim, Lee, Lee, Lee, and Kim: Clinical and Epidemiological Study of 1,165 Hospitalized Cases of Rotaviral Gastroenteritis Before and After the Introduction of Rotavirus Vaccine, 2006–2013
Original Article

Korean J Pediatr Infect Dis 2014;21(3):174-180.

Published online: 20 January 2014

DOI: https://doi.org/10.14776/kjpid.2014.21.3.174

Clinical and Epidemiological Study of 1,165 Hospitalized Cases of Rotaviral Gastroenteritis Before and After the Introduction of Rotavirus Vaccine, 2006–2013

Tae-Young Sohn, M.D., Chan-Jae Lee, M.D., Yoon-Joo Kim, M.D., Min-Jae Kang, M.D., Sung-Hye Kim, M.D., So-Yeon Lee, M.D., Dae-Hyoung Lee, M.D., Hae-Ran Lee, M.D., Kwang-Nam Kim, M.D.

Department of Pediatrics, Hallym University Medical Center, Gyeonggi, Korea

Received 3 April 2014       Revised 11 July 2014       Accepted 14 July 2014

Copyright © 2014 The Korean Society of Pediatric Infectious Diseases

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.

Keywords: Rotavirus, Gastroenteritis, Vaccine, Epidemiology

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Fig. 1.
Annual percentage of rotaviral gastroenteritis patients out of all gastro-enteritis patients (2006–2013).
kjpid-21-174f1.tif
Fig. 2.
Monthly incidence rate of rotaviral gastroenteritis:(A) 2006–2009, (B) 2010–2013.
kjpid-21-174f2.tif
Table 1.
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.

Table 2.
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.

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