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Lee, Kim, Kim, and Choi: The Epidemiological Trend of Rotavirus Gastroenteritis in Children in a Single Center from 2004 to 2012: A Retrospective Study
Original Article

Korean J Pediatr Infect Dis 2014;21(3):181-190.

Published online: 20 January 2014

DOI: https://doi.org/10.14776/kjpid.2014.21.3.181

The Epidemiological Trend of Rotavirus Gastroenteritis in Children in a Single Center from 2004 to 2012: A Retrospective Study

Hae Sung Lee, M.D.∗, Dong Yeon Kim, M.D.∗, Jung Are Kim, M.D.∗, Soo-Han Choi, M.D.∗, †

∗Department of Pediatrics, KEPCO Medical Foundation KEPCO Medical Center, Seoul, Korea

†Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea

Received 17 June 2014       Revised 28 August 2014       Accepted 1 September 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 investigate the epidemiological trend of rotavirus acute gastroenteritis (RV-AGE) in children. Methods: A retrospective review was performed in patients (1 month to 18 years of age) with acute gastroenteritis at KEPCO Medical Center from September 2004 to August 2013. Comparative analyses were performed based on periods: pre-vaccine (2004-2006) and post-vaccine (2008-2012) in all patients; 2004–2006 (period A), 2007–2009 (period B) and 2010–2012 (period C) in patients under 5 years of age. Results: Proportion of RV-AGE decreased from 25.0% (337/1,346) in pre-vaccine period to 20.8% (459/2,210) in post- vaccine period (rate ratio (RR), 0.83 [95% CI, 0.73–0.93]; P=0.0029). The median age of patients with RV-AGE in post- vaccine period (2.6 years) was significantly (P<0.0001) higher than that in pre-vaccine period (1.6 years). In patients hos-pitalized with AGE, proportion of RV-AGE was significantly reduced in patients 6 to 23 months old (RR, 0.62 [95% CI, 0.51–0.75]; P<0.0001). Significant decline in proportion of RV-AGE was observed in patients under 5 years of age: period A, 26.9% (308/1,144); period B, 22.7% (295/1,299); period C, 20.6% (186/902) (P=0.0007). After the introduction of rotavirus vaccine, a significant decreasing trend of RV-AGE proportion was observed in patients 6 to 11 months old (P=0.0018) and 12 to 23 months old (P=0.0152). Conclusion: Decrease in RV-AGE proportion and increase in age of patients with RV-AGE were observed after the intro-duction of rotavirus vaccine in this single center study. Continued and systematic surveillance is needed to assess the impact of rotavirus vaccine.

Keywords: Rotavirus Infections, Rotavirus Vaccines, Epidemiology, Child

References

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Fig. 1.
Distribution of rotavirus positive rate.∗ In this study: From 2004–2005 to 2012–2013 (ex. 2004 Year=September 2004 to August 2005).† In national laboratory surveillance: From 2005 to 2013(ex. 2005 Year=January 2005 to December 2005) (Source from reference 15, 16 and 17).
kjpid-21-181f1.tif
Fig. 2.
Monthly distribution of rotavirus positive rate in pre (2004–2006) and post (2008–2012) vaccine period.
kjpid-21-181f2.tif
Fig. 3.
Rate ratio of age-specific rotavirus gastroenteritis in patients hospitalized with acute gastroenteritis: from 2008 to 2012 vs. pre-vaccine period (2004–2006). Vertical bars indicate the 95% confidence intervals.
kjpid-21-181f3.tif
Fig. 4.
Comparison of age distribution of patients with rotavirus gastroenteritis (under 5 years of age). The box plot provides the median value with minimum, maximum, 25th and 75th percentiles.
kjpid-21-181f4.tif
Fig. 5.
Rotavirus positive rate in patients with acute gastroenteritis (A) and in patients hospitalized with acute gastroenteritis (B) (under 5 years of age).∗ Indicate P<0.05 for decline in the positive rate or proportion of hospitalization as compared with the rate in the pre-vaccine period (2004–2006).† Indicate P<0.05 for decline in the rate as compared with the rate in the transition period (2007–2010).
kjpid-21-181f5.tif
Table 1.
Comparison of Rotavirus Gastroenteritis between Pre- and Post-Vaccine Period
  Pre-vaccine period (2004–2006) Post-vaccine period (2008–2012) P-value
No. of patients 337 459  
Age, median, years (range) 1.6 (0.09–15.8) 2.6 (0.08–18.5) <0.0001
Rotavirus positive rate, % 25.0 20.8 0.0035
Age subgroup∗,%      
<6 months 11.5 5.5 0.0560
6–11 months 20.0 9.5 0.0001
12–23 months 37.6 26.1 0.0004
24–35 months 29.9 33.8 0.4492
36–47 months 31.3 35.9 0.5120
48–59 months 25.0 22.2 0.7200
5–9 years 17.9 21.7 0.0011
10–18 years 3.9 7.7 0.0112
Proportion of hospitalized patients, % 27.4 22.3 0.0019
Age subgroup∗,%      
<6 months 13.2 6.3 0.1243
6–11 months 22.2 9.6 0.0001
12–23 months 40.9 28.4 0.0005
24–35 months 30.9 35.6 0.4181
36–47 months 33.7 38.2 0.5787
48–59 months 25.0 23.9 0.8561
≥5 years 14.5 13.4 0.6936

∗ No. of rotavirus antigen positive patients/No. of patients with acute gastroenteritis in corresponding age subgroup.

Table 2.
Epidemiological Trends of Rotavirus Gastroenteritis from 2007 to 2012
Year 2007 2008 2009 2010 2011 2012 P-value
Positive rate, % 20.5 21.9 22.3 23.9 13.0 20.8 0.1987†
% Decrease from 2004 to 2006 22.0 14.2 11.0 4.7 48.1 17.1  
Age, median, years (range) 1.7 1.8 2.6 2.6 3.5 3.6 <0.0001‡
  (0.1–10.4) (0.2–11.2) (0.08–16.5) (0.2–16.9) (0.3–10.7) (1.0–18.5)  
Age subgroup∗,%              
<6 months 3.6 5.7 6.5 8.3 3.8 0.0 0.9858†
6–11 months 12.0 12.8 16.9 10.8 1.9 0.0 0.0018†
12–23 months 32.5 32.9 22.5 30.7 12.9 26.4 0.0152††
24–35 months 33.8 29.4 37.9 46.7 22.6 26.5 0.6477†
36–47 months 17.0 34.0 30.8 43.8 41.9 26.7 0.0723†
48–59 months 17.2 19.4 31.3 9.5 20.0 32.4 0.3129†
5–9 years 19.0 17.5 27.6 27.5 11.8 23.8 0.8718††
10–18 years 8.3 6.1 2.1 8.0 2.6 25.9 0.0381†

∗ No. of rotavirus antigen positive patients/No. of patients with acute gastroenteritis in corresponding age subgroup.

† Chi-squared test for trend from 2007 to 2012.

‡ Kruskall-Wallis test.

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