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Increased rotavirus vaccination in Germany could lead to decline in nosocomial illnesses
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A survey of patients with rotavirus in Germany showed that the disease can have severe effects and is often nosocomial in nature.
Carl-Heinz Wirsing von König, MD, of the Institut für Hygiene and Laboratoriumsmedizin in Germany, and colleagues looked at surveys of patients enrolled in the German Pediatric Surveillance Unit for rare diseases between April 2009 and March 2011.
The researchers noted 130 cases of confirmed “very severe rotavirus” during the study period. Of these children, 17 cases were believed to be nosocomial in nature, 14 of which were in the neonatal ICU. One child died in the group of children with nosocomial-related rotavirus, and two other children who had community-acquired rotavirus also died.
Necrotizing enterocolitis was noted in 12 of the infants with rotavirus in the NICU. Other complications included encephalopathy and hypernatremia or hyponatremia.
Although rotavirus vaccine is not routinely recommended in Germany, “in five federal states in Germany, the rotavirus vaccine has been implemented in the local vaccination group. In these states, the coverage is almost 60% as opposed to 20% in the 11 remaining federal states,” the researchers wrote in their study. “There has been a significant drop in rotavirus notifications in 2010 compared to 2006 in states with high rotavirus vaccination coverage.”
The researchers said a vaccination coverage rate of “about 90% might induce a herd immunity, which may play a vital role in reducing the number of nosocomially acquired rotavirus diseases.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Andi L. Shane, MD, MPH, MSc
The authors present a prospective review of the epidemiology of severe rotavirus infections among hospitalized infants and children as reported to the German Pediatric Surveillance Unit for rare diseases (ESPED) between April 2009 and March 2011. One hundred thirty cases of severe rotavirus disease, defined by stool detection of rotavirus antigen and clinical and laboratory criteria requiring intensive care, were detected; 101 (78%) underwent complete case review. The cases were classified as community acquired (83%) and hospital acquired (17%).
A conservative overall incidence of 1.2 severe rotavirus infections per 100,000 children aged younger than 5 years was estimated during the 2-year surveillance period. In accordance with comparable studies, severe rotavirus infections were predominant among premature infants, representing 14 of 17 nosocomial infections, and 12 cases of clinical or surgical necrotizing enterocolitis. A cluster of six infections in a single neonatal ICU, all associated with concomitant adenovirus detection, suggests that these infections may have been due to nosocomial transmission. Among individuals with community-acquired infections, children aged younger than 5 years were also more likely to have severe infections, and children with severe rotavirus infections were more likely to have greater median lengths of hospitalization (6 days) than those with less severe infections (2 to 3 days).
This German surveillance study supports the notable burden of disease associated with severe rotavirus gastroenteritis in resource-endowed settings. There is no treatment for rotavirus gastroenteritis, and almost every child will have at least one rotavirus infection by aged 5 years. Oral and IV hydration are effective interventions but often must be delivered in an institutional setting at notable expense. Rotavirus immunization is highly effective at preventing severe rotavirus disease and the sequelae of dehydration.
Of note, there was no evidence of rotavirus immunization among the case reports reviewed in this evaluation. Fecal rotavirus antigen detection was due to a current or recent infection with a wild-type rotavirus strain and not to vaccine-associated shedding. Rotavirus immunization is not routinely offered nationally in Germany; however, in five of the 11 federal states where vaccination coverage rates approach 60%, a decline in rotavirus isolate reporting has been noted. When rates of individual protection reach a certain community-dependent level, routine rotavirus immunization affords protection to unimmunized individuals, resulting in additional declines in disease prevalence and an increase in the benefit side of the cost–benefit equation. National reporting, including a focused review on severe rotavirus infection, provides support for universal immunization to reduce the burden of rotavirus disease.
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