[Coincidental outbreaks of rotavirus and respiratory syncytial virus in Paris: a survey from 1993 to 1998]

[Nosocomial rotavirus gastroenteritis]

Rotavirus is the most common cause of gastroenteritis in children requiring hospitalization. It is a very resistant and contagious virus causing nosocomial gastroenteritis. In France, the vaccine against rotavirus has been available since 2006, but the vaccine is not recommended for infant vaccination. The aim of this retrospective study was to describe nosocomial rotavirus gastroenteritis (NRGE) and to assess its impact on children hospitalized in the General Pediatrics Department of Robert-Debré Hospital (Paris) between 1 January 2009 and 31 December 2013. We analyzed the demographic characteristics of children (age, term birth, underlying diseases) and the severity of the NRGE (oral or intravenous hydration), and assessed whether these children could benefit from vaccination against rotavirus.

RESULTS

One hundred thirty-six children presented nosocomial rotavirus infection, with an incidence of 2.5 NRGE per 1000 days of hospitalization. The incidence of NRGE was stable between 2009 and 2013 despite the introduction of specific hygiene measures. The average age of the children was 7 months (range: 0.5-111 months). Most often NRGE occurred in children hospitalized for respiratory diseases (65% of cases) and requiring prolonged hospitalization (median: 18 days). One-third of children were born premature (25%). Hydration was oral in 80 patients (59%), by intravenous infusion in 18 patients (13%), and intraosseous in one patient. Half of the patients were aged less than 5 months and could benefit from the protection afforded by vaccination.

CONCLUSION

NRGE are common. Rotavirus mass vaccination should have a positive impact on the incidence of NRGE by reducing the number of children hospitalized for gastroenteritis, therefore indirectly reducing the number of hospital cross-infections of hospitalized children who are too young to be vaccinated.

Hospital bed occupancy for rotavirus and all cause acute gastroenteritis in two Finnish hospitals before and after the implementation of the national rotavirus vaccination program with RotaTeq®

Background

Vaccination-impact studies of the live-attenuated pentavalent oral vaccine Rotateq® have demonstrated that the burden of rotavirus gastroenteritis has been reduced significantly after the introduction of RotaTeq® vaccination, but less is known about the benefit of this vaccination on hospital overcrowding.

Methods

As part of an observational surveillance conducted during the RV seasons 2000/2001 to 2011/2012, we analysed hospital discharge data collected retrospectively from two Finnish hospitals (Oulu and Tampere), concerning ICD 10 codes A00-09 (acute gastroenteritis, AGE) and A08.0 (rotaviral acute gastroenteritis RV AGE). We estimated the reduction in the number of beds occupied and analysed the bed occupancy rate, for RV AGE and all cause AGE, among 0–16 year-old children, before and after the implementation of the RV immunisation program.

Results

The rate of bed days occupied for RV AGE was reduced by 86% (95% CI 66%-94%) in Tampere and 79% (95% CI 47%-92%) in Oulu after RV vaccination implementation. For all cause AGE, reduction was 50% (95% CI 29% to 65%) in Tampere and 70% (95% CI 58% to 79%) in Oulu. Results were similar among 0–2 year-old children. This effect was also observed on overcrowding in both hospitals, with a bed occupancy rate for all cause AGE >25% in only 1% of the time in Tampere and 9% in Oulu after the implementation of the immunisation program, compared to 13% and 48% in the pre-vaccination period respectively. After extrapolation to the whole country, the annual number of prevented hospitalizations for all cause AGE in the post-vaccination period in Finland was estimated at 1,646 and 2,303 admissions for 0–2 and 0–16 year-old children respectively.

Conclusions

This study demonstrated that universal RV vaccination is associated with a clear decrease in the number of bed days and occupancy rates for RV AGE and all cause AGE. Positive consequences include increase in quality of care and a better healthcare management during winter epidemics.

Prospective surveillance of nosocomial viral infections during and after hospitalization at a university children's hospital

BACKGROUND

In Switzerland 5% to 10% of hospitalized adults acquire nosocomial infections (NI) but few data are available in children. Most former studies on NI in hospitalized children analyzed specific units or pathogens and neglected the postdischarge period. We aimed to prospectively assess viral NI occurring during and shortly after hospitalization in children.

METHODS

Prospective surveillance was performed during a 24-month period. Electronic standardized questionnaires were completed for each patient by physicians during hospital stay. On a ward-based rotational schedule, follow-up information was obtained from a subset of patients 1 week after hospital discharge. NI were defined using CDC recommendations.

RESULTS

Overall, 6250 patients (34,608 patient hospitalization days, PHD) were enrolled and 1272 patients were recruited for postdischarge surveillance. Mean hospitalization duration was 5 days. Fifty-two (0.8%) patients acquired 54 viral NI during hospitalization and 12 patients (1.1%) acquired 12 viral NI after hospital discharge (NI incidence: 1.9 per 1000 PHD including follow-up period). NI rate in infants was higher compared with children >12 months old (2.0% vs. 0.8%; P 0.05) and the infant ward also had the highest incidence (4.0 NI per 1000 PHD). Most NI were gastrointestinal tract infections with 55% caused by rotavirus infection. NI rates were highest between November and March.

CONCLUSIONS

A significant part of NI will only be detected if surveillance includes the immediate postdischarge period. Given the strong seasonality of pediatric NI, intensifying hygiene measurements particularly on infant wards and prior to the cold season would be beneficial in reducing NI incidence.

[Evolution of the number of rotavirus and respiratory syncytial virus infections in children hospitalised in a French university hospital between 1998 and 2005]

AIM

Respiratory syncytial virus (RSV) and Rotavirus infections represent up to 30% of cross infections in pediatric units. As they are a major public health problem, we studied their evolution and distribution at the Dijon University Hospital.

POPULATION AND METHODS

This exhaustive retrospective study included children under 15 with a new Rotavirus or RSV infection who were hospitalised at the Dijon University Hospital between 1998 and 2005. The general trend was determined by using moving averages, and the Spearman correlation coefficient r(s) was calculated.

RESULTS

From 1998 to 2005, 1886 new RSV (n=981) or Rotavirus (n=905) infections were identified in hospitalised children. The number of the infections decreased significantly, both for RSV (r(s)=-0.71 ; p<0.0001) and for Rotavirus (r(s)=-0.77 ; p<0.0001). Almost half of Rotavirus infections were nosocomial (46.3%) vs 5.3% of RSV infections, p<0.0001. There was no significant difference in the proportion of RSV nosocomial infections between the epidemic and non-epidemic period (4.9% of nosocomial infections vs 7.1% respectively, p=0.25). Rotavirus nosocomial infections were less frequent in epidemic period (41.6%) than in non-epidemic period (54.6%); p=0.0002.

CONCLUSION

RSV and Rotavirus infections significantly decreased between 1998 and 2005. Proportion of RSV or Rotavirus infections didn't increase in epidemic period, which could be explained both by an increased attention from healthcare professionals and by the effectiveness of hygiene measures taken.

[Methodological aspects of economic evaluation in pediatrics: illustration by RSV infection prophylaxis in the French setting]

The methodological approach of the economic evaluation of drugs in pediatrics is illustrated by the case study of the prophylaxis for RSV infections using palivizumab in the French setting. The indications for the reimbursement of this treatment have been restricted to premature children with bronchopulmonary dysplasia (BPD) or hemodynamically significant congenital-heart disease. A model was developed primarily using the results of the pivotal clinical studies on palivizumab. Unit costs were estimated (2006 values) in both societal and payer's perspectives. An assumption was made and discussed on the benefits of the prophylaxis on mortality. Based on the different data available and the estimated costs and benefits, different cost-effectiveness ratios (CERs) were estimated from both the society's and payer's points of view. A discount rate of 3% was applied to benefit. The CER obtained in the most unfavorable case is considered acceptable for the innovative-medical technologies in the French-healthcare system. Some of the parameters used by the model will be illustrated from the EPIPAGE study data from 2 of the 9 regions involved in this study: this evaluation suggests that the children not having an RSV infection during their 1st year of life will continue to require significantly fewer hospitalizations in the following years. These additional evaluations also suggest that the model overestimates the costs of the treatment with regard to the true medical situation. This could be explained by the model not using the children's exact weight or the real number of injections because the children had been discharged from the maternity ward based on their date of birth and the epidemic period. In spite of these factors, RSV prophylaxis using palivizumab in premature children with BPD or hemodynamically significant congenital-heart disease can be considered cost-effective in France.

[Prospective epidemiological study of rotavirus gastroenteritis in Europe (REVEAL study). Results in the French area of the study]

PRIMARY OBJECTIVE

To estimate the incidence of acute gastroenteritis (AGE) and rotavirus acute gastroenteritis (RVAGE) in children less than 5 years of age seeking medical care in primary care, emergency department, and hospital settings.

SECONDARY OBJECTIVES

To compare the clinical profile of RVAGE and non-RVAGE and to describe the distribution of RV serotypes among RVAGE cases.

METHODS

A prospective primary care, emergency ward and hospital-based observational study was conducted during 1 year in a selected city of France with 250,000 inhabitants. Children less than 5 years of age presenting with symptoms of AGE were included. Rotavirus was identified using an Elisa test in stools.

RESULTS

The estimated annual incidence of RVAGE was 1.56% for AGE and 0.87% for RVAGE in hospital, 5.87% for AGE and 2.65% for RVAGE in emergency-wards, 7.39% for AGE and 1.45% for RVAGE in primary care. Total incidence was 14.82% for AGE and 4.96% for RVAGE among children less than 5 years of age. RVAGE were more clinically severe than the AGE: dehydration (26.8% vs. 14.7%, p<0.0001), vomiting 84.9% vs. 60.9%, p<0.0001), fever (74.3% vs. 44.4%, p<0.0001), lethargy (84.9% vs. 70.2%, p<0.0001). G9 serotype was the most frequent serotype encountered (54.7%) during the study period followed by G3 serotype (33.6%) and G2 serotype (7.9%).

CONCLUSION

In this study, RVAGE, caused by serotypes G9 and G3, represented about 1/3 of AGE and were more severe than non-RV AGE with twice as high dehydration rate. These results underline the need for continued promotion on the use of oral rehydration fluids and provide some arguments on the benefits of vaccination against rotavirus and also permanent virological monitoring of circulating serotypes.

[Rotavirus infections in a paediatric hospital during 5 years]

Rotavirus is the major cause of gastroenteritis in children and the main cause of hospital acquired-infection in paediatric unit. We report the epidemiology of gastroenteritis in our hospital during five consecutive years. Rotavirus was involved in 13% of the patients. Seasonal peaks were observed in January and 45.8% of the patients were less than 6 month old. The rotavirus infection was hospital-acquired in 1/3 of the cases. During the winter period, the incidence of rotavirus nosocomial infection was 4.4%.

Burden of paediatric rotavirus gastroenteritis and potential benefits of a universal rotavirus vaccination programme with RotaTeq in France

This study aimed at estimating the paediatric RotaVirus GastroEnteritis (RVGE) burden in children aged up to 5 years, and at evaluating health and economic benefits of a universal infant vaccination with a pentavalent rotavirus vaccine, in France. A decision analytic model was constructed considering a cohort of French children from birth to 5 years old. In the absence of a universal rotavirus immunisation programme, the model predicts that of every new French birth cohort, 336,738 children would present a RVGE case, which would result in 33,386 hospitalisations, 14 deaths and more than 279,000 work days lost for the parents. The management of these RVGE cases would cost 63 million euro to the National Healthcare Payer and would reach up to 117 million euro when all indirect costs were included. The introduction of a universal rotavirus vaccination would avoid 249,400 RVGE cases and consequently about 25,700 hospitalisations, 6000 nosocomial infections, 81,200 emergency visits, 39,900 general practitioner or paediatrician consultations, 11 deaths and 206,700 parental work days lost. RVGE total costs would be reduced by 47 million euro for the National Healthcare Payer and by 88 million euro from the Societal perspective. Therefore, a routine universal rotavirus vaccination programme represents an opportunity to significantly reduce the high paediatric RVGE burden in France.

[Simultaneous outbreaks of rotavirus and respiratory syncytial virus in Paris: a 12-year survey]

OBJECTIVE

The authors had for aim to study the coincidence of RSV and rotavirus epidemic peaks in pediatric patients hospitalized in the Paris area.

METHODOLOGY

A retrospective hospital-based monocentric cohort study was made over a 12-year period (1993-2004). Clinical and laboratory findings were prospectively collected on admission.

RESULTS

Three thousand and four hundred ninety-six stool samples were positive for rotavirus; 3,507 nasopharyngeal aspirates were positive for RSV. The coincidence of epidemic peaks for both viruses in November, December, and January was observed during the 12 years of the study.

CONCLUSION

The exact coincidence of winter outbreaks of RSV and rotavirus is a characteristic of the Paris area. It contributes to increase overcrowding in pediatric units and nosocomial infections.

[Infant bronchiolitis point of care by physicians in the Ile-de-France bronchiolitis network]

OBJECTIVE

The Ile-de-France bronchiolitis network assessment gave us the opportunity to carry out a survey regarding the customary handling of acute bronchiolitis by physicians involved in this network. The aim of this study was to retrieve results relating to season 2003-2004 and to compare them with the September 2000 French consensus conference recommendations.

METHODS

The practitioners engaged using a special form subsequently transmitted to network joint committee collected the clinical and therapeutic data of the patients included in the Network. We analysed 342 exploitable forms.

RESULTS

Analysis of the physicians medications for patients classified as bronchiolitis showed that their behavior was on the whole keeping with the official recommendations. The nearly systematic prescription of specific respiratory physiotherapy (increase in expiratory flow) satisfies the expectations of the French consensus conference. Likewise, treatments such as bronchodilator or corticoids that are not recommended were prescribed only in approximately 1/4 of cases. Abstention from all medical treatment was found in only 41% of cases classified as bronchiolitis. However, in considering only the first episode of acute bronchiolitis, this rate increased to 54,3%. Short-acting bronchodilator usage may appear legitimate as a therapeutic test of reversibility. In our study, 1/3 of patients with bronchiolitis treated by bronchodilator underwent a second episode and 80% of them were older than 6 months.

CONCLUSION

Analysis of the practices of physicians participating in the Bronchiolite Ile-de-France Network proves very positive in light of the comparison with studies prior and subsequent to the consensus conference. In recognition of this, it is necessary to consider the importance of the network's training programs. Beyond the need to go on with the diffusion of the recommendations, it seems desirable to extend them to clinical situations not yet considered, especially recurrent bronchiolitis and infant asthma. Finally, this type of study should be repeated in order to measure the future evolution of medical practices, as well as extended to a larger scope than the Ile-de-France bronchiolitis Network.

[Nosocomial rotavirus infections in a pediatric unit: surveillance during four successive winters]

The incidence of rotavirus and RSV outbreaks during winter seasons leads to overcrowding of pediatric units in the Paris area, and increases the risk of viral nosocomial infections in hospitalized young infants.

OBJECTIVE

The aim of this study was to measure the incidence of rotavirus nosocomial infections in children less than 2 years of age during 4 consecutive winters.

METHODS

All infants admitted in the pediatric unit during the winter were prospectively screened for rotavirus with a stools exam. All children with negative stools examination on admission but developing diarrhea after 2 days of hospitalization underwent a new screening test for rotavirus in stools.

RESULTS

During the 4 consecutive winters, the global incidence of nosocomial rotavirus infection was 13.9% (12.7 to 15.9%). Asymptomatic carriage of rotavirus was detected in 3% of admitted infants. The risk of nosocomial rotavirus infection increases with young age and the length of hospital stay.

CONCLUSION

The incidence of nosocomial rotavirus infections was high in this unit. It is related to overcrowding due to coincidence of diarrhea and bronchiolitis outbreaks in the Paris area and to the young age of hospitalized patients.

The paediatric burden of rotavirus disease in Europe

Rotaviruses are a major cause of hospitalizations for acute gastroenteritis in developed countries. This review shows the burden of rotavirus disease in < 5-year-old children in Europe. An estimated 72,000-77,000 hospitalizations for community-acquired rotavirus disease occur annually in the 23 million under-fives living in the European Union (EU-25), with a median cost of Euro 1417 per case. Annual hospitalization incidence rates range from 0.3 to 11.9/1000 children < 5 years old (median 3/1000). The median proportion of hospital-acquired rotavirus disease among all cases of hospitalization for rotavirus disease is estimated to be 21%. Countries of the EU-25 require information on the burden of rotavirus disease to support introduction of rotavirus vaccines. Data on cases treated at home, medical visits, and emergency wards as well as rotavirus-associated deaths are limited. To fully evaluate the impact and effectiveness of rotavirus vaccination programmes in Europe, additional epidemiological studies will be critical and desirable.

Nosocomial rotavirus infection in European countries: a review of the epidemiology, severity and economic burden of hospital-acquired rotavirus disease

The data currently available on the epidemiology, severity and economic burden of nosocomial rotavirus (RV) infections in children younger than 5 years of age in the major European countries are reviewed. In most studies, RV was found to be the major etiologic agent of pediatric nosocomial diarrhea (31-87%), although the number of diarrhea cases associated with other virus infections (eg, noroviruses, astroviruses, adenoviruses) is increasing quickly and almost equals that caused by RVs. Nosocomial RV (NRV) infections are mainly associated with infants 0-5 months of age, whereas community-acquired RV disease is more prevalent in children 6-23 months of age. NRV infections are seasonal in most countries, occurring in winter; this coincides with the winter seasonal peak of other childhood virus infections (eg, respiratory syncytial virus and influenza viruses), thus placing a heavy burden on health infrastructures. A significant proportion (20-40%) of infections are asymptomatic, which contributes to the spread of the virus and might reduce the efficiency of prevention measures given as they are implemented too late. The absence of effective surveillance and of reporting of NRV infections in any of the 6 countries studied (France, Germany, Italy, Poland, Spain and the United Kingdom) results in severe underreporting of NRV cases in hospital databases and therefore in limited awareness of the importance of NRV disease at country level. The burden reported in the medical literature is potentially significant and includes temporary reduction in the quality of children's lives, increased costs associated with the additional consumption of medical resources (increased length of hospital stay) and constraints on parents'/hospital staff's professional lives. The limited robustness and comparability of studies, together with an evolving baseline caused by national changes in health care systems, do not presently allow a complete and accurate overview of NRV disease at country level to be obtained. RV is highly contagious, and the efficiency of existing prevention measures (such as handwashing, isolation and cohorting) is variable, but low at the global level because of the existence of numerous barriers to implementation (eg, lack of staff, high staff turnover, inadequate hospital infrastructure). Prevention of RV infection by mass vaccination could have a positive impact on the incidence of NRV by reducing the number of children hospitalized for gastroenteritis, therefore reducing the number of hospital cross-infections and associated costs.

Clinical characteristics of rotaviruses disease

Rotaviruses are the major causes of viral gastroenteritis in infant and the young children. There are a wide spectrum of clinical signs and symptoms of rotavirosis. Rotavirus infection is fecal-oral infection. Rotaviruses prove with Latex agglutination test and electron microscopy. In a four year period 943 stool samples out of 527 hospitalized patients had been analyzed. A presence of rotavirus is proved with a LA and EM tests at 170 (32,2%) patients age 0-7 years, in their stool samples. Analyzing age groups of these patients, it was found that the rotaviruses infection the most frequently occurred at age group from 7-24 months. From 170 positive patients, 122 or 71,8% were in this age group. At all patients was found diarrhea, vomiting in a 90,5% cases. Mild fever had 65,5% patients, signs of a respiratory infection appeared at 60,7% patients, abdominal pain at 13,3% patients. Severe dehydration had 49,9% patients and metabolic acidosis had 79,2% cases. Macroscopically blood in stool had 6,4% patients, slime in a stool 46,0% patients was found, and aholic stool had 8,4% patients. In all hospitalized patients disease lasted in average 12,6 days, and the hospitalization in average 10,2 days. None of the patient had any kind of complication, all of them very successfully cured. These results confirm that rotaviruses are important health problem among infant and the young children in Bosnia and Herzegovina.

Infections nosocomiales virales dans un service de pédiatrie : l'exemple des gastroentérites à rotavirus et des bronchiolites à VRS

Nosocomial infections are a preoccupation in a pediatric hospital mainly during the winter with bronchiolitis and gastroenteritis epidemics. We have examined the risk factors of nosocomial infections.

MATERIAL AND METHODS

A prospective study was conducted between November, 1999 and March, 2000 in the infants units of the Le Havre hospital. We systematically listed the admissions and contacted the family after their discharge by phone. A geographic information system was implemented to display the epidemiological data; this software is able to illustrate the sectors at risk.

RESULTS

During the study, 687 infants were hospitalized of whom 458 for bronchiolitis and community-acquired gastroenteritis. Mean age was 5.4 months old. No nosocomial bronchiolitis occurred. Prevalence of nosocomial gastroenteritis was 10% (68 cases including nine after discharge). Infants with nosocomial infection were younger than those with community-acquired infection (6.6 months vs. 11.2 months, P < 0.01). The mean length of stay was longer in nosocomial infection (7.7 vs. 4.1 days, P < 0.05). Among the infants with bronchiolitis, 16% have developed nosocomial intestinal infections (RR = 2.65, IC: 1.59-4.4; P < 0.01). The geographic analysis pointed the area with nosocomial risk (bedroom without water, nearness of nurse office and games room).

CONCLUSION

Geographic information system is a part of the quality control system and may have some interaction effect on final decision making. Incidence of nosocomial infections showed the need for a prevention strategy in a pediatric hospital.

Infection nosocomiale à rotavirus en pédiatrie générale. Enquête d’observation multicentrique

OBJECTIVE

Rotavirus nosocomial infection (RNI) is frequent in pediatric units. This study was designed to determine the incidence and the main risk factors of RNI in children aged 3 months-3 years and admitted for at least 48 hours days during the epidemic period.

PATIENTS AND METHODS

A stool sample was obtained within the 24 hours of admission. An additional sample was collected from rotavirus-negative children either the day of discharge, or when they developed abnormal clinical signs. Parents were contacted by phone after discharge. Children initially rotavirus-negative and positive 2 days or more after admission were considered as certain nosocomial cases. In the absence of the second sample, possible nosocomial cases were considered if new symptoms (i.e.; fever and or digestive symptoms) occurred 2 days or more after the first negative sample.

RESULTS

One hundred and seventeen children were included. The incidence was 11.1% for certain NRI, 16.8% for possible hospital-acquired cases and 19.4% for the whole cases. Possible risk factors were the low number of nurses during the weekend, the great number of medicine students in the unit, and no use of individual material.

CONCLUSION

NRI have a high incidence, whose reality can only be approximated by taking into account the possible NRI occurring at home after hospital-discharge.

Molecular epidemiology of subgroup C avian pneumoviruses isolated in the United States and comparison with subgroup a and B viruses

The avian pneumovirus (APV) outbreak in the United States is concentrated in the north-central region, particularly in Minnesota, where more outbreaks in commercial turkeys occur in the spring (April to May) and autumn (October to December). Comparison of the nucleotide and amino acid sequences of nucleoprotein (N), phosphoprotein (P), matrix (M), fusion (F), and second matrix (M2) genes of 15 U.S. APV strains isolated between 1996 and 1999 revealed between 89 and 94% nucleotide sequence identity and 81 to 95% amino acid sequence identity. In contrast, genes from U.S. viruses had 41 to 77% nucleotide sequence identity and 52 to 78% predicted amino acid sequence identity with European subgroup A or B viruses, confirming that U.S. viruses belonged to a separate subgroup. Of the five proteins analyzed in U.S. viruses, P was the most variable (81% amino acid sequence identity) and N was the most conserved (95% amino acid sequence identity). Phylogenetic comparison of subgroups A, B, and C viruses indicated that A and B viruses were more closely related to each other than either A or B viruses were to C viruses.

[Hospitalization for acute community-acquired rotavirus gastroenteritis: a 4-year survey]

OBJECTIVE

To evaluate the number of hospitalizations due to community-acquired rotavirus acute gastroenteritis in a general pediatric unit during a four-year survey.

RESULTS

From January 1997 to December 2000, 725 patients were admitted for acute gastro-enteritis to the general paediatric unit of a Parisian children hospital (nosocomial diarrhoea excluded) and 706 (97.5%) of these patients had had a stool microbiologic examination. Diarrhoea was caused by rotavirus in 359 patients (50.89%) and Salmonella sp in 61 (8.6%). Children and infants hospitalized for rotavirus acute gastroenteritis were younger (26% had three months or less, and 50.03% had six months or less) than in other European studies.

CONCLUSION

This study is the first in France reporting a systematic survey of hospitalized gastroenteritis during four years. More than half of hospitalized community-acquired gastroenteritis were due to rotavirus in this Parisian area. The young age of patients should be investigated in other French areas, searching for risk factors and rotavirus strains.

[Acute diarrhea and rotavirus infection in the child: assessment of data from emergency care and and the microbiology laboratory of the Armand-Trousseau (Paris) Hospital between 1988 and 2001]

MATERIAL AND METHODS

Between October 1, 1988 and March 31, 2001, a longitudinal survey was conducted at the French pediatric hospital Armand-Trousseau in Paris. Following data were simultaneously collected: consultations and hospitalizations for acute diarrhea at the emergency room, and identifications of rotavirus from diarrheic stools at the laboratory.

RESULTS

Acute diarrhea represented 9.3% to 11.1% of all consultations. The activity was continuous through the year with several epidemic peaks, the largest occurring during the winter months. The hospitalization rate was high and stable since 1989 (16.5% to 21%), reaching 22-26% at the winter peak. Overall, rotaviruses were identified in 22.4% of stool samples but the detection rate increased from 10% in 1989 to 31% in 1997. Rotaviruses were isolated mainly in winter, reaching the rate of 50-70% at the peak.

DISCUSSION

Despite numerous biases of methodology and the fact that data were extracted from two different sources, acute diarrhea appeared as a major epidemic phenomenon in Paris, and rotaviruses were the main pathogens identified in diarrheic infants in winter. The extent of the winter epidemic increased each year since ten years, in parallel with the increase of the global activity of the emergency room. Despite attempts to develop ambulatory care, admission rates remained high in patients with acute diarrhea and searching for care at the emergency room of our hospital, especially in winter.

CONCLUSION

These preliminary data were restricted to a single pediatric hospital in Paris. They need to be extended to a national level before considering a strategy for prevention using vaccination.

[Epidemiology of infant bronchiolitis in France]

Respiratory syncytial virus (RSV) bronchiolitis has become a major public health concern in France during the last decade. This winter epidemic mobilizes each year considerable means through the private ambulatory and public hospital nets. The epidemiology of RSV bronchiolitis remains difficult to characterize because of the lack of consensus for its definition. Several French studies are described here which suggest an increase in severity of the epidemics since 10 years in France. Peaks are more important each year and involve younger patients. This phenomenon does not concern other winter epidemics such as rotavirus gastroenteritis or influenza in infants. A policy of prevention of RSV bronchiolitis seams to be necessary in our country in the future.

[Nosocomial rotavirus infections in a general pediatric ward: epidemiology, molecular typing and risk factors]

OBJECTIVES

Nosocomial rotavirus infections induce difficult problems for pediatric wards during winter epidemics. This prospective study was carried out to measure their incidence in a general pediatric ward by using epidemiological tools, clinical and molecular methods, and to examine the main factors increasing the risk of cross contamination.

MATERIAL AND METHODS

The study was carried out on children, younger than three years old, hospitalized between 15 November 1996 and 1 March 1997. We examined the feces of all children for rotavirus on admission and during their hospital stay if they had developed diarrhea. The strains were typed by RNA electrophoresis. A cohort study was done to identify the factors of exposure to risk.

RESULTS

Three hundred twenty-six of the 415 hospitalized infants were studied. One hundred and five were hospitalized for gastroenteritis, including 39 (37.1%) with rotavirus infection. Among 221 infants admitted without diarrhea, 11 (5.0%) had an asymptomatic community infection and nine (4.3%) developed nosocomial gastroenteritis. The only significant predisposing factor (P = 0.003) for nosocomial infection was the distance between the hospital rooms and the nurses station. Despite the low level of typing (51%), the molecular study suggested a wide diversity of nosocomial and community strains.

CONCLUSION

The relatively low incidence of nosocomial infections found may be due to routine assignment to individual rooms, the isolation of infants admitted with acute diarrhea, and the policy of routine detection of asymptomatic carriers with the use of similar isolation measures for these children.