1
|
Arbanas I, Monescu V, Dragomir N, Sauciuc LD, Cojocaru E, Csutak K, Popovici BE, Andreea P, Elena-Daniela S, Lixandru RI, Bleotu L, Falup-Pecurariu O. A 7-Year Survey (2015-2021) in One Pediatric Hospital (Brasov, Romania) on Rotavirus Gastroenteritis Specified as Community- or Hospital-Acquired Infection in Young Children. Trop Med Infect Dis 2023; 8:509. [PMID: 38133441 PMCID: PMC10747557 DOI: 10.3390/tropicalmed8120509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
This project is an observational, descriptive study evaluating frequencies of rotavirus disease in hospitalized children aged less than 5 years old between 2015 and 2021 in the Pediatric Hospital of Brasov, Central Romania. The study compares socio-demographic (age, sex, place of living and ethnicity), clinical, and treatment aspects between community-acquired rotavirus gastroenteritis (CARG) and hospital-acquired rotavirus gastroenteritis (HARG). During that period, 1913 hospitalized children had a rapid positive immunichromatographic rotavirus test from stool specimens. Among them, 1620 (84.6%) were CARG and 293 (15.4%) were HARG. CARG conditions represented 28.5% of all acute hospitalized gastroenteritis (n = 5673) whereas HARG represented 5.2%. Around the same percentage of urban children were seen in CARG as in HARG (58.5% (n = 948) for CARG and 56.3% (n = 164) for HARG). About 64.9% (n = 1052) of CARG cases were from Roma population, and 66.5% (n = 195) in HARG. The age group with the highest frequency of the disease was 12 to 24 months old for both CARG and HARG. The average hospital duration was 5.09 days for CARG and 7.62 days for HARG. Diarrhea was the principal symptom in both CARG and HARG (92.6% (n = 1500) for CARG and 93.9% (n = 275) for HARG). Most CARG patients (61% (n = 989)) were treated for symptomatic management with iv fluids. Most HARG (60.4% (n = 177)) were treated for symptomatic management with iv fluids and antibiotics. A significant seasonal shift to a later period in the year was observed during the last registration year of 2021, possibly due to the COVID-19 epidemic. The seasonal disease burden of rotavirus infection in children remains high in hospital care in Romania, which may justify the systematic introduction of rotavirus vaccination across the whole country.
Collapse
Affiliation(s)
- Ioana Arbanas
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
- Faculty of Medicine Brasov, Transilvania University, 500019 Brasov, Romania
| | - Vlad Monescu
- Faculty of Mathematics, Transilvania University, 500091 Brasov, Romania
| | - Niculina Dragomir
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
| | - Larisa Diana Sauciuc
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
| | - Emanuela Cojocaru
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
| | - Katalin Csutak
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
| | - Bianca Elena Popovici
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
- Faculty of Medicine Brasov, Transilvania University, 500019 Brasov, Romania
| | - Pandaru Andreea
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
| | - Spirea Elena-Daniela
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
| | - Raluca-Ileana Lixandru
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
- Faculty of Medicine Brasov, Transilvania University, 500019 Brasov, Romania
| | - Laura Bleotu
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
| | - Oana Falup-Pecurariu
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
- Faculty of Medicine Brasov, Transilvania University, 500019 Brasov, Romania
| |
Collapse
|
2
|
Puoti MG, Assa A, Benninga M, Broekaert IJ, Carpi FJM, Deganello Saccomani M, Dolinsek J, Homan M, Mas E, Miele E, Tzivinikos C, Thomson M, Borrelli O. Drugs in Focus: Domperidone. J Pediatr Gastroenterol Nutr 2023; 77:e13-e22. [PMID: 37159421 DOI: 10.1097/mpg.0000000000003822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Domperidone is a peripheral dopamine-2 receptor antagonist with prokinetic and antiemetic properties. Its prokinetic effects are mainly manifest in the upper gastrointestinal (GI) tract. Currently its use is restricted to relief of nausea and vomiting in children older than 12 years for a short period of time. However, among (pediatric) gastroenterologists, domperidone is also used outside its authorized indication ("off label") for treatment of symptoms associated with gastro-esophageal reflux disease, dyspepsia, and gastroparesis. Little is known about its efficacy in the treatment of GI motility disorders in children and controversial data have emerged in the pediatric literature. As its use is off label, appropriate knowledge of its efficacy is helpful to support an "off label/on evidence" prescription. Based on this, the purpose of this review is to summarize all evidence on the efficacy of domperidone for the treatment of GI disorders in infants and children and to report an overview of its pharmacological properties and safety profile.
Collapse
Affiliation(s)
- Maria Giovanna Puoti
- From the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children, London, UK
| | - Amit Assa
- The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Marc Benninga
- the Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Ilse Julia Broekaert
- the Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Francisco Javier Martin Carpi
- the Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - Jernej Dolinsek
- the Department of Gastroenterology, Hepatology and Nutrition, University Medical Centre Maribor, Maribor, Slovenia
| | - Matjaz Homan
- the Department of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Emmanuel Mas
- the Service de Gastroentérologie, Hépatologie, Nutrition, Diabétologie et Maladies Héréditaires du Métabolisme, Hôpital des Enfants, CHU de Toulouse, F-31300 Toulouse, France, and IRSD, Université de Toulouse, INSERM, INRAE, ENVT, UPS, Toulouse, France
| | - Erasmo Miele
- the Department of Translational Medicine Science, Section of Paediatrics, University of Naples "Federico II", Naples, Italy
| | - Christos Tzivinikos
- the Paediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Mike Thomson
- the Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Weston Bank, Sheffield, UK
| | - Osvaldo Borrelli
- From the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children, London, UK
| |
Collapse
|
3
|
Olsson-Åkefeldt S, Rotzén Östlund M, Hammas B, Eriksson M, Bennet R. Reduction of rotavirus as a cause of nosocomial diarrhoea in northern Stockholm after introducing the rotavirus vaccine. Infect Dis (Lond) 2023; 55:175-180. [PMID: 36527430 DOI: 10.1080/23744235.2022.2153912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Vaccination against rotavirus was offered in Stockholm to children born on 1 March 2014 and onwards with 85% coverage after two years. We investigated changes in nosocomial diarrhoea 2010-2018 in children admitted to Astrid Lindgren Children's Hospital, Stockholm, Sweden. Methods: We retrospectively identified cases from diagnostic and virology department registers. Complications and chronic medical conditions were retrieved from the case records. Children <18 years of age who developed diarrhoea ≥48 h after admission for another diagnosis and had a faecal sample submitted to the virology department were included. Results: There were 474 episodes of nosocomial diarrhoea. Of these, 401 (85%) occurred in children with chronic medical conditions. In children <5 years the rates of nosocomial rotavirus gastroenteritis, with 95% confidence intervals, significantly decreased from 0.34 (0.25-0.45) per 100 admissions prevaccination to 0.09 (0.04-0.17) postvaccination and from 0,66 (0.48-0.88) to 0.16 (0.07-0.30) cases per 1000 hospital days. Postvaccination norovirus became the most frequent pathogen. Virus-positive cases were more common in young children and in winter months. Conclusions: Before the initiation of rotavirus vaccination, norovirus and rotavirus were equally common causes of nosocomial diarrhoea. Postvaccination, rotavirus was reduced by approximately 75% while the frequency of other viruses did not change.
Collapse
Affiliation(s)
- Selma Olsson-Åkefeldt
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Rotzén Östlund
- Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden
| | - Berit Hammas
- Department of Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Eriksson
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Rutger Bennet
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
4
|
Carias C, Hu T, Chen YT. Burden of rotavirus gastroenteritis on caregivers: Findings from a systematic literature review. Hum Vaccin Immunother 2022; 18:2047545. [PMID: 35377826 PMCID: PMC9196848 DOI: 10.1080/21645515.2022.2047545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rotavirus gastroenteritis (RVGE) poses a substantial clinical, economic, and humanistic burden globally. While predominantly affecting children, the burden of RVGE extends to caregivers and families but is often overlooked. In this systematic literature review, we aim to identify and summarize methods and estimates of RVGE associated caregiver burden. Of the 190 publications identified, 10 were included. Four studies used the EuroQoL-5 Dimension instrument and its associated Visual Analog Scale and reported a decrease in caregiver health related quality of life when a child contracted RVGE, with the greatest reduction observed in caregivers of hospitalized children. Other studies utilized surveys to assess impacts on caregivers’ quality of life. Caregivers of RVGE patients experienced multiple impacts beyond financial costs related to productivity and absenteeism, with disruptions to daily routines and anxiety/stress frequently reported. This review highlights the importance of including RVGE caregiver burden when evaluating interventions, such as vaccination, to decrease RVGE burden.
Collapse
Affiliation(s)
- Cristina Carias
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Tianyan Hu
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Ya-Ting Chen
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| |
Collapse
|
5
|
Arístegui J, Alfayate-Miguelez S, Carazo-Gallego B, Garrote E, Díaz-Munilla L, Mendizabal M, Méndez-Hernández M, Doménech E, Ferrer-Lorente B, Unsaín-Mancisidor M, Ramos-Amador JT, Illán-Ramos M, Croche-Santander B, Centeno Malfaz F, Rodríguez-Suárez J, Cotarelo Suárez M, San-Martín M, Ruiz-Contreras J. Clinical characteristics, health care resource utilization and direct medical costs of Rotavirus hospitalizations in Spain (2013-2018). Hum Vaccin Immunother 2022; 18:2046961. [PMID: 35435807 PMCID: PMC9196715 DOI: 10.1080/21645515.2022.2046961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rotavirus (RV) is the most common cause of severe gastroenteritis (GE) in infants and young children worldwide and is associated with a significant clinical and economic burden. The objective of this study was to analyze the characteristics, healthcare resource utilization and the direct medical costs related to RVGE hospitalizations in Spain. An observational, multicenter, cross-sectional study was conducted from June 2013 to May 2018 at the pediatric departments of 12 hospitals from different Spanish regions. Children under 5 years of age admitted to the hospital with a confirmed diagnosis of RVGE were selected. Data on clinical characteristics, healthcare resource use and costs were collected from patient records and hospital databases. Most children hospitalized for RVGE did not have any previous medical condition or chronic disease. Forty-seven percent had previously visited the Emergency Room (ER), 27% had visited a primary care pediatrician, and 15% had received pharmacological treatment prior to hospital admission due to an RVGE episode. The average length of a hospital stay for RVGE was 5.6 days, and the mean medical costs of RVGE hospitalizations per episode ranged from 3,940€ to 4,100€. The highest direct medical cost was due to the hospital stay. This study showed a high burden of health resource utilization and costs related to the management of cases of RVGE requiring hospitalization. RV vaccination with high coverage rates should be considered to minimize the clinical and economic impacts of this disease on the health-care system.
Collapse
Affiliation(s)
| | | | | | - Elisa Garrote
- Pediatrics, Hospital Universitario de Basurto, Bilbao, Spain
| | | | | | | | - Elia Doménech
- Paediatrics, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Belén Ferrer-Lorente
- Paediatrics, Hospital Germans Trias i Pujol, Badalona, Spain.,Paediatrics, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María Unsaín-Mancisidor
- Paediatrics, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Paediatrics, Hospital Universitario de Donostia, San Sebastián, Spain
| | - José Tomás Ramos-Amador
- Paediatrics, Hospital Universitario de Donostia, San Sebastián, Spain.,Paediatrics, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Marta Illán-Ramos
- Paediatrics, Hospital Universitario de Donostia, San Sebastián, Spain.,Paediatrics, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Borja Croche-Santander
- Paediatrics, Hospital Universitario Clínico San Carlos, Madrid, Spain.,Paediatrics, Hospital Juan Ramón Jiménez, Huelva, Spain
| | - Fernando Centeno Malfaz
- Paediatrics, Hospital Juan Ramón Jiménez, Huelva, Spain.,Paediatrics, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Julián Rodríguez-Suárez
- Paediatrics, Hospital Universitario Río Hortega, Valladolid, Spain.,Paediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Manuel Cotarelo Suárez
- Paediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain.,Medical Affairs Department, MSD, Madrid, Spain
| | - María San-Martín
- Paediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain.,Medical Affairs Department, MSD, Madrid, Spain
| | - Jesús Ruiz-Contreras
- Medical Affairs Department, MSD, Madrid, Spain.,Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| |
Collapse
|
6
|
Orosz N, Tóthné Tóth T, Vargáné Gyuró G, Tibor Nábrádi Z, Hegedűsné Sorosi K, Nagy Z, Rigó É, Kaposi Á, Gömöri G, Adi Santoso CM, Nagy A. Comparison of Length of Hospital Stay for Community-Acquired Infections Due to Enteric Pathogens, Influenza Viruses and Multidrug-Resistant Bacteria: A Cross-Sectional Study in Hungary. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15935. [PMID: 36498009 PMCID: PMC9739820 DOI: 10.3390/ijerph192315935] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Community-acquired infections (CAI) can affect the duration of care and mortality of patients. Therefore, we aimed to investigate these as well as factors influencing the length of hospital stay in patients with CAI due to enteric pathogens, influenza viruses and multidrug-resistant (MDR) bacteria. We obtained data on 531 patients with CAI from the medical databases of a Hungarian university hospital and analyzed their characteristics using a regression model. Patients with MDR bacterial infection had the highest mortality (26.24%) and they stayed significantly longer in the hospital than cases with other CAIs. Our results showed that infection by Clostridioides difficile (odds ratio (OR): 6.98, 95% confidence interval (CI): 1.03-47.48; p = 0.047), MDR Escherichia coli (OR: 7.64, 95% CI: 1.24-47.17; p = 0.029), MDR Klebsiella spp. (OR: 7.35, 95% CI: 1.15-47.07; p = 0.035) and hospitalization in the department of pulmonology (OR: 5.48, 95% CI: 1.38-21.76; p = 0.016) and surgery (OR: 4.19, 95% CI: 1.18-14.81; p = 0.026) significantly increased, whereas female sex (OR: 0.62, 95% CI: 0.40-0.97; p = 0.037) and hospitalization in the department of pediatrics (OR: 0.17, 95% CI: 0.04-0.64; p = 0.009) decreased the odds of staying in the hospital for more than 6 days. Our findings provide new information on the epidemiology of CAI and can contribute to the development of public health programs that decrease the burden of infections acquired in the community.
Collapse
Affiliation(s)
- Nikolett Orosz
- Department of Hospital Hygiene, University of Debrecen Clinical Centre, 4032 Debrecen, Hungary
| | - Tünde Tóthné Tóth
- Department of Hospital Hygiene, University of Debrecen Clinical Centre, 4032 Debrecen, Hungary
| | - Gyöngyi Vargáné Gyuró
- Department of Hospital Hygiene, University of Debrecen Clinical Centre, 4032 Debrecen, Hungary
| | - Zsoltné Tibor Nábrádi
- Department of Hospital Hygiene, University of Debrecen Clinical Centre, 4032 Debrecen, Hungary
| | - Klára Hegedűsné Sorosi
- Department of Hospital Hygiene, University of Debrecen Clinical Centre, 4032 Debrecen, Hungary
| | - Zsuzsa Nagy
- Department of Hospital Hygiene, University of Debrecen Clinical Centre, 4032 Debrecen, Hungary
| | - Éva Rigó
- Department of Hospital Hygiene, University of Debrecen Clinical Centre, 4032 Debrecen, Hungary
| | - Ádám Kaposi
- Department of Hospital Hygiene, University of Debrecen Clinical Centre, 4032 Debrecen, Hungary
| | - Gabriella Gömöri
- Department of Hospital Hygiene, University of Debrecen Clinical Centre, 4032 Debrecen, Hungary
| | | | - Attila Nagy
- Department of Health Informatics, Faculty of Health Sciences, University of Debrecen, 4028 Debrecen, Hungary
| |
Collapse
|
7
|
Elbashir I, Aldoos NF, Mathew S, Al Thani AA, Emara MM, Yassine HM. Molecular epidemiology, genetic diversity, and vaccine availability of viral acute gastroenteritis in the middle East and North Africa (MENA) region. J Infect Public Health 2022; 15:1193-1211. [PMID: 36240530 DOI: 10.1016/j.jiph.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/26/2022] [Accepted: 09/11/2022] [Indexed: 11/18/2022] Open
Abstract
Acute gastroenteritis is the cause of considerable mortality and morbidity worldwide, particularly among children under five years in underdeveloped countries. Most acute gastroenteritis (AGE) cases are attributed to viral etiologies, including rotavirus, norovirus, adenovirus, astrovirus, and sapovirus. This paper aimed to determine the prevalence rate of different viral etiologies of AGE in the Middle East and North Africa (MENA) region. Moreover, this paper explored rotavirus phylogenetic relatedness, compared VP7 and VP4 antigenic regions of rotavirus with vaccine strains, and explored the availability of vaccines in the MENA region. The literature search identified 160 studies from 18 countries from 1980 to 2019. The overall prevalence of rotavirus, norovirus, adenovirus, astrovirus, and sapovirus were 29.8 %, 13.9 %, 6.3 %, 3.5 %, and 3.2 % of tested samples, respectively. The most common rotavirus genotype combinations in the MENA region were G1P[8], G9P[9], and G2P[4], whereas GII.4 was the predominant norovirus genotype all of which were reported in almost all the studies with genotyping data. The comparison of VP7 and VP4 between circulating rotavirus in the MENA region and vaccine strains has revealed discrete divergent regions, including the neutralizing epitopes. Rotavirus vaccine was introduced to most of the countries of the MENA region; however, only a few studies have assessed the effectiveness of vaccine introduction. This paper provides a comprehensive update on the prevalence of the different viral agents of AGE in the MENA region.
Collapse
Affiliation(s)
- Israa Elbashir
- Biomedical Research Center, Qatar University, 2713 Doha, Qatar.
| | - Noor F Aldoos
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar.
| | - Shilu Mathew
- Biomedical Research Center, Qatar University, 2713 Doha, Qatar.
| | - Asmaa A Al Thani
- Biomedical Research Center, Qatar University, 2713 Doha, Qatar; Department of Biomedical Sciences, College of Health Science-QU Health, Qatar University, Doha 2713, Qatar
| | - Mohamed M Emara
- Basic Medical Sciences Department, College of Medicine, QU Health, Qatar University, 2713 Doha, Qatar.
| | - Hadi M Yassine
- Biomedical Research Center, Qatar University, 2713 Doha, Qatar.
| |
Collapse
|
8
|
BD MAX Enteric Bacterial, Bacterial Plus, and Virus Panels for Diagnosis of Acute Infectious Gastroenteritis: a Cost-Benefit Analysis. Microbiol Spectr 2022; 10:e0088022. [PMID: 36069590 PMCID: PMC9603360 DOI: 10.1128/spectrum.00880-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Economic assessment is required to gauge the value of implementing PCR syndromic platforms in the microbiology laboratory for the diagnosis of community-acquired acute gastroenteritis (AGE) in pediatric and adult in- and outpatients. A cost-benefit analysis was conducted from a health care system perspective using BD MAX Enteric Bacterial, Bacterial Plus, and Virus panels. Two 6-month periods were selected, in which either conventional procedures (in 2017) or BD MAX PCR multiplex panels (in 2018) were used. We retrospectively reviewed medical records of all patients with positive results and a representative sample of negative ones. A Markov model was used to represent transition probabilities between different health care states from time of stool microbiological study until completion of AGE-episode-associated health care. A total of 1,336 medical records were reviewed (829 in 2018 and 507 in 2017), showing overall a significantly higher positivity rate in 2018 than in 2017 (26% versus 6%, P < 0.001). The total cost per individual associated with health care for AGE was €314 in 2018 and €341 in 2017; when we only considered the pediatric cohort, the figures were €271 and €456, respectively. Using Tornado sensitivity analyses, we found that the three variables that most influenced the model in descending order of weight were the probability of longer hospital stays, the probability of returning to the emergency room (ER), and the probability of hospitalization from the ER. Use of BD MAX enteric PCR platforms for the diagnosis of community-acquired AGE instead of a non-PCR-based conventional approach results in an incremental benefit from a health care perspective in the general population, particularly children. IMPORTANCE The implementation of multiplex molecular panels allows microbiological laboratories to quickly, sensitively, and accurately diagnose acute infectious gastroenteritis. This methodology therefore allows faster decisions regarding treatment and infection control measures. Economic evaluations are required to gauge the value of implementing these syndromic PCR platforms in a community-based acute gastroenteritis setting. We studied the potential clinical and cost benefits, in terms of both their impact on laboratory costs and the subsequent costs of managing patients.
Collapse
|
9
|
Łukasik J, Dierikx T, Besseling-van der Vaart I, de Meij T, Szajewska H. Multispecies Probiotic for the Prevention of Antibiotic-Associated Diarrhea in Children: A Randomized Clinical Trial. JAMA Pediatr 2022; 176:860-866. [PMID: 35727573 PMCID: PMC9214631 DOI: 10.1001/jamapediatrics.2022.1973] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE The efficacy of multispecies probiotic formulations in the prevention of antibiotic-associated diarrhea (AAD) remains unclear. OBJECTIVE To assess the effect of a multispecies probiotic on the risk of AAD in children. DESIGN, SETTING, AND PARTICIPANTS This randomized, quadruple-blind, placebo-controlled trial was conducted from February 2018 to May 2021 in a multicenter, mixed setting (inpatients and outpatients). Patients were followed up throughout the intervention period. Eligibility criteria included age 3 months to 18 years, recruitment within 24 hours following initiation of broad-spectrum systemic antibiotics, and signed informed consent. In total, 646 eligible patients were approached and 350 patients took part in the trial. INTERVENTIONS A multispecies probiotic consisting of Bifidobacterium bifidum W23, Bifidobacterium lactis W51, Lactobacillus acidophilus W37, L acidophilus W55, Lacticaseibacillus paracasei W20, Lactiplantibacillus plantarum W62, Lacticaseibacillus rhamnosus W71, and Ligilactobacillus salivarius W24, for a total dose of 10 billion colony-forming units daily, for the duration of antibiotic treatment and for 7 days after. MAIN OUTCOMES AND MEASURES The primary outcome was AAD, defined as 3 or more loose or watery stools per day in a 24-hour period, caused either by Clostridioides difficile or of otherwise unexplained etiology, after testing for common diarrheal pathogens. The secondary outcomes included diarrhea regardless of the etiology, diarrhea duration, and predefined diarrhea complications. RESULTS A total of 350 children (192 boys and 158 girls; mean [range] age, 50 [3-212] months) were randomized and 313 were included in the intention-to-treat analysis. Compared with placebo (n = 155), the probiotic (n = 158) had no effect on risk of AAD (relative risk [RR], 0.81; 95% CI, 0.49-1.33). However, children in the probiotic group had a lower risk of diarrhea regardless of the etiology (RR, 0.65; 95% CI, 0.44-0.94). No differences were observed between the groups for most of the secondary outcomes, including adverse events. CONCLUSIONS AND RELEVANCE A multispecies probiotic did not reduce the risk of AAD in children when analyzed according to the most stringent definition. However, it reduced the overall risk of diarrhea during and for 7 days after antibiotic treatment. Our study also shows that the AAD definition has a significant effect on clinical trial results and their interpretation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03334604.
Collapse
Affiliation(s)
- Jan Łukasik
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Thomas Dierikx
- Department of Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam UMC, Academic Medical Centre, Amsterdam, the Netherlands
| | | | - Tim de Meij
- Department of Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam UMC, Academic Medical Centre, Amsterdam, the Netherlands
| | - Hania Szajewska
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
| | | |
Collapse
|
10
|
Passos IPBD, Padoveze MC, Zem-Mascarenhas SH, Kawagoe JY, Felix AMDS, Timmons S, Figueiredo RMD. An innovative strategy for nursing training on standard and transmission-based precautions in primary health care: A randomized controlled trial. Am J Infect Control 2022; 50:657-662. [PMID: 34793890 DOI: 10.1016/j.ajic.2021.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Strategies to improve adherence to standard and transmission-based precautions are essential to reduce the risk of health care-associated infections. This study aims to evaluate the effectiveness of an educational strategy on precautions among nursing staff in primary health care settings. METHODS A randomized nonblinded controlled trial was conducted with 100 nursing staff working in 28 primary health care units. Groups were allocated randomly. The intervention group received a WebQuest educational strategy: a guided, creative method designed to engage participants in developing learning tasks, organized in 5 dimensions. The control group did not receive any training. Knowledge and self-reported adherence were assessed at 3 time points in the intervention group and at 2 time points in the control group. Data analyses were performed using Pearson's chi-square or Fisher's exact for categorical data, and Mann-Whitney and Repeated Measures analysis of variance for quantitative data. RESULTS A higher level of knowledge was identified in the postintervention for the dimensions of risk assessment, hand hygiene, and mask use and cough etiquette (all P values P < .05). The self-reported adherence increased in intervention (P = .008) and control groups (P = .005). The differences decreased after 6 months. CONCLUSIONS The educational intervention increased the knowledge and self-reported adherence to standard and transmission-based precautions.
Collapse
Affiliation(s)
| | - Maria Clara Padoveze
- Escola de Enfermagem da Universidade de São Paulo, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Julia Yaeko Kawagoe
- Nursing Master Program, d Programa de Mestrado Profissional em Enfermagem, São Paulo, SP, Brazil
| | | | - Stephen Timmons
- Business School, The University of Nottingham, Nottingham, United Kingdom
| | | |
Collapse
|
11
|
Gün E, Kendirli T, Öztürk AG, Botan E, Vatansever G, Arga G, Özdemir İ, Özdemir H, Tekin D, Çiftçi E, İnce E. Clinical Features and Outcomes of Children Admitted to the PICU due to Rotavirus Infection. Turk Arch Pediatr 2022; 56:591-595. [PMID: 35110058 PMCID: PMC8849640 DOI: 10.5152/turkarchpediatr.2021.21140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES In this study, we aimed to evaluate the clinical and laboratory features of the patients with rotavirus (RV) antigen positivity on or following admission to the pediatric intensive care unit (PICU). METHODS Patients admitted to the PICU due to community-acquired rotavirus (CA-RV) or hospital-acquired rotavirus (HA-RV)-induced gastroenteritis between January 1, 2013, and December 31, 2019 were evaluated. RESULTS Thirty-four patients with a mean age of 14.00 ± 19.17 months were enrolled. Fortyfour percent were girls. Twenty (58.8%) patients had a history of chronic diseases. Nine (26.5%) patients had CA-RV and 25 (73.5%) patients had HA-RV infection. RV antigens were simultaneously found in 44.1% (n = 14) of the other patients at the time of diagnosis. In the study sample, 5 patients had hyponatremia, 8 had hypernatremia, 6 had hypokalemia, 4 had hypoalbuminemia, 21 had leukocytosis, 2 had leukopenia and 3 had thrombocytopenia, and 17 had elevatedC-reactive protein (CRP) levels. Three patients had seizures, 1 patient had cardiac arrest, and 2 patients had secondary bacteremia. The mean (SD) PICU length of stay was 6 (6.02) with CA-RV gastroenteritis. All CA-RV patients survived, but 8 of the HA-RV patients succumbed to causes other than RV. CONCLUSION RV-related PICU admission is not rare, and occasional severe clinical consequences occur, especially in young children, with both CA-RV and HA-RV gastroenteritis. Appropriate timely intervention and meticulous follow-up improve survival.
Collapse
Affiliation(s)
- Emrah Gün
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Ahmet Gökcan Öztürk
- Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Edin Botan
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Göksel Vatansever
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Gül Arga
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - İhsan Özdemir
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Halil Özdemir
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Deniz Tekin
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Ergin Çiftçi
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Erdal İnce
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Ankara University School of Medicine, Ankara, Turkey
| |
Collapse
|
12
|
Stanyevic B, Sepich M, Biondi S, Baroncelli GI, Peroni D, Di Cicco M. The evolving epidemiology of acute gastroenteritis in hospitalized children in Italy. Eur J Pediatr 2022; 181:349-358. [PMID: 34327610 PMCID: PMC8760218 DOI: 10.1007/s00431-021-04210-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/14/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
Few data are available on the prevalence and features of acute gastroenteritis (AGE) in hospitalized children in Italy, where specific rotavirus vaccines were introduced into the national vaccination plan in 2017. To evaluate vaccination effects on AGE epidemiology, we analysed data from children aged ≤ 18 years admitted for AGE at the University Hospital of Pisa in 2019, comparing them with those recorded in 2012. Demographical, clinical, diagnostic, and treatment data were collected reviewing medical records and were therefore compared. In 2019 and 2012, 86 (median age 2.5 years [IQR 1.4-5.9]) and 85 children (median age 2.3 years [IQR 1.3-5.1]) were respectively admitted with AGE. The most common symptoms were diarrhoea and vomiting; decreased skin turgor was more frequent in 2019 (54% and 34% respectively, p = 0.01). Viral infections were more common than bacterial ones; in 2019, a decrease in rotavirus infections (67% and 22%, p = 0.003) and an increase in adenovirus infections (50% and 10%, p = 0.002) and in the number of patients with negative stool testing (58% and 39%, p = 0.04) were found.Conclusions: Viral infections are the leading cause of AGE in hospitalized children in Italy. The introduction of rotavirus vaccines did not reduce the number of hospitalizations per year. Adenovirus and other non-routinely screened viruses may be undergoing a selection process making them common causative agents for AGE. What is Known: • Rotavirus is the leading cause of acute severe gastroenteritis in children worldwide, especially < 5 years of age. • The introduction of specific vaccines may be changing its epidemiology. • Few data are available on acute gastroenteritis in hospitalized children in Italy. What is New: • Viral infections are the leading cause of acute gastroenteritis in hospitalized children in Italy. • Specific vaccines are reducing rotavirus infections, but adenovirus and other non-routinely screened viruses may be undergoing a selection process making them common causative agents for gastroenteritis.
Collapse
Affiliation(s)
- Brigida Stanyevic
- School of Medicine, University of Pisa, Via Roma n. 55, 56126 Pisa, Italy
| | - Margherita Sepich
- Paediatrics Unit, Pisa University Hospital, Via Roma n. 67, 56126 Pisa, Italy ,Department of Clinical and Experimental Medicine, University of Pisa, Via Roma n. 55, 56126 Pisa, Italy
| | - Samanta Biondi
- Paediatrics Unit, Pisa University Hospital, Via Roma n. 67, 56126 Pisa, Italy
| | | | - Diego Peroni
- Paediatrics Unit, Pisa University Hospital, Via Roma n. 67, 56126 Pisa, Italy ,Department of Clinical and Experimental Medicine, University of Pisa, Via Roma n. 55, 56126 Pisa, Italy
| | - Maria Di Cicco
- Paediatrics Unit, Pisa University Hospital, Via Roma n. 67, 56126, Pisa, Italy. .,Department of Clinical and Experimental Medicine, University of Pisa, Via Roma n. 55, 56126, Pisa, Italy.
| |
Collapse
|
13
|
Ranshing S, Ganorkar N, Ramji S, Gopalkrishna V. Complete genomic analysis of uncommon G12P[11] rotavirus causing a nosocomial outbreak of acute diarrhea in the newborns in New Delhi, India. J Med Virol 2021; 94:2613-2623. [PMID: 34811775 DOI: 10.1002/jmv.27468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/19/2021] [Indexed: 11/06/2022]
Abstract
Rotaviruses (RVs) are the major causative agents of acute gastroenteritis in children, but in neonates, RV infections are generally nosocomial in origin and mostly asymptomatic. However, there have been infrequent reports of nosocomial outbreaks of clinical disease in this population. In this study, we describe uncommon RV genotype; G12P[11] associated with an outbreak of acute gastroenteritis in the neonatal ward and neonatal intensive care unit (NICU) in New Delhi, North India. Full-genome analyses of the pathogenic G12P[11] strain was carried out to map the genotype constellation and further to explore the variations in the antigenic epitopes on the immunodominant VP7 and VP4 proteins, the amino acid sequences were compared with neonatal strains; ROTAVAC® (G9P[11]) and asymptomatic G12P[11] and also other G/P-type matched strains. The study revealed G12-P[11]-I1-R1-C1-M1-A1-N1-T1-E1-H1 human Wa-like genotype constellation and highlights evidence of gene reassortment. No significant differences were observed in the sequences of structural (except VP3) and nonstructural encoding genes of G12P[11] strains recovered from symptomatic and asymptomatic neonates. Presence of additional N-linked glycosylation site was noted in the G12 strains, as a consequence of a change from Asp→Asn at amino acid position 238. Interestingly, only two and four amino acids substitution within the 7-1a and 8-1 antigenic epitope were observed, respectively, compared with asymptomatic G12P[11] strain. The study emphasizes the importance of close monitoring of RV outbreaks in neonates for early alarming of novel strain.
Collapse
Affiliation(s)
- Sujata Ranshing
- Enteric Viruses Group, ICMR-National Institute of Virology, Pune, India
| | - Nital Ganorkar
- Enteric Viruses Group, ICMR-National Institute of Virology, Pune, India
| | - Siddarth Ramji
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | | |
Collapse
|
14
|
Ruiz-Contreras J, Alfayate-Miguelez S, Carazo-Gallego B, Onís E, Díaz-Munilla L, Mendizabal M, Méndez Hernández M, Ferrer-Lorente B, Unsaín-Mancisidor M, Ramos-Amador JT, Croche-Santander B, Centeno Malfaz F, Rodríguez-Suárez J, Cotarelo M, San-Martín M, Arístegui J. Rotavirus gastroenteritis hospitalizations in provinces with different vaccination coverage rates in Spain, 2013-2018. BMC Infect Dis 2021; 21:1138. [PMID: 34742235 PMCID: PMC8572461 DOI: 10.1186/s12879-021-06841-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/29/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Rotavirus (RV) vaccines are available in Spain since 2006 but are not included in the National Immunization Program. RV vaccination has reached an intermediate vaccination coverage rate (VCR) but with substantial differences between provinces. The aim of this study was to assess the ratio of RV gastroenteritis (RVGE) admissions to all-cause hospitalizations in children under 5 years of age in areas with different VCR. METHODS Observational, multicenter, cross-sectional, medical record-based study. All children admitted to the study hospitals with a RVGE confirmed diagnosis during a 5-year period were selected. The annual ratio of RVGE to the total number of all-cause hospitalizations in children < 5 years of age were calculated. The proportion of RVGE hospitalizations were compared in areas with low (< 30%), intermediate (31-59%) and high (> 60%) VCR. RESULTS From June 2013 to May 2018, data from 1731 RVGE hospitalizations (16.47% of which were nosocomial) were collected from the 12 study hospitals. RVGE hospital admissions accounted for 2.82% (95 CI 2.72-3.00) and 43.84% (95% CI 40.53-47.21) of all-cause and Acute Gastroenteritis (AGE) hospitalizations in children under 5 years of age, respectively. The likelihood of hospitalization due to RVGE was 56% (IC95%, 51-61%) and 27% (IC95%, 18-35%) lower in areas with high and intermediate VCR, respectively, compared to the low VCR areas. CONCLUSIONS RVGE hospitalization ratios are highly dependent on the RV VCR. Increasing VCR in areas with intermediate and low coverage rates would significantly reduce the severe burden of RVGE that requires hospital management in Spain. Clinical trial registration Not applicable.
Collapse
Affiliation(s)
| | - S Alfayate-Miguelez
- Pediatrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - B Carazo-Gallego
- Pediatrics, Hospital Regional Universitario de Málaga, Malaga, Spain
| | - E Onís
- Pediatrics, Hospital Universitario de Basurto, Bilbao, Spain
| | - L Díaz-Munilla
- Pediatrics, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - M Mendizabal
- Pediatrics, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - B Ferrer-Lorente
- Pediatrics, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - J T Ramos-Amador
- Pediatrics, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - F Centeno Malfaz
- Pediatrics, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | - M Cotarelo
- Medical Affairs Department, MSD Spain, C/Josefa Valcárcel, 38, 28027, Madrid, Spain
| | - M San-Martín
- Medical Affairs Department, MSD Spain, C/Josefa Valcárcel, 38, 28027, Madrid, Spain.
| | - J Arístegui
- Pediatrics, Hospital Universitario de Basurto, Bilbao, Spain
| |
Collapse
|
15
|
Mare A, Man A, Toma F, Ciurea CN, Coșeriu RL, Vintilă C, Maier AC. Hemolysin-Producing Strains among Diarrheagenic Escherichia coli Isolated from Children under 2 Years Old with Diarrheal Disease. Pathogens 2020; 9:pathogens9121022. [PMID: 33291609 PMCID: PMC7761922 DOI: 10.3390/pathogens9121022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022] Open
Abstract
Even if serotyping based on O antigens is still routinely used by most laboratories for the detection of diarrheagenic Escherichia coli, this method can provide false-positive reactions, due to the high diversity of O antigens. Molecular methods represent a valuable tool that clarifies these situations. In the Bacteriology Laboratory of Mureș County Hospital, between May 2016 and July 2019, 160 diarrheagenic E. coli strains were isolated from children under 2 years old with diarrheic disease. The strains were identified as Shiga toxin-producing E. coli (STEC)/enteropathogenic Escherichia coli (EPEC) via agglutination with polyvalent sera. STEC strains were serotyped using monovalent sera for serogroup O157. Simplex PCR was performed on the strains to determine the presence of the hlyA gene, and, for the positive ones, the hemolytic activity was tested. Antibiotic susceptibility of the identified diarrheagenic E. coli strains was also investigated. STEC strains were the most frequently identified (49.1%), followed by EPEC (40.2%). The hlyA gene was identified in 12 cases, representing 18.2% of the STEC strains. Even if the extended-spectrum β-lactamase (ESBL)-producing strains represented only 10%, a relevant percentage of multidrug-resistant (MDR) strains (24%) was identified.
Collapse
Affiliation(s)
- Anca Mare
- Department of Microbiology, Pharmacy, Sciences and Technology, George Emil Palade University of Medicine, 540142 Târgu Mureș, Romania; (A.M.); (A.M.); (F.T.)
| | - Adrian Man
- Department of Microbiology, Pharmacy, Sciences and Technology, George Emil Palade University of Medicine, 540142 Târgu Mureș, Romania; (A.M.); (A.M.); (F.T.)
| | - Felicia Toma
- Department of Microbiology, Pharmacy, Sciences and Technology, George Emil Palade University of Medicine, 540142 Târgu Mureș, Romania; (A.M.); (A.M.); (F.T.)
| | - Cristina Nicoleta Ciurea
- Department of Microbiology, Pharmacy, Sciences and Technology, George Emil Palade University of Medicine, 540142 Târgu Mureș, Romania; (A.M.); (A.M.); (F.T.)
- Correspondence: ; Tel.: +40-07-5908-3638
| | - Răzvan Lucian Coșeriu
- Infectious Diseases Laboratory, Mureș County Clinical Hospital, 540233 Târgu Mureș, Romania; (R.L.C.); (C.V.)
| | - Camelia Vintilă
- Infectious Diseases Laboratory, Mureș County Clinical Hospital, 540233 Târgu Mureș, Romania; (R.L.C.); (C.V.)
| | - Adrian Cornel Maier
- Department of Urology, Faculty of Medicine, University “Dunarea de Jos” Galați, 800008 Galați, Romania;
| |
Collapse
|
16
|
Camilloni B, Alunno A, Nunzi E, Sarnari L, Ianiro G, Monini M. Hospital-acquired rotavirus acute gastroenteritis in 10 consecutive seasons in Umbria (Italy). J Med Virol 2020; 92:3202-3208. [PMID: 32285951 DOI: 10.1002/jmv.25878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 04/02/2020] [Accepted: 04/11/2020] [Indexed: 11/11/2022]
Abstract
Group A rotaviruses (RVA) are the leading cause of acute gastroenteritis (AGE) in young (aged <5 years) children. Several studies showed that RVA is one of the main cause of nosocomial gastroenteritis in hospitalized pediatric population worldwide, with an incidence ranging from 8 to 33 cases per 100 hospitalized children. Nosocomial infections, in which AGE symptoms develop at least 2 days after admission, may severely affect children already admitted to hospital for other causes. This study aimed to define the trends of the RVA genotypes through statistical analysis of the data obtained by the rotavirus surveillance in Umbria in 10 consecutive seasons, from 2007-2008 to 2016-2017, with update information on hospital-acquired RVA AGE. During RVA gastroenteritis surveillance in Umbria (Italy) in 2007 to 2017, a total of 741 RVA positive faecal samples were collected from children hospitalized with AGE, and RVA strains were genotyped following standard EuroRotaNet protocols. Of the 741 analyzed samples, 75 (10%) were reported to be hospital-acquired. Comparing the distributions of the RVA genotypes circulating in the community or associated with nosocomial infections, we observed a different distribution of genotypes circulating inside the hospital wards, with respect to those observed in the community except in 2010 to 2011, 2011 to 2012, and 2012 to 2013 when G1P[8], G4P[8] and the novel strain G12P[8] caused a large community- and hospital-acquired outbreak. Of the 741 analyzed samples, 75 (10%) were reported to be hospital-acquired. Comparing the distributions of the RVA genotypes circulating in the community or associated with nosocomial infections, we observed a different distribution of genotypes circulating inside the hospital wards, with respect to those observed in the community except in 2010 to 2011, 2011 to 2012, and 2012 to 2013 when G1P[8], G4P[8], and the novel strain G12P[8] caused a large community- and hospital-acquired outbreak. The information from this study will be useful to implement guidelines for preventing nosocomial RVA AGE, which should include an improved management of the hospitalized patients and an increase in vaccination coverage.
Collapse
Affiliation(s)
| | - Anna Alunno
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Emilia Nunzi
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Laura Sarnari
- School of Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy
| | - Giovanni Ianiro
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marina Monini
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Rome, Italy
| |
Collapse
|
17
|
Azor-Martinez E, Garcia-Fernandez L, Strizzi JM, Cantarero-Vallejo MD, Jimenez-Lorente CP, Balaguer-Martinez JV, Torres-Alegre P, Yui-Hifume R, Sanchez-Forte M, Gimenez-Sanchez F. Effectiveness of a hand hygiene program to reduce acute gastroenteritis at child care centers: A cluster randomized trial. Am J Infect Control 2020; 48:1315-1321. [PMID: 32303373 DOI: 10.1016/j.ajic.2020.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 12/15/2022]
Abstract
We aimed to assess the effectiveness of an educational and hand hygiene program in daycare centers (DCCs) and homes on acute gastroenteritis (AGE) incidence in children attending DCCs. METHODS A randomized, controlled, and open study of 911 children aged 0-3 years attending 24 DCCs in Almería (Spain) with an 8-month follow-up was employed. Two intervention groups of DCCs families performed educational and hand hygiene measures, 1 with soap and water (soap and water group; n = 274), another with hand sanitizer (hand sanitizer group [HSG]; n = 339), and the control group (CG; n = 298) followed usual handwashing procedures. We compared AGE episode rates with Poisson regression model. RESULTS seven hundred fourteen AGE episodes were registered, significant differences between HSG and CG children were found during December and January. A multivariate model was applied and the adjusted incidence rate ratios by rotavirus vaccination found significant differences when children were previously vaccinated, the children in the soap and water group had a higher risk of AGE episodes (incidence rate ratio: 1.28, 95% confidence interval:1.0-1.64), compared with those in the HSG. CONCLUSIONS This study demonstrated that hand hygiene programs that included hand sanitizer were most effective in the winter months. Further, the largest reduction of AGE episodes occurred in the children that followed hand hygiene programs including hand sanitizer and educational measures for DCC staff, parents, and children, and were vaccinated for rotavirus.
Collapse
|
18
|
Kim GR, Kim SH, Jeon GW, Shin JH. Prevalence of Eleven Infectious Viruses Causing Diarrhea in Korea. Jpn J Infect Dis 2020; 73:427-430. [PMID: 32475874 DOI: 10.7883/yoken.jjid.2020.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Rotavirus and norovirus are well-known causes of viral infectious diarrhea. There are few reports on diarrhea caused by other viruses in Korea, although cases of gastroenteritis attributable to other viruses are increasing worldwide. The aims of this study were to detect various causes of viral diarrhea and to investigate their prevalence. A total of 801 fecal specimens submitted to a clinical microbiology laboratory for the detection of diarrheal viruses were included. We sought to detect rotavirus A/B/C, adenovirus, astrovirus, norovirus GI/GII, sapovirus, Aichi virus, human parechovirus, enterovirus, human cosavirus, human bocavirus, and Saffold virus using multiplex reverse transcription polymerase chain reaction (RT-PCR). At least one diarrheal virus was detected in 223 (27.8%) fecal specimens. Among them, two viruses were detected in 11 specimens. Rotavirus A was most common (17.1%; N = 137), followed by norovirus GII (5.0%; N = 40), enterovirus (4.2%; N = 34), adenovirus (1.0%; N = 8), astrovirus (1.0%; N = 8), human parechovirus (0.6%; N = 5), and human bocavirus (0.2%; N = 2). Rotaviruses B and C, norovirus GI, sapovirus, Aichi virus, human cosavirus, and Saffold virus were not detected. We confirmed that various diarrheal viruses can be detected in fecal specimens. We must consider the possibility of viruses other than rotavirus and norovirus being present in cases of diarrhea.
Collapse
Affiliation(s)
- Gyu Ri Kim
- Department of Laboratory Medicine, Inje University College of Medicine, Korea
| | - Si Hyun Kim
- Department of Clinical Laboratory Science, Semyung University, Korea
| | - Ga Won Jeon
- Department of Pediatrics, Inje University College of Medicine, Korea
| | - Jeong Hwan Shin
- Department of Laboratory Medicine, Inje University College of Medicine, Korea.,Paik Institute for Clinical Research, Inje University College of Medicine, Korea
| |
Collapse
|
19
|
Han MS, Chung SM, Kim EJ, Lee CJ, Yun KW, Choe PG, Kim NJ, Choi EH. Successful control of norovirus outbreak in a pediatric ward with multi-bed rooms. Am J Infect Control 2020; 48:297-303. [PMID: 31492554 DOI: 10.1016/j.ajic.2019.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/28/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Norovirus outbreaks in health care facilities are difficult to prevent and control. METHODS We describe a norovirus outbreak that occurred in a single pediatric ward with multi-bed rooms. RESULTS The outbreak began with 4 clustered cases with acute diarrhea in a pediatric ward between December 22 and 25, 2017. A total of 10 cases were identified during the outbreak, with a cumulative incidence of 8.77%. The median age of the cases was 10 months. Symptoms lasted for a median of 7.5 days, and norovirus shed in stool for a median of 19.5 days. The first 5 cases consecutively developed diarrhea; 4 of them were in the same room. The sixth case, which was linked with the clustered cases, had stayed in the intensive care unit and infected 3 other patients during the stay. After these 4 cases were transferred back to the ward, an additional patient was infected. Strict infection control measures were implemented, and the outbreak was successfully terminated 24 days after the initial case. CONCLUSIONS Controlling norovirus outbreak in a pediatric ward with multi-bed rooms is challenging. Early detection of the outbreak and prompt implementation of strict infection control measures are critical.
Collapse
|
20
|
de Waure C, Sarnari L, Chiavarini M, Ianiro G, Monini M, Alunno A, Camilloni B. 10-Year Rotavirus Infection Surveillance: Epidemiological Trends in the Pediatric Population of Perugia Province. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1008. [PMID: 32033439 PMCID: PMC7036783 DOI: 10.3390/ijerph17031008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/23/2020] [Accepted: 02/03/2020] [Indexed: 11/28/2022]
Abstract
Rotavirus (RV) infections are a leading cause of severe gastroenteritis in children, and vaccination is currently recommended in Italy, according to the National Immunization Plan 2017-2019. The objective of this study was to describe the epidemiological and molecular RV surveillance in the pediatric population of Perugia province, Umbria. Between September 2007 and August 2018, 663 RV-positive stool specimens were collected from children <15 years of age presenting with gastroenteritis to the emergency room of the Perugia province hospitals who were then hospitalized. Yearly hospitalization rates were expressed per 100,000 persons, and denominators were extrapolated from the National Institute of Statistics. During the 10-year surveillance, the epidemiological trend was fluctuating but slightly decreasing (Max: 89.7 per 100,000 in 2010/2011; Min: 34.8 per 100,000 in 2017/2018). The hospitalization rate was higher in males and in children under five years of age. Among common genotypes, G1P[8] was prevalent most of the years. The uncommon G12P [8] genotype emerged and was the most common in 2012/2013 (58.2%). Afterwards, its circulation remained high. As the Umbria Region started vaccinating from the 2018 birth cohort, our study reviewed pre-vaccination data and will help to assess the protection induced by vaccination and its effect on circulating strains.
Collapse
Affiliation(s)
- Chiara de Waure
- Department of Experimental Medicine, University of Perugia, 06132 Perugia, Italy; (C.d.W.); (L.S.)
| | - Laura Sarnari
- Department of Experimental Medicine, University of Perugia, 06132 Perugia, Italy; (C.d.W.); (L.S.)
| | - Manuela Chiavarini
- Department of Experimental Medicine, University of Perugia, 06132 Perugia, Italy; (C.d.W.); (L.S.)
| | - Giovanni Ianiro
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (G.I.); (M.M.)
| | - Marina Monini
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (G.I.); (M.M.)
| | - Anna Alunno
- Department of Medicine, University of Perugia, 06132 Perugia, Italy; (A.A.); (B.C.)
| | - Barbara Camilloni
- Department of Medicine, University of Perugia, 06132 Perugia, Italy; (A.A.); (B.C.)
| |
Collapse
|
21
|
Abstract
Acute diarrhoea is a leading cause of morbidity and mortality in the paediatric population. Racecadotril is an antisecretory drug recommended as an adjuvant antidiarrhoeal treatment.In the small bowel, the enzyme neutral endopeptidase (NEP) inhibits the action of enkephalins, which prevent water and electrolyte hypersecretion. By inhibiting NEP, racecadotril allows enkephalins to exhibit their antisecretory effects. Consequently, racecadotril reduces the secretion of water and electrolytes in the small intestine, without having an effect on intestinal motility. No serious adverse events related to racecadotril have been reported.Racecadotril has proven its efficacy as an adjuvant antidiarrhoeal drug with a good safety profile. Its addition to oral rehydration solution (ORS) appears clinically beneficial and potentially leads to health care savings.
Collapse
|
22
|
Montanari P, Calvi C, Daprà V, Alliaudi C, Cojocaru D, Graziano E, Zaniol E, Galliano I, Bergallo M. Norovirus infections in children less than five years of age hospitalized with acute gastroenteritis in Italy. MINERVA BIOTECNOL 2020. [DOI: 10.23736/s1120-4826.19.02593-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
23
|
Ranshing SS, Bavdekar AR, Vaidya UV, Behera MK, Walimbe AM, Gopalkrishna V. Clinical and genetic characteristics of unusual G12P[11] rotavirus strains recovered from neonates: A study from Pune, Western India. INFECTION GENETICS AND EVOLUTION 2019; 70:45-52. [DOI: 10.1016/j.meegid.2019.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 11/28/2022]
|
24
|
CORR Insights®: Outcome Selection and Methodological Quality of Major and Minor Shoulder Surgery Studies: A Scoping Review. Clin Orthop Relat Res 2019; 477:620-621. [PMID: 30614912 PMCID: PMC6382208 DOI: 10.1097/corr.0000000000000618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
25
|
Aloi M, Mennini M. Efficacy of gelatin tannate for acute diarrhea in children: a systematic review and meta-analysis. J Comp Eff Res 2018; 8:91-102. [PMID: 30465439 DOI: 10.2217/cer-2018-0115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To investigate by meta-analysis the efficacy of gelatin tannate (GT), a mucosal barrier protector, in children with acute gastroenteritis. METHODS A comprehensive literature search was conducted. Studies were selected according to PICO: Participants: children aged 0-12 years with acute diarrhea; Intervention: GT; Comparison: oral rehydration solution and/or placebo; Outcomes: diarrhea-related outcomes. RESULTS Three published randomized controlled trials were identified of pediatric diarrhea treated with GT (n = 203) or control (n = 204). GT significantly (p < 0.01) reduced stool frequency at 12 h in two randomized controlled trials. A significant treatment effect (risk ratio = 0.74; p < 0.01) in favor of GT was found for the exploratory composite outcome of 'diarrhea or liquid stools at 24 h' in three studies. Risk ratios in a single study which reported the percentage of patients with liquid stools at 12, 24 and 48 h favored GT at all time points. No significant differences were found between GT and control for patients with diarrhea at 12 or 24 h or for duration of diarrhea. CONCLUSION GT improved stool frequency and stool consistency in children with acute diarrhea, although further well-controlled studies would be useful to confirm a beneficial treatment effect.
Collapse
Affiliation(s)
- Marina Aloi
- Pediatric Gastroenterology & Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Maurizio Mennini
- Pediatric Gastroenterology & Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.,Department of Pediatrics, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| |
Collapse
|
26
|
Abstract
OBJECTIVE Despite a substantial consistency in recommendations for the management of children with acute gastroenteritis (AGE), a high variability in clinical practice and a high rate of inappropriate medical interventions persist in both developing and developed countries.The aim of this study was to develop a set of clinical recommendations for the management of nonseverely malnourished children with AGE to be applied worldwide. METHODS The Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition (FISPGHAN) Working Group (WG) selected care protocols on the management of acute diarrhea in infants and children aged between 1 month and 18 years. The WG used a 3-step approach consisting of: systematic review and comparison of published guidelines, agreement on draft recommendations using Delphi methodology, and external peer-review and validation of recommendations. RESULTS A core of recommendations including definition, diagnosis, nutritional management, and active treatment of AGE was developed with an overall agreement of 91% (range 80%-96%). A total of 28 world experts in pediatric gastroenterology and emergency medicine successively validated the set of 23 recommendations with an agreement of 87% (range 83%-95%). Recommendations on the use of antidiarrheal drugs and antiemetics received the lowest level of agreement and need to be tailored at local level. Oral rehydration and probiotics were the only treatments recommended. CONCLUSIONS Universal recommendations to assist health care practitioners in managing children with AGE may improve practitioners' compliance with guidelines, reduce inappropriate interventions, and significantly impact clinical outcome and health care-associated costs.
Collapse
|
27
|
Costantino C, Restivo V, Tramuto F, Casuccio A, Vitale F. Universal rotavirus vaccination program in Sicily: Reduction in health burden and cost despite low vaccination coverage. Hum Vaccin Immunother 2018; 14:2297-2302. [PMID: 29757707 PMCID: PMC6183134 DOI: 10.1080/21645515.2018.1471306] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Rotavirus is considered the main cause of severe gastroenteritis and nosocomial infections in Pediatric units, especially during late winter and early spring season in temperate region. In 2013 Sicilian Region, for the first time in Italy, introduced universal Rotavirus vaccination. This study aims to estimate health and economic impact on rotavirus Gastroenteritis (RVGE) among children aged 0–59 months in Sicily, after rotavirus vaccine introduction. We analyzed hospital discharge records including a diagnosis of RVGE occurred from 1st January 2009 to 31st December 2016 among hospitalized children aged 0 to 59 months, residents in Sicily. RVGEs were defined as all hospitalizations with an ICD-9-CM diagnosis code of 008.61 on first or any diagnosis position. Also an economic impact analysis on Health Regional System was conducted. We observed a consistent decline of hospitalization after rotavirus vaccination introduction from 394 per 100,000 in 2009–2012 to 220 per 100,000 in 2013–2016. We found a change in the peak of reported cases by at least one month from March-April in the pre-vaccination period to May-June in the post-vaccination period. Since 2013, we estimated that the annual average cost saved is 1,134,056 € when considering direct and indirect costs to health care as well as vaccination costs. Our study is the first analysis conducted as far as we are aware in a high-income setting with poor coverage (lower than 50%), demonstrating a significant reduction of RVGE hospitalizations in Sicily after vaccine introduction. Moreover, was observed a consistent impact of vaccination on health care cost saving.
Collapse
Affiliation(s)
- Claudio Costantino
- a Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" - University of Palermo , Palermo , Italy
| | - Vincenzo Restivo
- a Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" - University of Palermo , Palermo , Italy
| | - Fabio Tramuto
- a Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" - University of Palermo , Palermo , Italy
| | - Alessandra Casuccio
- a Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" - University of Palermo , Palermo , Italy
| | - Francesco Vitale
- a Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" - University of Palermo , Palermo , Italy
| |
Collapse
|
28
|
Russo M, Coppola V, Giannetti E, Buonavolontà R, Piscitelli A, Staiano A. Oral administration of tannins and flavonoids in children with acute diarrhea: a pilot, randomized, control-case study. Ital J Pediatr 2018; 44:64. [PMID: 29866147 PMCID: PMC5987560 DOI: 10.1186/s13052-018-0497-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/09/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AG is the most common cause of pediatric consultations among children between 2 and 5 years of age and it still leads to high mortality and morbidity. Its management is based on rehydration therapy, but this treatment is not effective in reducing duration of diarrhea. For this reason, other safer and less expensive interventions, which could be added to oral rehydration therapy, are of great interest. METHODS A pilot, randomized, case-controlled trial was conducted in 60 children affected by AG (< 7 days) with mild-moderate dehydration, according to WHO recommendations, from1 year to 17 years old. Patients were divided into 2 Groups: Group 1 consisting of 30 children treated with Actitan F and standard oral rehydration (SOR); Group 2 consisting of 30 children who received only SOR. Both groups received treatment for seven days, respectively. Patients of Group 1 stopped for their own choice, SOR after the first 24 h and continued only with Actitan F. RESULTS After 24 h of treatment, the median number of stools was 3.5 for Group 1, and 4 for Group 2. In Group 1 the difference between the number of stools at baseline (n = 5) and after 24 h of treatment (n = 3.5) was significant (p < 0.0001). At the end of treatment, the median duration of diarrhea in Group 1 was 5 days, compared with 4 days in the Group 2, this difference was not statically significant (p 0.48). CONCLUSIONS Oral administration of Actitan F associated with SOR seems safe and effective treatment in shortening the duration of AG in children. Further studies confirming these data are needed. TRIAL REGISTRATION NCT03356327 (retrospectively registered).
Collapse
Affiliation(s)
- Marina Russo
- Department of Translational Medical Science, Section of Pediatrics, “Federico II” University of Naples, Via S. Pansini, 5, 80131 Naples, Italy
| | - Vincenzo Coppola
- Department of Translational Medical Science, Section of Pediatrics, “Federico II” University of Naples, Via S. Pansini, 5, 80131 Naples, Italy
| | - Eleonora Giannetti
- Department of Translational Medical Science, Section of Pediatrics, “Federico II” University of Naples, Via S. Pansini, 5, 80131 Naples, Italy
| | - Roberta Buonavolontà
- Department of Translational Medical Science, Section of Pediatrics, “Federico II” University of Naples, Via S. Pansini, 5, 80131 Naples, Italy
| | - Antonio Piscitelli
- Department of Translational Medical Science, Section of Pediatrics, “Federico II” University of Naples, Via S. Pansini, 5, 80131 Naples, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, “Federico II” University of Naples, Via S. Pansini, 5, 80131 Naples, Italy
| |
Collapse
|
29
|
Gagneux-Brunon A, Lucht F, Launay O, Berthelot P, Botelho-Nevers E. Vaccines for healthcare-associated infections: present, future, and expectations. Expert Rev Vaccines 2018; 17:421-433. [DOI: 10.1080/14760584.2018.1470507] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Amandine Gagneux-Brunon
- Inserm, CIC 1408, I-REIVAC, University Hospital of Saint-Etienne, Saint-Etienne, France
- GIMAP EA 3064, University of Lyon, Saint-Etienne, France
| | - Frédéric Lucht
- Inserm, CIC 1408, I-REIVAC, University Hospital of Saint-Etienne, Saint-Etienne, France
- GIMAP EA 3064, University of Lyon, Saint-Etienne, France
| | - Odile Launay
- Inserm CIC 1417, I-REIVAC, University of Paris-Descartes, University Hospital of Cochin-Broca-Hôtel-Dieu, Paris, France
| | - Philippe Berthelot
- GIMAP EA 3064, University of Lyon, Saint-Etienne, France
- Infection control unit, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Elisabeth Botelho-Nevers
- Inserm, CIC 1408, I-REIVAC, University Hospital of Saint-Etienne, Saint-Etienne, France
- GIMAP EA 3064, University of Lyon, Saint-Etienne, France
| |
Collapse
|
30
|
Kang HN, Park HK, Lee HJ, Moon JH, Oh JW, Kim CR. Rotavirus infection as a frequent cause of neonatal fever. Pediatr Int 2018; 60:366-371. [PMID: 29290098 DOI: 10.1111/ped.13504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 12/14/2017] [Accepted: 12/26/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fever rather than diarrhea or vomiting was the most common symptom of neonatal rotavirus (RV) infection in our previous study. We investigated whether RV infection is a major cause of neonatal fever and compared the clinical characteristics of bacterial infection, viral infection and unknown causes of neonatal fever. METHOD We reviewed the electronic medical records of 48 newborns aged ≤28 days who were admitted to the Special Care Nursery of Hanyang University Guri Hospital for fever (≥38°C) from 2005 to 2009. All the newborns underwent complete blood count, urinalysis, C-reactive protein, cultures of blood, urine, and cerebrospinal fluid as well as stool RV enzyme-linked immunosorbent assay. Respiratory virus polymerase chain reaction for cough or rhinorrhea, and stool culture for diarrhea were also done. RESULTS All the babies were term, with mean age 13 ± 8 days and peak body temperature 38.5 ± 0.5°C. The causes of neonatal fever were viral (44%), bacterial (10%) and unknown (46%). The viral infections included RV (n = 12), enterovirus (n = 6), respiratory syncytial virus (n = 2), and rhinovirus (n = 1). All the rotavirus genotypes were G4P[6]. Only three of 12 RV-infected febrile newborns had diarrhea. The bacterial infections included three cases of urinary tract infection (Escherichia coli, n = 2; Klebsiella pneumoniae, n = 1), and two cases of sepsis complicated with meningitis (all Streptococcus agalactiae). CONCLUSIONS RV infection is the most common single cause of neonatal fever. It may be necessary to include stool RV tests for febrile newborns.
Collapse
Affiliation(s)
- Ha-Na Kang
- Department of Pediatrics, Hanyang University Hospital, Guri, Korea
| | - Hyun Kyung Park
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Hyun-Ju Lee
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Jin-Hwa Moon
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Jae Won Oh
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Chang-Ryul Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| |
Collapse
|
31
|
Poelaert D, Pereira P, Gardner R, Standaert B, Benninghoff B. A review of recommendations for rotavirus vaccination in Europe: Arguments for change. Vaccine 2018; 36:2243-2253. [PMID: 29576308 DOI: 10.1016/j.vaccine.2018.02.080] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 02/15/2018] [Accepted: 02/19/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND More than 10 years after the authorisation of two rotavirus vaccines of demonstrated efficacy and with a strongly positive benefit-risk profile, uptake in Europe remains low. Only 13 countries in Europe provide a fully-funded rotavirus universal mass vaccination (UMV) programme, three provide a partially-funded programme, and one provides full funding for a reduced programme targeting at-risk infants. Around 40% of countries in Europe currently have no existing recommendations for rotavirus vaccine use in children from the national government. METHODS We provide an overview of the status of rotavirus vaccine recommendations across Europe and the factors impeding uptake. We consider the evidence for the benefits and risks of vaccination, and argue that cost-effectiveness and cost-saving benefits justify greater access to rotavirus vaccines for infants living in Europe. RESULTS Lack of awareness of the direct and indirect burden caused by rotavirus disease, potential cost-saving from rotavirus vaccination including considerable benefits to children, families and society, and government/insurer cost constraints all contribute to complacency at different levels of health policy in individual countries. CONCLUSIONS More than 10 years after their introduction, available data confirm the benefits and acceptable safety profile of infant rotavirus UMV programmes. Europe serves to gain considerably from rotavirus UMV in terms of reductions in healthcare resource utilization and related costs in both vaccinated subjects and their unvaccinated siblings through herd protection.
Collapse
|
32
|
Dort T, Schecroun N, Standaert B. Improving the Hospital Quality of Care during Winter Periods by Optimizing Budget Allocation Between Rotavirus Vaccination and Bed Expansion. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:123-132. [PMID: 29159785 PMCID: PMC5797246 DOI: 10.1007/s40258-017-0362-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND During each winter the hospital quality of care (QoC) in pediatric wards decreases due to a surge in pediatric infectious diseases leading to overcrowded units. Bed occupancy rates often surpass the good hospital bed management threshold of 85%, which can result in poor conditions in the workplace. This study explores how QoC-scores could be improved by investing in additional beds and/or better vaccination programs against vaccine-preventable infectious diseases. METHODS The Cobb-Douglas model was selected to define the improvement in QoC (%) as a function of two strategies (rotavirus vaccination coverage [%] and addition of extra hospital beds [% of existing beds]), allowing improvement-isocurves to be produced. Subsequently, budget minimization was applied to determine the combination of the two strategies needed to reach a given QoC improvement at the lowest cost. Data from Jessa Hospital (Hasselt, Belgium) were chosen as an example. The annual population in the catchment area to be vaccinated was 7000 children; the winter period was 90 days with 34 pediatric beds available. Rotavirus vaccination cost per course was €118.26 and the daily cost of a pediatric bed was €436.53. The target QoC increase was fixed at 50%. The model was first built with baseline parameter values. RESULTS The model predicted that a combination of 64% vaccine coverage and 39% extra hospital beds (≈ 13 extra beds) in winter would improve QoC-scores by 50% for the minimum budget allocation. CONCLUSION The model allows determination of the most efficient allocation of the healthcare budget between rotavirus vaccination and bed expansion for improving QoC-scores during the annual epidemic winter seasons.
Collapse
Affiliation(s)
- Thibaut Dort
- Keyrus Management S.A.-N.V., Strombeek-Bever, Belgium C/O GSK, Wavre, Belgium
| | | | | |
Collapse
|
33
|
Gagneux-Brunon A, Lucht F, Launay O, Berthelot P, Botelho-Nevers E. Les vaccins dans la prévention des infections associées aux soins. JOURNAL DES ANTI-INFECTIEUX 2017. [PMCID: PMC7148680 DOI: 10.1016/j.antinf.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Les infections associées aux soins (IAS) constituent un véritable problème de santé publique. Escherichia coli, Staphylococcus aureus, Clostridium difficile sont les plus souvent à l’origine des IAS. L’antibiorésistance fréquente complique encore la prise en charge et des impasses thérapeutiques existent à présent. Les mesures d’hygiène hospitalière bien qu’essentielles sont insuffisantes pour diminuer drastiquement les IAS. Ainsi, des stratégies alternatives à l’antibiothérapie s’avèrent nécessaires pour prévenir et traiter les IAS. Parmi celles-ci, la vaccination et l’immunisation passive sont probablement les plus prometteuses. Nous avons fait une mise au point sur les vaccins disponibles et en développement clinique pour lutter contre les IAS, chez les patients à risque d’IAS et les soignants. L’intérêt de la vaccination grippale et rotavirus chez les patients pour prévenir ces IAS virales a été examiné. Le développement d’un vaccin anti-S. aureus, déjà émaillé de 2 échecs est complexe. Toutefois, ces échecs ont permis d’améliorer les connaissances sur l’immunité anti-S. aureus. La mise à disposition d’un vaccin préventif anti-C. difficile semble plus proche. Pour les autres bactéries gram négatif responsables d’IAS, le développement est moins avancé. La vaccination des patients à risques d’IAS pose également des problèmes de réponse vaccinale qu’il faudra résoudre pour utiliser cette stratégie. Ainsi, la vaccination des soignants, de par l’effet de groupe permet également de prévenir les IAS. Nous faisons ici le point sur l’intérêt de la vaccination des soignants contre la rougeole, la coqueluche, la grippe, la varicelle, l’hépatite B pour réduire les IAS avec des vaccins déjà disponibles.
Collapse
|
34
|
Al-Aidaroos AY, Standaert B, Meszaros K, Shibl AM. Economic assessment of rotavirus vaccination in Saudi Arabia. J Infect Public Health 2017; 10:564-571. [DOI: 10.1016/j.jiph.2016.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 10/16/2016] [Accepted: 11/18/2016] [Indexed: 01/03/2023] Open
|
35
|
Edwards CH, Bekkevold T, Flem E. Lost workdays and healthcare use before and after hospital visits due to rotavirus and other gastroenteritis among young children in Norway. Vaccine 2017; 35:3528-3533. [PMID: 28545926 DOI: 10.1016/j.vaccine.2017.05.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cost-effectiveness of rotavirus vaccination is affected by assumptions used in health economic evaluations. To inform such evaluations, we assessed healthcare use before and after hospitalisations due to rotavirus and other acute gastroenteritis (AGE) among children <5years of age in Norway and estimated daycare and work absenteeism. METHODS We conducted post-discharge interviews with caregivers of 282 children hospitalised with AGE at two hospitals in Norway during April 2014-February 2017. We collected data on healthcare use and absenteeism from daycare and work. We examined healthcare seeking and absenteeism patterns for RV-specific and other gastroenteritis. RESULTS Caregivers of 485 (37%) of 1 298 hospitalised children were invited to participate, and 282 (58%) completed the questionnaire. Among these, 106 (38%) were rotavirus-positive, 119 (42%) were rotavirus-negative, and for 57 (20%) children no rotavirus testing was performed. Overall, 97% of children had been in contact with a healthcare provider before hospital admission and 28% had contacted a healthcare provider after discharge. Children that attended daycare were absent from daycare for a mean of 6.3days (median 5days). Caregivers of these children reported work absenteeism in 74% of cases. The mean duration of work absenteeism among caregivers was 5.9days (median 5days) both for RV-positive and RV-negative cases. CONCLUSION In Norway, work absenteeism and healthcare use before and after hospitalisation due to rotavirus and non-rotavirus gastroenteritis are considerable and impose an economic burden on the healthcare system and society.
Collapse
Affiliation(s)
- Christina H Edwards
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway.
| | - Terese Bekkevold
- Department of Vaccine-Preventable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Elmira Flem
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
36
|
Impact of self-financed rotavirus vaccines on hospital stays and costs in Spain after a 3-year introductory period. Epidemiol Infect 2017; 145:1773-1785. [PMID: 28367780 DOI: 10.1017/s0950268817000620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Vaccination has reduced rotavirus hospitalizations by 25% in European regions with low-moderate vaccine availability. We aimed to quantify the reduction in hospital costs after the longest period in which Rotarix® and Rotateq® were simultaneously commercially available in Spain. Cases, length of stay (LOS), and diagnosis-related groups (DRGs) were retrieved from the Minimum Basic Data Set. Healthcare expenditure was estimated through the cost accounting system Gescot®. DRGs were clustered: I, non-bacterial gastroenteritis with complications; II, without complications; III, requiring surgical/other procedures or neonatal cases (highest DRG weights). Comparisons between pre (2003-2005)- and post-vaccine (2007-2009) hospital stays and costs by DRG group were made. Rotaviruses were the most common agents of specific-coded gastroenteritis (N = 1657/5012). LOS and extended LOS of rotaviruses fell significantly in 2007-2009 (β-coefficient = -0·43, 95% confidence intervals (95% CI) -0·68 to -0·17; and odds ratio 0·62, 95% CI 0·50-0·76, respectively). Overall, costs attributable to rotavirus hospitalizations fell approximately €244 per patient (95% CI -365 to -123); the decrease in DRG group III was €2269 per patient (95% CI -4098 to -380). We concluded modest savings in hospital costs, largely attributable to cases with higher DRG weights, and a faster recovery. A universal rotavirus vaccination program deserves being re-evaluated, regarding its potential high impact on both at-risk children and societal costs.
Collapse
|
37
|
Beglinger S. [Not Available]. PRAXIS 2017; 106:209-217. [PMID: 28211756 DOI: 10.1024/1661-8157/a002607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Zusammenfassung. Die häufigsten Gründe, weshalb ein Kind in der Praxis oder im Spital vorgestellt wird, sind Dehydratation und Trink-/Essensverweigerung aufgrund einer akuten Gastroenteritis (AGE). Die häufigste Ursache einer AGE ist das Rotavirus, gefolgt von Norovirus und seltenen bakteriellen Erkrankungen. Eine Erregerdiagnostik ist dabei nur selten nötig. Der Dehydratationsgrad wird vornehmlich klinisch anhand eines Dehydratations-Scores gestellt. Ziel der Dehydratationstherapie sind die rasche Rehydrierung und Wiederaufnahme von Flüssigkeit und Nahrung durch das Kind. Eine Rehydratationstherapie (RT) sollte wenn immer möglich per os oder per Magensonde stattfinden und nur in schweren Fällen intravenös. Bei einem prolongierten Verlauf sind weitere Abklärungen beim gastroenterologischen Spezialisten empfehlenswert.
Collapse
Affiliation(s)
- Svetlana Beglinger
- 1 Interdisziplinäre Notfallstation, Universitäts-Kinderspital beider Basel
| |
Collapse
|
38
|
Marinosci A, Doit C, Koehl B, Belhacel K, Mariani Kurkdjian P, Melki I, Renaud A, Lemaitre C, Ammar Khodja N, Blachier A, Bonacorsi S, Faye A, Lorrot M. [Nosocomial rotavirus gastroenteritis]. Arch Pediatr 2016; 23:1118-1123. [PMID: 27642146 DOI: 10.1016/j.arcped.2016.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 06/22/2016] [Accepted: 07/07/2016] [Indexed: 11/16/2022]
Abstract
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.
Collapse
Affiliation(s)
- A Marinosci
- Service de pédiatrie générale, hôpital Robert-Debré, AP-HP, 75019 Paris, France
| | - C Doit
- Service de microbiologie, hôpital Robert-Debré, AP-HP, 75019 Paris, France; Équipe d'hygiène hospitalière, hôpital Robert-Debré, AP-HP, 75019 Paris, France
| | - B Koehl
- Service de pédiatrie générale, hôpital Robert-Debré, AP-HP, 75019 Paris, France; Université Paris Diderot, Paris 7, 75019 Paris, France
| | - K Belhacel
- Équipe d'hygiène hospitalière, hôpital Robert-Debré, AP-HP, 75019 Paris, France
| | | | - I Melki
- Service de pédiatrie générale, hôpital Robert-Debré, AP-HP, 75019 Paris, France; Université Paris Diderot, Paris 7, 75019 Paris, France
| | - A Renaud
- Service de pédiatrie générale, hôpital Robert-Debré, AP-HP, 75019 Paris, France
| | - C Lemaitre
- Service de pédiatrie générale, hôpital Robert-Debré, AP-HP, 75019 Paris, France; Université Paris Diderot, Paris 7, 75019 Paris, France
| | - N Ammar Khodja
- Équipe d'hygiène hospitalière, hôpital Robert-Debré, AP-HP, 75019 Paris, France
| | - A Blachier
- Département d'informatique médical (DIM), hôpital Robert-Debré, AP-HP, 75019 Paris, France
| | - S Bonacorsi
- Service de microbiologie, hôpital Robert-Debré, AP-HP, 75019 Paris, France; Université Paris Diderot, Paris 7, 75019 Paris, France; Inserm, IAME, UMR 1137, 75018 Paris, France
| | - A Faye
- Service de pédiatrie générale, hôpital Robert-Debré, AP-HP, 75019 Paris, France; Université Paris Diderot, Paris 7, 75019 Paris, France; Inserm, ECEVE UMRS 1123, 75019 Paris, France
| | - M Lorrot
- Service de pédiatrie générale, hôpital Robert-Debré, AP-HP, 75019 Paris, France; Université Paris Diderot, Paris 7, 75019 Paris, France; Inserm, ECEVE UMRS 1123, 75019 Paris, France.
| |
Collapse
|
39
|
Tichopád A, Müllerová J, Jackowska T, Nemes E, Pazdiora P, Sloesen B, Štefkovičová M. Cost Burden of Severe Community-Acquired Rotavirus Gastroenteritis Requiring Hospitalization in the Czech Republic, Slovakia, Poland, and Hungary: A Retrospective Patient Chart Review. Value Health Reg Issues 2016; 10:53-60. [PMID: 27881278 DOI: 10.1016/j.vhri.2016.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/21/2016] [Accepted: 07/21/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To provide valuable local data on the economic burden of rotavirus gastroenteritis (RVGE) for decision making on introduction of rotavirus vaccination in Central European countries. METHODS We conducted a retrospective patient hospital chart review during the winter RVGE peak in the Czech Republic (n = 109), Hungary (n = 109), Poland, (n = 112), and Slovakia (n = 115) to estimate resource use and associated costs from the payer's perspective in children younger than 5 years with severe RVGE requiring hospitalization. Microcosting analysis was used to estimate the average costs of treating RVGE inpatients including pre- and posthospitalization costs. RESULTS The average cost of treatment was €476, €316, €741, and €594 in the Czech Republic, Hungary, Poland, and Slovakia, respectively. Extrapolating these costs to the total number of RVGE hospitalizations gives annual cost estimates of €2.1 million, €1.5 million, €13.2 million, and €1.5 million, respectively. The main component of expenditure in all the four countries is the hospital stay, but wide variation among countries was observed (total cost of treating RVGE in hospital was almost 2.5-fold higher in Poland than in Hungary). In countries with diagnosis related group (DRG) costs available, the best agreement between real resource-use-driven costs and the DRG cost was found in the Czech Republic and Hungary, with differences of only €22 and €33, respectively. In Poland, the microcosting indicated higher overall costs incurred in hospital than the DRG cost, with a difference exceeding €190. CONCLUSIONS Hospitalization of children with RVGE represents a substantial economic burden for the national health systems in these countries.
Collapse
Affiliation(s)
| | | | - Teresa Jackowska
- Department of Pediatrics, the Center of Postgraduate Medical Education, Warsaw, Poland
| | - Eva Nemes
- Department of Pediatrics, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Petr Pazdiora
- Department of Epidemiology of Medical Faculty, Charles University, Pilsen, Czech Republic
| | | | - Mária Štefkovičová
- Faculty of Health Care, Alexander Dubček University of Trenčín, Trenčín, Slovakia
| |
Collapse
|
40
|
Vecchio AL, Dias JA, Berkley JA, Boey C, Cohen MB, Cruchet S, Liguoro I, Lindo ES, Sandhu B, Sherman P, Shimizu T, Guarino A. Comparison of Recommendations in Clinical Practice Guidelines for Acute Gastroenteritis in Children. J Pediatr Gastroenterol Nutr 2016; 63:226-35. [PMID: 26835905 PMCID: PMC6858859 DOI: 10.1097/mpg.0000000000001133] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Acute gastroenteritis (AGE) is a major cause of child mortality and morbidity. This study aimed at systematically reviewing clinical practice guidelines (CPGs) on AGE to compare recommendations and provide the basis for developing single universal guidelines. METHODS CPGs were identified by searching MEDLINE, Cochrane-Library, National Guideline Clearinghouse and Web sites of relevant societies/organizations producing and/or endorsing CPGs. RESULTS The definition of AGE varies among the 15 CPGs identified. The parameters most frequently recommended to assess dehydration are skin turgor and sunken eyes (11/15, 73.3%), general appearance (11/15, 66.6%), capillary refill time, and mucous membranes appearance (9/15, 60%). Oral rehydration solution is universally recognized as first-line treatment. The majority of CPGs recommend hypo-osmolar (Na 45-60 mmol/L, 11/15, 66.6 %) or low-osmolality (Na 75 mmol/L, 9/15, 60%) solutions. In children who fail oral rehydration, most CPGs suggest intravenous rehydration (66.6%). However, nasogastric tube insertion for fluid administration is preferred according by 5/15 CPGs (33.3%). Changes in diet and withdrawal of food are discouraged by all CPGs, and early refeeding is strongly recommended in 13 of 15 (86.7%). Zinc is recommended as an adjunct to ORS by 10 of 15 (66.6%) CPGs, most of them from low-income countries. Probiotics are considered by 9 of 15 (60%) CPGs, 5 from high-income countries. Antiemetics are not recommended in 9 of 15 (60%) CPGs. Routine use of antibiotics is discouraged. CONCLUSIONS Key recommendations for the management of AGE in children are similar in CPGs. Together with accurate review of evidence-base this may represent a starting point for developing universal recommendations for the management of children with AGE worldwide.
Collapse
Affiliation(s)
- Andrea Lo Vecchio
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Jorge Amil Dias
- Departamento de Pediatria Médica, Hospital de São João, Porto, Portugal
| | | | - Chris Boey
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mitchell B. Cohen
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | | | - Ilaria Liguoro
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | | | - Bhupinder Sandhu
- Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Philip Sherman
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Alfredo Guarino
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| |
Collapse
|
41
|
Epidemiological trends for hospital admissions for acute rotavirus gastroenteritis in Belgium following the introduction of routine rotavirus vaccination and the subsequent switch from lyophilized to liquid formulation of Rotarix™. Epidemiol Infect 2016; 144:3017-3024. [PMID: 27373141 PMCID: PMC5080678 DOI: 10.1017/s0950268816001151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study describes epidemiological trends for acute rotavirus gastroenteritis (RVGE) in Belgium in children aged ⩽5 years during the period June 2007 to May 2014 after the introduction of routine rotavirus (RV) vaccination. This period encompassed the switch from lyophilized to the liquid formulation of Rotarix™ (GlaxoSmithKline, Belgium) in August 2011. Uptake of RV vaccine remained consistently high throughout the study period with Rotarix the brand most often used. RV was present in 9% (1139/12 511) of hospitalized cases with acute gastroenteritis included in the study. Epidemiological trends for hospital admissions for RVGE remained consistent throughout the study period, with no evidence of any change associated with the switch from lyophilized to liquid formulation of Rotarix. This suggests both formulations perform similarly, with the liquid formulation not inferior regarding ability to reduce hospital admissions for acute RVGE in children aged ⩽5 years. A strong seasonal effect was observed with most RVGE occurring in the winter months but with some variability in intensity, with highest incidence found in those aged 6–24 months. The main observation was the decreased number of hospital admissions for RVGE in Belgium that occurred during winter 2013/2014.
Collapse
|
42
|
Gan ZK, Jin H, Li JX, Yao XJ, Zhou Y, Zhang XF, Zhu FC. Disease burden of enterovirus 71 in rural central China: A community-based survey. Hum Vaccin Immunother 2016; 11:2400-5. [PMID: 26158689 DOI: 10.1080/21645515.2015.1059980] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
In recent years, the epidemics of hand, foot, and mouth disease (HFMD) centered in the Asian-Pacific region have been characterized by high morbidity and mortality. Enterovirus 71 (EV71) infections were responsible for the majority of the infections leading to severe cases of HFMD and death. This is a community-based survey aimed to estimate the disease burden of EV71 in rural central China, especially for HFMD. From 2011 to 2013, demographic and socio-economic data were gathered from 343 ill children and their parents using a structured questionnaire. We quantified the health burden of disease resulting from EV71 infection in disability-adjusted life years (DALYs). Among 343 cases, 303 had confirmed HFMD, 6 presented with herpangina, 25 presented with respiratory symptoms, and 9 presented with non-specific symptoms. The number of severe cases was 47 (including 1 death) and all of these presented with HFMD. The total cost per patient for severe HFMD, mild HFMD, herpangina, respiratory disease, and non-specific disease was $2149.47, $513.22, $53.28, $31.95, and $39.25, respectively. The overall cost of EV71-related diseases as a proportion of local farmers' per capita net income ranged from 0.18% for those with non-specific disease to 187.12% for those with severe HFMD. The loss of DALYs for the 5 forms of disease were 3.47, 1.76, 1.07, 1.44, 1.22 person-years per 1000 persons, respectively. This study provides data on cost of treatment and health burden for diseases caused by EV71, which can be used in the evaluation of EV71 vaccine cost-effectiveness.
Collapse
Affiliation(s)
- Zheng-kai Gan
- a School of Public Health; Southeast University ; Nanjing , Jiangsu Province , PR China
| | - Hui Jin
- a School of Public Health; Southeast University ; Nanjing , Jiangsu Province , PR China
| | - Jing-xin Li
- b Jiangsu Provincial Center for Disease Control and Prevention ; Nanjing , Jiangsu Province , PR China
| | - Xue-jun Yao
- c School of Public Health; Nanjing Medical University ; Nanjing , Jiangsu Province , PR China
| | - Yang Zhou
- a School of Public Health; Southeast University ; Nanjing , Jiangsu Province , PR China
| | - Xue-feng Zhang
- b Jiangsu Provincial Center for Disease Control and Prevention ; Nanjing , Jiangsu Province , PR China
| | - Feng-cai Zhu
- b Jiangsu Provincial Center for Disease Control and Prevention ; Nanjing , Jiangsu Province , PR China
| |
Collapse
|
43
|
Jabeen F. Detection of rotavirus infection in an era of vaccination. J Hosp Infect 2016; 93:115-6. [DOI: 10.1016/j.jhin.2016.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 03/19/2016] [Indexed: 10/22/2022]
|
44
|
Gervasi G, Capanna A, Mita V, Zaratti L, Franco E. Nosocomial rotavirus infection: An up to date evaluation of European studies. Hum Vaccin Immunother 2016; 12:2413-8. [PMID: 27185183 PMCID: PMC5027725 DOI: 10.1080/21645515.2016.1183858] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Rotavirus (RV) is worldwide considered as the most important viral agent of acute gastroenteritis in children less than 5 y. Since 2006, the availability of anti-RV vaccines has deeply modified the incidence and economic burden of RV infection. In Europe, some countries have introduced an anti-RV vaccination program in the last 10 y. Although community acquired RV (CARV) disease is the most studied condition of RV infection, recently some authors have highlighted the importance of nosocomial RV (nRV) disease as an emerging public health issue. The aim of this review is to summarize the epidemiology of both CARV and nRV, in order to discuss the difficulty of a clear evaluation of the burden of the disease in absence of comparable data. In particular, we focused our attention to European studies regarding nRV in terms of divergences related to definition, report of incidence rate and methodological issues.
Collapse
Affiliation(s)
- G Gervasi
- a Specialization School for Hygiene and Preventive Medicine , University of Rome Tor Vergata , Rome , Italy
| | - A Capanna
- a Specialization School for Hygiene and Preventive Medicine , University of Rome Tor Vergata , Rome , Italy
| | - V Mita
- b Department of Biomedicine and Prevention , University of Rome Tor Vergata , Rome , Italy
| | - L Zaratti
- b Department of Biomedicine and Prevention , University of Rome Tor Vergata , Rome , Italy
| | - E Franco
- b Department of Biomedicine and Prevention , University of Rome Tor Vergata , Rome , Italy
| |
Collapse
|
45
|
Standaert B, Alwan A, Strens D, Raes M, Postma MJ. Improvement in hospital Quality of Care (QoC) after the introduction of rotavirus vaccination: An evaluation study in Belgium. Hum Vaccin Immunother 2016; 11:2266-73. [PMID: 25902371 PMCID: PMC4635727 DOI: 10.1080/21645515.2015.1029212] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
During each winter period hospital emergency rooms and pediatric wards are often overwhelmed by high patient influx with infectious diseases leading to chaotic conditions with poor quality of care (QoC) delivery as a consequence. The conditions could be improved if we were able to better control the influx by introducing for instance better prevention strategies against some of the most frequent infectious diseases. New prevention strategies using vaccination against rotavirus infection were introduced in Belgium in November 2006. We developed a measure of hospital QoC suitable for assessing the impact of pediatric rotavirus vaccination. The study is retrospective collecting routine data on bed and staff management in one pediatric hospital in Belgium. The data were divided in pre- and post-vaccination periods during rotavirus-epidemic and non-epidemic periods. The scores were constructed using Explanatory Factor Analysis (EFA). All patients enrolled were admitted to the pediatric ward over the period from 1 January 2004 to 31 December 2009. The results of the epidemic period indicated that bed-day occupancy, bed-day turnover and unplanned readmissions for acute gastroenteritis were lower in the post-vaccination compared with the pre-vaccination periods. The QoC scores were therefore significantly lower (indicating improved QoC) after the introduction of rotavirus vaccination, compared with pre-vaccination. The data suggests that the reduction in the winter peak of rotavirus-related hospitalizations after the introduction of the vaccine reduces pressure on hospital resources and improves the quality of hospital care. The findings should be further tested in similar settings.
Collapse
|
46
|
Hullegie S, Bruijning-Verhagen P, Uiterwaal CSPM, van der Ent CK, Smit HA, de Hoog MLA. First-year Daycare and Incidence of Acute Gastroenteritis. Pediatrics 2016; 137:peds.2015-3356. [PMID: 27244798 DOI: 10.1542/peds.2015-3356] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Daycare attendance has been associated with increased acute gastroenteritis (AGE) incidence in the first years of life. We investigated the effects of first-year daycare attendance on AGE incidence and primary care contact rate up to age 6 years. METHODS Children enrolled in the Wheezing Illnesses Study Leidsche Rijn cohort were managed until age 6 years. Data on primary care diagnosed AGE episodes and number of associated contacts per episode were collected from health records. Children were categorized according to first year daycare attendance and age-month at entry when applicable. Generalized estimating equations were used to assess associations between first-year daycare and AGE incidence or primary care contact rate. RESULTS A total of 1344 out of 2220 children (83%) attended daycare before age 1 year. Overall, the 6-year primary care AGE incidence rate (IR) among first-year daycare attendees and nonattendees was comparable (IR: 12.2/100 vs 13.3/100 child-years). First-year daycare attendees had a higher AGE incidence during the first year (IRR: 1.13; 95% confidence interval: 1.06-1.21) and lower during the third to sixth year of age compared with nonattendees (P < .001). The daycare-associated increase in AGE incidence was most pronounced during the first 12 months after enrollment into daycare and demonstrated clear seasonality. A similar pattern was observed for primary care contact rate per AGE episode. CONCLUSIONS First-year daycare attendance advances the timing of AGE infections, resulting in increased AGE disease burden in the first year and relative protection thereafter. Protection against AGE infection persists at least up to age 6 years. Future studies should address whether this protective effect persists during later childhood.
Collapse
Affiliation(s)
| | - Patricia Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, and National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | | | - Cornelis K van der Ent
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; and
| | | | | |
Collapse
|
47
|
Shioda K, Cosmas L, Audi A, Gregoricus N, Vinjé J, Parashar UD, Montgomery JM, Feikin DR, Breiman RF, Hall AJ. Population-Based Incidence Rates of Diarrheal Disease Associated with Norovirus, Sapovirus, and Astrovirus in Kenya. PLoS One 2016; 11:e0145943. [PMID: 27116458 PMCID: PMC4845984 DOI: 10.1371/journal.pone.0145943] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 12/10/2015] [Indexed: 12/22/2022] Open
Abstract
Background Diarrheal diseases remain a major cause of mortality in Africa and worldwide. While the burden of rotavirus is well described, population-based rates of disease caused by norovirus, sapovirus, and astrovirus are lacking, particularly in developing countries. Methods Data on diarrhea cases were collected through a population-based surveillance platform including healthcare encounters and household visits in Kenya. We analyzed data from June 2007 to October 2008 in Lwak, a rural site in western Kenya, and from October 2006 to February 2009 in Kibera, an urban slum. Stool specimens from diarrhea cases of all ages who visited study clinics were tested for norovirus, sapovirus, and astrovirus by RT-PCR. Results Of 334 stool specimens from Lwak and 524 from Kibera, 85 (25%) and 159 (30%) were positive for norovirus, 13 (4%) and 31 (6%) for sapovirus, and 28 (8%) and 18 (3%) for astrovirus, respectively. Among norovirus-positive specimens, genogroup II predominated in both sites, detected in 74 (87%) in Lwak and 140 (88%) in Kibera. The adjusted community incidence per 100,000 person-years was the highest for norovirus (Lwak: 9,635; Kibera: 4,116), followed by astrovirus (Lwak: 3,051; Kibera: 440) and sapovirus (Lwak: 1,445; Kibera: 879). For all viruses, the adjusted incidence was higher among children aged <5 years (norovirus: 22,225 in Lwak and 17,511 in Kibera; sapovirus: 5,556 in Lwak and 4,378 in Kibera; astrovirus: 11,113 in Lwak and 2,814 in Kibera) compared to cases aged ≥5 years. Conclusion Although limited by a lack of controls, this is the first study to estimate the outpatient and community incidence rates of norovirus, sapovirus, and astrovirus across the age spectrum in Kenya, suggesting a substantial disease burden imposed by these viruses. By applying adjusted rates, we estimate approximately 2.8–3.3 million, 0.45–0.54 million, and 0.77–0.95 million people become ill with norovirus, sapovirus, and astrovirus, respectively, every year in Kenya.
Collapse
Affiliation(s)
- Kayoko Shioda
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Oak Ridge Institute for Science and Technology, Oak Ridge, Tennessee, United States of America
- * E-mail:
| | - Leonard Cosmas
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Allan Audi
- Kenya Medical Research Institute, Center for Global Health Research, Nairobi, Kenya
| | - Nicole Gregoricus
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jan Vinjé
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Umesh D. Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joel M. Montgomery
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Daniel R. Feikin
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Robert F. Breiman
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Aron J. Hall
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
48
|
Abstract
BACKGROUND Norway has initiated a publicly funded rotavirus immunization program for all age-eligible children in 2014. We aimed to estimate the healthcare costs of rotavirus gastroenteritis in children younger than 5 years old. METHODS We identified all gastroenteritis cases in children younger than 5 years old treated during 2009-2013 through the national claims database for primary care and the national hospital registry. We estimated direct medical costs of rotavirus-associated primary care consultations and hospital encounters (inpatient admission, outpatient visit and ambulatory care). We performed a range of one-way sensitivity analyses to explore uncertainty in the cost estimates. RESULTS Before vaccine introduction, the mean healthcare cost of rotavirus gastroenteritis in children younger than 5 years old was €4,440,337 per year. Among rotavirus-associated costs, 92% were hospital costs and the remaining 8% were primary care costs. The mean annual cost of rotavirus-associated hospital encounters was €4,083,691, of which 95% were costs of inpatient hospital admissions. The average healthcare cost of medically attended gastroenteritis in children younger than 5 years old was approximately €8 million per year, of which rotavirus-related costs represented 56%. CONCLUSIONS Healthcare costs of rotavirus gastroenteritis in Norway are substantial. The cost-effectiveness of ongoing rotavirus immunization program should be reassessed.
Collapse
|
49
|
Disidratazione acuta da gastroenterite nei lattanti. EMC - URGENZE 2016. [PMCID: PMC7158998 DOI: 10.1016/s1286-9341(16)76183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Il bambino sotto 1 anno e, soprattutto, di meno di 6 mesi è ad alto rischio di disidratazione, la cui causa principale è una gastroenterite acuta, soprattutto di origine virale. La gestione di una disidratazione da gastroenterite ha due componenti: la sua correzione e il rapido ripristino della normale perfusione tissutale e il mantenimento dei fabbisogni di acqua e di nutrienti, per limitare al massimo il deficit energetico. La valutazione della gravità della disidratazione è l’elemento chiave che guiderà la terapia. La perdita di peso, espressa in percentuale di peso corporeo prima dell’episodio di disidratazione, è il metodo di riferimento, ma è spesso difficile o impossibile da ottenere. Inoltre, i segni clinici, come l’alterazione dell’aspetto generale, l’allungamento del tempo di riempimento capillare, il riconoscimento di una plica cutanea persistente, gli occhi infossati, una secchezza delle mucose e la mancanza di lacrime, sono i principali elementi che permettono di valutare la gravità della disidratazione. Il trattamento si basa sulla rapida correzione del deficit del settore extracellulare. Un’espansione volemica di 20 ml/kg di una soluzione isotonica somministrata per via endovenosa o intraossea può essere necessaria nella fase iniziale nei casi più gravi (disidratazione > 10%). In tutti gli altri casi, la reidratazione per via orale per correggere il deficit di acqua in 4-6 ore è la tecnica di scelta, che si è dimostrata efficace, sicura e veloce. Essa utilizza delle soluzioni di reidratazione adattate che soddisfano criteri specifici. Il loro utilizzo precoce è la prevenzione più efficace delle forme gravi. L’allattamento al seno non deve essere interrotto e l’alimentazione artificiale deve essere ripresa da 4 a 6 ore dopo l’inizio della reidratazione. La vaccinazione contro i rotavirus prima dei 6 mesi è fortemente raccomandata.
Collapse
|
50
|
Michałek D, Kołodziej M, Konarska Z, Szajewska H. Efficacy and safety of gelatine tannate for the treatment of acute gastroenteritis in children: protocol of a randomised controlled trial. BMJ Open 2016; 6:e010530. [PMID: 26895988 PMCID: PMC4762119 DOI: 10.1136/bmjopen-2015-010530] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Worldwide, acute gastroenteritis in children, usually caused by viruses, leads to considerable morbidity and mortality. The treatment is aimed at preventing and treating dehydration, promoting weight gain after rehydration, and reducing the duration and severity of diarrhoea. Effective and inexpensive interventions that could add to the effect of oral rehydration therapy are of interest. Recently, in many European countries, gelatine tannate is being widely marketed for treating acute gastroenteritis. Gelatine tannate is a complex of tannic acid, which possesses astringent and anti-inflammatory properties, and a protective gelatine. Currently, there is no evidence to support the use of gelatine tannate for treating acute gastroenteritis in children and only scant evidence to support the use of gelatine tannate in adults. We aim to assess the efficacy of gelatine tannate for the treatment of acute gastroenteritis in children. METHODS AND ANALYSIS This will be a blind, placebo-controlled, randomised trial. Children younger than 5 years of age with acute gastroenteritis defined as a change in stool consistency to loose or liquid form (according to the Bristol Stool Form scale or Amsterdam Stool Form scale) and/or an increase in the frequency of evacuations (typically ≥ 3 in 24 h), lasting for no longer than 5 days, will be recruited. A total of 72 children will be randomised to receive either gelatine tannate (children younger than 3 years of age will receive 250 mg, 4 times/day, and those older than 3 years of age will receive 500 mg, 4 times/day) or matching placebo for 5 days. The primary outcome measure is the duration of diarrhoea. ETHICS AND DISSEMINATION The Bioethics Committee approved the study protocol. The findings of this trial will be submitted to a peer-reviewed paediatric journal. Abstracts will be submitted to relevant national and international conferences. TRIAL REGISTRATION NUMBER NCT02280759; Pre-results.
Collapse
Affiliation(s)
- Dorota Michałek
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Maciej Kołodziej
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Zofia Konarska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|