THE BURDEN OF ROTAVIRUS GASTROENTERITIS, AS THE RATIONALE FOR ROUTINE VACCINATION
Authors: KHARIT S M. , BEKHTEREVA M. K. , LOBZIN J. V. , RUDAKOVA A. V. , PODKOLZIN A. T. , TIKUNOVA N. V. 
Published: May 2017

Rotavirus infection is the second after pneumococcal cause in the incidence of diseases and mortality in children under 5 years. That has defined the who’s recommendation for the introduction of vaccination against rotavirus infection in the vaccination schedules of all countries of the world. In our country that vaccination recommended for epidemic indications for introduction into the regional program. However, vaccination is carried out only in certain regions. One of the reasons for low uptake of this vaccine is the underestimation of the burden of disease.

The aim the study.To assess the significance of rotavirus gastroenteritis in the structure of acute gastroenteritis in children under 5 years receiving treatment in outpatient clinics, to study the genetic diversity of rotaviruses, to compare the costs associated with the treatment of acute rotavirus and non-rotavirus gastroenteritis.

Methods.Prospective, observational, epidemiological study. The inclusion of participants under the age of 5 years with the symptoms of acute gastroenteritis who meet the criteria of inclusion/exclusion. Examination, medical history, samples of faeces were carried out in the first day of treatment (day of inclusion in the study). Parents were given a questionnaire for 14 days. The severity of the disease was determined according to the scale of Vesicare, the disease dynamics was assessed by the answers of the questionnaire. Examination of feces samples was carried out centrally by PCR. Rotavirus positive samples were genotypically PCR and in case of detection of rare genotypes have been sequenced genomic RNA.

Results.The study included 501 baby — boys — 286 (57,1%), girls — 215 (42,9%). The average age was 22.6 ± 15.2 months. 50 children (10.0 per cent) mentioned various background pathology, the others were deemed healthy. Rotavirus was diagnosed in 151 patients 31.4% (95% CI: 26.9 percent - 35.3 percent), which accounted 66,52% (151 of 227) among all cases with confirmed etiology. Genotyping was prevalent G1P [8] to 34.5%, and G4P[8] — 39,2%. Clinical manifestations in rotavirus gastroenteritis was more severe, severe course observed in 65.5% of cases in the comparison group -at 30.4%. Significantly more often than in the comparison group (Р χ2 < 0,001) was observed vomiting (140cases из151 — 93,3%, compared to 239 of 336 -71,1%) and elevated temperature (146 of 151 — 97,3% compared with 254 of 336 — 75,6%). The average temperature was 38,5 ± 0,6 OS in the comparison group — 38,0 ± 2,2 OS, remained 3,1 ± 1,4 and 2.5 ± 1.2 day, respectively. The frequency of episodes of diarrhoea in the first day of illness was 6.4 ± 2.7 times, in comparison with 5.2 ± 2.8, duration of diarrhea was 6.3 ± 3.2 days and 4.5 ± 2.6 days. The costs for parents of patients with acute rotavirus gastroenteritis was (M ± SD) 2873.4 ± 2276.4 rubles, against 2007.4 ± 2150.4 rubles in the comparison group (t = 3.965; p= < 0,001, as amended by Starlite for inequality of variances).

Conclusion.The introduction of routine vaccination of children in the first year of life will reduce by more than a third of the number of appeals to medical institutions about intestinal infections and partially prevent the costs associated with the treatment of this pathology.