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Current Trends Rotavirus Surveillance -- United States, 1989-1990

Rotavirus infection is the most common cause of dehydrating diarrhea in children in the United States (1). In January 1989, CDC established a National Rotavirus Surveillance System (NRSS) to monitor national patterns in the epidemiology of rotavirus. This report summarizes findings from the NRSS from January 1989 through November 1990.

In January 1989, 99 laboratories began submitting monthly reports of positive detections, numbers of specimens tested, and laboratory methods used to detect rotavirus. Of those laboratories, 72 in 48 states also provided retrospective data for 1984-1988; these data indicate a temporal and geographic sequence of peaks in reported positive detections that begins in the southwest in November and ends in the northeast in March (2).

From January 1989 through November 1990, 56 laboratories submitted reports every month; they included 12 pediatric, 17 community, and 23 university hospital laboratories; two public health laboratories; and two commercial laboratories. To detect rotavirus, most (46 (82%)) of these laboratories used enzyme immunoassay techniques, four used a latex agglutination test, and six used electron microscopy.

For the 23-month period, 48,035 specimens were tested for rotavirus; 9639 (20%) were positive. The total number of specimens tested each month varied from 1410 in September 1990 to 3275 in January 1990. For all centers combined, the percentage of positive specimens was highest in February 1990 (1056 (36%) of 2925) and lowest in October 1990 (103 (6%) of 1817) (Figure 1).

October 1989 through May 1990 was the first full rotavirus season for prospective surveillance in the United States. During that period, peaks in the positive detection rate varied by region, beginning in December in the West (36% positive detections), January-February in the South (32%-33%), February in the North Central (49%), and March in the Northeast (47%). By June, no region had more than 16% positive detections, and three of the four regions had less than 10% positive detections. For the 1990-91 rotavirus season, an increase in positive detections was reported in the West during November 1990 (positive rate of 21%) when compared with August-October (1%-4%). Reported by: National Rotavirus Surveillance System laboratories. Viral Gastroenteritis Section, Respiratory and Enteric Virus Br, Div of Viral and Rickettsial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Rotavirus, the most important cause of pediatric gastroenteritis in the United States, is responsible for an estimated one third of all hospitalizations for diarrhea in children less than 5 years of age (3). These hospitalizations occur predominantly in the winter, and in one large children's hospital, rotavirus accounted for 3% of all hospital days (4). Rotavirus disease-associated hospitalization rates are highest for children less than 2 years of age (3,4).

From 1979 through 1985, an average of 500 children died annually from diarrheal disease in the United States (5); an estimated 20% of these deaths were caused by rotavirus infection (3). Death rates for diarrheal disease were highest in the South and among black children less than 6 months of age (5). Patterns of childhood mortality related to diarrheal disease reflect the winter seasonality of rotavirus (3).

Because national rotavirus surveillance data suggest an increase in the risk for rotavirus infections from October through May, health-care providers should consider rotavirus as a cause of diarrhea in groups at risk and be familiar with approaches for management of this disease. Many deaths and hospitalizations may be prevented by the aggressive use of oral rehydration therapy, which is underused (6-8). Vaccines for prevention or modification of rotavirus diarrhea are under development but are unlikely to be available for 3-5 years.

For most children hospitalized with rotavirus gastroenteritis, no laboratory diagnosis is made (4), and only a small number of deaths from rotavirus infection have been virologically confirmed (9). Because the ninth revision of the International Classification of Diseases (ICD) did not include a rubric for rotavirus enteritis, proxy codes (3-5) were used to reflect this cause of death; however, the 10th revision will introduce a specific rubric (National Center for Health Statistics, unpublished data). The wider use of rapid diagnostic tests for rotavirus, combined with the use of a specific ICD rubric, will permit improved surveillance of rotavirus hospitalizations and deaths.

References

  1. Kapikian AZ, Chanock RM. Rotaviruses. In: Fields BN, Knipe DM, Chanock RM, Hirsch MS, Melnick JL, Monath TP, eds. Virology. Vol 2. 2nd ed. New York: Raven Press, 1990:1353-404.

  2. LeBaron CW, Lew J, Glass RI, et al. Annual rotavirus epidemic patterns in North America: results of a 5-year retrospective survey of 88 centers in Canada, Mexico, and the United States. JAMA 1990;264:983-8.

  3. Ho MS, Glass RI, Pinsky PF, Anderson LJ. Rotavirus as a cause of diarrheal morbidity and mortality in the United States. J Infect Dis 1988;158:1112-6.

  4. Matson DO, Estes MK. Impact of rotavirus infection at a large pediatric hospital. J Infect Dis 1990;162:598-604.

  5. Ho MS, Glass RI, Pinsky PF, et al. Diarrheal deaths in American children: are they preventable? JAMA 1988;260:3281-5.

  6. Santosham M, Daum RS, Dillman L, et al. Oral rehydration therapy of infantile diarrhea: a controlled study of well-nourished children hospitalized in the United States and Panama. N Engl J Med 1982;306:1070-6.

  7. Avery ME, Snyder JD. Oral therapy for acute diarrhea: the underused simple solution. N Engl J Med 1990;323:891-4.

  8. Mauer AM, Dweck HS, Finberg L, et al. American Academy of Pediatrics Committee on Nutrition: use of oral fluid therapy and posttreatment feeding following enteritis in children in a developed country. Pediatrics 1985;75:358-61.

  9. Carlson JAK, Middleton PJ, Szymanski MT, Huber J, Petric M. Fatal rotavirus gastroenteritis: an analysis of 21 cases. Am J Dis Child 1978;132:477-9.



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