Rotavirus in pediatric gastroenteritis in Nicaraguan children

Rotavirus, the most common diarrheic pathogen in children worldwide, causes approximately one third of diarrhea-associated hospitalizations and 800,000 deaths per year. To prevent the enormous health burden of rotavirus-associated disease is a global public health goal developed as well as implementation of safe and effective vaccines to be used in developing countries.

We examined the epidemiology and disease burden of rotavirus diarrhea among hospitalized and outpatient children in Leon, Nicaragua, through several studies carried out from 1991 to 2003. Rotavirus was detected in 28-40% of children hospitalized for diarrhea and in 15% who were treated as outpatients. The mean age distribution of children hospitalized with rotavirus diarrhea, varied from 9.2 months in 1994 to 14 months in 2002-2003. Overall median duration of hospitalization was two days. Rotavirus was detected year-round but generally exhibited seasonal peaks during the dry months (February to June).

In our material, collected during 2001 to 2003, rotavirus strains of serotype G1 P[8] were the predominant, followed by G2 P[4] and G3 P[8], G4 P[6] and 4% were uncommon strains. A shift for G types was observed; genotype G2 was the most prevalent during 2001 (70%) but decreased in 2002 when the predominating genotype became G1 (75%). The G3 genotype, which was not detected in 2001, emerged late in 2002 and was the most dominant strain in 2003 (59%).

The health care costs of rotavirus diarrhea hospitalization were estimated through the register of hospital stay (bed day), the cost of the treatment and laboratory services, and additional expenses by the parents. The mean total costs including the costs paid by the family and by the Health Ministry sources were calculated to USD 117.4 per child hospitalized with rotavirus diarrhea. However, children with rotavirus negative stools spent longer time in hospital compared to children whose stools were positive (3.6 versus 2.9 days), and the calculated costs for these children rose to USD 147.9.

Overall, among the total population less than 3 years of age in Nicaragua, we estimated that 2,603 cases of hospitalization due to rotavirus associated diarrhea occurs per year in Nicaragua, a disease burden which represents a cost of more than USD 270,000 from the Health care sources. If all cases of severe diarrhea are considered, including other etiologies of gastroenteritis, the total cost burden amounts to more than USD 800,000, a sum that represents around 0.6 % of the total budget of the national Health care sources. Besides, the total cost for these parents was estimated to amount to further USD 90,000.

Our results confirm that rotavirus is the most important cause of severe diarrhea in Nicaragua and represent an important disease burden in hospital costs. A rotavirus, vaccine program should be of considerable benefit to prevent these severe cases.

List of scientific papers

I. Espinoza F, Paniagua M, Hallander H, Svensson L, Strannegard O (1997). "Rotavirus infections in young Nicaraguan children. " Pediatr Infect Dis J 16(6): 564-71
https://pubmed.ncbi.nlm.nih.gov/9194106

II. Espinoza F, Paniagua M, Hallander H, Hedlund KO, Svensson L (1997). "Prevalence and characteristics of severe rotavirus infections in Nicaraguan children. " Ann Trop Paediatr 17(1): 25-32
https://pubmed.ncbi.nlm.nih.gov/9176574

III. Lovmar L, Fock C, Espinoza F, Bucardo F, Syvanen AC, Bondeson K (2003). "Microarrays for genotyping human group a rotavirus by multiplex capture and type-specific primer extension. " J Clin Microbiol 41(11): 5153-8
https://pubmed.ncbi.nlm.nih.gov/14605152

IV. Espinoza F, Bucardo F, Paniagua M, Hallander H, Svensson L, Bondeson K (2004). "Shift of rotavirus in Nicaragua 2001-2003." (Manuscript)

V. Espinoza F, Paniagua M, Bucardo F, Argeñal H, Tercero F, Svensson L, Mollby R, Hallander H (2004). "Rotavirus disease burden in Nicaraguan children." (Submitted)