SUPPLEMENT
The Clinical Burden of Rotavirus Disease
Retrospective Analysis of Infant and Childhood Gastroenteritis in
Seven Countries in Central and Eastern Europe
Zso´fia Me´szner, MD, PhD,* A
´
gnes Balogh, MSc,* Krisztia´n Ba´nyai, PhD,† Jo´zsef Kova´cs, MD, PhD,‡
Petr Pazdiora, MD, PhD,§ Jacek Mrukowicz, MD, PhD, Ge´za Molna´r, MD, PhD,¶
Vladimir Tatochenko, MD,# Maria Avdicova, MD, PhD,** and Alenka Kraigher, MD, PhD†
Background: Rotavirus (RV) is the leading cause of acute gastro-
enteritis (GE) among infants and young children worldwide. How-
ever, little is currently known concerning the specific burden of
RVGE in Central and Eastern Europe (CEE). This study was
undertaken to asses the burden of RVGE among children aged 5
years in 7 CEE countries (Czech Republic, Hungary, Poland, Ro-
mania, Russia, Slovakia, and Slovenia).
Methods: Data relating to the incidence of total GE and RVGE
(including associated hospitalizations and mortality) were retrospec-
tively collected between 1998 and 2003 and analyzed individually
for each country and collectively using the ‘pyramid’ model of
disease burden established by Parashar.
Results: Although limited by differences in methods of reporting
and data collection between countries, available data clearly dem-
onstrate the clinical significance of RVGE in CEE. RV accounts for
up to 55.3% of all GE hospitalizations in children aged 5 years in
this region. G1 seems to be the most common circulating RV type,
followed by G3 and G9. Death caused by RV is rare in CEE,
reflecting appropriate disease management. Although specific health
economic data are lacking, the high rate of hospitalization caused by
RVGE in CEE countries is likely to be associated with significant
direct and indirect public health costs.
Conclusion: Prevention of RV disease through routine childhood
vaccination would be expected to reduce the substantial burden of
acute GE disease among infants and young children in CEE, pri-
marily through a reduction in the number of RV-related hospital-
izations, with associated reductions in both medical and social costs.
Key Words: rotavirus, gastroenteritis, diarrhea, disease burden,
Central and Eastern Europe
(Pediatr Infect Dis J 2008;27: S33–S41)
A
cute diarrhea in infancy and early childhood is one of the
most important public health challenges worldwide.
1
Although mortality has substantially decreased in developed
countries since the early 1980s, diarrhea remains a leading
cause of death in young children in the developing world.
2
Rotavirus (RV) is the most common cause of gastroenteritis
(GE) among infants and young children,
3–5
with recent esti-
mates suggesting that RV infections lead to as many as 39%
of all childhood diarrhea-related hospitalizations and 611,000
childhood diarrhea-related deaths globally each year.
4
Vac-
cination is considered the most effective public health strat-
egy to prevent RV infection and reduce disease burden, and
development of safe and effective vaccines to reduce the
morbidity and mortality caused by RVGE in children has
been given a high priority by the World Health Organisation.
5
Two new RV vaccines have now been licensed or are nearing
licensure in many parts of the world—a live attenuated
G1P8 human RV vaccine (Rotarix; GlaxoSmithKline Bio-
logicals, Rixensart, Belgium), licensed in Europe and more
than 60 other countries around the world,
6
and a pentavalent
live human-bovine reassortant vaccine (Rotateq; Merck &
Co., Whitehouse Station, NJ) licensed in the United States,
Europe, and Australia.
7
It is important to determine the burden of RVGE in
specific countries and regions to guide future recommenda-
tions for RV vaccine use. Studies have been undertaken to
analyze the clinical and economical burden of RVGE in both
developed and developing countries,
3–5
with recent data high-
lighting the significant public health burden associated with
RVGE within the European Union (EU).
8 –11
Little is cur-
rently known concerning the specific burden of RVGE in
Central and Eastern Europe (CEE). Although public health
systems in CEE are traditionally well organized, data collect-
ing and reporting methods are often biased by insufficient or
outdated infrastructure and logistics. Furthermore, although
financial resources (eg, gross domestic product per capita)
vary considerably between countries in this region, these are
generally an order of magnitude lower than in North America
From the *National Institute of Child Health (OGYEI), Szent La´szlo´ Hos-
pital for Infectious Diseases, Budapest, Hungary; †Institute of State
Public Health Service, Baranya County, Hungary; ‡GlaxoSmithKline
Biologicals, Hungary; §Institute of Epidemiology, Medical Faculty of
Charles University, Plzenˇ , Czech Republic; Polish Institute for Evidence
Based Medicine, Krakow, Poland; ¶Institute of Public Health, Cluj,
Romania; #Central Institute of Epidemiology, Moscow, Russia; **De-
partment of Epidemiology, Regional Office of Public Health, Banska
Bystrica, Slovakia; and ††Institute of Public Health, Ljubljana, Slovenia.
Support was provided by GlaxoSmithKline Biologicals for data analysis and
manuscript preparation.
Address for correspondence: Zso´ fia Me´szner, MD, PhD, National Institute of
Child Health, 64 Dioszegi ut Budapest, Hungary H-1113. E-mail:
zsmeszner@ogyei.hu.
Copyright © 2007 by Lippincott Williams & Wilkins
ISSN: 0891-3668/08/2701-0033
DOI: 10.1097/INF.0b013e31815eee3b
The Pediatric Infectious Disease Journal • Volume 27, Number 1, January 2008 S33