The Experts below are selected from a list of 309 Experts worldwide ranked by ideXlab platform
Timo Vesikari - One of the best experts on this subject based on the ideXlab platform.
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Human bocavirus types 1, 2 and 3 in acute Gastroenteritis of childhood.
Acta Paediatrica, 2012Co-Authors: Minna Risku, Suvi Lappalainen, Sirpa Rasanen, Minna Kätkä, Timo VesikariAbstract:Aim: Recently identified human bocavirus (HBoV) types 2 and 3 have been associated with acute Gastroenteritis in children. We studied 878 stool specimens from children with acute Gastroenteritis and 112 controls (43 children with unspecified fever, 33 with respiratory tract infection and 36 healthy children) for known HBoVs. The same specimens were previously studied for rotaviruses, noroviruses, sapoviruses, adenoviruses, coronaviruses and aichivirus. Methods: HBoVs were detected by PCR and positive amplicons were sequenced to identify HBoV1, HBoV2, HBoV3 and HBoV4. Results: HBoV of any type was found in 85 (9.7%) cases of acute Gastroenteritis and in 6 (5.4%) controls. HBoV1 was detected in 49 (5.6%) cases and 2 (1.8%) controls, HBoV2 in 29 (3.3%) cases and 2 (1.8%) controls and HBoV3 in 8 (0.9%) cases and 2 (1.8%) controls. No HBoV4 was found. HBoV as a single infection was found in 16 (1.8%) cases and in 6 (5.4%) controls; in the remaining cases, a known Gastroenteritis virus was also found. Among the single HBoV infections, HBoV2 was the most common type with 8 (50%) cases. Conclusion: HBoVs are rarely found alone in children with acute Gastroenteritis. Further studies are warranted to confirm a possible specific association of HBoV2 with Gastroenteritis.
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noroviruses as a major cause of acute Gastroenteritis in children in finland 2009 2010
Scandinavian Journal of Infectious Diseases, 2011Co-Authors: Leena Puustinen, Sirpa Rasanen, Vesna Blazevic, Marjo Salminen, Minna Hamalainen, Timo VesikariAbstract:AbstractNoroviruses are, after rotaviruses, the second most common cause of acute Gastroenteritis in young children. In a prospective study conducted in 2009–2010 at the Tampere University Hospital, 195 stool specimens were collected from cases of acute Gastroenteritis in children and examined for noroviruses, sapoviruses, and rotaviruses, using a reverse transcriptase polymerase chain reaction (RT-PCR). Noroviruses were found in 49 (25%) of the cases and sapoviruses in 12 (6%). The norovirus genotype GII.4 dominated with a 76% share; other genotypes detected were GII.7/GII.6 (16%), GII.g/GII.12, GII.e/GII.4, and GII.7 (2% each). For comparison, 47 (24%) cases of rotavirus Gastroenteritis were diagnosed in the same period. In conclusion, after the introduction of rotavirus vaccination in Finland in September 2009, noroviruses have become as common as rotaviruses as the causative agents of acute Gastroenteritis in young children, and are likely to become the leading cause. Norovirus GII.4 continues to be t...
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Noroviruses as a major cause of acute Gastroenteritis in children in Finland, 2009–2010
Scandinavian Journal of Infectious Diseases, 2011Co-Authors: Leena Puustinen, Sirpa Rasanen, Vesna Blazevic, Marjo Salminen, Minna Hamalainen, Timo VesikariAbstract:AbstractNoroviruses are, after rotaviruses, the second most common cause of acute Gastroenteritis in young children. In a prospective study conducted in 2009–2010 at the Tampere University Hospital, 195 stool specimens were collected from cases of acute Gastroenteritis in children and examined for noroviruses, sapoviruses, and rotaviruses, using a reverse transcriptase polymerase chain reaction (RT-PCR). Noroviruses were found in 49 (25%) of the cases and sapoviruses in 12 (6%). The norovirus genotype GII.4 dominated with a 76% share; other genotypes detected were GII.7/GII.6 (16%), GII.g/GII.12, GII.e/GII.4, and GII.7 (2% each). For comparison, 47 (24%) cases of rotavirus Gastroenteritis were diagnosed in the same period. In conclusion, after the introduction of rotavirus vaccination in Finland in September 2009, noroviruses have become as common as rotaviruses as the causative agents of acute Gastroenteritis in young children, and are likely to become the leading cause. Norovirus GII.4 continues to be t...
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detection of human coronaviruses in children with acute Gastroenteritis
Journal of Clinical Virology, 2010Co-Authors: Minna Risku, Suvi Lappalainen, Sirpa Rasanen, Timo VesikariAbstract:Abstract Background Human coronaviruses (HCoVs) are known respiratory pathogens. Moreover, coronavirus-like particles have been seen by electron microscope in stools, and SARS-HCoV has been isolated from intestinal tissue and detected in stool samples. Objectives To find out if HCoVs can be found in stools of children with acute Gastroenteritis and to assess the significance of HCoVs in the etiology of acute Gastroenteritis in children. Study design 878 stool specimens from children with acute Gastroenteritis and 112 from control children were tested by RT-PCR to detect HCoV groups 1B, 2A and SARS. HCoVs were typed by sequencing all PCR positive samples. Results Twenty-two (2.5%) of the 878 stool specimens of children with acute Gastroenteritis were positive for HCoVs. The following HCoV types were detected: OC43 (10 cases, 45.5%), HKU1 (6 cases, 27.3%), 229E (2 cases, 9.1%) and NL63 (4 cases, 18.2%). In 4 of the cases a HCoV was the only detected virus; in the remaining cases rotavirus or norovirus was found in the same sample. In control groups there were two HCoV positive samples of 112 tested. Conclusions This study shows that all known non-SARS HCoVs can be found in stools of children with acute Gastroenteritis. On the basis of this study, the significance of coronaviruses as gastrointestinal pathogens in children appears minor, since most of the coronavirus findings were co-infections with known Gastroenteritis viruses.
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Aichi virus infection in children with acute Gastroenteritis in Finland.
Epidemiology and Infection, 2009Co-Authors: S. Kaikkonen, Sirpa Rasanen, Mika Rämet, Timo VesikariAbstract:Aichi virus has been proposed as a novel causative agent of acute Gastroenteritis. In addition to several Asian countries, South America and Africa, Aichi virus has also recently been found in Europe. Our objective was to study the causative role of Aichi virus in children with acute Gastroenteritis in Finland. We analysed 595 stool specimens from infants in an efficacy trial of rotavirus vaccine and 468 stool specimens from children in a hospital-based epidemiological and aetiological study of acute Gastroenteritis. The screening was done by nested reverse transcription-polymerase chain reaction amplifying a 519-bp segment and a 223-bp segment in the 3CD junction region of non-structural proteins. Aichi virus was detected in five stool samples (0.5%), of which four were co-infections with other Gastroenteritis viruses. Two Aichi virus genotypes, A and B, were found. Aichi virus appears to be rare in children with acute Gastroenteritis in Finland.
Benjamin A Lopman - One of the best experts on this subject based on the ideXlab platform.
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global prevalence of norovirus in cases of Gastroenteritis a systematic review and meta analysis
Lancet Infectious Diseases, 2014Co-Authors: Sharia M Ahmed, Aron J Hall, Anne E Robinson, Linda Verhoef, Prasanna Premkumar, Umesh D Parashar, Marion Koopmans, Benjamin A LopmanAbstract:Summary Background Despite substantial decreases in recent decades, acute Gastroenteritis causes the second greatest burden of all infectious diseases worldwide. Noroviruses are a leading cause of sporadic cases and outbreaks of acute Gastroenteritis across all age groups. We aimed to assess the role of norovirus as a cause of endemic acute Gastroenteritis worldwide. Methods We searched Embase, Medline, and Global Health databases from Jan 1, 2008, to March 8, 2014, for studies that used PCR diagnostics to assess the prevalence of norovirus in individuals with acute Gastroenteritis. We included studies that were done continuously for 1 year or more from a specified catchment area (geographical area or group of people), enrolled patients who presented with symptoms of acute Gastroenteritis, and used PCR-based diagnostics for norovirus on all stool specimens from patients with acute Gastroenteritis. The primary outcome was prevalence of norovirus among all cases of Gastroenteritis. We generated pooled estimates of prevalence by fitting linear mixed-effect meta-regression models. Findings Of 175 articles included, the pooled prevalence of norovirus in 187 336 patients with acute Gastroenteritis was 18% (95% CI 17–20). Norovirus prevalence tended to be higher in cases of acute Gastroenteritis in community (24%, 18–30) and outpatient (20%, 16–24) settings compared with inpatient (17%, 15–19, p=0·066) settings. Prevalence was also higher in low-mortality developing (19%, 16–22) and developed countries (20%, 17–22) compared with high-mortality developing countries (14%, 11–16; p=0·058). Patient age and whether the study included years of novel strain emergence were not associated with norovirus prevalence. Interpretation Norovirus is a key Gastroenteritis pathogen associated with almost a fifth of all cases of acute Gastroenteritis, and targeted intervention to reduce norovirus burden, such as vaccines, should be considered. Funding The Foodborne Disease Burden Epidemiology Reference Group (FERG) of WHO and the Government of the Netherlands on behalf of FERG.
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burden of norovirus Gastroenteritis in the ambulatory setting united states 2001 2009
The Journal of Infectious Diseases, 2013Co-Authors: Aron J Hall, Umesh D Parashar, Aaron T Curns, Paul A Gastanaduy, Benjamin A LopmanAbstract:Background. Gastroenteritis remains an important cause of morbidity in the United States. The burden ofnorovirus Gastroenteritis in ambulatory US patients is not well understood.Methods. Cause-specified and cause-unspecified Gastroenteritis emergency department (ED) and outpatientvisits during July 2001–June 2009 were extracted from MarketScan insurance claim databases. By using cause-specified encounters, time-series regression models were fitted to predict the number of unspecified Gastroenteritisvisitsdue tospecificpathogensother thannorovirus.Model residuals wereused toestimatenorovirusvisits.Market-Scan rates were extrapolated to the US population to estimate national ambulatory visits.Results. During 2001–2009, the estimated annual mean rates of norovirus-associated ED and outpatient visitswere 14 and 57 cases per 10000 persons, respectively, across all ages. Rates for ages 0–4, 5–17, 18–64, and ≥65years were 38, 10, 12, and 15 ED visits per 10000 persons, respectively, and 233, 85, 35, and 54 outpatientvisits per 10000 persons, respectively. Norovirus was estimated to cause 13% of all Gastroenteritis-associated am-bulatory visits, with ∼50% of such visits occurring during November–February. Nationally, norovirus contributedto approximately 400000 ED visits and 1.7 million office visits annually, resulting in $284 million in healthcarecharges.Conclusions. Norovirus is a substantial cause of Gastroenteritis in the ambulatory setting.Keywords. norovirus; Gastroenteritis; ambulatory care; United States.Noroviruses are the leading cause of acute gastroenter-itis (ie, diarrhea or vomiting) worldwide. The adventof molecular assays have shown that noroviruses arethe leading cause of foodborne disease [1], are respon-sible for approximately half of all Gastroenteritis out-breaks [2], and are the leading cause of sporadicGastroenteritis across all ages [3,4].In the United States, noroviruses are estimated to cause21 million episodes of Gastroenteritis every year [1 ]andare increasingly recognized as a cause of severe disease,leading to an estimated 71000 hospitalizations [ 5] and800 deaths annually [6].However, the absence of sensi-tive diagnostic tests in clinical settings has precluded acomprehensive description of the US norovirus diseaseburden. Notably, the contribution of norovirus to gas-troenteritis in the ambulatory setting is sparsely char-acterized. The few studies estimating the incidence ofnorovirus-associated outpatient visits across all ages inEurope and the United States have yielded rates of 40–640 cases per 10000 persons [3,7–9].An improved understanding of the role of norovirusamong healthcare encounters for Gastroenteritis hasimportant implications for the practice and develop-ment of preventive strategies (eg, infection controlmeasures and vaccines) and could help guide clinicalmanagement (eg, antibiotics vs rehydration therapy).Our objective was to assess the contribution of norovi-rus to Gastroenteritis-associated ambulatory visits inthe United States, including both ED and outpatientvisits, across all ages and to provide estimates of thenational burden.
Aaron T Curns - One of the best experts on this subject based on the ideXlab platform.
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burden of norovirus Gastroenteritis in the ambulatory setting united states 2001 2009
The Journal of Infectious Diseases, 2013Co-Authors: Aron J Hall, Umesh D Parashar, Aaron T Curns, Paul A Gastanaduy, Benjamin A LopmanAbstract:Background. Gastroenteritis remains an important cause of morbidity in the United States. The burden ofnorovirus Gastroenteritis in ambulatory US patients is not well understood.Methods. Cause-specified and cause-unspecified Gastroenteritis emergency department (ED) and outpatientvisits during July 2001–June 2009 were extracted from MarketScan insurance claim databases. By using cause-specified encounters, time-series regression models were fitted to predict the number of unspecified Gastroenteritisvisitsdue tospecificpathogensother thannorovirus.Model residuals wereused toestimatenorovirusvisits.Market-Scan rates were extrapolated to the US population to estimate national ambulatory visits.Results. During 2001–2009, the estimated annual mean rates of norovirus-associated ED and outpatient visitswere 14 and 57 cases per 10000 persons, respectively, across all ages. Rates for ages 0–4, 5–17, 18–64, and ≥65years were 38, 10, 12, and 15 ED visits per 10000 persons, respectively, and 233, 85, 35, and 54 outpatientvisits per 10000 persons, respectively. Norovirus was estimated to cause 13% of all Gastroenteritis-associated am-bulatory visits, with ∼50% of such visits occurring during November–February. Nationally, norovirus contributedto approximately 400000 ED visits and 1.7 million office visits annually, resulting in $284 million in healthcarecharges.Conclusions. Norovirus is a substantial cause of Gastroenteritis in the ambulatory setting.Keywords. norovirus; Gastroenteritis; ambulatory care; United States.Noroviruses are the leading cause of acute gastroenter-itis (ie, diarrhea or vomiting) worldwide. The adventof molecular assays have shown that noroviruses arethe leading cause of foodborne disease [1], are respon-sible for approximately half of all Gastroenteritis out-breaks [2], and are the leading cause of sporadicGastroenteritis across all ages [3,4].In the United States, noroviruses are estimated to cause21 million episodes of Gastroenteritis every year [1 ]andare increasingly recognized as a cause of severe disease,leading to an estimated 71000 hospitalizations [ 5] and800 deaths annually [6].However, the absence of sensi-tive diagnostic tests in clinical settings has precluded acomprehensive description of the US norovirus diseaseburden. Notably, the contribution of norovirus to gas-troenteritis in the ambulatory setting is sparsely char-acterized. The few studies estimating the incidence ofnorovirus-associated outpatient visits across all ages inEurope and the United States have yielded rates of 40–640 cases per 10000 persons [3,7–9].An improved understanding of the role of norovirusamong healthcare encounters for Gastroenteritis hasimportant implications for the practice and develop-ment of preventive strategies (eg, infection controlmeasures and vaccines) and could help guide clinicalmanagement (eg, antibiotics vs rehydration therapy).Our objective was to assess the contribution of norovi-rus to Gastroenteritis-associated ambulatory visits inthe United States, including both ED and outpatientvisits, across all ages and to provide estimates of thenational burden.
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norovirus and medically attended Gastroenteritis in u s children
The New England Journal of Medicine, 2013Co-Authors: Daniel C Payne, Jan Vinje, Peter G Szilagyi, Kathryn M Edwards, Mary Allen Staat, Geoffrey A Weinberg, Caroline B Hall, James D Chappell, David I Bernstein, Aaron T CurnsAbstract:Background Cases of rotavirus-associated acute Gastroenteritis have declined since the introduction of rotavirus vaccines, but the burden of norovirus-associated acute Gastroenteritis in children remains to be assessed. Methods We conducted active surveillance for laboratory-confirmed cases of norovirus among children younger than 5 years of age with acute Gastroenteritis in hospitals, emergency departments, and outpatient clinical settings. The children resided in one of three U.S. counties during the years 2009 and 2010. Fecal specimens were tested for norovirus and rotavirus. We calculated population-based rates of norovirus-associated acute Gastroenteritis and reviewed billing records to determine medical costs; these data were extrapolated to the U.S. population of children younger than 5 years of age. Results Norovirus was detected in 21% of young children (278 of 1295) seeking medical attention for acute Gastroenteritis in 2009 and 2010, with norovirus detected in 22% (165 of 742) in 2009 and 20% (...
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the roles of clostridium difficile and norovirus among Gastroenteritis associated deaths in the united states 1999 2007
Clinical Infectious Diseases, 2012Co-Authors: Aron J Hall, Umesh D Parashar, Aaron T Curns, Clifford L Mcdonald, Ben LopmanAbstract:Background. Globally, Gastroenteritis is recognized as an important contributor to mortality among children, but population-based data on Gastroenteritis deaths among adults and the contributions of specific pathogens are limited. We aimed to describe trends in Gastroenteritis deaths across all ages in the United States and specifically estimate the contributions of Clostridium difficile and norovirus. Methods. Gastroenteritis-associated deaths in the United States during 1999–2007 were identified from the National Center for Health Statistics multiple-cause-of-death mortality data. All deaths in which the underlying cause or any of the contributing causes listed Gastroenteritis were included. Time-series regression models were used to identify cause-unspecified Gastroenteritis deaths that were probably due to specific causes; seasonality of model residuals was analyzed to estimate norovirus-associated deaths. Results. Gastroenteritis mortality averaged 39/1 000 000 person-years (11 255 deaths per year) during the study period, increasing from 25/1 000 000 person-years in 1999–2000 to 57/1 000 000 person-years in 2006–2007 (P< .001). Adults aged ≥65 years accounted for 83% of Gastroenteritis deaths (258/1 000 000 person-years). C. difficile mortality increased 5-fold from 10/1 000 000 person-years in 1999–2000 to 48/1 000 000 person-years in 2006–2007 (P< .001). Norovirus contributed to an estimated 797 deaths annually (3/1 000 000 person-years), with surges by up to 50% during epidemic seasons associated with emergent viral strains. Conclusions. Gastroenteritis-associated mortality has more than doubled during the past decade, primarily affecting the elderly. C. difficile is the main contributor to Gastroenteritis-associated deaths, largely accounting for the increasing trend, and norovirus is probably the second leading infectious cause. These findings can help guide appropriate clinical management strategies and vaccine development.
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increasing rates of Gastroenteritis hospital discharges in us adults and the contribution of norovirus 1996 2007
Clinical Infectious Diseases, 2011Co-Authors: Ben Lopman, Aron J Hall, Aaron T Curns, Umesh D ParasharAbstract:Background. Diarrhea remains an important cause of morbidity, but until the mid 1990s, hospital admissions for diarrhea in the US adult population were declining. We aimed to describe recent trends in Gastroenteritis hospitalizations and to determine the contribution of norovirus. Methods. We analyzed all Gastroenteritis-associated hospital discharges during 1996–2007 from a nationally representative data set of hospital inpatient stays. Annual rates of discharges by age were calculated. Time-series regression models were fitted using cause-specified discharges as explanatory variables; model residuals were analyzed to estimate norovirus- and rotavirus-associated discharges. We then calculated the annual hospital charges for norovirus-associated discharges. Results. Sixty-nine percent of all Gastroenteritis discharges were cause-unspecified and rates increased by >50% in all adult and elderly age groups (>18 years of age) from 1996 through 2007. We estimate an annual mean of 71,000 norovirus-associated hospitalizations, costing $493 million per year, with surges to nearly 110,000 hospitalizations per year in epidemic seasons. We also estimate 24,000 rotavirus hospitalizations annually among individuals aged >5 years. Conclusions. Gastroenteritis hospitalizations are increasing, and we estimate that norovirus is the cause of 10% of cause-unspecified and 7% of all-cause Gastroenteritis discharges. Norovirus should be routinely considered as a cause of Gastroenteritis hospitalization.
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hospitalizations associated with rotavirus Gastroenteritis in the united states 1993 2002
Pediatric Infectious Disease Journal, 2006Co-Authors: Myrna Charles, Umesh D Parashar, Aaron T Curns, Robert C Holman, Roger I Glass, Joseph S BreseeAbstract:Background : In the United States, rotavirus Gastroenteritis remains a common disease of children that results in many hospitalizations, clinic visits and medical costs. It is a common cause of morbidity and is associated with a high economic burden in developing countries. Prevention of hospitalizations is the primary target of rotavirus vaccines. Methods: To update estimates of rotavirus hospitalization rates in the United States, we conducted a retrospective analysis of 10 years of national hospitalization data associated with Gastroenteritis and used both direct and indirect methods to estimate the percentage of cases associated with rotavirus Gastroenteritis. Results: During 1993-2002, an average of 18% of all hospitalizations with Gastroenteritis among children <5 years old were associated with rotavirus infection as determined by the rotavirus-specific International Classification of Diseases, 9th revision, Clinical Modification code. The annual proportion of rotavirus-associated hospitalizations increased from 15% in 1993-1995 to 21% in 2000-2002. Hospitalizations associated with rotavirus and those associated with nonspecific Gastroenteritis had a marked wintertime seasonality and similar age distribution, which peaked among children between 3 and 24 months old. Using indirect estimation methods, 58,000 to 70,000 rotavirus-associated hospitalizations were estimated to occur each year in the United States. Conclusions: Rotavirus Gastroenteritis remains an important cause of hospitalizations in the United States, and the rate has not declined from 1993 through 2002.
Umesh D Parashar - One of the best experts on this subject based on the ideXlab platform.
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global prevalence of norovirus in cases of Gastroenteritis a systematic review and meta analysis
Lancet Infectious Diseases, 2014Co-Authors: Sharia M Ahmed, Aron J Hall, Anne E Robinson, Linda Verhoef, Prasanna Premkumar, Umesh D Parashar, Marion Koopmans, Benjamin A LopmanAbstract:Summary Background Despite substantial decreases in recent decades, acute Gastroenteritis causes the second greatest burden of all infectious diseases worldwide. Noroviruses are a leading cause of sporadic cases and outbreaks of acute Gastroenteritis across all age groups. We aimed to assess the role of norovirus as a cause of endemic acute Gastroenteritis worldwide. Methods We searched Embase, Medline, and Global Health databases from Jan 1, 2008, to March 8, 2014, for studies that used PCR diagnostics to assess the prevalence of norovirus in individuals with acute Gastroenteritis. We included studies that were done continuously for 1 year or more from a specified catchment area (geographical area or group of people), enrolled patients who presented with symptoms of acute Gastroenteritis, and used PCR-based diagnostics for norovirus on all stool specimens from patients with acute Gastroenteritis. The primary outcome was prevalence of norovirus among all cases of Gastroenteritis. We generated pooled estimates of prevalence by fitting linear mixed-effect meta-regression models. Findings Of 175 articles included, the pooled prevalence of norovirus in 187 336 patients with acute Gastroenteritis was 18% (95% CI 17–20). Norovirus prevalence tended to be higher in cases of acute Gastroenteritis in community (24%, 18–30) and outpatient (20%, 16–24) settings compared with inpatient (17%, 15–19, p=0·066) settings. Prevalence was also higher in low-mortality developing (19%, 16–22) and developed countries (20%, 17–22) compared with high-mortality developing countries (14%, 11–16; p=0·058). Patient age and whether the study included years of novel strain emergence were not associated with norovirus prevalence. Interpretation Norovirus is a key Gastroenteritis pathogen associated with almost a fifth of all cases of acute Gastroenteritis, and targeted intervention to reduce norovirus burden, such as vaccines, should be considered. Funding The Foodborne Disease Burden Epidemiology Reference Group (FERG) of WHO and the Government of the Netherlands on behalf of FERG.
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diagnosis management and prevention of rotavirus Gastroenteritis in children
BMJ, 2013Co-Authors: Umesh D Parashar, E A S Nelson, G KangAbstract:#### Summary points Rotavirus is the leading cause of severe childhood Gastroenteritis. Each year, rotavirus is responsible for about 25 million clinic visits, two million hospital admissions, and 180 000-450 000 deaths in children under 5 years of age globally.1 2 3 Although rotavirus infection is prevalent worldwide, most deaths from this infection occur in developing countries (fig 1⇓). Gastroenteritis caused by rotavirus cannot be clinically distinguished from that caused by other enteric pathogens; diagnosis requires testing of fecal specimens with commercially available assays. However, rotavirus is not routinely tested for in patients with Gastroenteritis because the results do not alter clinical management, which relies mainly on appropriate rehydration therapy. Orally administered live attenuated vaccines that mimic natural infection offer the best protection against rotavirus. Two licensed rotavirus vaccines have been available since 2006 and have been implemented in many countries. We review approaches to diagnosis, management, and prevention of rotavirus Gastroenteritis. #### Sources and selection criteria We looked at recent conference proceedings and searched PubMed, the Cochrane Database of Systematic Reviews, and Clinical Evidence online using the terms “rotavirus”, “rotavirus Gastroenteritis”, and “rotavirus vaccines”. We focused on …
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burden of norovirus Gastroenteritis in the ambulatory setting united states 2001 2009
The Journal of Infectious Diseases, 2013Co-Authors: Aron J Hall, Umesh D Parashar, Aaron T Curns, Paul A Gastanaduy, Benjamin A LopmanAbstract:Background. Gastroenteritis remains an important cause of morbidity in the United States. The burden ofnorovirus Gastroenteritis in ambulatory US patients is not well understood.Methods. Cause-specified and cause-unspecified Gastroenteritis emergency department (ED) and outpatientvisits during July 2001–June 2009 were extracted from MarketScan insurance claim databases. By using cause-specified encounters, time-series regression models were fitted to predict the number of unspecified Gastroenteritisvisitsdue tospecificpathogensother thannorovirus.Model residuals wereused toestimatenorovirusvisits.Market-Scan rates were extrapolated to the US population to estimate national ambulatory visits.Results. During 2001–2009, the estimated annual mean rates of norovirus-associated ED and outpatient visitswere 14 and 57 cases per 10000 persons, respectively, across all ages. Rates for ages 0–4, 5–17, 18–64, and ≥65years were 38, 10, 12, and 15 ED visits per 10000 persons, respectively, and 233, 85, 35, and 54 outpatientvisits per 10000 persons, respectively. Norovirus was estimated to cause 13% of all Gastroenteritis-associated am-bulatory visits, with ∼50% of such visits occurring during November–February. Nationally, norovirus contributedto approximately 400000 ED visits and 1.7 million office visits annually, resulting in $284 million in healthcarecharges.Conclusions. Norovirus is a substantial cause of Gastroenteritis in the ambulatory setting.Keywords. norovirus; Gastroenteritis; ambulatory care; United States.Noroviruses are the leading cause of acute gastroenter-itis (ie, diarrhea or vomiting) worldwide. The adventof molecular assays have shown that noroviruses arethe leading cause of foodborne disease [1], are respon-sible for approximately half of all Gastroenteritis out-breaks [2], and are the leading cause of sporadicGastroenteritis across all ages [3,4].In the United States, noroviruses are estimated to cause21 million episodes of Gastroenteritis every year [1 ]andare increasingly recognized as a cause of severe disease,leading to an estimated 71000 hospitalizations [ 5] and800 deaths annually [6].However, the absence of sensi-tive diagnostic tests in clinical settings has precluded acomprehensive description of the US norovirus diseaseburden. Notably, the contribution of norovirus to gas-troenteritis in the ambulatory setting is sparsely char-acterized. The few studies estimating the incidence ofnorovirus-associated outpatient visits across all ages inEurope and the United States have yielded rates of 40–640 cases per 10000 persons [3,7–9].An improved understanding of the role of norovirusamong healthcare encounters for Gastroenteritis hasimportant implications for the practice and develop-ment of preventive strategies (eg, infection controlmeasures and vaccines) and could help guide clinicalmanagement (eg, antibiotics vs rehydration therapy).Our objective was to assess the contribution of norovi-rus to Gastroenteritis-associated ambulatory visits inthe United States, including both ED and outpatientvisits, across all ages and to provide estimates of thenational burden.
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the roles of clostridium difficile and norovirus among Gastroenteritis associated deaths in the united states 1999 2007
Clinical Infectious Diseases, 2012Co-Authors: Aron J Hall, Umesh D Parashar, Aaron T Curns, Clifford L Mcdonald, Ben LopmanAbstract:Background. Globally, Gastroenteritis is recognized as an important contributor to mortality among children, but population-based data on Gastroenteritis deaths among adults and the contributions of specific pathogens are limited. We aimed to describe trends in Gastroenteritis deaths across all ages in the United States and specifically estimate the contributions of Clostridium difficile and norovirus. Methods. Gastroenteritis-associated deaths in the United States during 1999–2007 were identified from the National Center for Health Statistics multiple-cause-of-death mortality data. All deaths in which the underlying cause or any of the contributing causes listed Gastroenteritis were included. Time-series regression models were used to identify cause-unspecified Gastroenteritis deaths that were probably due to specific causes; seasonality of model residuals was analyzed to estimate norovirus-associated deaths. Results. Gastroenteritis mortality averaged 39/1 000 000 person-years (11 255 deaths per year) during the study period, increasing from 25/1 000 000 person-years in 1999–2000 to 57/1 000 000 person-years in 2006–2007 (P< .001). Adults aged ≥65 years accounted for 83% of Gastroenteritis deaths (258/1 000 000 person-years). C. difficile mortality increased 5-fold from 10/1 000 000 person-years in 1999–2000 to 48/1 000 000 person-years in 2006–2007 (P< .001). Norovirus contributed to an estimated 797 deaths annually (3/1 000 000 person-years), with surges by up to 50% during epidemic seasons associated with emergent viral strains. Conclusions. Gastroenteritis-associated mortality has more than doubled during the past decade, primarily affecting the elderly. C. difficile is the main contributor to Gastroenteritis-associated deaths, largely accounting for the increasing trend, and norovirus is probably the second leading infectious cause. These findings can help guide appropriate clinical management strategies and vaccine development.
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increasing rates of Gastroenteritis hospital discharges in us adults and the contribution of norovirus 1996 2007
Clinical Infectious Diseases, 2011Co-Authors: Ben Lopman, Aron J Hall, Aaron T Curns, Umesh D ParasharAbstract:Background. Diarrhea remains an important cause of morbidity, but until the mid 1990s, hospital admissions for diarrhea in the US adult population were declining. We aimed to describe recent trends in Gastroenteritis hospitalizations and to determine the contribution of norovirus. Methods. We analyzed all Gastroenteritis-associated hospital discharges during 1996–2007 from a nationally representative data set of hospital inpatient stays. Annual rates of discharges by age were calculated. Time-series regression models were fitted using cause-specified discharges as explanatory variables; model residuals were analyzed to estimate norovirus- and rotavirus-associated discharges. We then calculated the annual hospital charges for norovirus-associated discharges. Results. Sixty-nine percent of all Gastroenteritis discharges were cause-unspecified and rates increased by >50% in all adult and elderly age groups (>18 years of age) from 1996 through 2007. We estimate an annual mean of 71,000 norovirus-associated hospitalizations, costing $493 million per year, with surges to nearly 110,000 hospitalizations per year in epidemic seasons. We also estimate 24,000 rotavirus hospitalizations annually among individuals aged >5 years. Conclusions. Gastroenteritis hospitalizations are increasing, and we estimate that norovirus is the cause of 10% of cause-unspecified and 7% of all-cause Gastroenteritis discharges. Norovirus should be routinely considered as a cause of Gastroenteritis hospitalization.
Clive Graham - One of the best experts on this subject based on the ideXlab platform.
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hospital based surveillance to estimate the burden of rotavirus Gastroenteritis among european children younger than 5 years of age
Pediatrics, 2009Co-Authors: Johannes Forster, Alfredo Guarino, Nathalie Parez, Fernando Moraga, Enriqueta Roman, Olivier Mory, Alberto E Tozzi, Ana Lopez De Aguileta, Ulrich Wahn, Clive GrahamAbstract:OBJECTIVES.Rotavirus is the leading cause of acute Gastroenteritis requiring hospitalization in young children. Data on the burden of rotavirus Gastroenteritis are needed to guide recommendations for rotavirus vaccine use. This study was undertaken to estimate the burden of rotavirus Gastroenteritis in European children 5 years of age. METHODS. This prospective, study was conducted in 12 hospitals in France, Germany, Italy, Spain, and the United Kingdom. A sample of all children aged 5 years presenting to emergency departments or hospitalized because of community-acquired acute Gastroenteritis was enrolled for parental interview and stool collection. Acute Gastroenteritis was defined as diarrhea ( 3 loose stools per 24 hours) for 14 days. Rotavirus was detected by enzyme-linked immunosorbent assay and typed by reverse-transcriptase polymerase chain reaction. RESULTS.Between February 2005 and August 2006, 3734 children with communityacquired acute Gastroenteritis were recruited and retained for analysis (55.9% via the emergency department, 41.8% hospitalized). Of the 2928 community-acquired acute Gastroenteritis cases for which stool samples were available, 43.4% were rotavirus-positive by enzyme-linked immunosorbent assay (32.8% emergency department, 56.2% hospitalized). Of these rotavirus Gastroenteritis cases 80.9% occurred in children aged 2 years and 15.9% among infants aged 6 months. Acute Gastroenteritis was more severe in rotavirus-positive subjects (Vesikari score 11 in 53.3% compared with 31.0% of rotavirus-negative subjects). All 1271 rotaviruspositive strains were genotyped (G1P[8]: 40.3%; G9P[8]: 31.2%; G4P[8]: 13.5%; G3P[8]: 7.1%). CONCLUSIONS.Rotavirus Gastroenteritis places high demands on European health care systems, accounting for 56.2% of hospitalizations and 32.8% of emergency department visits because of community-acquired acute Gastroenteritis in children aged 5 years. Most community-acquired rotavirus Gastroenteritis occurs in children aged 2 years, and a high proportion occurs in infants aged 6 months. Cases were also observed among very young infants 2 months of age. Rotavirus vaccination is expected to have a major impact in reducing morbidity and the pressure on hospital services in Europe. Pediatrics 2009;123:e393–e400 www.pediatrics.org/cgi/doi/10.1542/ peds.2008-2088 doi:10.1542/peds.2008-2088 Ms Barberousse’s current affiliation is Department of Infection and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Hospital-based surveillance to estimate the burden of rotavirus Gastroenteritis among European children younger than 5 years of age.
Pediatrics, 2009Co-Authors: Johannes Forster, Alfredo Guarino, Nathalie Parez, Fernando Moraga, Enriqueta Roman, Olivier Mory, Alberto E Tozzi, Ana Lopez De Aguileta, Ulrich Wahn, Clive GrahamAbstract:OBJECTIVES: Rotavirus is the leading cause of acute Gastroenteritis requiring hospitalization in young children. Data on the burden of rotavirus Gastroenteritis are needed to guide recommendations for rotavirus vaccine use. This study was undertaken to estimate the burden of rotavirus Gastroenteritis in European children
