Acute
Gastroenteritis
in
Finnish
Children:
Etiology
and
Impact
of
Rotavirus
Vaccination
Timo
Vesikari
University
of
Tampere
Medical
School
Tampere,
Finland
Acute
gastroenteritis
remains
a
significant
clinical
problem
in
Finnish
children.
As
a
result
of
improved
hygienic
conditions,
diarrhea
of
bacterial
origin
has
become
rare
and
accounts
for
less
than
5%
of
all
gastroenteritis
episodes.
Viral
gastroenteritis
has
not
declined
in
the
past
two
decades.
Acute
gastroenteritis
is
predominantly
a
winter
disease;
due
to
climatic
conditions
the
epidemic
season
may
be
as
long
as
November
to
June.
About
one
in
20
Finnish
children
is
hospitalized
for
acute
gastroenteritis
in
the
first
five
years
of
life;
rotavirus
is
responsible
for
50
?
60%
of
the
hospitalized
cases.
To
combat
severe
rotavirus
disease,
trials
of
live
attenuated
oral
rotavirus
vaccines
have
been
conducted
in
Finland
since
the
1980's.
A
recent
large
trial
of
oral
rhesus-human
reassortant
rotavirus
vaccine
provided
an
opportunity
to
examine
in
detail
the
viral
etiology
of
acute
gastroenteritis
and
the
impact
of
rotavirus
vaccination
on
all
gastroenteritis
in
young
Finnish
children.
Rotaviruses,
enteric
adenoviruses,
astroviruses,
Norwalk-like
viruses
(NLVs)
and
Sapporo-like
viruses
(SLVs)
were
identified
using
sensitive
RT-PCR
or
PCR-methods.
In
placebo
vaccinated
children
between
2
months
and
2
years
of
age
a
causative
virus
was
detected
in
502
(60%)
of
832
episodes
of
gastroenteritis.
The
most
commonly
detected
viruses
were:
rotaviruses
31%,
NLVs
20%,
SLVs
9%,
astroviruses
9%,
and
enteric
adenoviruses
6%.
In
hospitalized
cases
(N=60),
a
causative
virus
was
found
in
85%
of
the
cases
(rotaviruses
64%,
NLVs
10%,
enteric
adenoviruses
7%,
SLVs
and
astroviruses
2%
each).
The
study
results
show
that
the
vast
majority
of
clinically
significant
episodes
of
gastroenteritis
are
of
viral
origin,
and
the
causative
virus
can
be
identified
using
appropriate
(RT-)PCR
methods.
Rotavirus
vaccination
prevented
all
rotavirus
gastroenteritis
by
61%,
severe
rotavirus
gastroenteritis
by
89%,
and
all
severe
gastroenteritis
by
60%.
In
addition
to
the
protective
effect
against
rotavirus,
the
vaccine
had
a
mild
ameliorating
effect
on
enteric
adenovirus-
and
SLV-associated
diarrhea.
Rotavirus
vaccination
is
the
only
foreseeable
way
to
significantly
reduce
the
burden
of
acute
gastroenteritis
in
Finnish
children.
After
the
recent
withdrawal
in
the
USA
of
rhesus
rotavirus
vaccine
because
of
intussusception,
studies
should
continue
to
search
for
new,
safe,
and
effective
alternative
rotavirus
vaccines.
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