Nosocomial Rotavirus Infections: A Meta-analysis

Abstract

BACKGROUND AND OBJECTIVES: Nosocomial rotavirus (nRV) infections represent an important part of rotavirus (RV)-associated morbidity. The incidence of nRV influences the estimated total RV disease burden, an important determinant of cost-effectiveness of RV vaccination programs. Our aim is to summarize the existing evidence and produce reliable estimates of nRV incidence, in pediatric settings in Europe and North America. METHODS: We searched electronic databases for studies on nRV incidence among pediatric inpatients. To ascertain complete case reporting, only studies describing active nRV surveillance in their methodology were included. Random effects meta-analysis was performed. Meta-regression was used to obtain results adjusted for important study characteristics. RESULTS: Twenty surveillance studies met the quality criteria for inclusion. The pooled unadjusted nRV incidence was 2.9 per 100 hospitalizations (95% confidence interval [CI]: 1.6–4.4). Incidence was significantly influenced by studies' seasonality-months (RV epidemic season only or year-round) and the age range of included patients. Highest nRV incidence was found for children <2 years of age, hospitalized during the epidemic months (8.1/100 hospitalizations; 95% CI: 6.4–9.9). The adjusted year-round nRV incidence estimate without age restriction was 0.4/100 hospitalizations (95% CI: 0.1–2.1) and 0.7 (95% CI: 0.0–1.8) for children <5 years of age. CONCLUSIONS: This is the first meta-analysis to summarize results of surveillance studies on nRV incidence. nRV is an important problem among hospitalized infants during the winter months. The lower season and age-adjusted nRV incidence estimate seems more appropriate for application in population-based burden of disease analysis.