The burden of hospitalised rotavirus infections in Fiji

Abstract

Rotavirus is the most common cause of acute severe dehydrating diarrhoea in young children worldwide. We describe the burden of rotavirus disease and the rotavirus types causing it in the largest city in Fiji. During 2006 and 2007, 592 children under 5 years of age were admitted to hospital in Suva, Fiji with acute diarrhoea. Of the 454 children for whom a stool specimen was tested, 39% were positive for rotavirus and the predominant strain found was the serotype G3[P8]. There is a significant burden of disease due to rotavirus in Fiji and the introduction of rotavirus vaccines into the national immunization schedule may drastically reduce inpatient diarrhoeal disease.

Introduction

Rotavirus is the commonest cause of severe acute gastroenteritis in children under 5 years of age in both the developed and the developing world. Globally, rotavirus is responsible for enormous morbidity and is estimated to cause 114 million episodes of diarrhoea per year [1]. While the proportion of these infections that result in death is relatively small, the high number of cases means there are estimated to be over half a million deaths among infants and children worldwide per annum due to rotavirus [2].

In the last few years, rotavirus vaccines have been licensed in more than 100 countries but are only available in the national immunization schedules of about eleven predominantly high and middle-income countries. These vaccines can prevent severe rotavirus disease and thereby have the potential to markedly reduce this morbidity. In 2006, the GAVI Alliance indicated that they would support the introduction of rotavirus vaccine in eligible countries in regions where vaccine efficacy had been demonstrated. However, these vaccines are expensive and widespread introduction into a non-GAVI eligible developing country like Fiji could overstretch an already overburdened health budget. Although most governments are very keen to introduce measures to relieve their population of medical disease, rotavirus vaccine introduction may be prevented by lack of funds. Nonetheless, if a vaccine can be shown to be safe, reliable and cost effective by reducing the financial burden that comes with reducing the medical and social costs of infection, then this may make the prospect of its introduction more feasible. In this study we aimed to describe the burden of rotavirus diarrhoeal disease requiring admission among children under 5 years of age in the largest hospital in Fiji, particularly regarding the demographics of those affected and to record the serotypes responsible for the disease.