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Estimated mortality and hospital admission due to rotavirus infection in the WHO European region

  • C. J. WILLIAMS (a1) (a2), A. LOBANOV (a3) and R. G. PEBODY (a1)

In 2006 two rotavirus vaccines were licensed for use in young children in Europe. This study aimed to estimate the mortality and hospital admissions due to rotavirus in children aged <5 years in the WHO European region using data from routine sources and published literature. We grouped 49/52 countries in the region by their World Bank Gross National Income (GNI) per capita. We obtained for children aged <5 years: populations, hospital discharges for diarrhoeal disease, estimated mortality rates and the percentage of deaths attributable to diarrhoeal disease, from WHO data sources or published literature, and combined them to estimate country-specific diarrhoeal disease mortality. Rotavirus-attributable percentages of hospital admissions due to diarrhoeal disease were obtained through a literature search, and an income-group median applied to countries in each GNI category. In the countries we studied in the WHO European region, rotavirus infection causes an estimated 6550 deaths (range 5671–8989) and 146 287 (range 38 374–1 039 843) hospital admissions each year in children aged <5 years. Hospital admission rates were similar across income groups (medians 2·0, 2·8, 4·2 and 1·9/1000 per year in low-, lower-middle-, upper-middle- and high-income countries, respectively). Seven countries, mostly in the low- and lower-middle-income groups, accounted for 93% of estimated deaths. Disease burden varied dramatically by income level in the European region. Rotavirus vaccination in Azerbaijan, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan and Turkey could potentially prevent 80% of all regional rotavirus deaths. Data from low-income countries is still sparse, and improved disease burden studies are required to better inform regional vaccine policy.

Corresponding author
*Author for correspondence: Dr C. J. Williams, Norfolk, Suffolk and Cambridgeshire Health Protection Unit, Norfolk Office, Healthy Living Centre, Thetford Community Healthy Living Centre, Croxton Road, Thetford IP24 1JD, Norfolk, UK. (Email:
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1. Djuretic T, et al. An estimate of the proportion of diarrhoeal disease episodes seen by general practitioners attributable to rotavirus in children under 5 y of age in England and Wales. Acta Paediatrica (Suppl.) 1999; 88: 3841.
2. Koopmans M, Van Asperen I. Epidemiology of rotavirus infections in The Netherlands. Acta Paediatrica (Suppl. 1) 1999; 88: 3137.
3. Parashar UD, et al. Global illness and deaths caused by rotavirus disease in children. Emerging Infectious Diseases 2003; 9: 565572.
4. Ruiz-Palacios GM, et al. Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. New England Journal of Medicine 2006; 354: 1122.
5. Vesikari T, et al. Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. New England Journal of Medicine 2006; 354: 2333.
6. European Medicines Agency. European public assessment report: Rotarix. European medicines agency website 2007 ( Accessed December 2007.
7. European Medicines Agency. European public assessment report: Rotateq. European medicines agency website 2007 ( Accessed December 2007.
8. Soriano-Gabarro M, et al. Burden of rotavirus disease in European Union countries. Pediatric Infectious Diseases Journal 2006; 25 (Suppl.): S7S11.
9. Semenza JC, et al. Water distribution system and diarrheal disease transmission: a case study in Uzbekistan. American Journal Tropical Medicine and Hygiene 1998; 59: 941946.
10. WHO. European Health for All database. World Health Organisation, 2006 ( Accessed December 2007.
11. WHO Regional Office for Europe. European hospital morbidity database, 2007 ( Copenhagen, Denmark.
12. World Bank website. World Development Indicators Online (WDI). World Bank, 2007. ( Accessed December 2007.
13. Ryndich AA, et al. Rotavirus gastroenteritis in different regions of Russia [in Russian]. Zhurnal mikrobiologii, epidemiologii i immunobiologii 1993; 6: 4041.
14. Solodovnikov I, et al. Rotavirus gastroenteritis: the status of the problem in Moscow [in Russian]. Zhurnal mikrobiologii, epidemiologii i immunobiologii 1999; 6: 121.
15. Amar CF, et al. Detection by PCR of eight groups of enteric pathogens in 4627 faecal samples: re-examination of the English case-control Infectious Intestinal Disease Study (1993–1996). European Journal of Clinical Microbiology and Infectious Diseases 2007; 26: 311323.
16. WHO. Core health indicators, 2006. World Health Organisation Statistical Information System.
17. WHO. The World health report 2006: working together for health, 2006. Geneva: World Health Organization.
18. Bryce J, et al. WHO Child Health Epidemiology Reference Group. WHO estimates of the causes of death in children. Lancet 2005; 365: 11471152.
19. WHO. WHO mortality profiles. World Health Organisation website 2007 ( Accessed December 2007.
20. World Population Prospects. The 2006 revision population database. United Nations population division, 2006 ( Accessed December 2007.
21. WHO. European Health for All mortality database. World Health Organization, 2006 ( Accessed December 2007.
22. Isakbaeva ET, et al. Rotavirus disease in Uzbekistan: cost-effectiveness of a new vaccine. Vaccine 2007; 25: 373380.
23. WHO. Causes of death among children under five years of age (percentage). World Health Organisation Statistical Information System Indicator definitions and metadata, 2006 ( Accessed December 2007.
24. Williams CJ, et al. Survey of rotavirus surveillance, laboratory capacity and disease burden in the eastern part of the WHO European Region. Eurosurveillance 2008; 13(34) (
25. Tran Minh NN. Survey of the deaths due to acute gastro-enteritis avoidable with the rotavirus vaccine, France, November 2004–March 2005. Poster presentation at 2006 EPIET Scientific seminar.
26. Jit M, et al. Estimating the number of deaths with rotavirus as a cause in England and wales. Human Vaccines 2007; 3: 2326.
27. GAVI Alliance. Eligible countries. GAVI alliance 2007 ( Accessed December 2007.
28. Turkish Ministry of Health. Refik Saydam Hygiene centre presidency, School of public health BU. National burden of disease and cost effectiveness project: burden of disease final report, 2004.
29. Hacettepe University Institute of Population Studies. General Directorate of Mother and Child Health/Family Planning MoH. Turkey demographic and health survey, 2003. Institute of Population Studies, 2004 ( Accessed December 2007.
30. Takala AK, et al. Economic evaluation of rotavirus vaccinations in Finland: randomized, double-blind, placebo-controlled trial of tetravalent rhesus rotavirus vaccine. Clinical Infectious Diseases 1998; 27: 272282.
31. New Medicine. Rotarix. Pharmaceutical Journal 2006; 276: 619.
32. Lob-Levyt J. Re: 2007 Update on support to countries from the GAVI alliance. GAVI Alliance, 2007.
33. Rafiev K. The spread of rotavirus gastroenteritis in the Republic of Tajikistan. Zhurnal mikrobiologii epidemiologii i immunobiologii 1999; 3: 2628.
34. Isakbaeva ET, et al. Rotavirus disease in Uzbekistan: cost-effectiveness of a new vaccine. Vaccine 2007; 25: 373380.
35. Ahmetagic S, et al. Acute infectious diarrhea in children. Medicinski Arhiv 2003; 57: 8792.
36. Diamanti E, et al. An epidemiological study on viral infantile diarrhoea in Tirana. New Microbiologica 1996; 19: 914.
37. Superti F, et al. Electropherotypes of rotavirus strains causing gastroenteritis in infants and young children in Tirana, Albania, from 1988 to 1991. Acta Virologica (English edn), 1995; 39: 257261.
38. David E, et al. The etiology of acute diarrheal diseases in hospitalized children and as outpatients. Bacteriologia Virusologia Parazitologia Epidemiologia 1996; 41: 3741.
39. Kurugol Z, et al. Rotavirus gastroenteritis among children under five years of age in Izmir, Turkey. Turkish Journal of Paediatrics 2003; 45: 290294.
40. Karadag A, et al. Childhood diarrhoea in Ankara, Turkey: epidemiological and clinical features of rotavirus-positive versus rotavirus-negative cases. Scandinavian Journal of Infectious Diseases 2005; 37: 269275.
41. Mrukowicz JZ, et al. Epidemiology and impact of rotavirus diarrhoea in Poland. Acta Paediatrica (Suppl.) 1999; 88: 5360.
42. Szücs G, et al. Burden of human rotavirus-associated hospitalizations in three geographic regions of Hungary. Acta Paediatrica (Suppl.) 1999; 88: 6165.
43. Banyai K, et al. Survey of rotavirus infection in a Hungarian paediatric hospital. A short communication. Acta Microbiologica et Immunologica Hungarica 2004; 51: 431435.
44. Ginevskaya VA, et al. Electropherotypes and serotypes of human rotavirus in Estonia. Archives of Virology 1994; 137: 199207.
45. Pazdiora P. Diagnosis of rotavirus infections in 2004, major characteristics in 1998–2004 in the Czech Republic [in Czech]. Epidemiologie Mikrobiologie Imunologie 2006; 55: 3236.
46. Pazdiora P. Diagnosis of rotavirus infections and their reporting in the Czech Republic in 2001 [in Czech]. Epidemiologie Mikrobiologie Imunologie 2003; 52: 912.
47. Steyer A, et al. The emergence of rotavirus genotype G9 in hospitalised children in Slovenia. Journal of Clinical Virology 2005; 33: 711.
48. Kafetzis DA, et al. Epidemiology, clinical course and impact on hospitalization costs of acute diarrhea among hospitalized children in Athens, Greece. Scandinavian Journal of Infectious Diseases 2001; 33: 681685.
49. Van DP, et al. Multicenter prospective study of the burden of rotavirus acute gastroenteritis in Europe, 2004–2005: the REVEAL study. Journal of Infectious Diseases 2007; 195 (Suppl. 1): S4S16.
50. Diez-Domingo J, et al. Rotavirus gastroenteritis among children under five years of age in Valencia, Spain. Pediatric Infectious Disease Journal 2006; 25: 455457.
51. Cilla G, et al. Incidence, seasonality and serotypes of rotavirus in Gipuzkoa (Basque Country), Spain. A 14-year study. Epidemiology and Infection 2000; 125: 677683.
52. Visser LE, et al. Impact of rotavirus disease in Spain: an estimate of hospital admissions due to rotavirus. Acta Paediatrica (Suppl.), 1999; 88: 7276.
53. Sanchez F, et al. Diversity of group A human rotavirus types circulating over a 4-year period in Madrid, Spain. Journal of Clinical Microbiology 2004; 42: 16091613.
54. Gabutti G, et al. Epidemiology and burden of rotavirus-associated hospitalizations in Ferrara, Italy. Journal of Preventive Medicine and Hygiene 2007; 48: 59.
55. Caprioli A, et al. Enteropathogens associated with childhood diarrhea in Italy. The Italian Study Group on Gastrointestinal Infections. Pediatric Infectious Disease Journal 1996; 15: 876883.
56. Berner R, Schumacher RF, Forster J. Survey on rotavirus infections in a German pediatric hospital. European Journal of Clinical Microbiology & Infectious Diseases 1997; 16: 479481.
57. Berner R, et al. Occurrence and impact of community-acquired and nosocomial rotavirus infections – a hospital-based study over 10 y. Acta Paediatrica (Suppl.) 1999; 88: 4852.
58. Ryan MJ, et al. Hospital admissions attributable to rotavirus infection in England and Wales. Journal of Infectious Diseases 1996; 174 (Suppl. 1): S12S18.
59. Vesikari T, Rautanen T, Von B. Rotavirus gastroenteritis in Finland: burden of disease and epidemiological features. Acta Paediatrica (Suppl.), 1999; 88: 2430.
60. de Wit, Koopmans MP, et al. Hospital admissions for rotavirus infection in the Netherlands. Clinical Infectious Diseases 2000; 31: 698704.
61. Johansen K, et al. Incidence and estimates of the disease burden of rotavirus in Sweden. Acta Paediatrica (Suppl.), 1999; 88: 2023.
62. Fischer TK. Incidence of hospitalizations due to rotavirus gastroenteritis in Denmark. Acta Paediatrica 2001; 90: 10731075.
63. Fischer TK, et al. Incidence and cost of rotavirus hospitalizations in Denmark. Emerging Infectious Diseases 2007; 13: 855859.
64. Lynch M, et al. Rotavirus in Ireland: national estimates of disease burden, 1997 to 1998. Pediatric Infectious Disease Journal 2001; 20: 693698.
65. O'Mahony J, et al. Rotavirus gastroenteritis among paediatric patients at Tralee General Hospital. Irish Medical Journal 2000; 93: 274277.
66. Bucher B, Aebi C. Population-based epidemiology of rotavirus hospitalisations in Switzerland. Swiss Medical Weekly 2006; 136: 726731.
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