Prospective hospital-based surveillance to estimate rotavirus disease burden in the Gauteng and North West Province of South Africa during 2003-2005

Abstract

Background: Rotavirus is considered to be the most common cause of serious acute dehydrating diarrhea worldwide. However, there is a scarcity of information on rotavirus disease burden in sub-Saharan Africa.

Methods: We conducted prospective, hospital-based surveillance for rotavirus diarrhea among children <5 years of age at the tertiary care Dr. George Mukhari Hospital (DGM) and at the Brits district Hospital (BH) in the Gauteng and North West Provinces in South Africa; we estimated that up to 80% of children <5 years of age in their catchment areas who are hospitalized for diarrhea are admitted to one of these hospitals.

Results: At DGM, 2553 children <5 years of age were admitted for diarrhea from January 2003 through December 2005, and 852 children <5 years of age were treated for diarrhea at BH during 2004-2005. We examined stool specimens from 450 children (53%) at BH and from 1870 children (73%) admitted to DGM. An estimated 22.8% (95% confidence interval [CI], 21.2%-24.5%) of the children hospitalized with diarrhea at DGM were rotavirus positive, and the corresponding figure at BH was 18.2% (95% CI, 14.9%-22.1%). Among children <5 years of age admitted to DGM for any reason, an estimated 5.5% (95% CI, 5.1%-6.0%) had rotavirus diarrhea. Our incidence estimates suggest that 1 in 43-62 children in the area is likely to be hospitalized with rotavirus diarrhea by 2 years of age.

Conclusions: Prevention of serious rotavirus illness by vaccination will substantially reduce not only the disease burden among young children but also the case load in South African health care facilities.