Norovirus Gastroenteritis among Hospitalized Patients, Germany, 2007-2012

Abstract

We estimated numbers of hospitalizations for norovirus gastroenteritis (NGE) and associated medical costs in Germany, where norovirus testing is high because reimbursement is affected. We extracted aggregate data for patients hospitalized with a primary or secondary code from the International Classification of Diseases, 10th Revision (ICD-10), NGE diagnosis during 2007-2012 from the German Federal Statistics Office. We assessed reliability of the coding system in patient records from a large academic hospital. Approximately 53,000-90,000 NGE hospitalizations occurred annually in Germany (21,000-33,000 with primary and 32,000-57,000 with secondary ICD-10-coded NGE diagnoses). Rates of hospitalization with NGE as primary diagnosis were highest in children <2 years of age; rates of hospitalization with NGE as secondary diagnosis were highest in adults >85 years of age. The average annual reimbursed direct medical cost of NGE hospitalizations was €31-43 million. Among patients with a NGE ICD-10 code, 87.6% had positive norovirus laboratory results.

Keywords: Germany; cost; disease burden; enteric infections; gastroenteritis; hospitalization; norovirus; nosocomial; viruses.

Figure 1

Annual number and incidence of hospitalizations for norovirus gastroenteritis as primary diagnosis, Germany, 2007–2012. A) Annual cases by age group; B) annual incidence (no. cases/10,000 population) by age group. Inset shows incidence by age group among children <5 years of age.

Figure 2

Annual number and incidence of hospitalizations for norovirus gastroenteritis as secondary diagnosis, Germany, 2007–2012. A) Annual cases by age group; B) annual incidence (no. cases/10,000 population) by age group. Inset shows incidence by age group among children <5 years of age.

Figure 3

Monthly number of hospitalizations for rotavirus and norovirus gastroenteritis as primary diagnosis among all age groups (A) and among children 1 to <2 years of age (B), Germany, 2009–2012.

Figure 4

Regional distribution of norovirus hospitalizations among all age groups, by federal state, Germany, 2010. Numbers in parentheses indicate no. cases/10,000 population. Map template obtained from http://www.presentationmagazine.com/editable-maps/page/3.