Investigation of a Rotavirus Gastroenteritis Outbreak among Immunosuppressed Patients in a Hospital Setting

Abstract

Objective: Rotavirus (RV) is the most common cause of severe dehydrating diarrhoea in healthy infants and young children. The aims of this study were to investigate a RV outbreak in the pediatric hematology and oncology ward and to examine possible associations between immune status and RV infection.

Patients and methods: Twenty-eight children (19 boys and 9 girls) who were hospitalized for treatment of hematological malignancy and solid organ tumor during the RV outbreak were enrolled in this study. Fourteen of the 28 patients developed RV gastroenteritis (GE) during the observation period. RV antigen and RV IgG and IgA were measured by enzyme-linked immunosorbent assays. RV G and P types were determined by reverse transcriptase-polymerase chain reaction.

Results: Mean duration of RVGE in 14 patients was 13.9 days and mean severity score was 7.4. Two RV strains (G3P [8] and G2P [4]) were mainly circulating in the ward, which might result in the formation of a reassortant G2P [8] strain and mixed infection with G2+3P [8] in the immunocompromised patients. RV antigenemia was detected in 22 of the 28 patients (78.6%). RV-specific IgG titers in acute-phase sera of RVGE group were significantly lower than those in non-RVGE group (P=0.001). Mean age of the patients was significantly lower in RVGE group (5.5 ± 4.6 years) than non RVGE group (10.6 ± 4.5 years) (P=0.015).

Conclusion: Our data demonstrate that host factors including age, underlying diseases, and immune status may be associated with the susceptibility of RV infection in immunocompromised patients at the time of the nosocomial infection.

Keywords: Antigenemia; Gastroenteritis; Immunocompromised patients; Rotavirus.

Figure 1:

Associations between rotavirus antigens in stool (black boxes) and rotavirus antigenemia (shaded bars). White boxes indicate rotavirus antigen negative in both stool and serum samples. Stool samples were collected only if the patient had GE symptoms. Case 26 died of the underlying disease and case 27 and 28 patients were discharged during the study period.

Figure 2:. Antibody profiles in sera of immunosuppressed patients.

A. Comparison of rotavirus-specific IgG titers in acute sera from RVGE patients and non RVGE patients (samples collected in the 1st week of the outbreak). B. B and C. Kinetics of rotavirus-specific IgG titers from acute phase (1st week of the outbreak) to convalescent phase (4th week) of RVGE and non RVGE patients.