Rotavirus disease in Germany--a prospective survey of very severe cases.

OBJECTIVE: Rotavirus (RV) gastroenteritis is a notifiable disease in Germany. The reports to the authorities contain few data concerning the severity of disease. The aims of this study were to determine incidence and outcome of very severe cases of RV disease. METHODS: Cases of very severe RV disease were collected by the German Paediatric Surveillance Unit for rare diseases (Erhebungseinheit für seltene pädiatrische Erkrankungen in Deutschland) using anonymous questionnaires based on hospitalized patients between April 2009 and March 2011. Inclusion criteria were detection of RV antigen in feces, patient aged 0-16 years and 1 or more of the following criteria: intensive care treatment, hypernatremia or hyponatremia (>155 mmol/L or <125 mmol/L), clinical signs of encephalopathy (somnolence, seizures, apnea) and RV-associated death. RESULTS: During 2 years, 130 cases of very severe RV disease were reported, 101 of 130 were verified. Seventeen patients had nosocomial infection, of whom 14 were neonates in intensive care. Among those, 12 infants had verified or suspected necrotizing enterocolitis. Eighty-four community-acquired cases were reported, median age was 10.5 months (0-108 months). The median hospital stay was 6 days, and 48 patients needed intensive care treatment. Among children less than 5 years of age, the yearly incidence of community-acquired very severe RV disease was 1.2 of 100,000 (95% confidence interval: 0.9-1.4/100,000). A total of 26 of 84 and 10 of 84 patients had severe hypernatremia or hyponatremia, respectively, and 58 of 84 patients had signs of encephalopathy. Three deaths were reported (1 nosocomial and 2 community acquired). CONCLUSIONS: RV infection in Germany can have a life-threatening course. A substantial number are nosocomial infections.

The parental appraisal of the morbidity of diarrhea in infants and toddlers (PAMODI) survey.

This study analyzed parental perception of the impact of diarrhea on quality of life of their children. A standardized questionnaire was completed by 2023 parents in Germany with children with diarrhea who were younger than 2 years old. Parents stated the most worrying aspects of diarrhea. A health score was measured using a visual analogue scale (0 = worst health, 100 = best health). Clinical symptoms were quoted by 72% of parents as one of the most worrying dimensions, with duration/frequency of diarrhea and weight loss perceived most meaningful. Next were behavioral/physical symptoms (51%), with an inflamed bottom for mild disease and pain for severe cases being most meaningful. Parental concern is characterized by sympathy and anxiety for the child. The health score for the diarrheal episode was 54.6 for mild and 33.9 for severe cases. Parents perceive a high disease burden of diarrhea and clinically less meaningful aspects play a significant role.