Baylor College of Medicine, Department of Pediatrics, Section of Infectious Diseases, 1102 Bates Ave, Suite 1120, Houston, TX 77030, USA.
Pediatrics. 2010 Feb;125(2):e191-8. doi: 10.1542/peds.2008-1262. Epub 2010 Jan 25.
Two vaccines to prevent disease from rotavirus among young children were recently approved in the United States. Although previous studies of the burden of rotaviral disease have focused on hospitalizations, the assessment of baseline disease burden in ambulatory settings is useful for evaluating the overall impact of the vaccine.
Outpatient and emergency department (ED) data for 1994-2006 were analyzed from 2 nationally representative databases: the National Ambulatory Medical Care Survey and the National Hospital Medical Care Survey. Visits by children (younger than 5 years) with acute gastroenteritis (AGE) were identified by using a defined set of International Classification of Diseases, Ninth Revision, Clinical Modification codes. Two previously described methods (the winter-residual-excess [WRE] and Brandt methods) were used to estimate the proportion of AGE attributable to rotavirus and to determine the annual number of visits, annual average visits, and annual visit rates in each setting.
The estimated average annual number of rotavirus-associated visits over the 13-year period was 782 453 outpatient visits and 164 261 ED visits from the WRE method and 665 773 outpatient visits and 205 206 ED visits from the Brandt method. This resulted in an average of 39.1 and 33.3 outpatient visits per 1000 children and 8.2 and 10.3 ED visits per 1000 children for both the WRE and Brandt methods, respectively. The average annual proportion of visits for AGE attributed to rotavirus was 34.2% (29.1% from the Brandt method) in the outpatient setting and 21.8% (27.1% from the Brandt method) in the ED, with wide variations in individual years.
Before the rotavirus vaccine, rotavirus seemed to be associated with a large number of outpatient and ED visits among young children. Rotavirus vaccine has the potential to reduce many outpatient and ED visits.
两种预防小儿轮状病毒疾病的疫苗最近在美国获得批准。尽管先前关于轮状病毒疾病负担的研究主要集中在住院治疗上，但在门诊环境中评估疾病基线负担对于评估疫苗的总体影响是有用的。
使用两个具有全国代表性的数据库（国家门诊医疗调查和国家医院医疗调查）分析了 1994 年至 2006 年的门诊和急诊（ED）数据。通过使用国际疾病分类，第九版，临床修正版的一组定义代码来识别患有急性胃肠炎（AGE）的儿童（5 岁以下）的就诊。使用两种先前描述的方法（冬季剩余过剩[WRE]和 Brandt 方法）来估计 AGE 归因于轮状病毒的比例，并确定在每种情况下的年就诊次数，年平均就诊次数和年就诊率。
在 13 年期间，WRE 方法估计的轮状病毒相关就诊的平均年就诊次数为 782453 次门诊就诊和 164261 次 ED 就诊，Brandt 方法为 665773 次门诊就诊和 205206 次 ED 就诊。这导致 WRE 和 Brandt 方法的门诊就诊中，每 1000 名儿童分别有 39.1 次和 33.3 次就诊，ED 就诊中，每 1000 名儿童分别有 8.2 次和 10.3 次就诊。在门诊环境中，AGE 归因于轮状病毒的年就诊比例平均为 34.2%（Brandt 方法为 29.1%），在 ED 中为 21.8%（Brandt 方法为 27.1%），个别年份差异很大。
在轮状病毒疫苗之前，轮状病毒似乎与幼儿大量的门诊和 ED 就诊有关。轮状病毒疫苗有可能减少许多门诊和 ED 就诊。
