Nosocomial rotavirus gastroenteritis in a Canadian paediatric hospital: incidence, disease burden and patients affected.

Rotavirus is a well-recognised nosocomial pathogen in paediatric settings. Although rotavirus gastroenteritis is a vaccine-preventable disease, there is currently no publicly funded programme in Canada. The objective of this study was to inform rotavirus vaccination strategy by determining the incidence of nosocomial rotavirus gastroenteritis (NRVGE), estimating the burden of disease and characterising the patients affected. We performed a retrospective cohort study of all NRVGE cases over a period of 10 years in a Canadian tertiary-care paediatric hospital. Cases (N = 214) were identified by the hospital's prospective surveillance programme for nosocomial infections. The incidence was 0.5 per 1,000 patient-days (95% confidence interval: 0.43-0.57) with no significant decline over the 10-year period. The infection rate per hospital day was highest among patients with a hospital stay of > 5 days. A chronic underlying medical condition was present in 126 patients (59%), was often associated with previous hospitalisation, and was identifiable early in life for 95 patients (44%). Rehydration was required for 132 (62%) patients and was intravenous in 98 (46%). Twenty-six patients (12%) required readmission, for a median of four days, for NRVGE that occurred after discharge. Nosocomial rotavirus infection continues to be an important problem in paediatric hospitals, predominantly for children with underlying medical conditions requiring recurrent and prolonged hospitalisation. A rotavirus immunisation programme targeted at vulnerable patients, such as infants with congenital pathology and low birth weight, requires assessment in Canada and other countries that have not introduced universal rotavirus immunisation.