In Europe, children who are hospitalised with severe RVGE represent the greatest medical burden of RV infection. A recent review using methodology based on the Centers for Disease Control and Prevention model estimates that almost 90,000 children younger than 5 years will be admitted to hospital with RVGE each year in the EU. This translates to a cumulative incidence rate of 1 in 54 children experiencing a severe RV infection requiring hospitalisation by the age of 5 years (37). Infants at ages 6 to 23 months have the greatest risk for being hospitalised with RVGE (75). Using the same Centers for Disease Control and Prevention model, it is estimated that 200 to 250 deaths are caused each year by severe RV in children ages 5 years or younger in the EU (37). However, limited data are available to demonstrate direct evidence for the actual number of deaths occurring as a result of RVGE in the EU.
Adults exposed to infected children have a high risk for contracting RV. Although infection in adults is more frequently asymptomatic, RV is still shed in their stools and can therefore be transmitted to children (27,29). Elderly adults and people with compromised immune systems are at greater risk of developing severe symptoms of RV infection and experiencing prolonged viral dissemination (27). As a result, these individuals more often require medical attention (27).
Nosocomial RV infection represents a particular problem for children in Europe. Results from observational studies in European and other industrialised countries indicate the rate of incidence of RVGE during hospitalisation is 7.0 to 15.8/1000 child-days of hospitalisation for infants younger than 2 years, and 0.7 to 8.1/1000 child-days of hospitalisation for children younger than 5 years (57,76). In a systematic review of observational studies of RV disease burden in Europe, it was estimated that for every 4 children <5 years of age admitted to hospital with community-acquired RVGE, there was 1 case of nosocomial RVGE (57).
When evaluating the overall economic burden of disease, direct costs (medical and nonmedical), indirect costs, and other costs to individuals and society should be considered (77). Direct medical costs include visits to the doctor and emergency room, hospitalisation, and the cost of laboratory diagnosis; other direct (nonmedical) costs include additional nappies (diapers), over-the-counter medicines, transportation, and child care. Indirect costs include loss of earnings to attend to a sick child and work time lost, and other costs can include those incurred as a consequence of side effects of disease, infection-control measures, reduced quality of life, and family disruption and stress.
A study in Finland conducted in the mid-1990s indicated that direct medical costs accounted for 89% of the total cost of RV disease and, of those, 75% were related to hospitalisation (78). In other countries, the relative importance of direct medical costs compared with nonmedical costs (including loss of work productivity and travel-related costs) may be different. In England, according to 1994 figures, nonmedical costs due to loss of earnings for caregivers were 47% of the total cost of disease, whereas National Health Service costs for general practice accounted for 28% of the total cost of disease (79). For Germany, it was estimated that 51.2% of the country's RV economic burden was related to the cost of hospitalisation, 27.4% to outpatient visits, and 21.4% to productivity losses (80).
For Europe, the mean cost per case hospitalised from RVGE was estimated to be €1216 (77,81). Multiplied by 87,313 (the estimated annual number of RVGE hospitalisations in children younger than 5 years of age in the EU 25 countries from 2000–2003) (37), the annual total cost of hospitalisation exceeds €106 million. The burden on health care resources is particularly prominent during the colder months, when the seasonal peak of RV cases coincides with a peak in incidence of other diseases such as influenza and respiratory syncytial virus bronchiolitis (77,79).
Nosocomial RV infection contributes a substantial economic burden to society owing to extended hospital stays and the cost of closing wards to new admissions to prevent further transmission of the virus (76,77,79). In France during 2001–2002, each case of nosocomial RV infection incurred an extra €1930 of direct medical costs, compared with hospital admissions that did not become infected with RV (82). The distribution of costs varies among individual countries, depending on the structure of health and social services.
In Europe, the estimated 700,000 annual cases of symptomatic RV disease requiring medical attention are responsible for considerable morbidity among infants and young children younger than 5 years of age. This figure translates to 1 symptomatic RV infection for every 7 children each year, and of these symptomatic cases 1 in 54 children (age ≤5 years) will require hospital treatment (37). With the development of vaccines against RV, RVGE has been promoted to the most common vaccine-preventable illness in infants and young children within the EU (37). This presents a new opportunity to prevent severe cases of RVGE in Europe.
J.G. is the principal investigator and coordinator of a European rotavirus strain surveillance programme supported jointly by Sanofi Pasteur MSD and GlaxoSmithKline (GSK). He is also the principal investigator of a burden-of-disease study funded by Sanofi Pasteur MSD. For both of these activities, J.G. is funded entirely by the Health Protection Agency (HPA). He has also received travel grants and honoraria for consultancy services from Sanofi Pasteur MSD. T.V. has received honoraria for consultancy services and lectures from Chiron, Merck, GSK, MedImmune, and Wyeth. He has been the principal investigator in clinical trials for RotaShield (Wyeth-Lederle Vaccines), RotaTeq (Merck), and Rotarix (GlaxoSmithKline Biologicals). P.V.D. has been the principal investigator of vaccine studies for Merck, Sanofi Pasteur, Sanofi Pasteur MSD, GSK Biologicals, Wyeth, and Berna Biotech (a Crucell company), for which the University of Antwerp obtains unrestricted educational grants; the University of Antwerp received travel support grants and honoraria from Sanofi Pasteur MSD, Merck, and GSK Biologicals. C.G. has been the principal investigator in epidemiological studies supported by Sanofi Pasteur MSD and GSK Biologicals. He has also received honoraria for consultant services, and educational and research grants from Abbott, Bristol-Myers Squibb, Gilead, GSK, Sanofi Pasteur MSD, and Tibotec. J.M. has received honoraria for consultant services and lectures from GSK, MSD, Wyeth, Nutricia Poland, Nestlé Poland, Sanofi Pasteur Poland, and Pfizer, research grants from Nutricia and Wyeth, and financial support for scientific congresses from Nestlé Poland and GSK. A.G. is a member of the Italian Rotavirus Advocacy Committee; members of his group have received travel grants to attend meetings from companies active in the field of gastroenterology. He received research grants from Milupa, Dicofarm, and GSK. R.D. has been a scientific consultant to and a principal investigator for studies supported by Aventis Pasteur, Berna Biotech, GSK, MedImmune, Merck, Novartis, and Wyeth-Lederle Vaccines. He has also received lecture fees from GSK, Wyeth, Sanofi Pasteur, and Novartis. H.S. has received lecture fees and/or honoraria for consultant services from Nestlé, Nutricia Poland, Numico, Mead Johnson Nutritionals Poland, Mead Johnson International, Biocodex France, Danone, Crotex, Merck, Biomed Lublin, Biomed Kraków, and GSK. She has received research grants or donations from Dicofarm Italy, Nutricia Research Foundation, and Biomed Lublin, and sponsorship to attend meetings from Nestlé Poland, Danone, and GSK. V.U. has been the principal investigator of studies supported by GSK, Novartis, and Wyeth-Lederle Vaccines. He has also been a scientific consultant to Aventis Pasteur, Baxter, GSK, Merck, and Wyeth-Lederle Vaccines, and has received sponsorship from these companies to attend scientific meetings.
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