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A Hospital-based Surveillance of Rotavirus Gastroenteritis in Children <5 Years of Age in Singapore

Phua, Kong Boo MBBS, FRACP*; Tee, Nancy MBBS, FRCPA; Tan, Nancy MD*; Ramakrishnan, Gunasekaran MSc; Teoh, Yee-Leong MD§; Bock, Hans MD; Liu, Yanfang MD

The Pediatric Infectious Disease Journal: December 2013 - Volume 32 - Issue 12 - p e426–e431
doi: 10.1097/INF.0b013e31829f2cb0
Original Studies

Background: In Singapore, 2 rotavirus vaccines were licensed in October 2005 and July 2007, respectively, for vaccinating infants aged ≥6 weeks against rotavirus gastroenteritis. These vaccines are optional and are not included in the National Childhood Immunization Program. This study aimed to determine the incidence of rotavirus gastroenteritis-associated hospitalizations among children <5 years of age.

Methods: Children <5 years, who were hospitalized for acute gastro enteritis, were enrolled between September 2005 and April 2008. Stool samples were tested for the presence and serotyping of rotavirus. Incidence and proportion of gastroenteritis and rotavirus gastroenteritis cases were calculated with 95% confidence intervals.

Results: Among 1976 children included in the according-to-protocol cohort, 781 were rotavirus positive with a median age of 24 months (range: 0–59 months). The overall incidence of rotavirus gastroenteritis hospitalizations during the entire study period in children <5 years of age was 4.6 (95% confidence interval: 4.3–4.9) per 1000 person-years with the highest number of cases observed in children 13–24 months of age (26.5%). G1P[8] (18.3%) and G9P[8] (9.9%) were the most common rotavirus types. Rotavirus gastroenteritis hospitalizations peaked between January and March.

Conclusion: Rotavirus infection was the primary cause of acute gastro enteritis hospitalizations among children <5 years of age, constituting nearly one-third of gastroenteritis hospitalizations in Singapore. The predominant strain observed in Singapore was G1P[8]. Results of this study suggest the need for implementation of rotavirus vaccination into National Childhood Immunization Program in Singapore.

From the Departments of *Pediatrics and Pathology and Laboratory Medicine, KK Women’s and Children’s Hospital, Singapore; GlaxoSmithKline Pharmaceuticals Pvt Ltd, India; §Emergent BioSolutions; and GlaxoSmithKline Vaccines Pvt Ltd, Singapore.

Accepted for publication June 5, 2013.

This study was sponsored and funded by GlaxoSmithKline (GSK) Biologicals SA. GSK Biologicals SA was involved in all stages of the study conduct and analysis. GSK Biologicals SA also took in charge of all costs associated with the development and the publishing of this article.

K.B.P. has received money for travel related to the study and payment for lectures or speakers bureau, grant paid to the institution for the conduct of the study. H.B., Y.L. and Y.-L.T. are ex-employees of GlaxoSmithKline (GSK) and held shares of GSK. G.R. is an employee of GSK. The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Kong Boo Phua, MBBS, FRACP, KK Women’s and Children’s Hospital, 100 Bukit Timah Rd, Singapore 229899. E-mail:

© 2013 by Lippincott Williams & Wilkins, Inc.