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Bernstein, David I. MD, MA

The Pediatric Infectious Disease Journal: March 2009 - Volume 28 - Issue 3 - p S49
doi: 10.1097/INF.0b013e3181967bda

From the Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, OH.

Disclosure: Dr. Bernstein receives royalties for his work in the development of Rotarix and the patent for 89-12. He is also a consultant for GlaxoSmithKline.

Address for correspondence: David I. Bernstein, MD, MA, Cincinnati Children's Hospital Medical Center; University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH 45229. E-mail:

Recent data suggest that hospitalization and death from childhood diarrhea has decreased dramatically in the last 30 years. For example, it is estimated that diarrhea-related deaths worldwide have decreased from 4.6 million in 1982 to approximately 1.6 million in 2003.1 However, as the number of serious cases of diarrhea has declined, the importance of rotavirus as a cause of diarrhea has increased. Rotavirus is the most common etiologic agent of severe diarrhea in young children worldwide, currently accounting for almost 40% of diarrhea-related hospitalizations.1 Although most deaths occur in developing countries, rotaviral infection is associated with 55,000 to 70,000 hospitalizations and 20 to 60 deaths per year among children aged <5 years in the United States.2 The increased importance of rotavirus as a cause of diarrhea is probably because improvements in hygiene and sanitation are more likely to decrease diarrhea caused by bacterial and parasitic agents. In addition, unlike some bacterial and parasitic pathogens, there is no specific antimicrobial therapy for rotavirus infection. Thus, vaccination early in life is the most effective intervention to decrease the incidence of severe rotaviral disease and its most serious sequelae (eg, dehydration, physician visits, hospitalizations, deaths).2

This supplement is based on a roundtable discussion that occurred in Phoenix, Arizona in February 2008 that was designed to discuss a number of current issues in rotavirus disease. David I. Bernstein, MD, MA (Cincinnati Children's Hospital, Cincinnati, OH) provides an overview of rotaviral disease.3 This includes a review of the rotavirus epidemiology, disease burden, course of the disease, diagnosis, and treatments. Dr. F. Raúl Velázquez (Mexican Institute of Social Security Mexico City, Mexico) discusses the protective effects associated with natural infection and how an understanding of natural immunity influences the development of effective vaccines.4 Dr. Richard Ward, PhD (Cincinnati Children's Hospital, Cincinnati, OH) discusses the structure of rotavirus and how this relates to the mechanisms of protection against disease.5 This includes the relative importance of cellular and humoral mechanisms of protection. Finally, Dr. Miguel O'Ryan (University of Chile, Santiago, Chile) reviews the changing landscape of rotavirus serotypes.6 This section includes a discussion of the distribution and prevalence of the most common rotaviral serotypes, as well as a review of newly emerging strains that are of clinical significance.

Overall, this supplement is designed to educate pediatricians regarding the importance of rotaviral disease and to provide a therapeutic rational for universal vaccination in infants and young children. Readers will be able to understand the benefits of early immunization against rotavirus, how the two current rotavirus vaccines differ in their approach to providing protection, and how serotype trends and patterns impact vaccine efficacy.

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1. Parashar UD, Gibson CJ, Bresse JS, et al. Rotavirus and severe childhood diarrhea. Emerg Infect Dis. 2006;12:304–306.
2. Centers for Disease Control and Prevention. Prevention of rotavirus gastroenteritis among infants and children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2006;55(RR-12):1–16.
3. Bernstein DI. Rotavirus overview. Pediatr Infect Dis J. 2009;28:S50–S53.
4. Velázquez FR. Protective effects of natural rotavirus infection. Pediatr Infect Dis J. 2009;3:S54–S56.
5. Ward R. Mechanisms of protection against rotavirus infection and disease. Pediatr Infect Dis J. 2009;28:S57–S59.
6. O'Ryan M. The ever-changing landscape of rotavirus serotypes. Pediatr Infect Dis J. 2009;28:S60–S62.
© 2009 Lippincott Williams & Wilkins, Inc.