To the Editors:
We read the article by Enweronu-Laryea et al1 regarding acute rotavirus gastroenteritis in children in Southern Ghana with great interest. Turkey is a developing country with a population of 73 million people and a diarrhea-associated mortality rate of 3.84 deaths per 1000 children <5 years of age.2 A model described by Parashar et al3 projected 13,371,800 episodes of diarrhea annually in Turkey among children <5 years, corresponding to 94,817 hospitalizations and 1,182,046 outpatient visits.
In study of Enweronu-Laryea et al,1 rotavirus was detected in 49.4% (1504/3044) of cases, and caused over 30% of acute gastroenteritis hospitalizations all year round and up to 70% of cases during peak seasons. In that study mortality from acute gastroenteritis occurred in 1.5% (45/3044) of cases and 49% (22/45) of these were rotavirus positive.
In our study, of 5435 hospitalizations in a tertiary referral hospital between January 2008 and January 2009, 509 pediatric patients were hospitalized with a diagnosis of acute gastroenteritis.4 Among these patients, rotavirus was isolated in 198 patients (38.9%). There was no mortality in our study. Average total cost of hospital stay for gastroenteritis was 171.25 USD for each patient. In another study from Turkey,5 a total of 411 children <5 years who were hospitalized for gastroenteritis in 4 centers were enrolled and rotavirus was identified in 53% of samples from the 338 children tested.
In developing countries, rotavirus causes significant morbidity and mortality such as in Ghanaian children. Ghana introduced rotavirus vaccination in the national immunization program in 2012. Epidemiologic data on rotavirus disease burden are useful for guiding rotavirus vaccination recommendations, including assessment of the need for vaccination and the potential impact of the vaccine in reducing the burden of rotavirus disease. In Turkey and other developing countries, studies are warranted for decision making to include a rotavirus vaccine in the national immunization program.
Aslınur Ozkaya-Parlakay, MD
Ankara Hematology and Oncology
Hasan Tezer, MD
Pediatric Infectious Disease Department
1. Enweronu-Laryea CC, Sagoe KW, Mwenda JM, et al. Severe acute rotavirus gastroenteritis in children less than 5 years in southern Ghana: 2006–2011. Pediatr Infect Dis J. 2014;33(suppl 1):S9–S13
2. World population prospects: the 2004 revision. New York: United Nations Population Division, Department of Economic and Social Affairs, 2005. Available at: http://www.un.org/esa/population/publications/WPP2004/2004Highlights_finalrevised.pdf
3. Parashar UD, Bresee JS, Glass RI. The global burden of diarrhoeal disease in children. Bull World Health Organ. 2003;81:236
4. Gurbuz F, Tezer H, Revide-Sayli T. Etiologic factors and clinical findings of patients hospitalized children for acute gastroenteritis: epidemiologic study. Turkish J Pediatr Dis. 2010;4:211–218
5. Ceyhan M, Alhan E, Salman N, et al. Multicenter prospective study on the burden of rotavirus gastroenteritis in Turkey, 2005–2006: a hospital-based study. J Infect Dis. 2009;200(suppl 1):S234–S238