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Acute Gastroenteritis (acute + gastroenteritis)
Selected AbstractsPresence of High Numbers of Transcriptionally Active Helicobacter pylori in Vomitus from Bangladeshi Patients Suffering from Acute GastroenteritisHELICOBACTER, Issue 4 2009Anders Janzon Abstract Background:,Helicobacter pylori is one of the most prevalent human bacterial pathogens; however, its transmission pathways remain unknown. New infections of H. pylori during outbreaks of gastroenteritis have been suggested previously, and to explore this transmission route further H. pylori was quantified in vomitus and diarrheal stool of patients suffering from acute gastroenteritis in Dhaka, Bangladesh. Materials and Methods:, Vomitus and stool samples from 28 patients seeking care at the International Centre for Diarrhoeal Disease Research hospital were analyzed for presence of H. pylori and other pathogens using quantitative culturing, real-time polymerase chain reaction (PCR), and H. pylori stool antigen test. Bacterial gene expression was analyzed using reverse transcriptase real-time PCR. Results:, The results of real-time PCR show that 23 (88%) of the 26 vomitus samples and 17 (74%) of the 23 stool samples were H. pylori positive, while stool antigen test show that 14 (67%) of the 21 stool samples were H. pylori positive. H. pylori could not be isolated by culture. Analysis using quantitative culture and real-time PCR to detect Vibrio cholerae showed strong correlation between these methods, and validating real-time PCR. Analysis of H. pylori virulence gene transcription in vomitus, diarrheal stool, antral and duodenal biopsy specimens, and in vitro cultures showed that cagA, flaA, and ureA were highly transcribed in vomitus, biopsy specimens, and cultures, whereas hpaA and vacA were expressed at lower levels. No H. pylori gene expression was detected in diarrheal stool. Conclusions:, We conclude that high numbers of transcriptionally active H. pylori are shed in vomitus, which indicates that new infections may be disseminated through vomiting. [source] External Validation of the Clinical Dehydration Scale for Children With Acute GastroenteritisACADEMIC EMERGENCY MEDICINE, Issue 6 2010Benoit Bailey MD Abstract Objectives:, The objective was to validate the clinical dehydration scale (CDS) for children with gastroenteritis in a different pediatric emergency department (ED) from where it was initially derived and validated. Methods:, A prospective cohort study was performed in a tertiary care pediatric ED over a 1-year period. A sample of triage nurses were trained in applying the CDS. The CDS consists of four clinical characteristics (general appearance, eyes, mucous membranes, and tears), each of which are scored 0, 1, or 2 for a total score of 0 to 8, with 0 representing no dehydration; 1 to 4, some dehydration; and 5 to 8, moderate/severe dehydration. Children 1 month to 5 years of age with vomiting and/or diarrhea who had the CDS documented at triage and a final diagnosis of gastroenteritis, gastritis, or enteritis were enrolled. Exclusion criteria included a chronic disease, treatment with intravenous (IV) rehydration within the previous 24 hours, visit to the ED for the same illness in the 7 days prior to arrival, and diarrhea of more than 10 days' duration. The primary outcome was the length of stay (LOS) in the ED from the time of seeing a physician to discharge, analyzed with a Kruskal-Wallis test. Results:, From April 2008 to March 2009, 150 patients with a mean (±SD) age of 22 (±14) months (range = 4 months to 4 years) were enrolled. Fifty-six patients had no dehydration, 74 had some dehydration, and 20 had moderate/severe dehydration. The median LOS in the ED after being seen by a physician was significantly longer as children appeared more dehydrated according to the CDS: 54 minutes (interquartile range [IQR] = 26,175 minutes), 128 minutes (IQR = 25,334 minutes), and 425 minutes (IQR = 218,673 minutes) for the no, some, and moderate/severe dehydration groups, respectively (p < 0.001). Conclusions:, The CDS has been further validated in children with gastroenteritis in a different pediatric center than the original one where it was developed. It is a good predictor of LOS in the ED after being seen by a physician. ACADEMIC EMERGENCY MEDICINE 2010; 17:583,588 © 2010 by the Society for Academic Emergency Medicine [source] Presence of High Numbers of Transcriptionally Active Helicobacter pylori in Vomitus from Bangladeshi Patients Suffering from Acute GastroenteritisHELICOBACTER, Issue 4 2009Anders Janzon Abstract Background:,Helicobacter pylori is one of the most prevalent human bacterial pathogens; however, its transmission pathways remain unknown. New infections of H. pylori during outbreaks of gastroenteritis have been suggested previously, and to explore this transmission route further H. pylori was quantified in vomitus and diarrheal stool of patients suffering from acute gastroenteritis in Dhaka, Bangladesh. Materials and Methods:, Vomitus and stool samples from 28 patients seeking care at the International Centre for Diarrhoeal Disease Research hospital were analyzed for presence of H. pylori and other pathogens using quantitative culturing, real-time polymerase chain reaction (PCR), and H. pylori stool antigen test. Bacterial gene expression was analyzed using reverse transcriptase real-time PCR. Results:, The results of real-time PCR show that 23 (88%) of the 26 vomitus samples and 17 (74%) of the 23 stool samples were H. pylori positive, while stool antigen test show that 14 (67%) of the 21 stool samples were H. pylori positive. H. pylori could not be isolated by culture. Analysis using quantitative culture and real-time PCR to detect Vibrio cholerae showed strong correlation between these methods, and validating real-time PCR. Analysis of H. pylori virulence gene transcription in vomitus, diarrheal stool, antral and duodenal biopsy specimens, and in vitro cultures showed that cagA, flaA, and ureA were highly transcribed in vomitus, biopsy specimens, and cultures, whereas hpaA and vacA were expressed at lower levels. No H. pylori gene expression was detected in diarrheal stool. Conclusions:, We conclude that high numbers of transcriptionally active H. pylori are shed in vomitus, which indicates that new infections may be disseminated through vomiting. [source] Assessment of norovirus contamination in environmental samples from Florianópolis City, Southern BrazilJOURNAL OF APPLIED MICROBIOLOGY, Issue 1 2010M. Victoria Abstract Aims:, To assess norovirus (NoV) contamination in aquatic ecosystems in the city of Florianópolis, in Southern Brazil, to provide epidemiological data that can support actions for environmental contamination control. Methods and Results:, An adsorption,elution method, followed by ultrafiltration, was performed to concentrate the viruses. NoV were detected using semi-nested PCR and quantified by real-time PCR. From June 2007 to May 2008, NoV were detected in 23% (22/94) of the samples analysed, including seawater, drinking water, superficial water (creek and brackish lagoon) and treated sewage. The mean viral loads for genogroups (G)I and GII in treated sewage samples were 297 and 440 genomic copies (gc) l,1, respectively, whereas creek water samples contained 2603 and 1361 gc l,1, respectively. Six samples were sequenced: two samples were GII.4, two were GII.2 and two were GI.3. Conclusions:, NoV were detected in all water types analysed, demonstrating the widespread contamination of this geographical area with several cocirculating strains belonging to GI and GII. Significance and Impact of the Study:, This study demonstrates the environmental spread of NoV in environmental waters and highlights the potential hazard for human health following the consumption of or contact with these waters, which could result in waterborne or foodborne acute gastroenteritis. [source] Human caliciviruses detected in Mexican children admitted to hospital during 1998,2000, with severe acute gastroenteritis not due to other enteropathogensJOURNAL OF MEDICAL VIROLOGY, Issue 4 2010Ana Lorena Gutiérrez-Escolano Abstract Few studies exist regarding the frequency of human caliciviruses as single etiologic agents in sporadic cases, or in outbreaks occurring in children hospitalized for acute gastroenteritis. In this study, a total of 1,129 children of <5 years of age and hospitalized due to acute diarrhea were enrolled from three main hospitals in Mexico City during a period of 3 years (March 1998 to December 2000). After analyzing all fecal samples for several enteropathogens, 396 stools that remained negative were further screened for human caliciviruses by RT-PCR using a primer set specific to norovirus and sapovirus. Human caliciviruses were detected in 5.6% (22/396) of the children. The minimum incidence rate for 1999 were 5.3% (7/132) for 1999 and 7.8% (13/167) for 2000, since only fecal specimens that tested negative to other enteric pathogens were examined. Positive samples were further characterized using specific GI and GII primers and sequencing. Norovirus GII was detected in 19/22 samples, most of them were GII/4, while sapovirus GI/2 was detected in one sample. Associations between the presence of human calicivirus and clinical and epidemiological data revealed that diarrhea occurred with a seasonal pattern, and that children hospitalized due to human calicivirus disease scored an average of 13,±,3.2 (SD) points on the Vesikari scale, which corresponded to severe episodes. These results highlight that human caliciviruses, by themselves, are enteropathogens of acute severe diarrhea among young Mexican children requiring hospitalization and that their detection is important in order to reduce the diagnosis gap. J. Med. Virol. 82:632,637, 2010. © 2010 Wiley-Liss, Inc. [source] Diversity of viruses associated with acute gastroenteritis in children hospitalized with diarrhea in Ho Chi Minh City, VietnamJOURNAL OF MEDICAL VIROLOGY, Issue 5 2007Tuan Anh Nguyen Abstract A molecular epidemiological study on common diarrheal viruses was conducted in Ho Chi Minh City, Vietnam between October 2002 and September 2003. Fecal samples were collected from 1,010 hospitalized children with acute gastroenteritis. Those samples were screened for groups A, B, and C rotavirus, adenovirus, genogroups I and II norovirus (NoV), sapovirus (SaV), and human astrovirus (HAstV) by RT-multiplex PCR, and the positive specimens were characterized further by ELISA, nested PCR, or sequencing. Among the diarrheal viruses detected, group A rotavirus was the most common, with a proportion of 67.4%, whereas NoV GII, adenovirus, SaV, and HAstV were also found in 5.5, 3.2, 0.8, and 0.6%, respectively. It is noteworthy that the group C rotavirus was first reported in Vietnam, with a proportion of 0.5% in this study. Fifty-six of 1,010 (5.5%) samples were found positive with more than one viral agent, in which 25 samples contained both group A rotavirus and NoV GII. Group A rotavirus could be identified throughout year with the peaks in both the dry and rainy season, whereas other viruses prevailed mainly in the rainy season. G-typing for the group A rotavirus showed that genotype 1 was still the most prevailing (33.0%), but interestingly, serotype 9 was emergent and became the third most common rotavirus G-type in these samples (13.7%). The four most common G,P combinations globally, G1P[8], G2P[4], G3P[8], and G4P[8] were found in 46.8% of rotavirus-positive samples, and it is of interest that one unusual rotavirus G9P[19] strain was first detected in Vietnam. The majority of NoV strains belonged to GII/4, and SaV strains mainly clustered with the Manchester strain (GI/1). Twenty-seven out of 32 adenovirus strains were identified as serotype 41. All HAstVs belonged to genotype 1. The results indicated clearly the impact of viral agents causing gastroenteritis and the importance of vaccination against diarrhea in Vietnam. J. Med. Virol. 79:582,590, 2007. © 2007 Wiley-Liss, Inc. [source] Human astrovirus, norovirus (GI, GII), and sapovirus infections in Pakistani children with diarrheaJOURNAL OF MEDICAL VIROLOGY, Issue 2 2004Tung Gia Phan Abstract Fecal specimens from 517 infants and young children admitted to the Civil Karachi Hospital, Dow Medical College, Karachi city, Pakistan with acute gastroenteritis from 1990 to 1994 were collected and screened by RT-PCR for human astrovirus (AstV), norovirus (NV), and sapovirus (SV). The specific epidemiological data for illness caused by these viruses in Pakistan are not available. AstV, NV, and SV were detected in 58, 51, and 17 of 517 fecal specimens, and this represented 11.2, 9.9, and 3.2%, respectively. An outbreak of gastroenteritis attributable to AstV serotype 1 was identified during September and October 1990. Moreover, one specimen with a triple mixed infection between AstV (serotypes 1 and 3) and NV GII was found. NV and SV were subjected to molecular analysis by sequencing. One of the sequenced specimens positive for SV turned out to be similar to a strain tentatively called a genogroup IV. The result underscores the importance of these viruses in association with acute gastroenteritis in Karachi city, Pakistan. J. Med. Virol. 73:256,261, 2004. © 2004 Wiley-Liss, Inc. [source] Surveillance and risk factors of norovirus gastroenteritis among children in a southern city of China in the fall,winter seasons of 2003,2006JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2010Ying-Chun Dai Aim: Noroviruses (NoVs) are an important cause of acute gastroenteritis but knowledge on the disease burden and epidemiology in children in the developing countries remains limited. In this study, we performed a surveillance of NoV gastroenteritis in children of China to address some of the questions. Methods: Faecal specimens from children (<5 years of age) at outpatient clinics of the Nan Fang Hospital in Guangzhou, China during the fall,winter seasons in 2003,2006 were tested for rotaviruses (RVs) and NoVs. A questionnaire on clinical records and hygiene habits was collected from each patient. Results: Among 957 stool specimens tested, 488 (51%) specimens were positive for RVs. NoVs were detected in 112 (24%) of the 469 RV negative specimens. The Genogroup II (GII), particularly GII-4, viruses were predominant. No significant difference of clinical symptoms, hospitalisation and patient care expenses were found between children infected with NoVs and RVs. Consumption of uncooked food is a risk for NoV infection. Contact with diarrhoea patients is a suspected risk factor. Cutting nails frequently is a protective factor against NoV infection. Conclusions: NoVs are an important cause of acute gastroenteritis in children which need special attention of patient care at the clinics in addition to RVs. The awareness of those risk factors may help future disease control and prevention. [source] Rotavirus hospitalisation in New Zealand children under 3 years of ageJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2006Keith Grimwood Objective: To describe the epidemiology of severe rotavirus gastroenteritis and to estimate the hospitalisation rates of this illness in New Zealand children under 3 years of age. Methods: Children under 3 years of age with acute diarrhoea admitted to 1 of 8 study hospitals between 1 May 1998 and 30 April 2000 were surveyed. Their socio-demographic, treatment and length-of-stay data were recorded and stool samples tested by a rotavirus-specific enzyme-linked immunoassay. National hospital discharge data for infectious diarrhoea (International Classification of Diseases, ninth revision, 003,009) were reviewed, allowing population-based estimates for rotavirus-related hospitalisation in New Zealand. Results: Of 2019 enrolled children, 1138 (56.4%) provided stools for testing, and of these 485 (42.6%) tested rotavirus positive. Rotavirus detection varied significantly by age (26.8% for 0 to 5 months, 42.5% for 6 to 11 months and 52.1% for children aged 12 to 35 months; P < 0.001), and by season (51.2% in winter/spring vs. 24.5% in summer/autumn; P < 0.001). While those infected with rotavirus were more likely to be dehydrated (50.6% vs. 37.4%; P < 0.001), their median hospital stay was similar (1.0 vs. 2.0 days; P = 0.09) to other children with acute gastroenteritis. The estimated national hospitalisation rate for rotavirus diarrhoea in children under 3 years, standardised for age and season, was 634 (95% CI 597, 672) per 100 000. In New Zealand, rotaviruses result in 1 in 52 children being hospitalised by 3 years of age. Conclusions: Rotavirus diarrhoea is an important, potentially vaccine-preventable cause of hospitalisation in New Zealand children, especially during winter and spring seasons. [source] Milk formulas in acute gastroenteritis and malnutrition: A randomized trialJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2002RH Kukuruzovic Objective: To compare three low-lactose milk formulas differing in osmolality and degree of protein hydrolysis in the treatment of diarrhoea and malnutrition in subjects with high rates of lactose intolerance, osmotic diarrhoea and a tropical/environmental enteropathy. Methods: A randomized double-blind trial of 180 Aboriginal children under 3 years of age admitted with acute diarrhoea and/or malnutrition was carried out. The intervention milk formulas were: (i) De-Lact, a low-osmolality lactose-free formula; (ii) O-Lac, a lactose-free formula; and (iii) Alfaré, a partially hydrolysed formula. Outcome measures were diarrhoeal severity, weight gain, formula palatability and changes in intestinal permeability (L/R ratios). Results: The duration of diarrhoea in days (mean; 95% confidence interval) was significantly longer on Alfaré (8.5; 7.0,10.0) compared to De-Lact (6.1; 5.0,7.2) and O-Lac (6.9; 5.6,8.1; P = 0.04). There were no differences in mean intake between formulas, but palatability of Alfaré was significantly worse (P < 0.01) than the other formulas. Over the trial 5 days, improvement in L/R ratios was significantly greater (P = 0.05) for De-Lact (18.6; 10.6,26.6) than for Alfaré (8.5; 2.1,14.9). Weight gain was not significantly different between the three formulas, except in a malnourished subgroup who had better weight gain on De-Lact (P = 0.05). Conclusions: In these Aboriginal children with diarrhoea and growth failure, a low osmolality milk was associated with better outcomes and a partially hydrolysed formula with less improvement in mucosal recovery, suggesting that cow's milk protein intolerance is not contributing to greater diarrhoeal severity or enteropathy in Aboriginal children. [source] Dehydration in acute gastroenteritisJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2002DR Brewster First page of article [source] Clinical trial: oral ondansetron for reducing vomiting secondary to acute gastroenteritis in children , a double-blind randomized studyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2010H. L. YILMAZ Summary Background, Vomiting as a consequence of gastroenteritis frequently occurs in children. It is still debatable whether vomiting should be treated with antiemetic drugs. Aim, To investigate potential beneficial effects of ondansetron in treating vomiting during acute gastroenteritis. Methods, A randomized, double blind, placebo-controlled trial was performed in our emergency departments. Children, aged 5 months to 8 years, were randomized to receive either ondansetron 0.2 mg/kg or placebo at 8h intervals. The primary outcome measure was the frequency of emesis during an 8-h-period after enrolment. Results, A hundred and nine patients were enrolled; 54 received placebo and 55 received ondansetron. As compared with the children who received placebo, children who received ondansetron were less likely to vomit both during the first 8-h follow-up in the emergency department [relative risk (RR): 0.33, 95% CI: 0.19,0.56, NNT: 2, 95% CI: 1.6,3.5], and during the next 24-h follow-up (RR: 0.15, 95% CI: 0.07,0.33, NNT: 2, 95% CI: 1.3,2.1). Conclusion, Ondansetron may be an effective and efficient treatment that reduces the incidence of vomiting from gastroenteritis during both the first 8 h and the next 24 h, and is probably a useful adjunct to oral rehydration. [source] Saccharomyces boulardii for treating acute gastroenteritis in children: updated meta-analysis of randomized controlled trialsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2009H. Szajewska No abstract is available for this article. [source] Postinfectious gastroparesis related to autonomic failure: a case reportNEUROGASTROENTEROLOGY & MOTILITY, Issue 2 2006A. Lobrano Abstract, Background and aim:, Severe dysautonomia may be secondary to viral infections, resulting in impaired autoimmune, cardiovascular, urinary and digestive dysfunction. Herein, we present a case of a 31-year-old white female patient who had severe gastroparesis related to autonomic failure following an episode of acute gastroenteritis. This seems to be the first report providing thorough assessment of the enteric and autonomic nervous system by analysis of full-thickness small intestinal biopsies, cardiovagal testing and autopsy. Hospital course:, This patient affected by a severe gastroparesis was treated with antiemetics, prokinetics, analgesics and gastric electrical stimulation to control symptoms. Nutritional support was made using jejunal feeding tube and, in the final stage of disease, with total parenteral nutrition. Autonomic studies revealed minimal heart rate variability and a disordered Valsalva manoeuvre although the enteric nervous system and the smooth muscle layer showed a normal appearance. Hospital courses were complicated by episodes of bacteraemia and fungemia. Serum antiphospholipid antibodies were noted but despite anticoagulation, she developed a pulmonary embolism and shortly thereafter the patient died. Autopsy revealed acute haemorrhagic Candida pneumonia with left main pulmonary artery thrombus. Sympathetic chain analysis revealed decreased myelinated axons with vacuolar degeneration and patchy inflammation consistent with Guillain-Barre syndrome. The evaluation of the enteric nervous system in the stomach and small bowel revealed no evidence of enteric neuropathy or myopathy. Conclusion:, A Guillain-Barre-like disease with gastroparesis following acute gastroenteritis is supported by physiological and autonomic studies with histological findings. [source] Serum zinc levels in children with acute gastroenteritisPEDIATRICS INTERNATIONAL, Issue 3 2007AKGÜN ÖLMEZ Abstract Background: The aim of the present study was to determine the serum zinc levels on admission and 7,10 days after clinical recovery from acute gastroenteritis of <8 days' duration. Methods: This prospective study included 82 infants aged 2,24 months who had no associated bacterial infection, chronic disease, prior antibiotic use, moderate or severe malnutrition or dysentery. Forty-one healthy children formed the control group. Results: The mean serum zinc level on admission (Zn1) was 11.85 ± 2.83 ,mol/L and at 7,10 days after recovery (Zn2) was 10.92 ± 2.17 ,mol/L; mean serum zinc level of the control group was 11.81 ± 3.45 ,mol/L. Zn2 was significantly lower than Zn1, but there was no statistical difference between the mean of the control group and Zn1 and Zn2. When dehydrated patients were excluded from the patient group, Zn1 and Zn2 did not differ. Although asymptomatic, 39% of the control group had low zinc. Serum zinc levels were not affected by sex, age, clinical characteristics of the patients or severity of gastroenteritis. Conclusion: Serum zinc levels of the patients admitted with acute gastroenteritis without any other disease and without moderate or severe malnutrition were not affected by disease state. Gastroenteritis did not further decrease serum zinc levels in patients with asymptomatic or subclinical zinc deficiency. [source] Evaluation of faecal calprotectin as a valuable non-invasive marker in distinguishing gut pathogens in young children with acute gastroenteritisACTA PAEDIATRICA, Issue 9 2010Josef Sýkora Abstract Aim:, The aim of the study is to evaluate faecal calprotectin (f-CP) in children ,3 years of age with acute gastroenteritis (AG) as an early predictor of bacterial inflammation. Methods:, We prospectively analysed f-CP levels and diagnostic workup in 107 consecutive children (66 AG, 41 controls). Results:, Children with bacterial AG (BAG) was found to have higher diarrheal frequency (p < 0.01), fever (p < 0.01), erythrocyte sedimentation rate (p < 0.001), white blood count (p < 0.01) and C-reactive protein (CRP) (p < 0.001) compared with viral AG (VAG). Vomiting was frequent in VAG (p < 0.001). f-CP negatively correlated with age in controls (r = ,0.5998). BAG demonstrated significantly higher f-CP levels [median, 219 ,g/g, interquartile range (IQR): 119,350.2] compared with VAG (49.3 ,g/g, IQR: 8.8,131.1) as well as controls (26.5 ,g/g, IQR: 14.9,55.1) (p < 0.001). VAG and control f-CP levels were similar. f-CP was the best-rated marker of BAG with a diagnostic accuracy of 92%. Receiver,operator characteristic analysis revealed an area under curve of 0.95 for identifying BAG; sensitivity and specificity of f-CP were 93% and 88%, respectively, at an adjusted cut-off point of 103.9 ,g/g faeces. Combined f-CP and CRP yield improved diagnostic accuracy of 94% for BAG. Conclusion:, f-CP facilitates early discrimination between bacterial and viral causes of AG in young children. Combining f-CP with CRP increases the diagnostic power of diagnosing BAG. [source] Multicenter prospective study analysing the role of rotavirus on acute gastroenteritis in SpainACTA PAEDIATRICA, Issue 5 2010F Gimenez-Sanchez Abstract Background:, Paediatric rotavirus gastroenteritis is the most frequent cause of acute gastroenteritis (AGE) in children up to 5 years of age worldwide. Aim:, To analyse the clinical characteristics of AGE caused by rotavirus comparing to AGE caused by other agents. Methods:, The study was conducted in 30 health-care centers in Spain (25 hospitals and five primary centers) between January and March 2006. Children with AGE up to 2 years of age were included. Stool samples were analysed using immunochromatographic test to identify rotavirus infection. Clinical and epidemiological data were analysed. Results:, A total of 1192 children were enrolled (mean age: 11.2 months). Fever, Vomiting, weakness and dehydration were more frequent in rotavirus-positive AGE cases. Severity score was higher and hospitalization was likely in AGE caused by rotavirus. Family AGE illness was more frequent in children with rotavirus-positive AGE. Breastfeeding was found as a protective factor against Rotavirus AGE. Conclusion:, Rotavirus is the primary causal agent of AGE in children under 2 years of age in Spain, causing more severe symptoms and more hospital admissions than other causal agents. Our data support the interest of the introduction of the available rotavirus vaccines in the Spanish immunization schedule. [source] | |||||||||||||||||||||||||