(INF-P4) Rotavirus infection in the elderly: A 7-year study prior to the introduction of rotavirus vaccination in children in Gothenburg

Författare/Medförfattare

NamnArbetsplatsOrganisationOrtLandAffiliation
Thomas Andreasson Infektionskliniken Sahlgrenska Universitetssjukhuset Göteborg 1
Lars Gustavsson 1
Maria Andersson Klinisk mikrobiologi/virologi Sahlgrenska Universitetssjukhuset Göteborg 2
Johan Westin 1
Magnus Lindh 2
Lars-Magnus Andersson 1

Abstrakt

BACKGROUND
Gastroenteritis caused by rotavirus has been recognized as a leading cause of diarrhea-associated morbidity and mortality in children worldwide. However, rotavirus infections in adults have not been studied to the same extent.
Our aim was to describe clinical and epidemiological characteristics in elderly hospitalized patients with rotavirus.

METHODS
We included all patients 60 years of age and older, hospitalized at the Sahlgrenska University Hospital in Gothenburg from September 2009 through May 2016, with a fecal swab sample positive by PCR for  otavirus. Medical records were reviewed retrospectively, and data on all-cause mortality rate, community vs. hospital onset of symptoms, ward type, date of sampling and co-morbidities was registered. Genotyping was performed by an in-house multiple PCR.

RESULTS
159 patients with positive rotavirus PCR were included. Hospital onset of symptoms (n=35, 22%) was less frequent than community onset (n=124, 78%). Ninety-nine (62%) of the patients with positive PCR were  sampled between March through May. In the years 2013 and 2014, G2P4 was more frequent than other genotypes and found in 77% (50/65) of samples. In the other years, genotype distribution was more varied. Four patients (2,5%) died within 30 days from positive rotavirus PCR. Three of these patients were admitted to the same clinic within one month and tested positive for the same genotype of rotavirus (G2P4). All three had hospital onset of symptoms. Five additional patients at the same clinic, four with hospital onset of symptoms, were also positive for rotavirus G2P4 during the same time period. We believe these patients represent an unrecognized nosocomial outbreak with a case fatality rate of 3/8 (38%).

CONCLUSIONS
In the seven years preceding general rotavirus vaccination in children in Gothenburg, rotavirus infection was a notable cause of gastroenteritis-associated morbidity and hospitalization in elderly. G2P4 was the  most common genotype observed. Genotyping revealed a probable nosocomial outbreak with high 30-day mortality rate among the affected patients.