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Am Fam Physician. 2002;66(2):322-325

Rotavirus (RV) is the most common cause of acute gastroenteritis. Recent studies have shown that the symptom complex occurring with RV infection is broader than just diarrhea, often including vomiting and fever. Staat and colleagues examined the symptoms occurring in children who were hospitalized or admitted to a short-stay unit to find out if they had RV infection with vomiting and/or fever but without diarrhea.

Children were studied at three prominent pediatric hospitals in the United States from late 1997 to mid-1998. Children admitted to these hospitals who were 15 days to four years of age and had had diarrhea for less than seven days, vomiting, and/or a fever without a clear cause were invited to enroll. Diarrhea was defined as at least three stools with loose consistency during a 24-hour period. Vomiting was defined as expulsion of gastric material occurring at least once in the previous 24 hours. Fever was defined as a rectal temperature greater than 38°C (100.4°F). Caregivers, usually the parents, were interviewed for pertinent medical history and demographic information, and stool samples were collected from the children and tested for RV antigen.

A total of 862 children were enrolled; 40 percent of them were younger than six months of age, and 11 percent were older than 35 months of age. RV was found in the stool of 234 of these children. Among these children, diarrhea, vomiting, and fever in combination were the most common symptoms. Ninety-seven percent of the children with RV excretion presented with acute gastroenteritis (diarrhea and/or vomiting), and 91 percent presented with diarrhea, with or without vomiting or fever.

RV infection was found more commonly in children six months of age or older. Of children who were admitted for only fever or vomiting, the rate of positive RV infection was higher among those who developed diarrhea and/or the other absent symptom while in the hospital. The RV season was noted to begin in mid-January and end in late May to early June at all three sites. March was the peak hospitalization period at all three hospitals.

The authors conclude that the rate of RV infection in children under four years of age admitted with the classic symptoms of diarrhea, vomiting, and fever was 56 percent. The rate was 25 percent among children with only two symptoms and 13 percent among those with vomiting and/or fever but no diarrhea. The incidence of RV was low (17 percent) among children younger than six months of age with any constellation of symptoms. These results increase our understanding of the burden of RV infection among children and will help determine the efficacy of future rotavirus vaccines.

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Copyright © 2002 by the American Academy of Family Physicians.

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