Peer-reviewed article
Epidemiology and Clinical Impact of Pediatric Viral Gastroenteritis Before and After Rotavirus Vaccination in Sicily.
Floriana Bonura, Arcangelo Pepe, Dario Genovese, Emanuele Amodio, Chiara Filizzolo et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined viral gastroenteritis in 693 children hospitalized in Sicily between 2017 and 2020, comparing results with the pre-vaccination period from 2011–2012. Rotavirus remained the most common cause of severe gastroenteritis, though its prevalence dropped from 32.6% before vaccination to 13.3% after universal rotavirus vaccination was introduced in 2012. Children with rotavirus infection were older and experienced more severe symptoms including vomiting, fever and dehydration, and the virus was significantly associated with unvaccinated status. Seasonal patterns of rotavirus disease became less pronounced after vaccination, and the dominant viral strains shifted over time.
Key points
- Rotavirus prevalence declined from 32.6% in the pre-vaccine period (2011–2012) to 13.3% after universal vaccination was implemented in 2012
- Rotavirus infection was significantly associated with unvaccinated status
- Children with rotavirus-associated gastroenteritis were older (median 32.6 months) compared to other causes (30.5 months) and had greater clinical severity
- Seasonal patterns of rotavirus became attenuated following vaccine introduction
- Rotavirus remained the leading cause of severe pediatric acute gastroenteritis despite the decline in cases
Limitations
This is a retrospective observational study at a single hospital in Sicily, so results may not be generalizable to other regions or countries with different vaccination coverage or epidemiological patterns. The study did not assess vaccination coverage rates in the 2017–2020 cohort, limiting interpretation of why some rotavirus cases still occurred.
Abstract
Acute gastroenteritis (AGE) remains a leading cause of pediatric mortality and morbidity, with rotavirus as the leading cause of severe disease. Post-vaccine surveillance is essential to monitor circulating pathogens and assess vaccination impact. Sicily was the first Italian region to implement universal rotavirus vaccination in 2012. We retrospectively studied 693 children hospitalized for suspected viral AGE at the Children's Hospital of Palermo (March 2017-February 2020), testing stool samples for viral and bacterial enteric pathogens. Rotavirus remained the most common agent (13.3%), followed by norovirus (12.1%), adenovirus (11.3%), Salmonella spp. (4.6%) and astrovirus (3.2%). The study population was categorized as rotavirus-associated AGE (RV-AGE) or other-cause AGE (O-AGE). Epidemiological, clinical and virological features were compared with the pre-vaccine period (2011-2012). At least one pathogen was detected in 47.5% of samples. RV-AGE cases were older than those with O-AGE (median 32.6 vs. 30.5 months; p < 0.01) and had greater clinical severity, with higher frequency of vomiting, fever and dehydration. Rotavirus infection was significantly associated with unvaccinated status. Compared with the pre-vaccine era, rotavirus prevalence declined (32.6% vs. 13.3%), seasonal patterns were attenuated and genotype distribution shifted toward G2P[4], G9P[8] and equine-like G3P[8] strains. Despite the decline in RV-AGE following vaccine introduction, rotavirus remains a relevant cause of pediatric AGE, underscoring the need for high vaccination coverage and continued surveillance.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
Problem
Rotavirus causing severe pediatric acute gastroenteritis with significant mortality and morbidity
- Intervention
- Universal rotavirus vaccination program implemented in Sicily in 2012
- Population
- Children hospitalized for suspected viral acute gastroenteritis in Sicily
Key finding
Rotavirus prevalence declined from 32.6% pre-vaccination to 13.3% post-vaccination