Morbidity and ambulatory resource utilization for diarrheal diseases

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Rotavirus vaccines were developed with the target of reducing severe diseases, (ie, deaths and hospitalizations). Baseline data on incidence of these outcomes were gathered and evidence is emerging rapidly that 5-antigen bovine reassortant rotavirus vaccine (RV5 [Rotateq]) is highly protective against severe disease. There is little knowledge of the national burden of less severe rotavirus disease. Pre-licensure studies of RV5 and post-licensure observation suggest that direct and indirect vaccine effect on less severe rotavirus disease may be substantial. In this issue of The Journal, Pont et al report rates of diarrhea-associated visits to outpatient offices/clinics and Emergency Departments (ED) over the last decade before universal implementation of RV5 in a national sample of children under 5 years of age. They found that the burden of diarrheal disease and resource utilization was substantial, especially for children younger than 3 years of age (1315 outpatient visits and 428 ED visits per 10 000 person years) and incidence did not change over the years studied. Rotavirus was estimated to be responsible for 29% of outpatient visits and 25% of ED visits for diarrhea illness, contributing approximately 750,000 visits annually for children under 5 years of age. A second finding in this study was that utilization of ED compared with outpatient clinics/offices by black patients exceeded that of white patients, both among families with private insurers and with Medicaid/SCHIP.

The findings of this national study will help assess impact of RV5 vaccine and will serve to generate hypotheses for study of differences in healthcare use by race.

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