Gastroenteritis is defined as the inflammation of the mucus membranes of the gastrointestinal tract and is characterized by diarrhea or vomiting. It is a common childhood disease. Children in developing countries are particular at risk of both morbidity and mortality. Worldwide, gastroenteritis affects 3 to 5 billion children each year, and accounts for 1.5 to 2.5 million deaths per year or 12% of all deaths among children less than 5 years of age.1–3 In developed countries, such as the United States, acute gastroenteritis seldom causes deaths, however, it still accounts for 300 deaths per year.2 Moreover, it puts a heavy burden on the health care system. Acute gastroenteritis causes 1.5 million visits to primary care providers each year and 220,000 hospital admissions for children under the age of 5 years; that is 10% of all the hospital admissions of children in the United States.2
In general, developing countries have a higher rate of hospital admissions as compared to developed countries. In the United States, the admission rate is 9 per 1000, per annum, for children younger than 5 years old.4
When compared to the United Kingdom and Australia, the admission rates are around 12 to 15 per 1000 per annum.5,6 However, the rate increases dramatically to 26 per 1000 per annum in China.7
This may be due to the facts that children in developed countries have a better nutrition status and better primary care. The difference can also be explained by the fact that, the incidence of acute gastroenteritis is significantly higher in developing countries than the industrialized countries.8
Interestingly, Hong Kong is a developed city, and yet the admission rate is even higher than many of the developing countries.9
This may reflect that the decision of admission does not simply depend on the clinical situations, but it can also be affected by the parents’ wishes and other social factors.
Etiology Viruses are the most important etiology and are responsible or approximately 70% of the episodes of acute gastroenteritis in children.10 There are over 20 different types of viruses that have been identified as etiological agents.11 Worldwide, rotavirus is still the most common virus causing this disease and accounts for some 30% to 72% of all the hospitalizations and 4% to 24% of acute gastroenteritis at the community level.12–15 Virtually all children have been infected with rotavirus by the age of 3 years.16 Rotavirus infection is seasonal in temperate climates, peaking in late winter, although it occurs throughout the year in the tropics. The peak age for infection ranges from 6 months to 2 years. Other common viruses causing gastroenteritis include calicivirus, adenovirus and astrovirus. Globally these viruses are responsible for diarrhea episodes in hospitalized children, with detection rates varying from 3.2%–29.3%, 1%–31%, and 1.8%–16%, respectively.17–20 Rates of virus infection are similar in both developed and less developed countries.21 Bacterial infection accounts for 10% to 20% of all the acute gastroenteritis.22
The most common bacterial causes are, Salmonella species, Campylobacter species, Shigella species and Yersina species. Vibrio cholerae remains a major cause of diarrhea, especially after a disaster where sanitation is compromised.
Rotavirus as a prototypic
virus for gastroenteritis Rotavirus is a prototypical virus because it is the most common virus that causes acute gastroenteritis in children which
results in hospitalization and treatment with intravenous fluid.
According to the data from the United States, approximately 410,000 physician visits are due to the rotavirus infection, the cause of 205,000 to 272,000 emergency department visits, which results in 55,000 to 70,000 hospitalizations.23
In the United States, 1 in 67–85 children will be hospitalized because of rotavirus infection by the age of 5 years.24 On the other hand, Hong Kong has a very high rate of hospitalization.
By the age of 5 years, the cumulative risk is 1 in 24, a figure that is 3 times higher than the that of the United States.9
For each admission in the United States, the hospital costs range from $2999 to $3400 with the family costs being $359 which includes the caregivers loss of work.24–26 In Hong Kong, admission costs are less expensive although they are not unsubstantial at $1868 (US) for each admission and $120 for family expenses.9
Adding in the prevalence of the disease, gastroenteritis causes a significant economic burden to the health care system. As to the severity of the disease, a study that included 234 hospitalized children infected with rotavirus, 63% of them had diarrhea, vomiting and fever, 21% had diarrhea and vomiting, 7% had diarrhea and fever, 4% had vomiting and fever, 3% had fever alone, 2% had vomiting alone and 0.4% had diarrhea alone.27 In general, 90% of the hospitalized patients had vomiting. Vomiting is one of the most important symptoms for considering failure of oral rehydration therapy and requiring intravenous therapy
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