Rotavirus vaccines and the prevention of hospital-acquired diarrhea in children.

Rotavirus, the major cause of severe acute dehydrating gastroenteritis in children less than 5 years of age, is responsible for an estimated 20-50% of all hospitalizations for diarrhea and approximately 440,000 deaths annually, primarily in the developing world. Rotavirus vaccines are considered the most promising means for disease prevention. While the prime rationale for developing rotavirus vaccines has been the enormous burden of rotavirus infection leading to severe and fatal disease, a secondary benefit may be the prevention of nosocomial rotavirus diarrhea. We have reviewed the burden of intra-hospital-acquired rotavirus infections from several countries and found that in the United States alone, as many as 25% of rotavirus hospitalizations or approximately 16,000-18,000 hospitalizations each year might be due to rotavirus infections acquired within hospitals. To countries with low rotavirus-associated mortality, prevention of these infections and the resulting economic savings therefore represent an important secondary goal. Several rotavirus vaccines are in development, and two candidates are currently being tested in large-scale safety and efficacy trials. Development of safe and effective rotavirus vaccines will protect children worldwide against the severe consequences of rotavirus infections including prolonged hospitalizations for nosocomially acquired infections.