Rotavirus gastroenteritis among children under five years of age in Izmir, Turkey

Little is known about the epidemiology of rotavirus infection in Turkey. The aim of the study was to determine the incidence and clinical significance of rotavirus gastroenteritis, in view of the potentially available prevention by rotavirus vaccination. The study also sought to determine possible risk factors for rotavirus gastroenteritis. Therefore, 920 children under five years of age with acute gastroenteritis admitted to three pediatric hospitals in Izmir were studied. Rotavirus was identified in 39.8% of the children. Most children with rotavirus gastroenteritis (80.7%) were younger than two years of age. Marked seasonality of rotavirus gastroenteritis was observed, with a peak incidence from January to March. A total of 91% of rotavirus strains that were typed were of serotypes G 1-4. There was no significant difference among rotavirus-positive and rotavirus-negative patients with regard to family income. Compared with children who were exclusively breast-fed, those who were not exclusively breast-fed were at a two-fold greater risk of rotavirus diarrhea. Rotavirus gastroenteritis was significantly more severe than non-rotavirus gastroenteritis; 69% of children with rotavirus infection had severe gastroenteritis (score > or = 11). In conclusion, rotavirus is the most common cause of severe gastroenteritis among children under five years of age in Izmir. A new potent rotavirus vaccine, when available, will provide effective protection against severe rotavirus infection. Promotion of breast-feeding would augment the impact of rotavirus vaccines in preventing severe childhood diarrhea.     

Epidemiology of rotavirus infection in Thailand

Rotavirus is a major cause of acute severe diarrhea in children worldwide and an important cause of death among young children in developing countries. Group A rotaviruses are antigenically complex and multiple serotypes infect humans. Reassortant rotavirus vaccines are now available which offer protection against severe illness caused by rotavirus serotypes G1-4. Before vaccines are introduced into target populations, it is necessary to establish the baseline data of the epidemiology of rotavirus infection in those countries. The purpose of the present study is to provide information related to the epidemiology of rotavirus infection in Thailand. All rotavirus studies performed in Thailand were found through Medline and Thai Index Medicus searches. A total of 26 of the most relevant studies published in international and national journals are reviewed. Most studies reported that the prevalence of rotavirus infection in Thailand was 27-34%, although a few studies have reported a prevalence above this range. The peak seasonal distribution of rotavirus infection among children hospitalized with diarrhea in Thailand was seen in the dry cool seasons: October to February. The prevalence of rotavirus infection was most frequently found in children aged 6-11 months up to 2 years. G1 was the most prevalent serotype in Thailand, followed by G2, G4 and G3, respectively. At least three G serotypes, mostly G1, G2 and G4, are seen to coexist in Thailand each epidemic year and in some studies all four G-serotypes were reported in the same epidemics. In a 1996-1997 study, G9 was the third prevailing serotype after G1 and G2, respectively. These results indicate that rotavirus epidemics occur in Thailand every year and children are the most affected population. In Thailand, although G1-G4 have been reported, G1 is the most prevalent serotype in each epidemic and G9 is becoming increasingly common.     

Molecular epidemic features and variation of rotavirus among children with diarrhea in Lanzhou,China, 2001–2006

Background  Human rotavirus (HRV) is the most common pathogen causing severe diarrhea among infants and young children worldwide. This study aims to understand rotavirus epidemiology and its variation in the period of 2001–2006 in Lanzhou, Gansu Province, China, and to provide an epidemiological basis for the development of rotavirus vaccine. Methods  A total of 1019 stool specimens were collected from patients with acute diarrhea admitted to the First Hospital of Lanzhou University from 2001 to 2006, who were younger than 5 years old. Dako IDEIATM kits were used for detection of rotavirus, and RT-PCR was performed for determination of G serotype and P genotype of the rotavirus. Results  Rotavirus was present in 51.6% (526) of the 1019 specimens. G serotype identified G3 at 40.9%, G2 14.6%, G1 22.2% and G9 1.9%. Mixed-G infection was observed in 4.4% and non-typeable infection 16.0%. P genotype was observed in 372 samples, of which P[8] accounted for 186 cases (50.0%), P[4] 72 cases (19.4%), mixed-P infection 2 cases (0.5%), and non-typeable cases 112 (30.1%). G3 was the most prevalent G serotype found in this study from 2001 to 2004, G2 was the most prevalent G serotype (34.4%) from 2004 to 2005, and G1 (61.5%) was the most prevalent strain from 2005 to 2006. G9 was detected in 10 cases (1.9%) and G4 was not detected during this 5-year period. P[8] was the most prevalent P genotype found over the 5 consecutive years of this study, although there was a significant transition of P genotype from 2004 to 2005 with P[4] (45%) identified as the predominant P genotype, followed by P[8] (22.1%). The predominant G-P combination was P[8]G1 (33.6%), followed by P[8]G3 (32.1%) and P[4]G2 (17.2%). Rotavirus diarrhea admissions peaked between October and December. Continuous surveillance showed that the incidence rate of rotavirus was the highest in infants aged 6–23 months, averaging 11.0–11.9 months. Conclusions  Five years of continuous surveillance showed that rotavirus remains the most significant viral agent causing diarrhea hospitalization among children under 5 years old in Lanzhou, China although the predominant strain of rotavirus varies between years. Mixed-G serotype infection also appears to occur at a relatively high rate in Lanzhou.     

2009-2010年南京地区5岁以下儿童轮状病毒性腹泻临床特点及分子流行病学研究

目的 了解2009年7月-2010年6月南京地区轮状病毒性腹泻的流行病学情况及病毒的血清及基因分型特点,为轮状病毒感染性腹泻的防治提供科学依据.方法 收集2009年7月-2010年6月本科随机留取水样泻患儿粪便标本300份,标本采集后立即保存于- 20℃冰箱,集中进行病毒检测和数据分析.使用ELISA法检测A组人类轮状病毒(HRV),应用Trizol法提取HRV RNA,反转录合成病毒cDNA,采用巢式反转录PCR法对HRV标本进行G血清型和P基因型分型.结果 300份患儿粪便标本中113份标本检测出A组HRV,阳性率为37.67％.G血清型最常见的为G3型[44份(38.94％)],其次为G2型[10份(8.85％)],G1型、G2+G3型各2份(1.77％),G9型1份(0.88％),未能分型54份(47.79％);P基因型最常见的为P[8]型[38份(33.63％)],其次为P[4]型[19份(16.81％)],未能分型56份(49.56％),未发现P[6]、P[9]、P[10]型.G血清型和P基因型组合以G3P[8]为主(18/113例,15.93％).南京地区HRV腹泻季节高峰在10月份-次年1月份,95.58％的腹泻儿童在2岁以前感染过HRV,HRV组发热率、腹泻次数、出现呕吐和脱水症状的概率与HRV阴性组比较差异均有统计学意义(Pa＜0.05).结论 HRV是引起南京地区婴幼儿水样泻的最主要的病原体,以G3P[8]为主要优势株.     

Epidemiological changes in rotavirus gastroenteritis in children under 5 years of age after the introduction of rotavirus vaccines in Korea

Rotavirus gastroenteritis is the leading cause of severe acute gastroenteritis in children worldwide and is associated with high hospitalization and mortality rates in children younger than 5 years of age. Vaccination is necessary to prevent rotavirus infection. Two live attenuated and orally administered rotavirus vaccines became commercially available in Korea. The aim of this study is to describe epidemiological changes in rotavirus gastroenteritis after the introduction of rotavirus vaccines in Korea. The medical records of 11,199 children younger than 5 years of age and hospitalized for acute gastroenteritis from August 2007 to July 2010 in eight Korean hospitals were reviewed. Rotavirus was detected in stool samples obtained from 2,959 children (26.42 %). The authors evaluated the percentage of rotavirus gastroenteritis among all acute gastroenteritis hospitalizations in eight hospitals located in different geographical areas and analyzed epidemiological changes in rotavirus gastroenteritis according to age, geographical area, and season. According to the findings, the percentage of rotavirus gastroenteritis showed a decrease in children eligible for vaccination during the study period. After introduction of the vaccine, reduced rates of rotavirus detection were observed in all of the geographical areas, and the greatest reduction was observed in Seoul. In Seoul, there was a marked delay of the rotavirus season. Conclusion: Epidemiologic changes in Korea after the introduction of rotavirus vaccine are consistent with changes observed in other countries.     

Rotavirus infection in children in Japan

Currently, a high morbidity of rotavirus diarrhea has been seen in children in developed and developing countries. Improvement of the vaccines is necessary in order to reduce the burden of diarrhea caused by rotavirus. A survey of rotavirus infection from diarrheal stool specimens in children of seven regions in Japan was conducted from 1984 to 1999. The present study discusses the survey results and reviews the national and international data of more than 23 papers and congress proceedings about rotavirus infection in Japan. We analyze the prevalence of rotavirus infection in acute diarrheal in- and outpatients, the distribution of rotavirus G-serotypes and surveillance data for seasonality and age groups in Japan. The data indicated that rotavirus is the most important cause of diarrhea in Japan among young children, with the prevalence ranging from approximately 9.7 to 88%. The most common rotavirus strains belonged to serotype G1, specifically since 1993. Serotypes G2, G3 and G4 had also been documented to be predominantly based in the area and year before 1992. However, untypeable rotavirus strains had been found each year, with a prevalence up to 56.7% which suggests that rare serotypes (except G1-4) or new serotypes might exist. Unexpectedly, in Tokyo and Sapporo from 1998 to 1999, G9 was found to be the first most prevailing serotype with a high prevalence of 52.9 and 71.4%, respectively. Despite these data from different geographic areas, the year under investigation was relatively clear in respect to seasonality, with a peak of rotavirus activity in late winter (February) through early spring (March). Age distribution had also characterized that the infection was predominant among children aged 1-2 years of age, although it was also common in children of 2-3 years. In addition, mixed infection with bacteria was documented.     

Rotaviruses in infants with diarrhea studied by viral RNA electrophoresis in Ankara, Turkey

Incidence of rotavirus in children under 2 years of age, admitted to 2 children's hospitals i n Ankara, Turkey, from July 1984-June 1985 was measured using viral RNA electrophoresis in agarose gels. 375 children were selected at random from over 14,000 diarrhea admissions, and their stool specimens taken on admission were compared to those of 333 children without diarrhea. 61 (16.3%) of the diarrhea cases had detectable rotavirus, compared to 0% in controls. Bacteriologic tests for salmonella, Shigella and Campylobacter jejuni were positive for 51 (13.6%) of the diarrhea patients and 1.8% of controls. 1 child had both rotavirus and Salmonella. Rotavirus infection was highest in November- March, peaking in December. Bacterial diarrhea was prevalent in the summer. This pattern is typical of a temperate climate, although in developed countries bacterial gastroenteritis is not as prevalent. Since there are about 2340 diarrhea admissions annually for rotavirus in Ankara, from a population of 2,700,000, rotavirus vaccination seems appropriate.     

Rotavirus gastroenteritis in Finland: burden of disease and epidemiological features

The burden of disease attributable to childhood rotavirus infection in Finland was assessed from data on hospital admissions for acute gastroenteritis and from reported virological diagnoses of rotavirus from 1985 to 1995. The mean number of hospitalizations (3584 annually in children under 5 y of age) corresponded to approximately 5.6% of the birth cohort. Rotavirus was estimated to be responsible for 54% of cases; accordingly, 3% of all children in Finland are hospitalized for rotavirus diarrhoea. The monthly distribution of hospitalizations for acute diarrhoea showed a similar pattern as monthly diagnoses of rotavirus, with a long epidemic period starting as early as November or December and lasting until June or even July. The prevalent rotavirus G-type throughout the study period was G1, which was detected in over 60% of the cases; however, in the season 1988-89 G4 was the prominent type. Improved case management has led to a shorter duration of hospital stay (3.3 d in 1985 vs. 2.3 d in 1995), but otherwise these was no significant trend for rotavirus gastroenteritis over the years. These findings underscore the need to control rotavirus gastroenteritis with a specific intervention, notably rotavirus vaccination.     

Rotavirus gastroenteritis in Finland: burden of disease and epidemiological features

The burden of disease attributable to childhood rotavirus infection in Finland was assessed from data on hospital admissions for acute gastroenteritis and from reported virological diagnoses of rotavirus from 1985 to 1995. The mean number of hospitalizations (3584 annually in children under 5 y of age) corresponded to approximately 5.6% of the birth cohort. Rotavirus was estimated to be responsible for 54% of cases; accordingly, 3% of all children in Finland are hospitalized for rotavirus diarrhoea. The monthly distribution of hospitalizations for acute diarrhoea showed a similar pattern as monthly diagnoses of rotavirus, with a long epidemic period starting as early as November or December and lasting until June or even July. The prevalent rotavirus G-type throughout the study period was G1, which was detected in over 60% of the cases; however, in the season 1988-89 G4 was the prominent type. Improved case management has led to a shorter duration of hospital stay (3.3 d in 1985 vs. 2.3 d in 1995), but otherwise these was no significant trend for rotavirus gastroenteritis over the years. These findings underscore the need to control rotavirus gastroenteritis with a specific intervention, notably rotavirus vaccination.     

Child rotavirus infection in association with acute gastroenteritis in two Chinese sentinel hospitals

Rotavirus gastroenteritis is an important pediatric disease in China. In a survey of rotavirus infection at two sentinel hospitals in China (Beijing Friendship Hospital and Changchun Children's Hospital), 296 cases were detected. A total of 283 (95.6%) cases of rotavirus infection occurred in children under 5 years of age. Serotype G1 (62%) was most prevalent followed by G2 (28.5%), G3 (5%) and G4 (2%). Mixed infections (n = 8, 3%) were rate, and 16 isolates (5.5%) remained non-typeable. A consistent epidemic occurred during the winter. Rotavirus was responsible for about 61.8% of diarrhea-related hospitalizations in children under 5 years of age, with a mean hospital stay of 5.6 days (1.0-21 days). The estimated rate of rotavirus-attributed hospitalizations was 16/1000 children under 5 years of age per year. Rotavirus-related death is rare in Changchun and Beijing. The present findings suggest that a rotavirus vaccine for the prevention of severe disease and a reduction of treatment costs would be of significant benefit to China.     

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目的通过分子流行病学调查研究兰州地区婴幼儿病毒性腹泻的病原学特点。方法采用酶联免疫吸附试验(ELISA)及逆转录聚合酶链反应(RTPCR),对2003年7月至2004年6月兰州地区收集的624例婴幼儿腹泻粪便标本随机抽取271例进行轮状病毒(RV)、杯状病毒(HuCV)及星状病毒(AstV)检测。结果在271例标本中共检出RV感染153例(56.46%),其中G394例(61.44%),G24例(2.61%),G93例(1.96%),未发现G1、G4型和混合感染;在随机抽取的69例G分型阳性标本中,检出P[8]型28例(40.58%);RV的感染对象主要为6～23月龄的婴幼儿,发病高峰在10、11月份(86.27%、73.81%)。在118例RVELISA阴性标本中检出HuCV感染13例(11.02%),其中诺如病毒(NLV)GⅡ型11例,札如病毒(SLV)2例,未检出NLVGⅡ型,发病年龄1～18个月(11.31±4.53个月);同时检出AstV感染7例(5.93%),发病年龄4～12个月(8.27±2.69)个月,其中有1例合并有SLV感染,另有1例为迁延性腹泻。HuCV和AstV感染均未表现出明显的季节性。结论RV是兰州婴幼儿病毒性腹泻的主要病原,其流行的主要血清型为G3型,HuCV和AstV亦是重要病原之一。     

Clinico-laboratory analysis of the diarrhea syndrome in young children excreting rotaviruses with feces

A total of 404 children admitted to the infectious hospital of the non-intestinal type were examined with the aid of counter immunoelectroosmophoresis. Rotavirus antigen was detected in feces in 46.8% of 126 children admitted with a diagnosis of diarrhea, in 10.8% of 278 without diarrhea, and also in 32.9% of 149 children with diarrhea that occurred at the hospital. The clinical course of acute rotavirus gastroenteritis appeared to be materially influenced by acute respiratory viral infection, particularly influenza, and by certain types of opportunistic bacteria contained in high concentrations by the intestine.     

马鞍山、苏州地区婴幼儿轮状病毒腹泻临床特征和G血清型研究

目的　研究马鞍山和苏州地区婴幼儿轮状病毒 (RV)腹泻的临床特征和G血清型。方法　收集马鞍山和苏州地区5岁以下儿童急性腹泻粪便标本 1 2 67份 ,采用酶联免疫吸附试验和巢式 聚合酶链反应检测RV感染和血清型。结果　 1 2 67份标本中RV阳性 378份 ,血清型G型是优势株共 2 50株 ,其中G1 1 0 0株 ,G3 1 1 1株 ,G2 8株 ,G4、G9各 3株 ,混合感染 4株 ,未能分型2 1株 (8.40 % )。马鞍山地区以G1型为主 (58.54 % ) ,苏州地区以G3型为优势株 (47.85 % )。结论　RV是导致马鞍山和苏州地区婴幼儿腹泻的主要病原 ,流行的血清型分别为G1和G3型。     

Prospective epidemiological study of rotavirus gastroenteritis in Europe (REVEAL study). Results in the French area of the study]

PRIMARY OBJECTIVE: To estimate the incidence of acute gastroenteritis (AGE) and rotavirus acute gastroenteritis (RVAGE) in children less than 5 years of age seeking medical care in primary care, emergency department, and hospital settings. SECONDARY OBJECTIVES: To compare the clinical profile of RVAGE and non-RVAGE and to describe the distribution of RV serotypes among RVAGE cases. METHODS: A prospective primary care, emergency ward and hospital-based observational study was conducted during 1 year in a selected city of France with 250,000 inhabitants. Children less than 5 years of age presenting with symptoms of AGE were included. Rotavirus was identified using an Elisa test in stools. RESULTS: The estimated annual incidence of RVAGE was 1.56% for AGE and 0.87% for RVAGE in hospital, 5.87% for AGE and 2.65% for RVAGE in emergency-wards, 7.39% for AGE and 1.45% for RVAGE in primary care. Total incidence was 14.82% for AGE and 4.96% for RVAGE among children less than 5 years of age. RVAGE were more clinically severe than the AGE: dehydration (26.8% vs. 14.7%, p<0.0001), vomiting 84.9% vs. 60.9%, p<0.0001), fever (74.3% vs. 44.4%, p<0.0001), lethargy (84.9% vs. 70.2%, p<0.0001). G9 serotype was the most frequent serotype encountered (54.7%) during the study period followed by G3 serotype (33.6%) and G2 serotype (7.9%). CONCLUSION: In this study, RVAGE, caused by serotypes G9 and G3, represented about 1/3 of AGE and were more severe than non-RV AGE with twice as high dehydration rate. These results underline the need for continued promotion on the use of oral rehydration fluids and provide some arguments on the benefits of vaccination against rotavirus and also permanent virological monitoring of circulating serotypes.     

Multicenter prospective study analysing the role of rotavirus on acute gastroenteritis in Spain

Background: Paediatric rotavirus gastroenteritis is the most frequent cause of acute gastroenteritis (AGE) in children up to 5 years of age worldwide. Aim: To analyse the clinical characteristics of AGE caused by rotavirus comparing to AGE caused by other agents. Methods: The study was conducted in 30 health‐care centers in Spain (25 hospitals and five primary centers) between January and March 2006. Children with AGE up to 2 years of age were included. Stool samples were analysed using immunochromatographic test to identify rotavirus infection. Clinical and epidemiological data were analysed. Results: A total of 1192 children were enrolled (mean age: 11.2 months). Fever, Vomiting, weakness and dehydration were more frequent in rotavirus‐positive AGE cases. Severity score was higher and hospitalization was likely in AGE caused by rotavirus. Family AGE illness was more frequent in children with rotavirus‐positive AGE. Breastfeeding was found as a protective factor against Rotavirus AGE. Conclusion: Rotavirus is the primary causal agent of AGE in children under 2 years of age in Spain, causing more severe symptoms and more hospital admissions than other causal agents. Our data support the interest of the introduction of the available rotavirus vaccines in the Spanish immunization schedule.     

马鞍山、苏州地区5岁以下腹泻儿童轮状病毒G、P分型研究

目的 研究马鞍山和苏州地区5岁以下腹泻儿童轮状病毒G型和P型的分型。方法 对马鞍山和苏州地区5岁以下急性腹泻儿童粪便标本1267份，采用酶联免疫吸附试验和巢式-聚合酶链式反应检测轮状病毒感染和血清型。结果 轮状病毒阳性标本378份，主要来自2岁以下婴幼儿；血清型G型是优势株共250株，其中G1100株，G28株，G3111株，G43株，G93株，混合感染4株，未能分型21株(8．40％)；马鞍山以G1型为主(58．54％)，苏州以G3型为优势株(47．85％)；P基因型两地区流行株为P[4]和P[8]，分别占52．33％和47．67％，G1P[4]成为仅次于G1P[8]的GP组合。结论 在苏州和马鞍山地区5岁以下儿童轮状病毒腹泻中，流行的血清型分别为G3和G1，P基因型流行株为P[4]和P[8]。     

Recommendations for the use of rotavirus vaccines in infants

Rotavirus infection occurs in the majority of healthy children before five years of age, and is the most common diarrheal illness associated with hospitalization. The majority of children present with symptoms of vomiting, diarrhea and fever. As a result, rotavirus gastroenteritis is responsible for greater morbidity than other common childhood diarrheal illnesses. The highest risk of severe disease is in children younger than two years of age. It is estimated that one in 20 children will require an emergency department visit. In addition to community-acquired infections, hospital-acquired infections are also significant. There are currently two licensed rotavirus vaccines in Canada. Both vaccines are administered orally and are highly effective against severe disease and hospitalization. Large pre- and postmarketing studies have shown no increased risk of intussusception with the current rotavirus vaccines. The present statement provides information concerning the clinical disease and rotavirus vaccines in Canada.     

Rotavirus and other enteropathogens in childhood acute diarrhoea: a study of two centres in Malaysia

AIM: To study the role of rotavirus in children hospitalised for acute gastroenteritis (AGE) in two urban hospitals in Malaysia. METHODS: A 12-month prospective study (January to December 2002), in children younger than 14 years with AGE hospitalised to the paediatric units of University of Malaya Medical Centre (UMMC), Kuala Lumpur; and Hospital Sultanah Aminah (HSA), Johor Bahru, Malaysia was conducted. RESULTS: In 2002, 399 and 1307 children with AGE were admitted to UMMC and HSA, respectively. Two hundred and eighty-eight (72%) stool samples from UMMC and 901 (69%) samples from HSA were analysed. Rotavirus was the most common aetiological agent identified in both centres (average 32%; UMMC 35%, HSA 30%, P = 0.94). The peak age group for rotavirus-related hospitalisation was 24-35 months for UMMC and 12-23 months for HSA. Nine percent of patients hospitalised for rotavirus infection in UMMC and 22% of patients in HSA were older than 5 years of age. An outbreak of rotavirus infection within the communities served by both centres resulting in an increase in hospital admissions of rotavirus gastroenteritis was observed in both units from January to March 2002. CONCLUSION: The peak age group for rotavirus-related hospital admission in this study was much older, between 12 to 35 months. It is uncertain whether this was related to the outbreak of rotavirus gastroenteritis observed within two urban areas from January to March 2002 causing re-infection with rotavirus in older children.     

Rotavirus vaccines: an update

PURPOSE OF REVIEW: Rotavirus infection is the most common cause of severe diarrhea disease in infants and young children worldwide and has a major global impact on childhood morbidity and mortality. Vaccination is the only control measure likely to have a significant impact on the incidence of severe dehydrating rotavirus disease. RECENT FINDINGS: Rotavirus disease prevention efforts suffered a great setback in 1999 with the withdrawal of the RRV-TV vaccine less than a year after its introduction. Several new rotavirus vaccine candidates have now been developed and are undergoing clinical trials. SUMMARY: New safe and effective rotavirus vaccines offer the best hope of reducing the toll of acute rotavirus gastroenteritis in both developed and developing countries.     

Rotavirus diarrhea in Jewish and Bedouin children in the Negev region of Israel: epidemiology, clinical aspects and possible role of malnutrition in severity of illness

We conducted a 1-year prospective study in the Negev region of southern Israel to determine the epidemiologic and clinical patterns of rotavirus diarrhea. A total of 605 patients were studied, 392 Bedouins and 213 Jews, 441 of whom had diarrhea (449 episodes) and 164 did not. Rotavirus was the most common organism detected in children with diarrhea (63 of 444; 14%) but was rarely found in controls (3 of 163; 2%) (P less than 0.001). In 22% (12 of 54) of the rotavirus-positive patients, at least one other organism was also detected. The rate of rotavirus detection decreased as age increased, from 18% in the first year to 8% in the third year of life. Hospitalization with rotavirus diarrhea occurred more frequently in the summer. However, during winter, when diarrhea was less prevalent in the community, the proportion of cases associated with rotavirus was higher. Compared with controls, malnourished children were more likely to be hospitalized. However, rotavirus was detected in similar proportions among well-nourished and malnourished cases with diarrhea. The most prevalent rotavirus serotype was type 1 (in 69%), followed by types 4 and 2 (18 and 13%, respectively). We estimated that during the study period, approximately 2% of all Bedouin infants vs. only 0.2% of Jewish infants were hospitalized with rotavirus disease in their first year of life. Clinical signs and symptoms and stool appearance were not useful in predicting rotavirus detection. Malnutrition seems to be an important indicator of disease severity, which may explain why the toll of rotavirus-associated morbidity and mortality is particularly high among children in developing countries.