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Open Access Research article

The burden of rotavirus gastroenteritis and hospital-acquired rotavirus gastroenteritis among children aged less than 6 years in Japan: a retrospective, multicenter epidemiological survey

Hitoshi Tajiri1*, Yuriko Takeuchi2, Tomoko Takano1, Toshihiro Ohura3, Ayano Inui4, Kimie Yamamoto5, Yoshihito Higashidate6, Hisashi Kawashima7, Shigeru Toyoda8, Kosuke Ushijima9, Gunasekaran Ramakrishnan10, Mats Rosenlund1011 and Katsiaryna Holl102

Author Affiliations

1 Osaka General Medical Center, 3-1-56, Mandai-Higashi, Sumiyoshi, Osaka 558-8558, Japan

2 GlaxoSmithKline, Tokyo, Japan

3 Sendai City Hospital, Sendai, Japan

4 Saiseikai Yokohamashi Tobu Hospital, Saiseikai, Japan

5 Kagoshima Medical Association Hospital, Kagoshima, Japan

6 Sapporo Social Insurance General Hospital, Sapporo, Japan

7 Tokyo Medical University Hospital, Tokyo, Japan

8 Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan

9 Kurume University Medical Center, Kurume, Japan

10 GlaxoSmithKline Vaccines, Wavre, Belgium

11 Centre for Pharmacoepidemiology, Unit for Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Karolinska, Sweden

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BMC Pediatrics 2013, 13:83  doi:10.1186/1471-2431-13-83

Published: 22 May 2013



Rotavirus is a leading worldwide cause of acute gastroenteritis in young children. This retrospective hospital-based study assessed the burden of rotavirus gastroenteritis in children younger than 6 years in Japan.


Children admitted to eight hospitals for acute gastroenteritis between 2008 and 2009 were identified from hospital admission databases. Diagnosis of acute gastroenteritis/rotavirus gastroenteritis and hospital-acquired rotavirus gastroenteritis was confirmed based on either the International Classification of Diseases and Related Health Problems 10th revision (ICD10) codes (intestinal infectious diseases [AA00-AA09] and rotavirus gastroenteritis [A08.0]) or from rapid rotavirus diagnostic test results.


Of 13,767 hospitalized children, 11.9% (1,644), 4.8% (665) and 0.6% (81) were diagnosed with acute gastroenteritis, rotavirus gastroenteritis and hospital-acquired rotavirus gastroenteritis, respectively. Among acute gastroenteritis hospitalizations, 40.5% (665/1,644; ICD10 and rapid test) and 57.7% (645/1,118; rapid test only) were confirmed as rotavirus positive. Of 1,563 children with community-acquired acute gastroenteritis, 584 (37.4%) cases were confirmed as rotavirus positive. The median durations of hospitalization for all and community-acquired rotavirus gastroenteritis were 5.0 days (range: 2.0−133.0 days) and 5.0 days (range: 2.0-34.0 days), respectively. Among rotavirus gastroenteritis hospitalizations, 12.2% (81/665) of cases were hospital-acquired and the median duration of hospitalization was 10.0 days (range: 2.0-133.0 days). The median duration of additional hospitalization due to hospital-acquired rotavirus gastroenteritis was 3.0 days (range: 0–14 days). The overall incidence rate of hospital-acquired rotavirus gastroenteritis was 1.0 per 1,000 children hospital-days. The number of rotavirus gastroenteritis cases peaked between February and May in both 2008 and 2009, and the highest number of cases was reported in March 2008 (21.8%; 145/665). The highest number of rotavirus gastroenteritis hospitalizations (24.1%; 160/665) was observed in children aged 12–18 months. The proportion of hospital-acquired rotavirus gastroenteritis was higher in children aged below 18 months as compared to children at least 18 months of age (0.94 [95% CI: 0.71-1.21] vs. 0.39 [95% CI: 0.25-0.58]) and for children hospitalized for at least 5 days compared to those hospitalized for less than 5 days (0.91 [95% CI: 0.72-1.14] vs. 0.15 [95% CI: 0.05-0.32]).


Both community- and hospital-acquired rotavirus gastroenteritis are significant public health problems in Japan. Data from this study justify the need for the introduction and implementation of rotavirus vaccination in the Japanese national immunization program.

Trial registration, NCT01202201

Children; Epidemiology; Gastroenteritis; Japan; Hospital-acquired; Rotavirus