Clinical Peculiarities of Rota Viral Infection, Molecular Epidemiology and Health-Related Quality of Life for Hospitalised Children in Children’s University Hospital and Their Family Members. Summary of the Doctoral Thesis

Abstract

Despite available specific prophylaxis, Rotavirus is still one of the leading causes of severe diarrhoea in young children and infants worldwide, representing a heavy public health burden. Limited data regarding the impact of rotavirus gastroenteritis and the quality of life of affected children and their families is available. The aim of the study was to estimate clinical peculiarities, molecular epidemiology and the impact of rotavirus infection on health-related quality of life (HRQL), to assess the social and emotional impact on the families of affected children, hospitalized in Children’s Clinical University Hospital in Riga. Study was designed as quantitative cross-sectional study consisting of two sections, where in the first section clinical, socio-epidemiological characteristics and molecular epidemiology of Rota viral infection were investigated, whereas in the second section emotional, social and economic burden of the patient family, as well as the quality of the child’s life and the factors associated with it was analysed. Descriptive statistics were used for data analyse. Results were considered to be statistically significant if p < 0.05. Data processing was performed using IBM SPSS Statistics (Statistical Package for the Social Science, Version 22.0). Study enrolled 527 Rota positive (with further PCR detection) cases (0–18 years of age) hospitalized from April 2013 to December 2015 and their caregivers respectively. P and G genotypes were detected in 462 samples, and paired with clinical and socio – epidemiological data for further interpretation. For the second section data of all cases (n = 527) were used for further interpretation. 92.9% (n = 429) of patients were less than 5 years old. Clinical symptoms were categorized as severe, according to the Vesikari score, in 87,0% patients (n = 402) (p < 0.001), and on average most of the children were hospitalized 2.5 days after the onset of symptoms. In single-type infections, the predominant G/P combinations were G4P[8], 60,2% (n = 278), G9P[8], 12,1% (n = 56), G2P[4] 10,6% (n = 49), G1P[8] 6,5% (n = 30), G3P[8] 4,1% (n = 19), G8P[8] 3,5% (n = 16), G2P[8] 2,6% (n = 12), G1P[4] 0,2% (n = 1) and G4P[4] 0,2% (n = 1). Statistically significant correlations were found among certain genotypes and severity of vomiting as a separate symptom. Infections with genotypes G4P[8], G8P[8] and G9P[8] had significantly more vomiting episodes than G1P[8] (p < 0.05). A significant correlation was found among stress/anxiety and irritability, tearfulness of the child (p < 0,001) and of fever level (p = 0.02). The analyses of social burden showed statistically significant associations with different sociodemographic factors – older age of the child (p < 0.001), older age of the mother (p < 0.001) and higher education level of the mother (p < 0.001) corresponded to higher proportions of caregivers reporting a need to introduce changes in their daily routine. To estimate economic burden of Rota virus infection, lost working days and additional financial expenditures were analysed. 55,3% (n = 289) of care givers had to take days off work and 75,2% (n = 380) reported additional expenditures, but no statistically significant correlations were found in association with the analysed factors. A better understanding on how an acute episode of Rota virus infection can affect the child and the child’s family could help to minimize parental fears and advice the parents on the characteristics of rotavirus infection as well as the optimal care of an affected child. Current study results proved the total burden of Rota viral infection, and emphasizes the routine immunization to be used as evidence based prophylaxis of the disease in Latvia.