• Pediatric Infection and Vaccine
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• v.21 no.3
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• pp.167-173
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• 2014

Purpose: This study aimed to examine the changes in the outbreak of acute gastroenteritis, rotavirus gastroenteritis after the introduction of the rotavirus vaccine in Korea. Methods: The current study investigated the number of inpatients in the pediatric ward of Inje University Sanggye Paik Hospital during the periods of 2005-2006 and 2011-2012. A retrospective analysis was conducted on the medical records of 2,840 patients <5 years of age who were hospitalized at Inje University Sanggye Paik Hospital in these time periods. Results: When we compared 2 separate sets of data from before (2005-2006) and after (2011-2012) vaccine introduction, there were statistically significant decreases in the number of patients who were hospitalized for acute gastroenteritis across all of the groups of patients <5 years of age except those <2 months of age. The number of patients with rotavirus gastroenteritis in all age groups declined except for children <2 months of age and those 2-5 months of age. Conclusion: These results show that after the introduction of a rotavirus vaccine in Korea, the incidence of rotavirus gastroenteritis decreased in 6-59-month-old patients hospitalized for acute gastroenteritis.

• Pediatric Infection and Vaccine
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• v.21 no.3
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• pp.174-180
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• 2014

Purpose: This study was performed to assess the clinical and epidemiological changes after the introduction of the rotavirus vaccine in Korea, as well as to determine the efficacy of the rotavirus vaccine among hospitalized rotaviral gastroenteritis patients over the past two years. Methods: We analyzed yearly and seasonal patterns of 1,165 inpatients who were hospitalized for rotaviral gastroenteritis under the age of 5 years between 2006 and 2013. We also conducted a survey among 460 gastroenteritis patients who were hospitalized between 2012 and 2013 regarding the rotavirus vaccination and the symptoms of gastroenteritis. Among those individuals surveyed, clinical indices were analyzed for 124 patients who were tested positive for the rotavirus antigen. Results: The incidence of Rotaviral gastroenteritis have decreased significantly by year 2010. After the introduction and widespread dissemination of the rotavirus vaccine, the onset of the disease and the seasonal peak have been delayed. Overall, the vaccinated group showed a lower rate of positivity than the unvaccinated group. Among the hospitalized rotaviral gastroenteritis patients, the vaccinated group had a shorter hospitalization period, less severe clinical symptoms of gastroenteritis, and better laboratory test results. Conclusions: After introduction of the rotavirus vaccine in Korea, there were two main trends observed: 1) the overall level of disease incidence was reduced; 2) the severity of rotaviral gastroenteritis cases also decreased. Based on this data, more children should receive vaccination in order to prevent the rotavirus infection and decrease the severity of rotaviral gastroenteritis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.2
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• pp.113-116
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• 2005

Purpose: There were a few reports for epidemiologic changes of rotavirus gastroenteritis during recent several years in Korea. We tried to know what is characteristics for the prevalence of rotavirus gastroenteritis in Jeju different from epidemiology of the other domestic area. Methods: We performed a retrospective study of 211 patients with rotavirus gastroenteritis admitted to the pediatric ward at Cheju National University hospital, from December 2001 to June 2005. We defined as rotavirus infection that was positive on immunochromatography method applied to stool samples. Results: Two hundred eleven patients with rotavirus gastroenteritis consisted of 13 patients in December 2001, 32 in 2002, 79 in 2003, 48 patients in 2004 and 39 in 2005 (until June). The monthly distributions, during 3 years from 2002 to 2004, were 40 patients (25.2%) in Jaunary, 56 (35.2%) in February, 31 (19.5%) in March and 23 (14.5%) in April. From May to December, there were only 9 patients (5.6%). Therefore, the prevalences of rotavirus gastroenteritis were concentrated on the 4 months (94.4%) including January, February, March and April. Also, the changes of the monthly distributions from January 2002 to June 2005 were not present. Conclusion: In recent years, the monthly distributions of rotavirus gastroenteritis in Jeju area were centered on the 4 months from January to April without prominent seasonal variation.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.2
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• pp.183-193
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• 2009

Purpose: Rotaviruses, noroviruses, astroviruses, and enteric adenoviruses cause acute gastroenteritis (AGE) in children. Some children with AGE have afebrile convulsions associated with viral gastroenteritis. The purpose of this study was to detect and genotype viruses from children with AGE or benign infantile seizures associated with mild gastroenteritis (BIS-MG). Methods: Between August 2004 and June 2005, 311 children with AGE were included. Four viral agents, including rotavirus, norovirus, astrovirus, and adenovirus, were analyzed from stool specimens of each patient using the latex agglutination method, enzyme immunoassay, and reverse transcriptase polymerase chain reaction. Genotyping of each virus was performed in 217 of the 311 children. Results: Among 217 children (male, 121; female, 96; mean age, 20.6${\pm}$15.4 months), rotavirus was detected in 109 (50.2%), norovirus in 28 (12.9%), adenovirus in 13 (6.0%), and astrovirus in 2 children (0.9%). Genotyping of rotavirus revealed positive results in 97 children; P[8]G3 in 36, P[4]G2 in 21, P[6]G4 in 10, P[4]G4 in 9, P[8]G9 in 6, P[8]G1 in 6, P[4]G3 in 4, P[4]G9 in 3, and P[6]G2 in 2. Genotyping of norovirus showed GII-4 in 27 of 28 children and GII-6 in 1 child. Sixteen children were diagnosed with BIS-MG. Rotavirus was detected in 13 of 16 children with BIS-MG, and norovirus in 2 children. Genotyping of rotavirus detected in children with BIS-MG revealed P[8]G3 in 6 children, P[4]G2 in 2 children, and P[4]G9 in 1 child. Conclusion: Analysis of viruses from stool specimens indicates that both rotavirus and norovirus are the main viruses related to BIS-MG in children.

• Pediatric Infection and Vaccine
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• v.13 no.2
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• pp.147-155
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• 2006

Purpose : The purpose of this study is to evaluate epidemiological data of pathogens obtained from stool exams and compare them with the clinical course in pediatric patients with symptoms of acute gastroenteritis. Methods : Subjects were selected from patients presenting with symptoms of acute gastroenteritis who visited the outpatient clinic or who were admitted to the Dankook University Hospital from December of 2004 to December of 2005. Stool exams for 17 pathogens was performed. RT-PCR was used to detect norovirus and enzyme-linked immunoabsorbant assay (ELISA) was used to detect rotavirus, adenovirus and astrovirus in the subjects stool samples. Ten different species of bacteria(Salmonella spp., Shigella spp., Clostridium perfrigens, Campylobacter spp., Escherichia coli, Vibrio spp., Staphylococcus aureus, Bacillus cereus, Yersinia spp., and L. monocytogenes) were each selectively cultivated and enzyme immunoassays(EIA) was used to test for antigens for C. parvum, E. histolytica and G. lamblia. Retrospective chart review was performed for comparisons of clinical manifestations. Results : A total of 215 subjects was selected and of these 89 cases(41.4%) showed positive results for at least one pathogen. Male to female ratio was 1.3:1. Age distribution showed 4 cases less than one month(4.5%), 4 cases from 1~2 months(4.5%), 24 cases from 3~12 months(26.7%), 47 cases form 13~48 months(52.8%), 10 cases greater than 48 months (21.2%). Viruses showed the greatest proportion of cases with 68 subjects(77.5%), of these rotavirus being the most commonly reported in 50 cases. Bacteria was identified in 26 cases (29.2%), of these nontyphoidal salmonella was noted in 10 cases. Protozoa followed with 21 cases(23.6%), of these C. parvum was noted in 11 cases and G. lamblia was noted in 10 cases. Mixed infections with more than two pathogens were seen in 22 cases(24.7%), of these viral infection with accompanying parasitic infection was seen in 12(54.5%) cases. Conclusion : In this study we examined various pathogens known to cause acute gastroenteritis in children. Further studies for various pathogens can provide useful information for management of the acute gastroenteritis.

• Clinical and Experimental Pediatrics
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• v.48 no.7
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• pp.753-759
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• 2005

Purpose : This study was performed to characterize clinical features of benign convulsions with gastroenteritis(CwG) in infants. Methods : We reviewed clinical features of 67 episodes in 64 patients with afebrile seizure accompanied gastroenteritis admitted to Dept. of Pediatrics Bundang CHA hospital from January 2001 to June 2004. Patients with meningitis, encephalitis/encephalopathy or apparent history of epilepsy were excluded. Results : There were 32 boys and 35 girls. The age of onset ranged from 1 to 42 months($18.5{\pm}6.1$ months). The number of children admitted to the hospital with acute gastroenteritis was 2,887 in the same period. The percentage of patients with CwG was 2.3. Seizure type was exclusively generalized tonic or tonic-clonic seizure. The average number of seizures during a single episode was 3.1 (range, 1-13). Two or more seizures occurred in 53(79.1%) of the 67 episodes. Antiepileptic drugs were administered for 42 episodes. Seizure did not cease after the administration of one kind of antiepileptic drug in 23 episodes(54.7%). The seizures were rather refractory to initial antiepileptic treatment. There were no abnormalities in serum biochemistry test including glucose and electrolytes. Cerebrospinal fluid was normal in all 54 episodes. Stool cultures were negative in 49 episodes. Rotavirus was positive in stools in 51(82.3%) of 62 episodes. Norovirus was positive in stools in 2 episodes and astrovirus in 1 of 18 episodes. CT and/or MRI were performed in 15 cases and demonstrated no neuroradiologic abnormalities. Of 73 Interictal EEG, initial 24 cases showed occasional spike or sharp wave discharges from the mid-line area during stage I-II sleep, which were apparently differentiated from vertex sharp transient or K-complexes. The mean follow-up period was 5.7 months(1-36 months). Three patients experienced a recurrence of CwG, but all patients exhibited normal psychomotor development at the last follow-up. Conclusion : Afebrile infantile convulsions with gastroenteritis are brief generalized seizure in cluster with normal laboratory findings and good prognosis. Therefore CwG is likely to be categorized as situation-related seizure of special syndrome. Recognition of this entity should lead to assurance of the parents and long-term anticonvulsant therapy is not usually warranted.

• Clinical and Experimental Pediatrics
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• v.48 no.10
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• pp.1121-1125
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• 2005

Purpose : Rotavirus is the main cause of infantile diarrheal disease worldwide, especially in patients 3-24 months of age. Infants younger than 3 months of age are relatively protected by transplacental antibody. So the purpose of this study is to evaluate the clinical features and severity of neonatal rotaviral gastroenteritis less than 1 month of age. Methods : A retrospective chart review was established of 62 neonates less than 1 month of age and with a diagnosis of rotaviral gastroenteritis who had been admitted to Pochon CHA University between June 2002 through July 2004. The rotavirus was examined by stool latex agglutination. Results : During 2 years, the total number of admitted patients for rotaviral gastroenteritis was 688 and among these, less than 1 month of age accounted for 9%(62). The occurrence was generally even distribution from January to July($7.14{\pm}1.0$) but since then decreased($2.4{\pm}1.8$). The most common chief complaint was mild fever(46%) when admitted which subsided within 1 hospital day in most patients. 4 patients had seizure and cyanosis with no typical symptoms of rotaviral gastroenteritis. During admission, all the patients had diarrhea. 17% of the patients had leukocytosis and positive C-reactive protein. In one patient, stool occult blood test was positive but there was no necrotizing gastroenteritis evidence. The mean period of hospital day was $5.8{\pm}2.5$ and breast-milk feeding was 62.9%. Conclusion : Neonatal rotaviral gastroenteritis is not a rare disease. Most patients have fever and diarrhea and improve through conservative therapy but a few patients may have severe complications so we must be more cautious about the hygiene for prevention.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.7 no.2
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• pp.239-242
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• 2004

Eosinophilic gastroenteritis is a rare condition of unknown etiology characterized by peripheral eosinophilia, eosinophilic infiltration of the gastrointestinal tract, and gastrointestinal symptoms. Eosinophilic gastroenteritis is generally classified according to the Klain classification: predominant mucosal, muscular, and subserosal disease. Mucosal involvement may result in abdominal pain, nausea, vomiting, diarrhea, weight loss, anemia, protein-losing enteropathy, and intestinal perforation. Patients with muscular layer disease generally have obstructive symptoms. Subserosal eosinophilic infiltration may result in development of eosinophilic ascites. Most commonly, the stomach, duodenum, and small bowel are involved. A 13-year-old girl came to our hospital presenting with chronic, intermittent abdominal pain. She showed peripheral eosinophilia and biopsy specimen of the duodenum revealed eosinophilic infiltration of the mucosal layer. We here report a case of eosinophilic gastroenteritis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.9 no.1
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• pp.65-69
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• 2006

We experienced a 15 month old child who had persistent gastroparesis after an acute viral illness tested positive for rotavirus. She was admitted because of persistent postprandial vomiting, abdominal distension and anorexia followed after acute rotavirus gastroenteritis. Other diagnostic tests did not demonstrate any evidence of some organic disease. But, we could find the delayed gastric emptying in gastric scintigraphy. The initial percentage gastric emptying in 60 minutes tested by scintigraphy was 13.4%. The second result of percentage gastric empting after clinical improvement was 49.9%.

• Pediatric Infection and Vaccine
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• v.21 no.3
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• pp.181-190
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• 2014

Purpose: This study was performed to investigate the epidemiological trend of rotavirus acute gastroenteritis (RV-AGE) in children. Methods: A retrospective review was performed in patients (1 month to 18 years of age) with acute gastroenteritis at KEPCO Medical Center from September 2004 to August 2013. Comparative analyses were performed based on periods: pre-vaccine (2004-2006) and post-vaccine (2008-2012) in all patients; 2004-2006 (period A), 2007-2009 (period B) and 2010-2012 (period C) in patients under 5 years of age. Results: Proportion of RV-AGE decreased from 25.0% (337/1,346) in pre-vaccine period to 20.8% (459/2,210) in post-vaccine period (rate ratio (RR), 0.83 [95% CI, 0.73-0.93]; P=0.0029). The median age of patients with RV-AGE in post-vaccine period (2.6 years) was significantly (P<0.0001) higher than that in pre-vaccine period (1.6 years). In patients hospitalized with AGE, proportion of RV-AGE was significantly reduced in patients 6 to 23 months old (RR, 0.62 [95% CI, 0.51-0.75]; P<0.0001). Significant decline in proportion of RV-AGE was observed in patients under 5 years of age: period A, 26.9% (308/1,144); period B, 22.7% (295/1,299); period C, 20.6% (186/902) (P =0.0007). After the introduction of rotavirus vaccine, a significant decreasing trend of RV-AGE proportion was observed in patients 6 to 11 months old (P =0.0018) and 12 to 23 months old (P =0.0152). Conclusion: Decrease in RV-AGE proportion and increase in age of patients with RV-AGE were observed after the introduction of rotavirus vaccine in this single center study. Continued and systematic surveillance is needed to assess the impact of rotavirus vaccine.