IMPACT Canadian Rotavirus Surveillance of Hospitalizations and Emergency Department Visits

Children age 0-16 admitted to the participating IMPACT hospitals with confirmation of positive stool samples; and children age 0-5 years presenting to the emergency departments of the participating IMPACT hospitals with a diagnosis of gastroenteritis.

There are three parts to this criteria- Hospital admission surveillance; Emergency Department determination of disease burden; and genotype surveillance

A. Hospital admission surveillance:

Inclusion Criteria:

• Age 0 to 16 years of age.
• Inpatient status at the IMPACT hospital
• Acute onset of symptoms of acute gastroenteritis with or without diarrheal stools, with or without vomiting, with or without fever.
• Laboratory confirmation of rotavirus in stool specimens or autopsy tissue sample with the use of antigen detection methods (enzyme linked immunoassay [ELISA] or immunochromatographic methods) or electron microscopy or molecular (PCR) diagnosis in a stool specimen taken within 14 days after the onset of gastrointestinal symptoms. Cases identified by autopsy must have had gastrointestinal symptoms before death.
• Referred cases of rotavirus infections that have laboratory confirmation from another institution using the same criteria as above

Exclusion criteria

• Non-laboratory confirmed diagnosis.
• Clinical data is not accessible to the nurse monitor.
• Incidental findings of rotavirus in patients admitted to hospital without acute gastrointestinal symptoms.

B. Emergency Department Visits for determination of disease burden and determination proportion of rotavirus infections

Inclusion criteria:

• The number of children under 5 years of age discharged from the ED with a ICD code diagnosis of diarrheal illness.
• Parents of children who present to the emergency departments at the participating centers will be asked to allow their child's stool sample to be tested for rotavirus according to the guidelines set out by the respective Ethics review boards at each IMPACT center.

C: Rotavirus genotyping

C. Rotavirus Genotype Surveillance - which includes both the specimens from A and B above.

Exclusion criteria:

- No stool sample

Inclusion criteria:

• Rotavirus identification: Rotavirus identification at sites will be accomplished by rotavirus antigen detected by EIA (Enzyme Immuno Assay) or electron microscopy.
• At all hospitals, patients admitted to hospital with acute diarrheal illness have stool specimens sent for viral testing. Stool specimens from admitted patients will be saved. The rotavirus positive specimens from patients presenting to the ED and who have consented to stool specimen that test positive for rotavirus will also be saved.
• A convenience sample of rotavirus positive specimens will be forwarded for genotype testing to the National microbiology laboratory. All rotavirus positive stools from the ED and hospitalized cases will be line listed by date of collection or diagnosis. At the end of the season, depending on the number of positives, the sites will select every second, third or fourth specimen (and so forth) to forward to the genotyping laboratory in order to equal 20 specimens per site and ensure equal representation for all time periods of the rotavirus season and from sites of acquisition (ED and hospitalized cases).
• This will yield a maximum of 280 samples per year. These stools will be stored frozen to -80°C for genotype analysis. Nine provinces will send isolates directly to the National Microbiology Laboratory under the direction of Dr. Timothy Booth for genotype analysis. The two IMPACT centers in Montreal will do genotype analysis in their provincial laboratory and will subsequently share the data with the Vaccine Evaluation Center in Vancouver. A proportion of the strains will be exchanged between both laboratories in order to validate results.