RESUMO
BACKGROUND: In December 2000, a large outbreak of gastroenteritis occurred in El Salvador that was associated with hospitalizations and deaths among children nationwide. Public concern was raised because the etiology was initially unknown and enteric control measures seemed ineffective. The outbreak was eventually linked to rotavirus, control measures were redirected to improving treatment with oral rehydration and surveillance was initiated to characterize the etiologic agents of gastroenteritis. METHODS: Demographic and clinical data and fecal specimens were collected from a systematic sample of children younger than 5 years old with acute gastroenteritis. Stools were tested for rotavirus, bacteria and parasites. Surveillance results were extrapolated to national data to estimate the national burden of rotavirus disease. RESULTS: Surveillance between May 2001 and April 2002 demonstrated that rotavirus has winter seasonality, was associated with vomiting and dehydration and accounted for an estimated 27% of 12,083 consultations for diarrhea. Children with rotavirus gastroenteritis were younger (median, 9 months) than those with gastroenteritis caused by other agents (median, 13 months for bacteria, 16 months for parasites). Extrapolating to national data, we estimated the risk of a child experiencing a rotavirus-related medical visit, hospitalization and death by the age of 5 years as 1:7, 1:56 and 1:531, respectively. CONCLUSIONS: The outbreak of gastroenteritis among children younger than 5 years of age between December 2000 and February 2001 represented an exaggerated rotavirus season. The surveillance activity after the outbreak suggests that rotavirus is the most common cause of diarrheal disease in El Salvador. Further surveillance could provide a sound basis for improving the response to epidemics of gastroenteritis and could provide data needed to decide whether rotavirus vaccination should be included in the national program for childhood immunizations.
