Co esponding au ho : Elda Skende i
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
The bu den o dia hea in child en’s hospi aliza ion p io and pos o a i us
accina ion
Elda Skende i 1, *, Albe a Shkembi 1, Gjeo gjina Kuli-Li o 2, Manika K eka-Face 1, G iselda Veizaj 1 and Admi
Sulo a i 3
1 Pedia ic, Gene al Pedia ic Wa d, Uni e si y Hospi al Cen e “Mo he Te eza”, Ti ana, Albania.
2 P o esso , Head o Pedia ic In ec ious Disease Wa d, Uni e si y Hospi al Cen e “Mo he Te eza”, Ti ana, Albania.
3 Radiologis , Ame ican Hospi al Cen e , P is ina, Koso o.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(03), 044-049
Publica ion his o y: Recei ed on 23 July 2025; e ised on 30 Augus 2025; accep ed on 01 Sep embe 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.3.3109
Abs ac
Dia hea is he passage o excessi ely liquid o equen s ools wi h inc eased wa e con en . Acu e dia hea is de ined
as he ab up onse o 3 o mo e loose s ools pe day and las s no longe han 14 days. The mos common causes o acu e
dia hea in child en a e i al in ec ion, o a i uses he mos common. Al hough o en conside ed a benign disease, acu e
gas oen e i is is a majo cause o mo bidi y and mo ali y in child en a ound he wo ld, esponsible o 1.34 million
dea hs annually in child en younge han 5 yea s, which accoun o 15% o all child dea hs. The in oduc ion and ee
access o Ro a ix since 2019 in Albania had an eno mous impac in mo bidi y and hospi aliza ion due o gas oen e i is
in child en.
Keywo ds: Gas oen e i is; Ro a i us; Vaccine; Child en; Hospi aliza ion
1. In oduc ion
Dia hea is conside ed he passage o excessi ely liquid o equen s ools wi h inc eased wa e con en . The pa e ns
o s ooling in young child en a y widely, consequen ly dia hea is a esul o a change om he no m. Equilib ium o
luid balance in humans depends on he sec e ion and eabso p ion o luid and elec oly es in he in es inal ac .
Dia hea is he e e sal o he no mal abso p i e s a us o wa e and elec oly e abso p ion o sec e ion. The inc eased
wa e con en in he s ools, abo e he no mal alue o app oxima ely 10 mL/kg/d in he in an and young child, is due
o an imbalance in he physiology o he small and la ge in es inal p ocesses in ol ed in he abso p ion o ions, o ganic
subs a es, and wa e . The 2 p ima y mechanisms esponsible o acu e gas oen e i is a e; damage o he illous b ush
bo de o he in es ine, causing malabso p ion o in es inal con en s and leading o an osmo ic dia hea, and he elease
o oxins ha bind o speci ic en e ocy e ecep o s and cause he elease o chlo ide ions in o he in es inal lumen,
leading o sec e o y dia hea [1].
Acu e dia hea is de ined as he ab up onse o 3 o mo e loose s ools pe day and las s no longe han 14 days [2].
Acu e dia hea in child en is usually caused by in ec ion o he small and/o la ge in es ine, al hough o he diso de s
may cause dia hea, including malabso p ion synd ome and en e opa hies. En e ic pa hogens adhe e o o in ade he
epi helium, a numbe o hem p oduce en e o oxins o cy o oxins. Fu he mo e, hese pa hogens igge elease o
cy okines a ac ing in lamma o y cells, which con ibu e o he ac i a ed sec e ion by inducing he elease o agen s
such as p os aglandins o pla ele -ac i a ing ac o . Fea u es o sec e o y dia hea include a high pu ging a e, a lack o
esponse o as ing, and a no mal s ool ion gap, indica ing ha nu ien abso p ion is in ac . The e m "acu e
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45
gas oen e i is" is commonly used synonymously wi h "acu e dia hea," howe e , he e m gas oen e i is implies
in lamma ion o bo h he s omach and he small in es ine.
The mos common causes o acu e dia hea in child en a e i al in ec ion, wi h o a i uses and no o i uses being mos
common. Vi al in ec ions damage small bowel en e ocy es and cause low g ade e e and wa e y dia hea wi hou
blood. The mos common age o i al in ec ion is be ween 6 mon hs and 2 yea s, and he way o ansmission is by he
ecal-o al o espi a o y ou e. Bac e ial pa hogens include Campylobac e jejuni, Salmonella, Esche ichia coli and
Shigella dysen e iae. Child en wi h bac e ial gas oen e i is a e mo e likely o ha e high e e and may ha e blood and
whi e blood cells in he s ool. Bac e ial pa hogens occasionally sp ead sys emically, especially in young child en [3, 4].
These pa hogens a e sp ead by pe son- o-pe son ou e o inges ion o con amina ed ood and d ink. The leas common
g oup o in ec ious dia heas a e he in es inal pa asi es; p o ozoa and helmin hs. Gia dia in es inalis is he mos
common in es inal pa asi e. Gia dia species a e closely ela ed o sani a ion and a e endemic in a eas wi h poo
sani a ion. In de eloping coun ies, wa e bo ne and ood-bo ne ou b eaks a e common, and he disease is an impo an
cause o mo bidi y [5, 6].
This s udy aims o measu e he p e alence o child en hospi alized wi h he diagnosis “Acu e gas oen e i is”, es ima e
he ole o gas oen e i is in child en mo bidi y p io and pos o a i us accina ion in Albania. Ro a i us accine was
in oduced in 2019 in Albania.
2. Me hod and Ma e ial
This is a e ospec i e s udy. In i a e included 5820 child en, aged 0-14 yea s old, hospi alized wi h he diagnosis
Gas oen e i is acu e, in he Gene al Pedia ic Wa d a he Uni e si y Hospi al Cen e “Mo he Te eza” in Ti ana, Albania
du ing an ele en-yea pe iod 2014-2024. Da a we e ex ac ed om he clinical eco ds.
3. Resul s
Da a e ealed ha he numbe o child en hospi alized wi h gas oen e i is acu e, in lic ed a sudden all in he yea s
2020-2024. The numbe o child en hospi alized wi h gas oen e i is acu e p io o o a i us, in 2014-2019 esul ed
conside ably highe . (Figu e 1)
Figu e 1 P e alence o hospi alized gas oen e i is
This d op, o gas oen e i is in hospi alized child en a e o a i us accina ion, was also e lec ed in he bu den o
gas oen e i is in child en mo bidi y. Gas oen e i is coun ed app oxima ely 30% in all child en’ hospi aliza ion du ing
2014-2019. A e o a i us accina ion his pe cen age ell o 14% du ing 2020-2024. (Figu e 2)
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Figu e 2 Bu den o gas oen e i is in child en’ mo bidi y
In an s esul ed he mos a ec ed age-g oup wi h 43% o cases, ollowed by he age g oup 2-5 yea s wi h 33% and wi h
he lowes numbe child en 5-14 yea s wi h 24% o cases. (Figu e 3)
Figu e 3 Age dis ibu ion o hospi alized gas oen e i is cases
Da a e ealed ha du ing he yea s 2020-2024 he numbe o cases o child en hospi alized wi h he diagnosis
gas oen e i is acu e decline in all seasons, howe e he mos a ec ed was he numbe o cases in win e and sp ing, as
he o a i us has a seasonal dis ibu ion sp ing in empe a e clima es, peaking in cold mon hs o win e and sp ing.
(Figu e 4)
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47
Figu e 4 Seasonal dis ibu ion o hospi alized gas oen e i is cases du ing 2014-2024
4. Discussion
Dia hea and Gas oen e i is a e one o he mos clinical condi ions in young child en. Acco ding o in e na ional
s a is ics, child en younge han 5 yea s ha e an es ima ed 1.7 billion episodes o dia hea each yea , leading o 124
million clinic isi s, 9 million hospi aliza ions, and 1.34 million dea hs, wi h mo e han 98% o hese dea hs occu ing
in he de eloping wo ld [7, 8, 9,10]
Al hough o en conside ed a benign disease, acu e gas oen e i is is a majo cause o mo bidi y and mo ali y in child en
a ound he wo ld, esponsible o 1.34 million dea hs annually in child en younge han 5 yea s, which accoun o 15%
o all child dea hs [7].
This s udy e ealed ha gas oen e i is used o be a majo cause in child en mo bidi y and hospi aliza ion anging om
25% o 31% o hospi aliza ion du ing he yea s 2014-2019. The yea 2020 esul ed in a sudden d op in he numbe o
child en hospi alized wi h gas oen e i is and he bu den o gas oen e i is in child en mo bidi y, his d op ollowed
e en in he consecu i e yea s 2020-2024. The sudden d op o gas oen e i is in child en in 2020 migh ha e been
pa ially ela ed o he global ou b eak o COVID-19. S ic qua an ine and he es ic i e measu es ha ollowed i , had
hei e ec in p e en ing he sp ead o o he childhood in ec ions including gas oen e i is. The declining in he
p e alence o gas oen e i is’ hospi aliza ion in child en in 2020 is logically assumed o ha e occu ed due o pandemic.
Howe e , on May 2023, he COVID-19 public heal h eme gency ended and he es ic i e measu es oo, bu he
p e alence o gas oen e i is, despi e a sligh inc ease, con inues o be conside ably lowe he p e ious o 2020.
These indings, h ough ligh o a consis en ac o , ha displays i s e ec on he conside able decline in he p e alence
o gas oen e i is in hospi alized child en. In 2019, in Albania was in oduced a mul i alen o a i us accine in i s
na ional immuniza ion p og am. Consequen ly, in he ollowing yea s 2020-2024, he e was obse ed a d as ic decline
in he numbe o child en hospi alized o gas oin es inal in ec ions. The bu den o gas oen e i is, in he gene al
mo bidi y o child en which equi ed hospi aliza ion, inqui ed a conside able decline oo, om app oxima ely 30% o
14% o he whole hospi aliza ions. The numbe o gas oen e i is dec eased in he whole yea , including win e and
summe mon hs, bu he mos conside able all was in he win e mon hs. These indings s a e ha o a i us
ep esen ed a majo cause o gas oen e i is in child en and was esponsible o a g ea deg ee o mo bidi y and
hospi aliza ion in child en. Ro a i us ep esen s he mos impo an i al pa hogen wo ldwide, esponsible o 37% o
dia hea- ela ed dea hs in child en younge han 5 yea s [11]. Ro a i us in ec ion ollows seasonal a ia ion, wi h an
inc eased incidence in win e and dec eased incidence in summe mon hs, o his eason he numbe o gas oen e i is
was especially declined in win e mon hs a e o a i us accina ion. Simila educ ion in gas oen e i is in child en
ha e epo ed e en Uni ed S a es o Ame ica. In he Uni ed S a es, ou ine o a i us accina ion has led o a 60-75%
educ ion in pedia ic o a i us hospi aliza ion since 2006 [12,13]
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(03), 044-049
48
Gas oen e i is con inuous o be a childhood disease. Mos o he child en (76%) we e younge han 5 yea s old. In an s
(0-2yea s), cons i u e he mos a ec ed g oup. The p edisposing ac o s a e he imma u e immune sys em o he young
child and he exposu e o he child day-ca e se ings. Despi e he high p e alence in child en, gas oen e i is is no a
se e e condi ion, i s se e i y depends on he deg ee o luid loss. The mos c ucial s ep in i s managemen is he accu a e
assessmen o he dehyd a ion s a us. Fo una ely, mos cases o dehyd a ion in child en can be accu a ely diagnosed
by a ca e ul clinical examina ion and ea ed wi h simple, cos -e ec i e measu es. Good hygiene is impo an o p e en
sp ead o in ec ion. This includes ca e ul hand washing, nappy disposal, and p epa a ion and s o age o ood and
d inking wa e . The majo ad ance in p e en ion was he de elopmen and licensing o wo o al o a i us accines,
whose sa e y and e icacy ha e been con i med in la ge scale ials, each in ol ing mo e han 60 000 child en [14,15].
Ro a eq (Me ck) is a h ee-dose li e human-bo ine pen a alen e-asso an accine. Ro a ix (GSK) is wo dose
a enua ed human (s ain G1P) mono alen accine. Bo h accines a e highly immunogenic. They p o ide c oss
p o ec ion agains common se o ypes and dec ease a es o se e e gas oen e i is, he need o in a enous luids, and
hospi al admission. The in oduc ion and ee access o Ro a ix since 2019 in Albania had an eno mous impac in
mo bidi y and hospi aliza ion due o gas oen e i is in child en.
5. Conclusion
Gas oen e i is cons i u es a mayo heal h conce n in child en in he whole wo ld. The use o o a i us accine has
esul ed in an eno mous impac in mo bidi y and hospi aliza ion due o gas oen e i is. The p e alence and he bu den
o gas oen e i is in childhood mo bidi y ha e in lic ed an almos d ama ic decline.
Compliance wi h e hical s anda ds
Acknowledgmen s
We hank all o he medical s a o he Gene al Pedia ic Wa d o he p ecious suppo .
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
S a emen o in o med consen
In o med Consen was aken om he pa en s o he hospi alized child en, included in he s udy, o using he da a o
he medical eco ds, p o iding anonymi y.
Re e ences
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