OBJECTIVES: Rotavirus (RV) infections are probably the most important cause of severe acute gastroenteritis (AGE) in infants and children up to 4 years of age. Evidence on the overall burden of RV-AGE in Germany is limited, especially due to under-reporting. The objective is to estimate the burden of disease and cost-of-illness of RV-AGE in Germany. METHODS: Data on incidence of community-acquired and nosocomial infections as well as related health care utilization were derived from a systematic literature review and official statistics. Population data and prices were taken from official statistics and price compendiums. A payers’ (sickness funds) perspective was taken. Costs include out- and inpatient care as well as work loss by parents (considering their labour force participation). The latter is paid by sickness funds in Germany (i.e. “childcare benefits”). Price level is that of 2002. RESULTS: Community-acquired RV-AGE requiring outpatient care occurs each year in nearly 120.000 children aged 0-48 months. 6.1% of those cases require hospitalisation resulting in about 7.350 inpatient cases and 38.250 inpatient days. Nosocomial infections result in 6.900 additional RV-AGE with a prolonged hospital stay amounting to 10.350 additional inpatient days. Outpatient costs amount to 8.5€m p.a. and account for 27.4% of overall costs. Inpatient care costs about 15.9€m (51.2%). Childcare benefits amount to 6.6€m (21.4%). Overall costs to payers are 31€m p.a. CONCLUSIONS: Rotavirus causes severe acute gastroenteritis among young children. The overall burden of rotavirus gastroenteritis is considerable and even underestimated as not all children are presented to physicians and stool samples are not analysed on a regular basis. Furthermore, rotavirus causes considerable costs to health care payers, especially due to hospitalizations and nosocomial infections.