Abstract
ObjectiveTo investigate the epidemiology of human adenovirus (HAdV), human astrovirus (HAstV), and sapovirus (SaV), children with acute diarrhea in Chongqing, China from 2017 to 2019 were enrolled. Improved surveillance could provide better guidance for diarrhea prevention.MethodsBetween 2017 and 2019, fecal specimens were collected from children <14 years of age presenting with acute diarrhea for treatment at the outpatient department of the Children’s Hospital, Chongqing Medical University. Human HAdV in the fecal specimens was detected by PCR, while RT-PCR was adopted for the detection of HAstV and SaV.ResultsA total of 1,352 fecal specimens were screened in this study. The detection rate of HAdV was 4.44% (60/1352), HAstV was 2.81% (38/1352), and SaV was 1.04% (14/1352). The prevalence of enteric viruses in males was not significantly different to females (p > 0.05). We found 96.67% (58/60) of the HAdV-positive cases, 92.11% (35/38) of the HAstV-positive cases, and 100% (14/14) of the SaV-positive cases among the children under 4 years old. HAdV cases were identified throughout the year, while the infection of HAstV peaked from March to May every year. By contrast, SaV was detected in May, July, and from September to December. In total, 41 strains of HAdV-F were identified, including F41 (39/60) and F40 (2/60). Furthermore, A31, B3, B7, C1, C2, C5, and C6 were also detected in the study. In addition, we detected two genotypes of HAstV, HAstV-1 (34/38) and HAstV-5 (4/38), and two genotypes of SaV, GI0.1 (13/14), GI0.2 (1/14).ConclusionThe enteric viruses HAdV, HAstV, and SaV contribute to the overall burden of diarrhea in Chongqing, especially in children <4 years of age. Two genotypes were identified for HAstV (HAstV-1 and HAstV-5) and SaV (GI.1 and GI.2) with an additional nine genotypes detected in HAdV cases. While the F41 HAdV strain was predominant, HAdV-A31 was also detected in 10% of cases. The study results along with continuous surveillance of enteric viruses will aid in the design and implementation of future enteric vaccines and diarrhea mitigation strategies.
Highlights
IntroductionSince 1990, mortality rate of children with diarrhea has been significantly decreased because of the improvements in water, sanitation, and hygiene [1, 2]
A total of 1,352 stool samples collected from children with acute diarrhea were enrolled from January 1, 2017 to December 31, 2019
The detection rates of the three viruses fluctuated in each year, the differences were not statistically significant (χ2 human adenovirus (HAdV) = 2.185, P = 0.335; χ2 human astrovirus (HAstV) = 1.881, P = 0.390; χ2 SaV = 3.301, P = 0.165)
Summary
Since 1990, mortality rate of children with diarrhea has been significantly decreased because of the improvements in water, sanitation, and hygiene [1, 2]. Diarrhea is still the world’s second leading infectious cause of death in children under 5 years old. According to a previous report, approximately 530,000 children under the age of 5 died from diarrheal diseases in 2017 [1]. Acute diarrhea could be caused by many factors, among which viral infection is the most common one [4]. Previous studies have identified that rotavirus (RV), norovirus (NoV), human adenovirus (HAdV), sapovirus (SaV), and human astrovirus (HAstV), are major viral etiologies of diarrheal illness [2]. Other diarrheal viruses, such as HAdV, HAstV, and SaV have attracted more attention [6]. Additional molecular screening for these viruses was implemented at a children’s hospital outpatient department for three years in this study, which would be benefit in understanding of epidemiology in SaV, HAstV, and HAdV
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