Incidence Of Acute Gastroenteritis Research Articles

Norovirus in children under 2 years of age: an epidemiological study in Panama during the COVID-19 pandemic.

Norovirus infection is a common cause of acute gastroenteritis (AGE). Surveillance activities are important to aid investigation into effective norovirus control strategies, including vaccination. Here, we report ancillary findings related to the incidence, prevalence, and etiology of AGE caused by norovirus in Panama after adjustment of study methodology to comply with national coronavirus disease 2019 (COVID-19) mandates. In January 2020, children aged <2 years began enrolling into an epidemiological study in Panama to estimate the burden of norovirus in preparation for evaluating upcoming prevention strategies. This included an observational, longitudinal, community-based AGE surveillance study and a hospital-based AGE surveillance study. For the longitudinal study, healthy children aged 5-18 months were enrolled from January 6 through March 23, 2020, with a follow-up of approximately 6 months. The last participant was contacted on September 23, 2020. For the hospital-based study, starting on January 21, 2020, children aged <2 years who were admitted to the Hospital del Niño Dr. José Renán Esquivel in Panama City due to AGE were evaluated. The last sample was collected on September 29, 2020. Collected stool samples were tested for norovirus as well as astrovirus, sapovirus, and various enteropathogens. Unfortunately, this study was disrupted by the subsequent implementation of disease transmission control procedures for the COVID-19 pandemic, and the study methodology was revised to comply with COVID-19 mandates. In the longitudinal surveillance cohort [N = 400 (Chiriquí, n = 239; Panama, n = 161)], a total of 185 AGE episodes were documented (Chiriquí, n = 85; Panama, n = 100) resulting in an overall AGE incidence of 11.6 (95% CI: 9.99-13.4) episodes per 100 child-months. The norovirus-related AGE incidence was 0.3 (95% CI: 0.10-0.73) episodes per 100 child-months (5/185 AGE episodes) and the prevalence of norovirus was 4.6% (13/282 stool samples collected). In the hospital-based surveillance cohort, at least one pathogen was detected in 50% of samples (44/88 stool samples collected) and norovirus prevalence was 6.8% (6/88 stool samples collected). This report demonstrates how the occurrence of the COVID-19 pandemic hindered the conduct of clinical trials. However, this also created unique research opportunities to investigate the potential impact of pandemic control measures on the etiology of infectious diarrheal disease.

Nonsecretor Phenotype Is Associated With Less Risk of Rotavirus-Associated Acute Gastroenteritis in a Vaccinated Nicaraguan Birth Cohort.

Histo-blood group antigens (HBGAs) have been associated with rotavirus vaccine take; but the effect of these HBGAs on rotavirus incidence and risk remains poorly explored in vaccinated populations. Rotavirus-associated acute gastroenteritis (AGE) was assessed in 444 Nicaraguan children followed from birth until 3 years of age. AGE episodes were tested for rotavirus by reverse-transcription quantitative polymerase chain reaction, and saliva or blood was used to determine HBGA phenotypes. Cox proportional hazards models were used to estimate the relative hazard of rotavirus AGE by HBGA phenotypes. Rotavirus was detected in 109 (7%) stool samples from 1689 AGE episodes over 36 months of observation between June 2017 and July 2021. Forty-six samples were successfully genotyped. Of these, 15 (35%) were rotavirus vaccine strain G1P[8], followed by G8P[8] or G8P[nt] (11 [24%]) and equine-like G3P[8] (11 [24%]). The overall incidence of rotavirus-associated AGE was 9.2 per 100 child-years, and was significantly higher in secretor than nonsecretor children (9.8 vs 3.5/100 child-years, P = .002). The nonsecretor phenotype was associated with decreased risk of clinical rotavirus vaccine failure in a vaccinated Nicaraguan birth cohort. These results show the importance of secretor status on rotavirus risk, even in vaccinated children.

Norovirus acute gastroenteritis among US and European travellers to areas of moderate to high risk of travellers' diarrhoea: a prospective cohort study.

Acute gastroenteritis (AGE) is a major medical condition for travellers worldwide, particularly travellers to low- and middle-income countries. Norovirus (NoV) is the most common cause of viral AGE in older children and adults, but data on prevalence and impact among travellers is limited. Prospective, multi-site, observational cohort study conducted 2015-2017, among adult international travellers from the US and Europe to areas of moderate to high risk of travel-acquired AGE. Participants provided self-collected pre-travel stool samples and self-reported AGE symptoms while travelling. Post-travel stool samples were requested from symptomatic subjects and a sample of asymptomatic travellers within 14days of return. Samples were tested for NoV by RT-qPCR, genotyped if positive, and tested for other common enteric pathogens by Luminex xTAG GPP. Of the 1109 participants included, 437 (39.4%) developed AGE symptoms resulting in an overall AGE incidence of 24.7 per 100 person-weeks (95% CI: 22.4; 27.1). Twenty NoV-positive AGE cases (5.2% of those tested) were identified at an incidence of 1.1 per 100 person-weeks (95% CI: 0.7; 1.7). NoV-positive samples belonged mostly to genogroup GII (18, 85.7%); None of the 13 samples sequenced belonged to genotype GII.4. Clinical severity of AGE was higher for NoV-positive than for NoV-negative cases (mean modified Vesikari Score 6.8 vs 4.9) with more cases classified as severe or moderate (25% vs 6.8%). Eighty percent of NoV-positive participants (vs. 38.9% in NoV-negative) reported at least moderate impact on travel plans. AGE is a prevalent disease among travellers with a small proportion associated with NoV. Post-travel stool sample collection timing might have influenced the low number of NoV cases detected; however, NoV infections resulted in high clinical severity and impact on travel plans. These results may contribute to targeted vaccine development and the design of future studies on NoV epidemiology.

The Effect of Virus-Specific Vaccination on Laboratory Infection Markers of Children with Rotavirus-Associated Acute Gastroenteritis

Rotavirus (RV) is one of the most common and important causes of acute gastroenteritis (AGE) in newborns and children worldwide. The aim of this study was to evaluate the effect of the RV vaccine on the natural history of RV infections using the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune inflammatory index (SII) as hematological indexes, clinical findings, and hospitalization. Children aged 1 month to 5 years who were diagnosed with RV AGE between January 2015 and January 2022 were screened, and 630 patients were included in the study. The SII was calculated by the following formula: neutrophil × platelet/lymphocyte. Fever and hospitalization were significantly higher and breastfeeding was significantly lower in the RV-unvaccinated group than in the RV-vaccinated group. The NLR, PLR, SII, and CRP were significantly higher in the RV-unvaccinated group (p < 0.05). The NLR, PLR, and SII were significantly higher both in the non-breastfed group than in the breastfed group and in the hospitalized group than in the not hospitalized group (p < 0.05). CRP was not significantly different in either the hospitalization group or the breastfeeding group (p > 0.05). SII and PLR were significantly lower in the RV-vaccinated group than in the RV-unvaccinated group in both the breastfed and non-breastfed subgroups. For NLR and CRP, while there was no significant difference according to RV vaccination status in the breastfed group, there was a significant difference in the non-breastfed group (p value: <0.001; <0.001). Despite the low level of vaccine coverage, the introduction of RV vaccination had a positive impact on the incidence of RV-positive AGE and related hospitalizations in children. These results showed that breastfed and vaccinated children were less prone to inflammation because their NLR, PLR, and SII ratios were lower. The vaccine does not prevent the disease 100%. However, it can prevent severe disease with exsiccation or death.

Epidemiology of acute gastroenteritis in France from November 2019–August 2021, in light of reported adherence to COVID-19 barrier measures

Since the start of the COVID-19 pandemic, French health authorities have encouraged barrier measures and implemented three lockdowns to slow SARS-CoV-2 transmission. We aimed to examine the impact of these measures on the epidemiology of acute gastroenteritis (AGE) in France, from November 2019 to August 2021. We describe trends in AGE indicators from syndromic surveillance and a sentinel surveillance network. Additionally, we describe reported AGE illness data from a community based cohort, and frequencies of adherence to COVID-19 barrier measures from repeated quantitative surveys. From week 7 in 2020, all AGE indicators reached the lowest levels observed since the last decade. During the first lockdown, the median incidence rate reported by the sentinel network was 32 per 100,000 inhabitants, 1.9 times lower than the minimum registered during the 2010–2019 period. Low activity persisted until April 2021. Reported illness from the community cohort mirrored these trends. Adherence to COVID-19 barrier measures was highest during the first lockdown, coinciding with the steep decrease in AGE incidence. Among children under 5 years, AGE incidence increased after the third lockdown in June and July 2021, but remained lower than previous winter-season peaks. Our study indicates that a reduction in adherence to COVID-19 barrier measures, and the end of the lockdowns, coincided with an increase in AGE incidence, particularly among young children. We therefore strongly recommend maintaining adherence to barrier measures in order to in order to limit the transmission of AGE related pathogens.

Common communicable diseases in the general population in France during the COVID-19 pandemic.

In France, social distancing measures have been adopted to contain the spread of COVID-19, culminating in national Lockdowns. The use of hand washing, hydro-alcoholic rubs and mask-wearing also increased over time. As these measures are likely to impact the transmission of many communicable diseases, we studied the changes in common infectious diseases incidence in France during the first year of COVID-19 circulation. We examined the weekly incidence of acute gastroenteritis, chickenpox, acute respiratory infections and bronchiolitis reported in general practitioner networks since January 2016. We obtained search engine query volume for French terms related to these diseases and sales data for relevant drugs over the same period. A periodic regression model was fit to disease incidence, drug sales and search query volume before the COVID-19 period and extrapolated afterwards. We compared the expected values with observations made in 2020. During the first lockdown period, incidence dropped by 67% for gastroenteritis, by 79% for bronchiolitis, by 49% for acute respiratory infection and 90% for chickenpox compared to the past years. Reductions with respect to the expected incidence reflected the strength of implemented measures. Incidence in children was impacted the most. Reduction in primary care consultations dropped during a short period at the beginning of the first lockdown period but remained more than 95% of the expected value afterwards. In primary care, the large decrease in reported gastroenteritis, chickenpox or bronchiolitis observed during the period where many barrier measures were implemented imply that the circulation of common viruses was reduced and informs on the overall effect of these measures.

Acute Gastroenteritis on Cruise Ships - Maritime Illness Database and Reporting System, United States, 2006-2019.

Problem/ConditionGastrointestinal illness is common worldwide and can be transmitted by an infected person or contaminated food, water, or environmental surfaces. Outbreaks of gastrointestinal illness commonly occur in crowded living accommodations or communities where persons are physically close. Pathogens that cause gastrointestinal illness outbreaks can spread quickly in closed and semienclosed environments, such as cruise ships. CDC’s Vessel Sanitation Program (VSP) is responsible for conducting public health inspections and monitoring acute gastroenteritis (AGE) illness on cruise ships entering the United States after visiting a foreign port.Period Covered2006–2019.Description of SystemVSP maintains the Maritime Illness Database and Reporting System (MIDRS) for monitoring cases of AGE illness among passengers and crew sailing on cruise ships carrying ≥13 passengers and within 15 days of arrival at U.S. ports from foreign ports of call. Cruise ships under VSP jurisdiction are required to submit a standardized report (24-hour report) of AGE case counts for passengers and crew 24–36 hours before arrival at the first U.S. port after traveling internationally. If the cumulative number of AGE cases increases after submission of the 24-hour report, an updated report must be submitted no less than 4 hours before the ship arrives at the U.S. port. A special report is submitted to MIDRS when vessels are within 15 days of arrival at a U.S. port and cumulative case counts reach 2% of the passenger or crew population during a voyage. VSP declares an outbreak when 3% or more of the passengers or crew on a voyage report AGE symptom to the ship’s medical staff.ResultsDuring 2006–2019, a total of 37,276 voyage reports from 252 cruise ships were submitted to MIDRS. Of the 252 cruise ships, 80.6% were extra large in size (60,001–120,000 gross registered tons [GRT]), 37.0% and 32.9% had voyages lasting 3–5 days and 8–10 days, respectively, and 53.2% were traveling to a port in the Southeast region of the United States at the time the final MIDRS report was submitted. During 2006–2019, VSP received 18,040 (48.4%) 24-hour routine reports, 18,606 (49.9%) 4-hour update reports, and 612 (1.6%) special reports (2% and 3% AGE reports). Incidence rates decreased from 32.5 cases per 100,000 travel days to 16.9 for passengers and from 13.5 to 5.2 for crew. Among passengers, AGE incidence rates increased with increasing ship size and voyage length. For crew members, rates were significantly higher on extra-large ships (19.8 per 100,000 travel-days) compared with small and large ships and on voyages lasting 6–7 days. Geographically, passenger incidence rates were highest among ships underway to ports in California, Alaska, Texas, New York, Florida, and Louisiana. Among passengers, AGE incidence rates were significantly higher on ships anchoring in California (32.1 per 100,000 travel-days [95% confidence interval (CI) = 31.7–32.4]); among crew, they were significantly higher in the South region of the United States (25.9 [CI = 25.1–26.7]).InterpretationThis report is the first detailed summary of surveillance data from MIDRS during 2006–2019. AGE incidence rates decreased during this time. Incidence rates among passengers were higher on mega and super-mega ships and voyages lasting >7 days. AGE incidence among crew was higher on extra-large ships and voyages lasting 6–7 days. Ship size and voyage length are associated with AGE incidence rates, and more targeted effort is needed to prevent disproportionate AGE incidence rates among passengers and crew sailing in high-risk situations.Public Health ActionsMaritime AGE surveillance provides important information about the epidemiology of gastrointestinal illness among cruise ship populations traveling in U.S. jurisdictions. AGE illness is highly contagious and can be transmitted quickly within vessels. State and local public health departments in the United States can use data in this report to better inform the traveling public about the risk for AGE and the importance of their role in minimizing the risk for illness while traveling onboard cruise ships. Key elements for reducing exposure to AGE illness, limiting the spread of illness, and preventing AGE outbreaks are proper hand hygiene practices and prompt isolation of symptomatic persons. Passengers can work in collaboration with cruise lines to promote onboard public health by frequently washing their hands, promptly reporting AGE illness symptoms, and isolating themselves from other persons immediately after illness onset. Access to and proper use of handwashing stations can reduce the risk for illness transmission aboard cruise ships.

Rotavirus gastroenteritis in children hospitalized in northeastern Poland in 2006–2020: Severity, seasonal trends, and impact of immunization

ObjectivesThe introduction of the rotavirus vaccine in 2006 significantly reduced childhood incidence of acute gastroenteritis (AGE) worldwide. The rotavirus vaccine was included in Poland’s national immunization program in 2021. Our study aimed to summarize the epidemiology of AGE in northeastern Poland prior to 2021 and to evaluate the effectiveness of voluntary, out-of-pocket rotavirus childhood vaccination on the incidence of rotavirus AGE. MethodsA review of patients aged 0–17 years with gastroenteritis hospitalized between 2006 and 2020 in northeastern Poland in the context of rotavirus vaccine coverage in the region. ResultsRotavirus was the most common agent of gastroenteritis in hospitalized patients. The seasonality of rotavirus gastroenteritis peaked between February and May in each year of study, except for 2020, when the COVID-19 pandemic skewed any viable comparison of seasonality. Rotavirus vaccine coverage in northeastern Poland did not exceed 25% during the study period and had no impact on hospitalization numbers. ConclusionsRotavirus was the primary causative agent of AGE in children hospitalized in northeastern Poland during the study period. Voluntary vaccinations did not affect the number of hospitalizations due to rotavirus AGE. Our data suggest that universal immunization is key to achieving a significant reduction of rotavirus-associated diarrhea.

An acute gastroenteritis outbreak associated with breakfast contaminated with norovirus by asymptotic food handler at a kindergarten in Shenzhen, China

BackgroundAn outbreak of acute gastroenteritis occurred in a kindergarten located Shenzhen City on March 4, 2018. We were invited to investigate to the risk factors associated with this outbreak.MethodsWe conducted retrospective cohort-studies on three different groups of subjects in order to figure out the difference of incidence of acute gastroenteritis among subjects of different activities on March 2: group one consisted of people who attended the Lantern festival activities; group two consisted of children and employees who ate breakfast and bread provided by the kindergarten; and groups three consisted of children and employees who did not eat breakfast or bread provided by the kindergarten. Fecal, anal swabs, dishware swabs and hand swabs specimens were collected in the study. Bacteria known to cause acute gastroenteritis were cultured. Viruses associated with acute gastroenteritis were tested using real-time PCR. Capsid gene fragment of 557 bp of norovirus was amplified and sequenced. The phylogenetic tree was constructed with MEGA 7.0 using neighbor-joining method based on capsid gene fragment of norovirus.ResultsA total of 143 suspected cases were identified in this outbreak. Diarrhea happened more often in adults than in children while emesis and bellyache were more frequently found in children than in adults. Higher AGE incidence was observed in group 2, children and employees who had breakfast in the kindergarten on March 2, as well as in group 3, and among employees who eating bread involved in breakfast provided on March 2. Five anal swab specimens were positive for norovirus. All noroviruses belongs to group II.3 and have an identity more than 99%.ConclusionA chef, as an asymptomatic carrier with norovirus, was the infectious resource in this outbreak. He contaminated breakfast food provided on March 2. Although morning check is implemented in kindergartens of China, employees are often excluded in morning check. Our finding highlights the importance of morning check covering employees and periodical training for cooks.

Clinical Profile and Epidemiology of Neonates Presenting with Acute Gastroenteritis with Special Emphasis on Acute Kidney Injury

Introduction: Acute Gastroenteritis (AGE) is one of the most common causes of hospitalisation in children as well as neonates. According to World Health Organisation (WHO), 80% of deaths due to diarrhoea occur in first two years of life. Acute Kidney Injury (AKI) is one of the most common complications associated with gastroenteritis and dehydration. Neonates constitute major bulk of infant mortality and morbidity. The goal of this study was to identify risk factors, feeding pattern and electrolyte abnormalities in neonates presenting with AGE. Aim: To study the clinical profile and epidemiology of neonates presenting with AGE with special emphasis on AKI. Materials and Methods: A prospective observational study was conducted in the Neonatal Intensive Care Unit (NICU) of Department of Paediatrics between December 2019 to May 2021 at MMIMS Research and Hospital, Mullana, Ambala, Haryana, India. Ethical clearance was obtained from the ethical committee prior to the study. A total of 510 neonates were admitted during this period in NICU. Out of them 151 neonates of AGE who met the inclusion criteria were enrolled in the study. Clinical Data and lab investigations i.e., serum electrolytes and Renal Function Test (RFT) were collected and entered in pretested proforma meeting the objectives of the study. Kidney Disease Improving Global Outcome (KDIGO) was used to diagnose AKI. Results: In this study, out of the 151 patients of AGE, 56 (37.09%) patients developed AKI. Hyperkalaemia in 85 (56.29%) patients was the most common electrolyte abnormality followed by hypernatremia 35 (23.18%). Hyponatraemia was present in only 15 (9.9%) patients. Acidosis was present in 41 (27.15%) patients. Exclusive formula feeding was the single most modifiable risk factor for AKI. Conclusion: It was found that feeding pattern is the most important and modifiable risk factor associated with increased incidence of AGE and AKI in neonates. Exclusive formula fed babies are more prone to AGE due to improper composition of feeds as compared to mixed feeding or exclusive breast feeding. Thus, exclusive breast feeding must be promoted. Hyperkalaemia remained the most common electrolyte abnormality in these patients.

Acute Gastroenteritis Disease Burden in Infants With Medical Risk Conditions in the Netherlands.

Infants with medical risk conditions are vulnerable to childhood infections including acute gastroenteritis (AGE). To guide prevention programs, we quantified AGE incidence, severity and virus prevalence among medical risk infants in the Netherlands. This prospective cohort-study was part of the RIVAR-project recruiting infants with prematurity, low birth weight or severe congenital conditions in 13 hospitals. Follow-up included 18 monthly health questionnaires detailing AGE symptoms and healthcare usage. Parents were also instructed to notify when an infant developed AGE, to collect a stool sample and complete a daily severity score (Modified Vesikari Severity). Stool samples were analyzed by real-time polymerase chain reaction for rotavirus, norovirus, adenovirus and astrovirus. Between November 2014 and October 2017, 631 infants participated during 9125 person-months of observation. In total, 559 episodes were identified. The mean AGE incidence rate was 73.5 per 100 person-years (PY) (95% confidence interval: 67.6-79.9) and increased with age [incidence rate: 48.3 (39.8-58.3) vs. 80.2 (73.0-88.1)/100 PY for ages 1-5 vs. 6-18 months, respectively]. Healthcare was attended for 38.1% (213/559) and 26.8% (68/254) were classified as severe based on the Modified Vesikari Severity. Stool samples were obtained from 254 AGE episodes. Norovirus was identified in 65 (25.6%) and rotavirus in 44 (17.7%). Adenovirus and astrovirus together accounted for 8.3% (N = 21). Severe AGE occurred most frequently in rotavirus positive episodes. The observed AGE incidence, severity and healthcare usage among medical risk infants confirms substantial disease burden. Norovirus and rotavirus are the dominant pathogens and severe episodes occurred most frequently in children with rotavirus infection. AGE prevention in medical risk infants should be prioritized.

Norovirus compared to other relevant etiologies of acute gastroenteritis among families from a semirural county in Chile

ObjectiveTo determine the dynamics of norovirus disease, a major cause of acute gastroenteritis (AGE), compared to other relevant etiologies, among families living in a lower middle income area. Study designFamilies with three or more members and with one or more healthy children <24 months of age were followed for 1–2 years to detect any AGE. Stool samples were tested for viral and bacterial pathogens and a questionnaire was completed for those with norovirus or rotavirus AGE. ResultsBetween April and June 2016, 110 families were enrolled, with 103 of them completing ≥12 months of follow-up. A total of 159 family AGE episodes were detected, mostly affecting one individual (92%). At least one pathogen was detected in 56% (94/169) of samples, of which 75/94 (80%) were sole infections. Norovirus was most common (n=26), followed closely by enteropathogenic Escherichia coli (EPEC) (n=25), rotavirus (n=24), and astrovirus (n=23). The annual incidence of family AGE was 0.77, and 0.12 for norovirus. Most norovirus AGE occurred in children <4 years old (96%). Only 13/159 (8%) index AGE cases resulted in a secondary case, of which four were associated with norovirus. The majority of norovirus strains were GII (85%), with a mild predominance of GII.4 (9/26; 35%); most norovirus isolates (69%) were recombinants. ConclusionsThe family incidence of AGE in this lower middle income community was nearly one episode per year, mostly caused by viruses, specifically norovirus closely followed by rotavirus and astrovirus. Norovirus infections primarily affected children <4 years old and secondary cases were uncommon.

Study of electrolyte disturbances and renal parameters in acute gastroenteritis under 5 years of age in a tertiary care hospital of Bengaluru, India

Background: Diarrhoea still continues to be a major cause of hospitalization and death in under fives. Electrolyte disturbances play an important role in the associated morbidity and mortality. Acute renal failure is one of the important complications of acute gastroenteritis (AGE) in children. Early intervention and proper fluid replacement may lessen this risk. This study was designed to find out the incidence of acute gastroenteritis and the status of associated electrolyte derangements and renal involvement.Methods: This was a cross sectional study conducted at KIMS, Bengaluru in which 117 children from the age of 1 month to 5 years with acute diarrhea were included based on a predefined inclusion and exclusion criteria. Demographic profile of the patients, details of diarrhea, clinical examination and accompanying degree of dehydration (defined as per WHO criteria) were recorded. Serum electrolytes along with renal parameters were investigated.Results: Total 117 children with acute gastroenteritis were enrolled in the study as per the inclusion criteria which constituted 5% of total paediatric admissions. Children aged 1-12 months had the highest incidence of diarrhea (50%). Male to female ratio is 1.3:1. 65% had some dehydration, 19% no dehydration and 16% had severe dehydration. Isonatremia was seen in 58% followed by hyponatremia in 35% and hypernatremia in only 7%. 83% had isokalemia, hypokalemia in 12%, hyperkalemia in 5%. Levels of serum sodium and potassium decreased with the severity of dehydration. Serum urea and creatinine were significantly high in severe dehydration (p value 0.001). Out of 28 children who were given diluted ORS before admission, majority had hyponatremia (39%) and all of them who received concentrated ORS had hypernatremia.Conclusions: Hyponatremic dehydration is the second most common type of dehydration next to isonatremic dehydration, but it is more common in children who took diluted ORS. Increased awareness regarding ORS preparation may help in preventing electrolyte imbalance in AGE. The levels of serum sodium and potassium decreased and urea and creatinine increased with severity of dehydration. Measurements of serum electrolytes and renal parameters early can help to predict the complications due to AGE and may help in the prevention of diarrhea related complications in children.

Prevalence and associated factors to rotavirus infection in children less than 5years in Enugu State, Nigeria.

Rotavirus is an important cause of morbidity and mortality in children 5 years and below. An epidemiological study was carried out to determine the prevalence of rotavirus in Enugu state and factors that contribute to the incidence in the state. Stool samples were collected from 179 children from different parts of the state. Rotavirus antigen was detected using enzyme immunoassay kit. A standardized structured questionnaire was used to obtain additional information from the parents/guardian of the children. Chi square was used to analyze the results and significance was determined at 0.05. The results showed 31.5% prevalence of rotavirus among children with acute gastroenteritis (AGE) and 25.7% prevalence in the general population. The prevalence was highest (60.9%) among children 0–12 months and decreased as the age increased. Rotavirus infection was significantly higher in bottle-fed children than in those feed exclusively breast milk. More viruses were detected in O (48.8%) and A (47.6%) blood group children than in children of other blood groups. More rotavirus caused AGE occurred in dry season compared to wet season, with highest incidence of both AGE and rotavirus infection occurring in January. Rotavirus diarrhoea was significantly associated with fever, vomiting and dehydration. The results of this study show that rotavirus continues to be an important cause of diarrhoea in children in this part of Nigeria and emphasize the need to factor in rotavirus and other viral agents in the diagnosis and treatment of diarrhoea in children 5 years and below.

Impact of self-financed rotavirus vaccination on acute gastroenteritis in young children in Turkey

ABSTRACT Rotavirus (RV) vaccines have been available in Turkey since 2006. These vaccines are not funded by the National Health System, so consequently their coverage rate in children has reached only 13–18%. We conducted a retrospective record review including all children ≤60 months of age presenting to study hospitals with suspected or clinical acute gastroenteritis (AGE) between 2012 and 2018. During the study, 109,605 children ≤60 months of age were admitted to pediatric out-patient clinics and pediatric emergency room, of which 15,501 (14%) were diagnosed with AGE. Incidence of RV-positive AGE decreased from 4.47 per 1,000 children in 2012 to 2.48 per 1,000 in 2018. A total of 4,805 (31%) such children were hospitalized with RV-positive AGE, a decrease from 1.9 per 1,000 children in 2012 to 0,45 per 1,000 in 2018. The length of hospital stays (LOS) of RV-positive AGE was 2.47 ± 1.15 days compared to LOS of RV-negative AGE 1.59 ± 1.17 days (p < .001). The overall cost of RV-positive AGE ($335 ± 200) was higher than that for RV-negative AGE ($280 ± 148) cases (p = .015). Vaccine effectiveness against any case of RV-positive AGE was 75,1% (95% CI: 65–86%). Despite the low level of vaccine coverage, the introduction of RV vaccination had a positive impact on the incidence of RV-positive AGE and related hospitalizations in young children.

Use of a probiotic mixture containing Bifidobacterium animalis subsp. lactis BB-12 and Enterococcus faecium L3 as prophylaxis to reduce the incidence of acute gastroenteritis and upper respiratory tract infections in children.

For healthy children, attending communities such as nurseries, kindergartens or schools, exposes them to the risk of acute gastroenteritis (AGE) and/or upper respiratory tract infections (URTIs). We therefore evaluated whether the use of a well-documented probiotic formula could act as prophylaxis for AGE and URTIs, reducing the risk of occurrence. In a randomized study, we tested a probiotic mixture containing Bifidobacterium animalis subspecies lactis BB-12 and Enterococcus faecium L3 on 94 healthy children, comparing the incidence and duration of episodes of AGE and the incidence of URTIs to those of a control group of 109 healthy, untreated subjects. In a subgroup consisting of 34 healthy, treated children, we also evaluated salivary IgA levels. The use of the probiotic formula significantly reduced the incidence and duration of episodes of AGE by 82% and 45%, respectively, and the incidence and duration of episodes of URTIs by 84% and 50%. Salivary IgA levels significantly increased three-fold after 90 days of probiotic treatment. The probiotic formula was well tolerated and no side effects occurred. According to our results, use of the probiotic strains BB-12 and L3 statistically reduced the risk of AGE and URTIs in healthy children and increased levels of salivary IgA.

Household presentation of acute gastroenteritis in a primary care sentinel network: retrospective database studies

BackgroundAcute gastroenteritis (AGE) is a highly transmissible condition spreading rapidly between individuals and within households. Rotavirus vaccination was introduced in the UK in 2013. The study objectives were to investigate how acute gastroenteritis incidence changed over 25 years and household incidence of AGE since 2013.MethodsRepeated cross-sectional study of Royal College of General Practitioners Research and Surveillance Centre network. We used a negative binomial model to report incidence rate ratio (IRR) using the last 5 years data. We also conducted a retrospective cohort analysis, using a shared gamma frailty model (2013–2017). We explored the impact of child under 5- years, household size, socioeconomic status quintile, and rurality.ResultsIn the cross-sectional analysis, the IRR of AGE in households with a child of under 5 years was 12.20 (95%CI 11.08–13.45-, p < 0.001) compared with households without; the IRR fell across IMD quintiles, for example there is a 37% decrease in incidence comparing IMD quintile 1 to quintile 5 (95%CI -0.52-0.76, p < 0.001),The cohort study revealed that the presence of an under 5 in the household was associated with a higher risk of household presentation (HR = 6.29, 95% CI 5.61–7.06, p < 0.001). In addition, we observe a reduction in risk of presentation from the most to the least deprived socioeconomic quintile (second quintile: HR = 0.74 (95%CI 0.59–0.92), to least deprived quintile, HR = 0.55 (95%CI 0.41–0.74). We saw a lower association with male gender, white ethnicity and living outside London, but an increased association with increasing household size.ConclusionsThe incidence of AGE has changed over time: pre-school children, larger households, and living in London were associated with higher rates, and male gender and higher economic status associated with lower rates.

Maternal FUT2 genotype in relation to risk of acute infections and rotavirus vaccine shedding in infancy

The human FUT2 gene codes fucosyltransferase2, an enzyme that catalyzes the production and secretion of H‐antigen in bodily fluids and tissues. FUT2 status has been associated with risk of infection for some pathogens. In addition, mothers who are homozygous positive or heterozygous for the FUT2 gene produce a class of oligosaccharides in their milk that can act as decoy receptors for some selected pathogens. The link between maternal FUT2 status and illnesses in breast‐fed infants is not clear.The Pediatric Respiratory &amp; Enteric Virus Acquisition and Immunogenesis Longitudinal (PREVAIL) Cohort study of mother‐infant pairs in Cincinnati, OH assessed whether an epidemiologic association may exist between maternal FUT2 genotype and incidence of acute gastroenteritis (AGE), acute respiratory infection (ARI), and rotavirus vaccine shedding in their infants. We expected that the exclusively breastfed children of FUT2+ mothers would have lower incidences of infection due to the unique breastmilk oligosaccharide composition.We included all 75 mother‐infant pairs who exclusively breastfed their infants, which provided a total of 1,243 child‐weeks of follow‐up from birth to 6 months. All mothers were genotyped for FUT2 by PCR. Of these, 40 (53%) infants were vaccinated against rotavirus and had ≥1 weekly stool sample collected within 8 weeks after vaccination and tested by real time RT‐PCR assays to determine vaccine shedding. Infant infection data came from weekly maternal reports of AGE and ARI that were collected by using an automated text messaging system.Infants of FUT2+ mothers were found to have longer duration of rotavirus shedding post‐vaccination than babies of FUT2− mothers (p=0.007). Additionally, infants of FUT2+ mothers had more AGE symptomatic study weeks (5.6%) than children of FUT2− mothers, who had no symptomatic AGE weeks (p&lt;0.001). Similarly, infants of FUT2+ mothers had ARI with fever for approximately 2.7% of study weeks, whereas babies of FUT2− mothers had no cases of ARI with fever (p=0.006). In this ongoing study, we plan to continue our analysis to include the infant’s own FUT2 status and medically‐attended illness.Support or Funding InformationCDC grant number U191P001059, IP‐16‐004

Effect of Definitions of Acute Gastroenteritis Episodes Using Symptom Diaries in Paediatric Cohorts: A Systematic Review.

Estimates of acute gastroenteritis (AGE) burden are difficult to compare between studies because of inconsistent definitions describing this illness. AGE definitions used in prospective, community-based childhood cohort studies were identified by searching databases for studies that collected daily observations of AGE symptoms. Disease definitions and refractory periods were extracted. Data from the Australian community-based Observational Research in Childhood Infectious Diseases birth cohort were used to calculate AGE incidence and duration using identified AGE definitions, and the World Health Organization definition for diarrhoea. Eight distinct AGE definitions were identified. All included loose stools and 7 included vomiting as symptoms. The refractory period separating episodes ranged from 1 to 21 days. When applied to the Observational Research in Childhood Infectious Diseases dataset, AGE incidence ranged from 0.8 to 2.6 episodes per child-year-at-risk, a 3-fold relative difference. Direct comparisons of rates from different cohorts can only be undertaken if a standard definition for AGE is adopted.

Renal Involvement in Acute Gastroenteritis under 5 years of Age in a Tertiary Care Hospital of Western Nepal–A prospective Observational Study

Background: Acute renal failure is one of the important complications of acute gastroenteritis in children. Early intervention and proper fluid replacement may lessen this risk. Acute gastroenteritis (AGE) is an infection of the gastrointestinal tract that commonly affects young children. It causes an increase in loss of water and electrolytes due to vomiting and diarrhea resulting to dehydration, which is the main cause of mortality in children under five years with acute gastroenteritis. Therefore, this study was designed to find out the incidence of AGE and the status of associated electrolyte derangements, renal involvement and other biochemical and haematological variables. Material and Methods: This cross sectional study comprised of 100 cases of AGE in children aged &lt;5 years of age. Demographic profile of the patients, details of diarrhea, and accompanying degree of dehydration (defined as per World health Organization criteria) with any associated complication were included. Various electrolyte parameters along with biochemical and hematological parameters (serum urea, serum creatinine, hemoglobin, total leukocyte count) were investigated. Results: This study found that urea and creatinine were elevated in 29(29%) and 62(62%) of the cases respectively. Electrolyte disturbances were seen in 42% of cases among which hyponatremia was the most common electrolyte disturbance seen. Majority of patients had isonatremic dehydration 58%. Hyponatremic dehydration was most common in some dehydration, which was 30%. We found hypokalemia in 31% cases. Conclusion: Measurements of renal parameters early can help to predict the complications due to AGE and may help in the prevention of diarrhea related complications in children.