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Astrovirus-associated diarrhea among Guatemalan ambulatory rural children
J R Cruz1, A V Bartlett, J E Herrmann
1Division of Nutrition and Health, Institute of Nutrition of Central America and Panama, Guatemala, Guatemala.
Insights
Astrovirus (AV) shedding is common in young Guatemalan children, contributing to significant diarrhea and poor nutritional status. This study monitored AV fecal excretion in children aged 0-3 years over two years.
Area of Science:
- Pediatric Infectious Diseases
- Gastroenterology
- Public Health
Background:
- Astroviruses (AVs) are a significant cause of gastroenteritis in young children worldwide.
- Limited data exists on the prevalence and impact of AV infections in rural, low-resource settings.
- Understanding AV shedding patterns is crucial for public health interventions.
Purpose of the Study:
- To determine the fecal excretion rates of astroviruses in young children in rural Guatemala.
- To assess the association between astrovirus infection and episodes of diarrhea.
- To evaluate the clinical and nutritional impact of astrovirus-associated diarrhea.
Main Methods:
- A longitudinal study monitored 321 children (0-3 years) in rural Guatemala from 1987-1989.
- Over 5,000 stool specimens were analyzed, including routine, pre-diarrheal, diarrheal, and convalescent samples.
- Astrovirus detection was performed, and co-infections with other enteropathogens were documented.
Main Results:
- Astrovirus shedding was detected in 38.6% of children, with 184 infections identified.
- Astroviruses were detected in 4.9% of samples collected one week before diarrhea onset and 7.3% during diarrhea episodes.
- Astrovirus-associated diarrhea lasted a median of 5 days, negatively impacted weight gain, and was linked to vomiting, fever, dehydration, and loss of appetite.
Conclusions:
- Astrovirus infections are prevalent in young children in rural Guatemala and contribute to significant diarrheal disease burden.
- Astrovirus diarrhea negatively affects child growth and nutritional status, exacerbating health issues in resource-poor environments.
- Findings highlight the need for targeted interventions to reduce astrovirus transmission and its associated morbidity.
Abstract:
Fecal excretion of astroviruses was monitored in 321 children, 0 to 3 years old, living in the rural highlands of Guatemala. During the longitudinal study, from February 1987 to February 1989, we examined 5,000 stool specimens, including 1,805 collected during 1,369 episodes of diarrhea, 830 collected during the convalescent week, and 216 and 244 collected 2 weeks and 1 week, respectively, before the onset of diarrhea. Routine specimens were taken once a month from every child who had been free from diarrhea for at least three consecutive weeks. Of the children, 124 (38.6%) excreted astroviruses during the study. In total, we identified 184 infections by astroviruses. Of the samples collected 2 weeks and 1 week before the initiation of symptoms, 0.9 and 4.9%, respectively, were positive, while 7.3% of the diarrhea episodes were associated with astroviruses. Of the convalescent specimens, 3.4% were shown to be positive; 2.4% of the 1,905 specimens taken in diarrhea-free periods contained astroviruses. Infections by other potential enteropathogens were documented in 54 and 65% of the asymptomatic and symptomatic astrovirus infections, respectively. Diarrhea associated with astroviruses alone had a median duration of 5 days and was associated with vomiting in 8.6%, with fever in 17.1%, with dehydration in 5.7%, and with loss of appetite in 34.3% of the episodes. Diarrhea due to astroviruses was accompanied by negative changes in weight gain. Astrovirus diarrhea contributes to the high morbidity observed in young children living under poor conditions and has a deleterious effect on their nutritional status.