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Viral agents of gastroenteritis. Public health importance and outbreak management
C W LeBaron1, N P Furutan, J F Lew
1Department of Pediatrics, Emory University.
Insights
Viral gastroenteritis is a major cause of childhood hospitalization and death globally. Increased knowledge of viral pathogens like rotavirus drives new diagnostic and control strategies, including surveillance and vaccine development.
Area of Science:
- Virology
- Public Health
- Pediatrics
Background:
- Infectious gastroenteritis hospitalizes over 210,000 US children annually and causes millions of deaths worldwide.
- Rotavirus is the leading cause of childhood diarrhea, infecting most US children by age four and causing severe dehydration.
- Emerging viral pathogens include enteric adenoviruses, calicivirus, astrovirus, and Norwalk-like agents.
Framework:
- Electron microscopy of stool specimens is the gold standard for diagnosing these viral agents, though limited to specialized centers like the CDC.
- Outbreak investigations require specific sample collection protocols: bulk stool from 10 ill individuals within 48 hours of illness onset and paired acute/convalescent serum samples.
Implementation:
- Control measures focus on eliminating common sources of infection (e.g., contaminated water, infected food handlers) and interrupting person-to-person transmission.
- National surveillance for viral gastroenteritis agents has been initiated by the CDC in anticipation of vaccine development.
Implications:
- Vaccine development, particularly for rotavirus, holds significant promise for future control of endemic viral diarrhea.
- Healthcare facilities capable of detecting rotavirus and other viral diarrhea agents are encouraged to participate in national surveillance efforts.
Abstract:
Each year, infectious gastroenteritis causes greater than 210,000 children in the United States to be hospitalized and 4-10 million children to die worldwide. Since the mid-1970s, knowledge has increased dramatically concerning the viral agents that are responsible for much of this public health burden. Rotavirus, the most common cause of diarrhea among children, infects virtually every child in the United States by the age of 4 years and causes potentially lethal dehydration in 0.75% of children less than 2 years of age. Other recently identified pathogens include the enteric adenoviruses, calicivirus, astrovirus, and the Norwalk family of agents. Conclusive diagnosis of these viruses requires electron microscopic examination of stool specimens, a laboratory technique that is available only at a few large centers, including CDC. Stool samples from an outbreak that are submitted to CDC for detection of viral pathology should be collected in bulk from 10 ill persons during their first 48 hours of illness, while feces are still liquid, and should be stored at 4 C (not frozen). Acute- and convalescent-phase serum samples should be collected from the same persons, plus from an equal number of controls, during the first week of illness and 3 weeks thereafter. Control measures for outbreaks of viral gastroenteritis should focus on the removal of an ongoing common source of infection (e.g., an ill food handler or the contamination of a water supply) and on the interruption of person-to-person transmission that can perpetuate an outbreak in a population after the common source has been removed. Because improvements in environmental hygiene may not be accompanied by reductions of endemic diarrhea caused by viruses, immunization may play an important role in future control; vaccine trials for rotavirus are in progress. In anticipation of vaccine development and use, CDC recently began national surveillance for the viral agents of gastroenteritis. Health-care facilities involved in the detection of rotavirus or the other viral agents of diarrhea can participate.