High prevalence of community-acquired norovirus gastroenteritis among hospitalized children: a prospective study

Acute gastroenteritis (AGE) causes significant morbidity, especially in young children, and frequently requires hospitalization even in developed countries. Surveillance studies of AGE are important to determine the prevalence and variety of bacterial and viral pathogens, to initiate targeted preventive measures, such as vaccine programmes, and to monitor its impact. A prospective study was conducted in children <5 years old, admitted with AGE between April 2006 and April 2007 to the Virgen del Rocío University Hospital, Seville, Spain. Demographic and clinical data were collected and patients followed-up after hospital discharge. A stool sample from each child was screened for enteropathogenic bacteria and tested by reverse transcription polymerase chain reaction for rotavirus, astrovirus, norovirus and sapovirus and by the immunochromatographic method for enteric adenoviruses. Norovirus was the most common pathogen in hospitalized children, being detected in 27%, followed by rotavirus 21%. Mixed infection occurred in nearly 20% of all norovirus infections and was most commonly associated with Salmonella spp. Rotavirus infection was associated with an overall higher severe clinical score compared with norovirus infection. Lactose intolerance was observed in 29 children (7.5%) and most commonly due to rotavirus infection (p <0.001). Seizures were reported in four children. Norovirus was the commonest cause of AGE in hospitalized children <5 years during 2006-2007 in Seville, Spain. The use of these molecular techniques should be included routinely for the surveillance of sporadic cases and outbreaks of norovirus AGE in children attending hospitals as well as healthcare centres.