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High detection rates of enteropathogens in asymptomatic children attending day care
Remko Enserink1, Rianne Scholts2, Patricia Bruijning-Verhagen1
1Center for Infectious Disease Control (Epidemiology and Surveillance Unit), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands ; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Asymptomatic enteropathogen infections are common in young children attending day care. Gastroenteritis symptoms represent only one manifestation of these widespread infections in this population.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Public health
Background:
- Gastroenteritis significantly impacts children under four, particularly those in day care settings.
- Understanding pathogen prevalence is crucial for managing child health in communal environments.
Purpose of the Study:
- To determine the prevalence of various enteropathogens in the intestinal flora of children attending day care.
- To investigate the relationship between pathogen occurrence, child characteristics, and sampling season.
Main Methods:
- Conducted a three-year enteropathogen surveillance across 29 Dutch child day care centers.
- Collected monthly fecal samples from randomly selected children, irrespective of symptoms.
- Utilized real-time multiplex PCR for molecular detection of 16 enteropathogenic bacteria, parasites, and viruses.
Main Results:
- Enteropathogens were detected in 78.0% of 5197 fecal samples.
- The majority (95.4%) of samples were from asymptomatic children.
- Bacterial pathogens were most frequent (EPEC 19.9%), followed by parasitic (D. fragilis 22.1%) and viral (norovirus 9.5%).
- Rotavirus and norovirus were significantly linked to gastroenteritis symptoms.
Conclusions:
- Asymptomatic enteropathogen infections are frequent among day care attendees.
- Gastroenteritis is only one clinical outcome of enteropathogen presence in this demographic.
- Highlights the importance of surveillance for asymptomatic carriage in child care settings.
Background:
Gastroenteritis morbidity is high among children under the age of four, especially amongst those who attend day care.
Objective:
To determine the prevalence of a range of enteropathogens in the intestinal flora of children attending day care and to relate their occurrence with characteristics of the sampled child and the sampling season.
Methods:
We performed three years of enteropathogen surveillance in a network of 29 child day care centers in the Netherlands. The centers were instructed to take one fecal sample from ten randomly chosen children each month, regardless of gastrointestinal symptoms at time of sampling. All samples were analyzed for the molecular detection of 16 enteropathogenic bacteria, parasites and viruses by real-time multiplex PCR.
Results:
Enteropathogens were detected in 78.0% of the 5197 fecal samples. Of the total, 95.4% of samples were obtained from children who had no gastroenteritis symptoms at time of sampling. Bacterial enteropathogens were detected most often (most prevalent EPEC, 19.9%), followed by parasitic enteropathogens (most prevalent: D. fragilis, 22.1%) and viral enteropathogens (most prevalent: norovirus, 9.5%). 4.6% of samples related to children that experienced symptoms of gastroenteritis at time of sampling. Only rotavirus and norovirus were significantly associated with gastroenteritis among day care attendees.
Conclusions:
Our study indicates that asymptomatic infections with enteropathogens in day care attendees are not a rare event and that gastroenteritis caused by infections with these enteropathogens is only one expression of their presence.
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