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A Comparison of Pathogen Detection and Risk Factors among Symptomatic Children with Gastroenteritis Compared with
Brian R Lee1, Christopher J Harrison1, Ferdaus Hassan1
1Children's Mercy Kansas City and University of Missouri Kansas City School of Medicine, Kansas City, MO.
Insights
Norovirus is the leading cause of acute gastroenteritis (AGE) in children, with sick contacts significantly increasing illness risk. Asymptomatic shedding of norovirus in healthy controls highlights transmission dynamics.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Public Health
Background:
- Acute gastroenteritis (AGE) remains a significant public health concern in children.
- Understanding pathogen distribution and risk factors is crucial for effective prevention and control strategies.
- The post-rotavirus vaccine era necessitates updated epidemiological data.
Purpose of the Study:
- To characterize the demographics, seasonality, and risk factors of AGE in children presenting to an emergency department.
- To compare pathogen prevalence and risk factors between children with AGE and matched healthy controls (HC).
- To provide insights into the epidemiology of AGE following the introduction of the rotavirus vaccine.
Main Methods:
- A prospective study enrolled children under 11 years with AGE and matched healthy controls (HC) from 2011-2016.
- AGE was defined by ≥3 diarrhea or ≥1 vomiting episodes.
- Pathogen detection, seasonality, and risk factors (e.g., sick contacts, daycare attendance) were analyzed and compared between groups.
Main Results:
- One or more pathogens were detected in 46.3% of AGE cases versus 17.3% of HC.
- Norovirus was the most frequent pathogen in AGE cases (22.7%), followed by rotavirus (7.8%).
- Children with AGE had significantly higher rates of sick contacts (both in- and out-of-home) and daycare attendance compared to HC.
Conclusions:
- Norovirus is the predominant pathogen causing AGE in this pediatric population.
- The presence of norovirus in HC suggests potential asymptomatic shedding and contributes to transmission.
- Close contacts and daycare attendance are significant risk factors for pediatric AGE.
Objective:
To describe demographics, pathogen distribution/seasonality, and risk factors in children seeking care for acute gastroenteritis (AGE) at a midwestern US emergency department during 5 postrotavirus vaccine years (2011-2016), and further, to compare the same data with matched healthy controls (HC).
Study Design:
AGE and HC participants <11 years old enrolled in the New Vaccine Surveillance Network study between December 2011 to June 2016 were included. AGE was defined as ≥3 diarrhea episodes or ≥1 vomiting episode. Each HC's age was similar to an AGE participant's age. Pathogens were analyzed for seasonality effects. Participant risk factors for AGE illness and pathogen detections were compared between HC and a matched subset of AGE cases.
Results:
One or more organisms was detected in 1159 of 2503 children (46.3%) with AGE compared with 99 of 537 HC (17.3%). Norovirus was detected most frequently among AGE (n = 568 [22.7%]) and second-most frequently in HC (n = 39 [6.8%]). Rotavirus was the second most frequently detected pathogen among AGE (n = 196 [7.8%]). Children with AGE were significantly more likely to have reported a sick contact compared with HC, both outside the home (15.6% vs 1.4%; P < .001) and inside the home (18.6% vs 2.1%; P < .001). Daycare attendance was higher among children with AGE (41.4%) compared with HC (29.5%; P < .001). The Clostridium difficile detection rate was slightly higher among HC (7.0%) than AGE (5.3%).
Conclusions:
Norovirus was the most prevalent pathogen among children with AGE. Norovirus was detected in some HC, suggesting potential asymptomatic shedding among HC. The proportion of AGE participants with a sick contact was approximately 10 times greater than that of HC.
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