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Asymptomatic Shedding of Enteric Viruses in Young Children: Insights From a Year-Long Prospective Surveillance Study
Lital Hadad1,2, Nitzan Avelson1,2, Maya Goldberger1
1The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Beersheba, Israel.
Insights
Asymptomatic children carry enteric viruses, with rotavirus and norovirus most common. Breastfeeding offers protection, while antibiotic use is linked to higher detection rates in these young children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Virology
Background:
- Enteric viruses are a primary cause of gastroenteritis in young children.
- Multiplex PCR diagnostics frequently detect these viruses in asymptomatic children.
Purpose of the Study:
- To investigate the prevalence and risk factors of enteric virus detection in asymptomatic children under 5 years old.
- To compare viral shedding and seasonal patterns between asymptomatic and symptomatic children.
Main Methods:
- Prospective study (March 2024-February 2025) of children under 5 without recent gastrointestinal symptoms or fever.
- Rectal swabs tested for rotavirus, norovirus, adenovirus, astrovirus, and sapovirus using multiplex PCR.
- Parental questionnaires and follow-up interviews for risk factor assessment and symptom monitoring.
Main Results:
- Enteric viruses detected in 17.6% of asymptomatic children; rotavirus (6.2%) and norovirus (5.1%) were most common.
- Breastfeeding showed significant protective effect (OR 0.19); recent antibiotic use was more frequent in virus-positive cases.
- Asymptomatic children had higher PCR cycle threshold (Ct) values than symptomatic children, indicating lower viral load, except for astrovirus.
Conclusions:
- Asymptomatic children can harbor and potentially transmit enteric viruses.
- Breastfeeding is a protective factor against enteric virus detection in young children.
- PCR Ct values, interpreted with clinical context, are crucial for understanding the significance of viral detection in children.
Abstract:
Enteric viruses are a leading cause of gastroenteritis in young children. With the increasing use of multiplex PCR, these viruses are frequently detected in asymptomatic children. In this prospective study conducted from March 2024 to February 2025, rectal swabs were collected from children < 5 years with no history of diarrhea or vomiting in the preceding month and no fever in the prior week. Samples were tested for rotavirus, norovirus, adenovirus, astrovirus, and sapovirus. Parental questionnaires and follow-up interviews assessed risk factors and monitored symptom development. Enteric viruses were detected in 17.6% of asymptomatic children, most commonly rotavirus (6.2%) and norovirus (5.1%). Detection peaked during the second year of life. No differences were observed in daycare attendance, number of siblings, or underlying conditions between virus-positive and virus-negative asymptomatic children. Breastfeeding was significantly protective (OR 0.19, 95% CI 0.06-0.51), while recent antibiotic use was more common in virus-positive cases. Compared with symptomatic children tested during the same period, asymptomatic children had significantly higher cycle threshold (Ct) values, except for astrovirus. Seasonal distribution of viruses was similar across both groups. These findings suggest that asymptomatic children may contribute to viral transmission and that Ct PCR results, alongside clinical context, may aid result interpretation.
