Enteric Viral Pathogens in Infants in the United States: 2017-2020

The introduction of rotavirus vaccines in the United States led to substantial reductions in rotavirus disease burden, whereas the relative burden of other viral pathogens causing acute gastroenteritis (AGE) increased. Our aim was to establish the community-level burden of enteric viral pathogens in a US cohort during the first 2 years of life.

From birth until age 2 years, weekly stools and AGE symptom surveys were collected from mother-child pairs in the PREVAIL (Pediatric Respiratory & Enteric Virus Acquisition and Immunogenesis Longitudinal) cohort. Stools were tested for 5 enteric viral pathogens, with infections defined by grouping proximal viral detections with the same genotype. Rates of infection and AGE symptoms were determined.

From 2017 to 2020, 245 children were followed, with 13 944 stools tested and 836 episodes of AGE recorded. Children had 3.8 enteric viral infections per child-year and over two-thirds had 1 or more symptomatic enteric viral infection by age 2 years. Norovirus Genogroup II (0.4 per child-year) and sapovirus (0.2 per child-year) had the highest incidence of symptomatic infections, followed by astrovirus, rotavirus, norovirus Genogroup I, and adenovirus 40/41 (each ≤0.1 per child-year). Approximately two-thirds of enteric viral infections were asymptomatic, and 90% were not medically attended. Symptomatic infections were infrequent before age 6 months.

Our findings show the high burden of symptomatic enteric viral infections, particularly norovirus, as well as the high frequency of asymptomatic infections, thereby improving our understanding of the epidemiology and clinical manifestations of enteric viral infections in young US children.