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Outbreaks of astrovirus gastroenteritis in day care centers
D K Mitchell1, R Van, A L Morrow
1Center for Pediatric Research, Eastern Virginia Medical School, Norfolk.
Insights
Astrovirus caused significant diarrhea outbreaks in day care centers, particularly affecting younger children. Many infections were asymptomatic, highlighting the need for surveillance in pediatric populations.
Area of Science:
- Virology
- Pediatrics
- Epidemiology
Background:
- Diarrhea outbreaks in childcare settings pose a significant public health challenge.
- Identifying the causative agents of pediatric gastroenteritis is crucial for effective control measures.
Purpose of the Study:
- To investigate the role of astrovirus in diarrhea outbreaks among infants and toddlers attending day care centers.
- To characterize astrovirus infections in this vulnerable population.
Main Methods:
- Prospective collection of stool specimens from children aged 6-30 months in day care centers over a six-year period (1986-1991).
- Testing for common enteropathogens including bacteria, rotavirus, adenovirus, and Giardia lamblia.
- Specific testing for astrovirus using enzyme immunoassay and confirmation by reverse transcriptase-polymerase chain reaction (RT-PCR).
Main Results:
- Astrovirus was identified as the causative agent in 7% of investigated outbreaks.
- 34% of children tested were infected, with nearly half of these infections being asymptomatic.
- Younger children (<12 months) showed a higher risk of infection and symptomatic illness.
Conclusions:
- Astrovirus is a notable cause of diarrhea outbreaks in day care settings.
- Younger children are more susceptible to astrovirus infection and associated symptoms.
- The high rate of asymptomatic infections underscores the importance of considering astrovirus in outbreak investigations.
Objective:
This study evaluated astrovirus as a cause of diarrhea outbreaks among infants and toddlers in day care centers.
Design:
Stool specimens were collected weekly during four periods (from January 1986 through December 1991) from children 6 to 30 months of age who were enrolled in prospective studies of diarrhea in day care centers. All diarrheal stool specimens were tested for bacterial enteropathogens, rotavirus, enteric adenovirus, and Giardia lamblia. A total of 1365 stool specimens from 70 outbreaks in which no etiologic agent was identified and from another 11 outbreaks with a known cause were tested for astrovirus, by means of a monoclonal antibody-based enzyme immunoassay. Confirmatory testing was performed by reverse transcriptase-polymerase chain reaction with primers designed to produce an 89 base-pair product.
Results:
Astrovirus was detected in 6 (7%) of the 81 outbreaks. Of 217 children tested, 73 (34%) were infected with astrovirus; infections in 35 (48%) were symptomatic and in 38 (52%) asymptomatic. The six outbreaks lasted 11 to 44 days (median 22 days). Astrovirus excretion was detected for a duration of 2 to 30 days, with excretion occurring from 1 to 8 days (median 2 days) before diarrhea began to 1 to 20 days (median 2 days) after diarrhea ceased. Younger children (< or = 12 months) were at greater risk than older children (p = 0.011) of becoming infected with astrovirus during an outbreak and were more likely (p = 0.015) to have symptoms when infected. Of 24 specimens with astrovirus by enzyme immunoassay, 20 (83%) were confirmed to have the virus by reverse transcriptase-polymerase chain reaction.
Conclusion:
Astrovirus was an important cause of outbreaks of diarrhea among children attending day care centers, more frequently infected younger children, and often produced asymptomatic infections.