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Master of Public Health

The Changing Landscape of Pediatric Viral Enteropathogens in the Post-Rotavirus Vaccine Era

AUTHORS

Halasa N , Piya B , Stewart LS , Rahman H , Payne DC , Woron A , Thomas L , Constantine-Renna L , Garman K , McHenry R , Chappell J , Spieker AJ , Fonnesbeck C , Batarseh E , Hamdan L , Wikswo ME , Parashar U , Bowen MD , Vinjé J , Hall AJ , Dunn JR , . Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2020 2 3; ().

ABSTRACT

BACKGROUND: Acute gastroenteritis(AGE) is a common reason for children to seek medical care. However, the viral etiology of AGE illness is not well described in the post-rotavirus vaccine era, particularly in the outpatient(OP) setting.

METHODS: Between 2012 and 2015, children 15 days through 17 years old presenting to Vanderbilt Children’s Hospital, Nashville, TN with AGE were enrolled prospectively from the inpatient, emergency department, and OP settings and stool specimens were collected. Healthy controls(HCs) were enrolled and frequency-matched for period, age group, race, and ethnicity. Stool specimens were tested by reverse-transcription real-time quantitative polymerase chain reaction for norovirus, sapovirus, and astrovirus RNA and by Rotaclone enzyme immunoassay for rotavirus antigen, followed by PCR verification of antigen detection.

RESULTS: A total of 3705 AGE cases and 1563 HC were enrolled, among whom 2885 cases(78%) and 1110 HCs(71%) provided stool specimens that were tested. All four viruses were more frequently detected in AGE cases vs. HC: norovirus, 22% vs. 8%; rotavirus, 10% vs. 1%; sapovirus, 10% vs. 5%; and astrovirus, 5% vs. 2%(p<0.001 for each virus, respectively). AGE rates in the OP setting due to norovirus were highest compared to the other three viruses. Children under five years old had higher OP AGE rates compared to older children for all viruses.

CONCLUSIONS: Norovirus remains the most common virus detected in all settings, occurring nearly twice as frequently as the next most common pathogens, sapovirus and rotavirus. Combined, these four viruses were associated with almost half of all AGE visits and therefore are an important reason for children to seek medical care.

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