Medical News: The Hidden Epidemic - Acute gastroenteritis (AGE) represents a significant public health challenge worldwide, particularly among children. This condition, marked by symptoms such as diarrhea, abdominal pain, nausea, and vomiting, is predominantly caused by enteric viruses. These pathogens are responsible for about 70% of AGE cases globally, infecting millions of children each year. Among these viruses, well-known culprits include rotavirus (RVA), adenovirus (AdV), and norovirus (NoV). However, recent research has identified a host of emerging viral pathogens that may also play a role in AGE episodes.
Ten Different Viruses Including Emerging Viruses, Causing Gastroenteritis I
n Children During And After The COVID-19 Pandemic
In a comprehensive study conducted by the Experimental Zooprophylactic Institute of Southern Italy, Nutrition and Veterinary Public Health in Rome, the National Specialty Hospital Santobono Pausilipon in Napoli, and the University of Naples Federico II, that is covered in this
Medical News report, researchers investigated the presence of ten different enteric viruses in 152 fecal samples collected from children hospitalized for gastroenteritis. This study offers a detailed look at the prevalence and impact of these viruses during and after the COVID-19 pandemic.
The Study: Methods and Findings
Researchers used real-time PCR to analyze the fecal samples and found that 49.3% were positive for viral detection. The breakdown of the prevalence is as follows: norovirus GII (19.7%), AdV (15.8%), RVA (10.5%), human parechovirus (HPeV) (5.3%), enterovirus (EV) (3.3%), and sapovirus (SaV) (2.6%). Other viruses, such as salivirus (SalV), norovirus GI, and astrovirus (AstV), each accounted for 1.3% of cases, with aichivirus (AiV) detected in only one patient.
Interestingly, the study revealed that in 38.2% of cases, only one virus was detected, while co-infections were present in 11.8% of the samples. Among children aged five years and younger, 56.0% tested positive for viral infections, compared to 40.0% of those older than five years.
Enteric Viruses: The Usual Suspects and Emerging Threats
-Norovirus (NoV): Norovirus is the leading cause of non-bacterial AGE worldwide, affecting people of all ages. This virus is grouped into genogroups (GI-GX), with GI and GII causing illness in humans. Norovirus GII was the most frequently identified in this study, accounting for 19.7% of cases.
-Rotavirus (RVA): RVA is a major cause of AGE in infants and children globally. While vaccination has reduced its incidence in countries with high vaccine coverage, it remains a significant pathogen, detected in 10.5% of the samples in this study.
-Adenovirus (AdV): Adenoviruses are double-stranded DNA viruses with various serotypes. Serotypes 40 and 41 of species F are specifically linked to AGE in children. In
this study, AdV was found in 15.8% of cases.
-Human Parechovirus (HPeV): Once neglected, HPeV is now recognized for its role in mild to severe gastrointestinal and respiratory symptoms. It was identified in 5.3% of the samples.
-Enterovirus (EV): Known for causing a range of illnesses from mild respiratory symptoms to severe neurological conditions, EV was detected in 3.3% of cases.
-Sapovirus (SaV): SaV, which causes gastroenteritis, was found in 2.6% of the samples.
-Salivirus (SalV), Astrovirus (AstV), and Aichivirus (AiV): These emerging viruses were less frequently detected but are suspected of contributing to AGE. Each accounted for 1.3% of cases, with AiV found in only one patient.
Co-Infections and Age-Related Findings
The study highlighted that co-infections were more prevalent among younger children (0-2 years), with norovirus GII - HPeV and norovirus GII - AdV being the most common combinations. Co-infections were notably more frequent in 2022, reflecting the lifting of COVID-19 restrictions, which likely increased viral transmission.
Among the different age groups, norovirus GII was the most prevalent pathogen in children aged 3-5 and over 5 years, while AdV was most common in children aged 0-2 years. RVA ranked third in prevalence across all age groups.
The Impact of the COVID-19 Pandemic
The COVID-19 pandemic and the resulting social restrictions significantly impacted viral circulation. The study observed a stark difference in viral positivity between 2021 (31.1%) and 2022 (57.0%). The stringent measures in 2021 likely limited the spread of enteric viruses, while the relaxation of these measures in 2022 facilitated increased transmission.
This trend was particularly evident among school-age children, who experienced a significant increase in viral infections once restrictions were lifted. The study suggests that the different social interactions of various age groups during the pandemic influenced these outcomes.
Viral Load Analysis
Quantitative analysis using droplet digital PCR (ddPCR) revealed that AdV exhibited the highest average concentration in fecal samples, followed by norovirus GII and RVA. This data is crucial for understanding the severity and transmission potential of these infections.
Viral Characterization and Phylogenetic Analysis
The study also included phylogenetic analysis of the identified viruses. For instance, adenovirus strains were characterized as HuAdV serotype 41 and HuAdVB serotype 3, among others. Norovirus sequencing confirmed the detection of genogroups GII.3 and GII.2, with GII.3 being the most frequent. Rotavirus strains included G1P[8] and G3P[8], common genotypes known for causing AGE in children.
The emerging viruses, such as astrovirus and parechovirus, were also sequenced, revealing strains consistent with those previously detected in the region. This highlights the persistent circulation of these pathogens and their potential role in causing gastroenteritis.
Discussion: The Need for Comprehensive Surveillance
The study underscores the complexity of viral gastroenteritis in children and the necessity for comprehensive viral surveillance. The identification of both well-known and emerging pathogens highlights the dynamic nature of enteric virus epidemiology.
Given the high prevalence of viral infections and the frequent misuse of antibiotics in treating gastroenteritis, the researchers advocate for the routine implementation of viral screening protocols in hospitals. This approach would help reduce unnecessary antibiotic use, align with European programs aiming to curb drug resistance, and improve patient care.
Conclusion: Looking Ahead
This study provides valuable insights into the diverse array of viruses causing gastroenteritis in children during and after the COVID-19 pandemic. The findings emphasize the importance of continued surveillance and research to understand the epidemiology of these viruses better and to develop effective prevention and treatment strategies.
As we move forward, it is crucial to recognize the impact of social and public health measures on viral transmission. The lessons learned from the COVID-19 pandemic can inform future strategies to control the spread of enteric viruses and protect the health of vulnerable populations, particularly children.
The study findings were published in the peer reviewed Journal of Medical Virology.
https://onlinelibrary.wiley.com/doi/10.1002/jmv.29679
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