[Epidemiology and burden of rotavirus diarrhea in day care centers in Lyon, France]

Antidiarrheal and antioxidant activities of Ajuga iva (L.) leave extract

We studied the effect of Ajuga iva leaves extract (AIE) on the intestinal absorption, motricity and its antioxidant capacity against diarrhea. Wistar rats were divided and received either: castor oil (CO), CO and loperamide or CO and different doses of AIE. AIE prevented dose-dependently CO-induced diarrhea. AIE at 800 mg/kg showed inhibition efficiency on defecation and diarrhea. The pro-oxidant effect of the CO in the small intestine was inhibited significantly in presence of AIE: increasing glutathione peroxidase (GPx) activity and lowering oxygen free radicals (OH°, O2°-), carbonyl protein and malondialdehyde (MDA) levels. However, co-administration of AIE in castor oil-exposed groups significantly increased the intestinal contents of calcium and magnesium. AIE exhibits significant anti-diarrheal activity, related in part to its antioxidant properties. Our investigation also provides experimental evidence for the traditional use of this medicinal plant in the treatment of diarrhea.

Transmission of acute gastroenteritis and respiratory illness from children to parents

BACKGROUND

Acute respiratory illness (ARI) and acute gastroenteritis (AGE) are the most common infections in children; the risk of such illness increases with daycare attendance. We estimated the risk of transmission of ARI and AGE from daycare attendees to their parents and describe measures used by families to prevent that transmission.

METHODS

We performed a retrospective cohort study of parents and children 12-60 months of age attending childcare centers attended by ≥60 children in the greater Québec City area, Canada. Participants were contacted at home by phone to answer a standardized questionnaire on infections that occurred in children and parents during the winter period.

RESULTS

Overall, 374 households and 608 participants were included. AGE and ARI occurred at an incidence of 8.7 and 19 episodes per 100 child-months, respectively. Transmission to parents occurred about once in every 3 episodes for both types of infections. AGE in parents caused more frequent work absenteeism than ARI (62% vs. 34%, P < 0.005) with slightly longer duration (23% vs. 15% missing ≥2 days). Hand hygiene with soap was the primary household preventive measure. The 2009 pandemic may have positively influenced home hand hygiene practices overall but alcohol-based disinfection was infrequently applied.

CONCLUSIONS

Parental risk and impact of AGE and ARI acquisition from their children are substantial. ARI occur more frequently overall among children, but parental work loss appears greater with AGE transmission. Our findings suggest that preventive practices to reduce the risk of secondary ARI and AGE transmission to parents warrants greater emphasis, evaluation and education.

[Day-care centers: Sites of viral contact]

La répétition des épisodes infectieux chez les nourrissons placés précocement en collectivités est une évidence. Leur tropisme sur la sphère respiratoire et l’appareil digestif l’est également. Leur probable retentissement au long cours est difficile à évaluer par la rareté des études prospectives. Le risque infectieux est lié en partie au type de structure de garde, ce risque est important dans les premiers mois de fréquentation et conditionne les récidives ultérieures. Les liens de causalité entre infection virale et asthme sont complexes. Les infections virales augmentent le risque d’asthme mais le statut asthmatique augmente aussi le risque de réponses sévères à une infection virale. Alors que les infections acquises dans cet environnement sont majoritairement virales, leur répétition conduit à une utilisation excessive des antibiotiques d’où une pression de sélection microbienne et un retentissement sur le microbiome digestif voire respiratoire.

Surveillance for rotavirus gastroenteritis in children less than 5 years of age in Togo

BACKGROUND

Rotavirus is the most common cause of severe gastroenteritis and dehydration in young children in both industrialized and developing countries. The anticipated introduction of rotavirus vaccine into Togo's national immunization program highlights the need for baseline data on the burden of this disease.

METHODS

We conducted sentinel surveillance for rotavirus gastroenteritis among children <5 years of age in Sylvanus Olympio Teaching Hospital of Lome (Togo) from February 2008 through January 2012, based on the World Health Organization's generic protocol. Rotavirus was detected in stool specimens by enzyme linked immunosorbent assay. The strain characterization by genotyping was performed at Noguchi Memorial Institute for Medical Research in Accra (Ghana) and at Medunsa campus in Pretoria (South Africa).

RESULTS

803 children with acute gastroenteritis were enrolled and of which 390 (48%) were positive for rotavirus. The difference of age among children with rotavirus and nonrotavirus gastroenteritis was significant (P < 0.010) with rotavirus cases younger than nonrotavirus cases. From December to February, significantly (P < 0.002) more cases of rotavirus gastroenteritis were enrolled compared with other months of the year. Vomiting (P = 0.04) was more common in children with rotavirus than nonrotavirus gastroenteritis. The most common G-P combinations were G3P[6] (23%), G1P[8] (12%), G1P[6/8] (8%), G2P[6] (7%), G12P[6] (7%) and G3/12P[6] (6%).

CONCLUSIONS

The prevalence of rotavirus is high among children with acute gastroenteritis in Togo. Continued and extended rotavirus surveillance will be important to monitor changes in the epidemiology of rotavirus disease and the impact of vaccination after introduction.

Infectious disease burden related to child day care in the Netherlands

BACKGROUND

Studying day-care-associated infectious disease dynamics aids in formulating evidence-based guidelines for disease control, thereby supporting day-care centers in their continuous efforts to provide their child population with a safe and hygienic environment. The objective of this study was to estimate the (excess) infectious disease burden related to child day-care attendance in the Netherlands.

METHODS

A Dutch surveillance network of child day-care centers (DCCs) prospectively reported on infectious disease episodes and related use of health care among their child population on a daily basis from March 2010 to March 2012.

RESULTS

Gastroenteritis (387 per 1000 child-years) and influenza-like illness (247 per 1000 child-years) were the most frequently reported infectious diseases. DCCs reported these infectious diseases to occur twice as often among children aged 0-2 years compared with children aged 2-4 years. Antibiotic treatment was required in 6%, a general practitioner visit in 29% and hospitalization in 2% of infectious disease episodes. DCC incidences of gastroenteritis and influenza-like illness requiring children to visit a general practitioner were approximately twice as high as general population estimates for this age group. Part of the DCCs indicated to not always wash the hands of children before eating (34%) or after a toilet visit (15%) or to not always clean the toilet and kitchen areas (17%) on a daily basis.

CONCLUSION

The infectious disease risk associated with child day-care attendance is substantial, particularly among the very young attendees, in excess of general population estimates for this age group and potentially partly preventable.

Burden of community-acquired and nosocomial rotavirus gastroenteritis in the pediatric population of Western Europe: a scoping review

BACKGROUND

Rotavirus affects 95% of children worldwide by age 5 years and is the leading cause of severe dehydrating diarrhea. The objective of this review was to estimate the burden of rotavirus gastroenteritis (RVGE) in the Western European pediatric population.

METHODS

A comprehensive literature search (1999-2010) was conducted in PubMed and other sources (CDC; WHO, others). Data on the epidemiology and burden of RVGE among children < 5 years-old in Western Europe --including hospital-acquired disease--were extracted.

RESULTS

76 studies from 16 countries were identified. The mean percentage of acute gastroenteritis (AGE) cases caused by rotavirus ranged from 25.3%-63.5% in children < 5 years of age, peaking during winter. Incidence rates of RVGE ranged from 1.33-4.96 cases/100 person- years. Hospitalization rates for RVGE ranged from 7% to 81% among infected children, depending on the country. Nosocomial RVGE accounted for 47%-69% of all hospital-acquired AGE and prolonged hospital stays by 4-12 days. Each year, RVGE incurred $0.54- $53.6 million in direct medical costs and $1.7-$22.4 million in indirect costs in the 16 countries studied. Full serotyping data was available for 8 countries. G1P[8], G2P[4], G9P[8], and G3P[8] were the most prevalent serotypes (cumulative frequency: 57.2%- 98.7%). Serotype distribution in nosocomial RVGE was similar.

CONCLUSIONS

This review confirms that RVGE is a common disease associated with significant morbidity and costs across Western Europe. A vaccine protecting against multiple serotypes may decrease the epidemiological and cost burden of RVGE in Western Europe.

Molecular and clinical characterization of rotavirus from diarrheal infants admitted to pediatric emergency units in france

BACKGROUND

rotaviruses are the major cause of acute gastroenteritis in young children worldwide, and require careful surveillance, especially in the context of vaccination programs. Prospective surveillance is required to monitor and characterize rotavirus infections, including viral and clinical data, and to detect the emergence of potentially epidemic strains.

METHODS

between 2006 and 2009, stool samples and clinical records were collected from 2044 children with acute diarrhea admitted to the pediatric emergency units of 13 French university hospitals. Rotaviruses were detected in stools, then genotyped by reverse transcription-polymerase chain reaction with regard to their outer capsid proteins VP4 and VP7.

RESULTS

the genotyping of 1947 rotaviruses showed that G1 (61.7%) and G9 (27.4%) strains were predominant and stable, followed by G2 (6.5%), G3 (4.0%), and G4 (2.5%) strains. Most strains were associated with P[8] (92.9%). Overall, 31 uncommon strains and possible zoonotic reassortants were detected including G12 and G8 strains, some being closely related to bovine strains. No difference in clinical presentation and severity was found among genotypes.

CONCLUSIONS

the relative stability of rotavirus genotypes currently cocirculating in France may ensure vaccine effectiveness in the short and medium term. However, the likely emergence of G12 and G8 strains should be monitored during ongoing and future vaccination programs, especially as all genotypes can cause severe infections. Special attention should be paid to the emergence of new rotavirus reassortants not included in current rotavirus vaccines.

Impact of community-acquired paediatric rotavirus gastroenteritis on family life: data from the REVEAL study

BACKGROUND

Rotavirus is the leading cause of acute gastroenteritis (AGE) and the most frequent cause of severe diarrhoea in children aged less than 5 years. Although the epidemiology of rotavirus gastroenteritis (RVGE) is well documented, there are few data on the impact of RVGE on the families of affected children.

METHODS

Data associated with the burden of RVGE, including number of working days lost, levels of parental stress, the need for alternative childcare arrangements and additional nappies used, were extracted from questionnaires completed by parents of children participating in a prospective, multicentre, observational study (Rotavirus gastroenteritis Epidemiology and Viral types in Europe Accounting for Losses in public health and society, REVEAL), conducted during 2004-2005 in selected areas of Belgium, France, Germany, Italy, Spain, Sweden, and the United Kingdom to estimate the incidence of RVGE in children aged less than 5 years seeking medical care as a result of AGE.

RESULTS

1102 children with RVGE were included in the present analysis. The proportion of RVGE cases that required at least one parent or other person to be absent from work was 39%-91% in the hospital setting, 44%-64% in the emergency department, and 20%-64% in primary care. Self-reported levels of parental stress were generally high (mean stress levels, > or = 5 on a 10-point visual analogue scale). Additional childcare arrangements were required in up to 21% of RVGE episodes. The mean number of nappies used per day during RVGE episodes was approximately double that used when the child was not ill.

CONCLUSIONS

Paediatric RVGE cases cause disruption to families and parental stress. The burden of RVGE on children and their families could be substantially reduced by routine rotavirus vaccination of infants.

[Sensitivity and specificity of the VIKIA Rota-Adeno immuno-chromatographic test (bioMérieux) and the ELISA IDEIA Rotavirus kit (Dako) compared to genotyping]

The performances of two diagnostic tests for rotavirus infection in stool samples were evaluated during a prospective study in children of less than 36 months in child-care centers of Lyon from November 2004 to May 2005. The VIKIA Rota-Adeno immuno-chromatographic test (bioMérieux) and the ELISA IDEIA Rotavirus kit (Dako) were compared with a referral method, the genotyping. Fifty-seven stool samples were collected and analyzed by RT-PCR. The virus genome was detected in 29 samples. The most frequent genotypic combinations were G9P[8] with a prevalence of 75.9%. Sensitivity and specificity of the VIKIA Rota-Adeno test and the ELISA IDEIA Rotavirus kit were strictly comparable and very good: 96.6% (83.0; 99.9) and 96.4% (81.6; 99.9), respectively. The immuno-chromatographic technique were in concordance with the ELISA tests in 93.6% of cases. Thus, the VIKIA Rota-Adeno test is a good alternative for the occasional analysis of stool samples in ambulatory practice.