Burden of viral pathogens causing acute gastroenteritis in children less than 2 years of age in a U.S. birth cohort

Jennifer Cannon, CDC Foundation

Jennifer L Cannon-CDC Foundation, Atlanta, Georgia, USA; Julia M Baker- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Claire P Mattison- Cherokee Nation Operational Solutions, Tulsa, Oklahoma, USA; Hannah Browne- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Kenny Nguyen- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Rachel M Burke- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Slavica Mijatovic-Rustempasic- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Mary C Casey-Moore- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Rashi Gautam- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Eddie Bartlett- Cherokee Nation Operational Solutions, Tulsa, Oklahoma, USA; Shane Embury- CDC Foundation, Atlanta, Georgia, USA; Allison Burrell- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Shannon Conrey- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA and Case Western Reserve University, Department of Population and Quantitative Health Sciences, Cleveland, Ohio, USA; Umesh D Parashar- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Daniel C Payne- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Mary Allen Staat- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA and Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA; Ardythe L Morrow- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Jan Vinjé- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Epidemology

Norovirus and sapovirus are leading causes of acute gastroenteritis (AGE) in children globally. However, the community-level burden and diversity of viral pathogens causing infection and AGE in young U.S. children is understudied due to the lack of longitudinal monitoring. From birth until age 2 years, weekly child stools and symptom surveys were collected by mothers enrolled in the PREVAIL cohort (Cincinnati, Ohio, U.S.A., 2017-2020). Stool specimens were tested for five enteric viral pathogens (norovirus GI/GII, sapovirus, astrovirus, wild-type rotavirus, and adenovirus 40/41), and infections were defined by grouping proximal viral detections with the same genotype. A total of 245 children were followed, with 13,944 stools tested and 836 episodes of AGE recorded. Nearly all children had ≥ 1 enteric virus infection with an incidence of 3.8 enteric viral infections per child-year by age 2. Over two-thirds of children had ≥ 1 symptomatic enteric viral infection by age 2. Norovirus GII (0.4 infections per child-year) and sapovirus (0.2 infections per child-year) were the highest incidence pathogens of viral AGE, with medical attention sought for 37% and 28% of symptomatic infections, respectively. However, 58% of all norovirus GII and 67% of all sapovirus infections were asymptomatic, particularly before six months of age. Our findings show the high burden of symptomatic norovirus GII and sapovirus infections, as well as a high frequency of asymptomatic infections in young U.S. children, improving our understanding of the epidemiology of enteric viral infections and providing critical information for a future pediatric norovirus vaccine.