A total of 305 faecal specimens collected from children under the age of 5 who presented with symptoms of acute gastroenteritis either as inpatients at Addenbrooke's Hospital (N = 100) or to General Practitioners in East Anglia (N = 205) during 1999-2001 were tested for the presence of rotavirus, norovirus, sapovirus, enteric adenoviruses (Group F, serotypes 40 and 41), and astrovirus. An aetiologic agent was found in 184 specimens (60.3%). The most commonly found single viral pathogen was rotavirus (27.9%), followed by norovirus (13.4%), enteric adenoviruses (7.9%), astrovirus (2.3%), and sapovirus (1%). Mixed infections were observed in 27 specimens (8.9%), and no aetiologic agent was found in over a third of the specimens tested. These data demonstrate that the diagnostic gap can be reduced considerably through the use of molecular amplification and detection techniques. However, additional work is required to reduce this deficit further by optimising sampling algorithms and by identifying other agents associated with viral gastroenteritis.

The aim of this study was to investigate the burden of disease associated with gastroenteric viruses (rotavirus, norovirus, sapovirus, astrovirus and enteric adenovirus) using structured surveillance of children aged <6 years in the community. Faecal samples were collected between 2000 and 2003 from 685 children with symptoms of gastroenteritis. The children comprised three groups; 223 in the structured surveillance cohort, 203 in a community cohort and 259 in a cohort of hospitalized children. All samples were tested for the presence of viral pathogens using molecular methods. Questionnaires were sent to the parents/carers of the children recruited to the structured surveillance cohort in order to collect data that would allow an estimation of the severity of illness by means of the Vesikari score, and of the cost associated with gastrointestinal disease in this age group. A viral aetiological agent was detected in 53.5% of samples tested. Rotavirus was the most common pathogen found in all three cohorts followed by norovirus and enteric adenoviruses. Multiple viruses were found in 8% of the samples, and commonly involved rotavirus and any other virus. G1P[8] was the most commonly detected rotavirus strain and there was no significant difference in the distribution of rotavirus genotypes among the three cohorts. Analysis of the questionnaires indicated that rotavirus infections were likely to be more severe than any other virus infection, and children from whom a viral pathogen was identified were more likely to require rehydration therapy.

A 4-yr-old boy with acute lymphoblastic leukaemia in remission developed an encephalopathy following an attenuated measles infection. He was treated with interferon and further deterioration was halted. Three weeks after interferon treatment was stopped, leukaemic blast cells reappeared in his peripheral blood and he died shortly thereafter. Aspects of diagnosis and treatment of this syndrome are discussed now that the presumptive clinical diagnosis is made more frequently.

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