Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE): epidemiology, emerging organisms, and economics

Abstract

BackgroundEach year in Canada there are 5 million episodes of acute gastroenteritis (AGE) with up to 70 % attributed to an unidentified pathogen. Moreover, 90 % of individuals with AGE do not seek care when ill, thus, burden of disease estimates are limited by under-diagnosing and under-reporting. Further, little is known about the pathogens causing AGE as the majority of episodes are attributed to an “unidentified” etiology. Our team has two main objectives: 1) to improve health through enhanced enteric pathogen identification; 2) to develop economic models incorporating pathogen burden and societal preferences to inform enteric vaccine decision making.Methods/DesignThis project involves multiple stages: 1) Molecular microbiology experts will participate in a modified Delphi process designed to define criteria to aid in interpreting positive molecular enteric pathogen test results. 2) Clinical data and specimens will be collected from children aged 0–18 years, with vomiting and/or diarrhea who seek medical care in emergency departments, primary care clinics and from those who contact a provincial medical advice line but who do not seek care. Samples to be collected will include stool, rectal swabs (N = 2), and an oral swab. Specimens will be tested employing 1) stool culture; 2) in-house multiplex (N = 5) viral polymerase chain reaction (PCR) panel; and 3) multi-target (N = 15) PCR commercially available array. All participants will have follow-up data collected 14 days later to enable calculation of a Modified Vesikari Scale score and a Burden of Disease Index. Specimens will also be collected from asymptomatic children during their well child vaccination visits to a provincial public health clinic. Following the completion of the initial phases, discrete choice experiments will be conducted to enable a better understanding of societal preferences for diagnostic testing and vaccine policy. All of the results obtained will be integrated into economic models.DiscussionThis study is collecting novel samples (e.g., oral swabs) from previously untested groups of children (e.g., those not seeking medical care) which are then undergoing extensive molecular testing to shed a new perspective on the epidemiology of AGE. The knowledge gained will provide the broadest understanding of the epidemiology of vomiting and diarrhea of children to date.

Multiplex tests to identify gastrointestinal bacteria, viruses and parasites in people with suspected infectious gastroenteritis: a systematic review and economic analysis

“…The remaining five records were included for full-text screening. 27,[53][54][55][56] A further four articles were excluded at the full-text stage as these studies did not contain a full economic evaluation (see Appendix 9).…”

Enteropathogen detection in children with diarrhoea, or vomiting, or both, comparing rectal flocked swabs with stool specimens: an outpatient cohort study

“…Three cohorts of participants were consecutively recruited by the Alberta Provincial Pediatric Enteric Infection Team: 11 (1) children with vomiting or diarrhoea in Pediatric Emergency Research Canada (PERC) emergency departments in Calgary and Edmonton (AB, Canada), and children in these departments with non-infectious illness whose caregivers agreed to submit specimens if they later developed vomiting or diarrhoea; (2) children receiving routine vaccinations at a Calgary public health clinic whose caregivers agreed to submit specimens if vomiting or diarrhoea developed later; and (3) symptomatic children identified via a province-wide nursing triage telephone resource called HealthLinkwho met triage criteria for the provision of care at home instead of seeking medical care. 12 Consent in this cohort was provided by telephone.…”

“…If a stool specimen was not provided before discharge from the emergency department, caregivers collected stool at home. For asymptomatic children 11 in the emergency departments or vaccination clinics who developed vomiting or diarrhoea later, specimen collection kits were provided for the collection of stool and rectal swab samples when symptoms developed. For symptomatic children assessed via Health Link, care-givers collected samples using specimen collection kits consisting of two rectal swabs, a stool container, and instructions that were couriered to their homes.…”

“…11 The electronic surveys were emailed daily (up to three times) until completed. If follow-up was not completed after three emails, we did a telephone follow-up.…”

Comparative Evaluation of Enteric Bacterial Culture and a Molecular Multiplex Syndromic Panel in Children with Acute Gastroenteritis

“…Population. This prospective cohort study was conducted as part of the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE) project (16). Eligible children were enrolled through the Alberta Children's Hospital (Calgary, AB, Canada) and Stollery Children's Hospital (Edmonton, AB, Canada) emergency departments (EDs) and a provincial nursing triage telephone advice line (Health Link) (17).…”