Etiology of acute diarrhea in children in Shanghai, 2015-2018

Abstract

Background Diarrhea is still a major cause of childhood morbidity and mortality worldwide. This hospital-based study aimed to monitor the consecutive epidemiological trend of etiology in children with acute diarrhea in Shanghai.Methods Outpatient children with diarrhea were prospectively enrolled within 7 days after onset of diarrheal symptoms during 2015-2018. Fresh stool samples were collected for testing enteropathogens. Enteric bacteria were identified and typed through culture and serotyping. Enteric viruses were identified through real-time PCR assay. hadResults Enteric pathogens were identified in 1572 (58.4%) of the 2692 enrolled children with acute diarrhea. Viruses were more frequently detected than bacteria (41.3% versus 25.0%), and co-infection with 2 or more pathogens was found in 13% of outpatients. Nontyphoidal Salmonella spp . (NTS) was the most common bacteria with 10.3% of isolate rate, followed by enteropathogenic Escherichia coli (EPEC) (6.5%), enteroaggregative Escherichia coli (EAEC) (6.2%), Campylobacter spp . (3.6%), enterotoxigenic Escherichia coli (ETEC) (1.1%), Shigella spp . (0.2%), and enterohemorrhagic Escherichia coli (EHEC) (0.1%). Rotavirus was the most common virus with 16.0% of detection rate, followed by norovirus (15.5%), adenovirus (7.2%), sapovirus (3.0%) and astrovirus (2.7%).Conclusions Infectious diarrhea remains the major cause of diarrhea in children in Shanghai. Rotavirus, norovirus and NTS were the major enteric pathogens responsible for diarrhea in Shanghainese children. Improving uptake of rotavirus vaccine and strengthening prevention of foodborne pathogens will be helpful to reduce the burden of diarrheal diseases in children in Shanghai.