Risk Factors and Clinical Profile of Sapovirus-associated Acute Gastroenteritis in Early Childhood

Abstract

Background: Sapovirus is increasingly recognized as an important cause of acute gastroenteritis (AGE) in children. We identified risk factors and characterized the clinical profile of sapovirus AGE in a birth cohort in León, Nicaragua. Methods: We conducted a case-control study nested within a birth cohort (n = 444). Fieldworkers conducted weekly household AGE surveillance. AGE stools were tested for sapovirus by reverse transcriptase quantitative polymerase chain reaction. For each first sapovirus episode, we selected 2 healthy age-matched controls and estimated independent risk factors of sapovirus AGE using conditional logistic regression. We compared clinical characteristics of sapovirus AGE episodes with episodes associated with other etiologies and identified co-infections with other enteric pathogens. Results: From June 2017 to July 2019, we identified 63 first sapovirus AGE episodes and selected 126 controls. Having contact with an individual with AGE symptoms and vaginal delivery were independent risk factors for sapovirus AGE. All cases experienced diarrhea, lasting a median 6 days; 23% experienced vomiting. Compared with children with AGE due to another etiology, sapovirus AGE was similar in severity, with less reported fever. Most cases experienced co-infections and were more likely than controls to be infected with diarrheagenic Escherichia coli or astrovirus. Conclusions: Sapovirus was a commonly identified AGE etiology in this Central American setting, and symptoms were similar to AGE associated with other etiologies. The association between vaginal delivery and sapovirus is a novel finding. Gut microbiome composition might mediate this relationship, or vaginal delivery might be a proxy for other risk factors. Further investigation into more specific biological mechanisms is warranted.

Seroepidemiology of SARS-CoV-2 infections in an urban Nicaraguan population

“…The Sapovirus-Associated Gastro-Enteritis (SAGE) study is a population-based birth cohort study in León, Nicaragua, described previously. 4 This cohort provided a platform to access a sample of all ages to understand the seroprevalence of SARS-CoV-2 in a Latin American context, and to examine differences in participant characteristics by evidence of prior infection. The study population included high-income families in the city center and low-income families in peri-urban neighborhoods, creating a scientifically-informative gradient to evaluate socioeconomic and environmental risk factors for SARS-CoV-2 infection.…”

Serological Humoral Immunity Following Natural Infection of Children with High Burden Gastrointestinal Viruses

“…These data suggest that first sapovirus infections provide immunity against homologous infections, but little protection against infections of different genogroups, and possibly different genotypes. Further, the low incidence of symptomatic sapovirus episodes in the first months of life in epidemiological studies supports early protection from maternal immunity [210,239].…”

“…Sharing clinical characteristics with closely-related noroviruses, common symptoms of sapovirus gastroenteritis include vomiting and diarrhea [210]. Farkas, et al reported the seroprevalence of sapovirus (Mex340 strain) in children between 20 and 24 months of age involved in a birth cohort was greater than 90%, showing the high incidence of infections in early childhood [211].…”

“…Sharing clinical disease characteristics with closely-related noroviruses, common symptoms of sapovirus gastroenteritis include vomiting and diarrhea, which typically resolve within one week [210]. A MAL-ED study of enteric infections in children in LMICs, found sapovirus to have the third highest attributable incidence for diarrhea of all enteric pathogens among children under 12 months of age, and the second highest attributable incidence among children between 12 and 24 months of age [1].…”

Seroepidemiology of SARS-CoV-2 infections in an urban population-based cohort in León, Nicaragua

“…The Sapovirus-Associated Gastro-Enteritis (SAGE) study is a population-based birth cohort study in León, Nicaragua, described previously. 11 This cohort provided a platform to access a sample of all ages from public health facility records, capturing a large and representative sample of this large urban area to understand the seroprevalence of SARS-CoV-2 in a Nicaraguan context, and to examine differences in participant characteristics by evidence of prior infection. The study population included high-income families in the city center and low-income families in peri-urban neighborhoods, creating a scientificallyinformative gradient to evaluate socioeconomic and environmental risk factors for SARS-CoV-2 infection.…”