The evolving epidemiology of acute gastroenteritis in hospitalized children in Italy

Abstract

Few data are available on the prevalence and features of acute gastroenteritis (AGE) in hospitalized children in Italy, where specific rotavirus vaccines were introduced into the national vaccination plan in 2017. To evaluate vaccination effects on AGE epidemiology, we analysed data from children aged ≤ 18 years admitted for AGE at the University Hospital of Pisa in 2019, comparing them with those recorded in 2012. Demographical, clinical, diagnostic, and treatment data were collected reviewing medical records and were therefore compared. In 2019 and 2012, 86 (median age 2.5 years [IQR 1.4–5.9]) and 85 children (median age 2.3 years [IQR 1.3–5.1]) were respectively admitted with AGE. The most common symptoms were diarrhoea and vomiting; decreased skin turgor was more frequent in 2019 (54% and 34% respectively, p = 0.01). Viral infections were more common than bacterial ones; in 2019, a decrease in rotavirus infections (67% and 22%, p = 0.003) and an increase in adenovirus infections (50% and 10%, p = 0.002) and in the number of patients with negative stool testing (58% and 39%, p = 0.04) were found.Conclusions: Viral infections are the leading cause of AGE in hospitalized children in Italy. The introduction of rotavirus vaccines did not reduce the number of hospitalizations per year. Adenovirus and other non-routinely screened viruses may be undergoing a selection process making them common causative agents for AGE. What is Known:• Rotavirus is the leading cause of acute severe gastroenteritis in children worldwide, especially < 5 years of age.• The introduction of specific vaccines may be changing its epidemiology.• Few data are available on acute gastroenteritis in hospitalized children in Italy. What is New:• Viral infections are the leading cause of acute gastroenteritis in hospitalized children in Italy.• Specific vaccines are reducing rotavirus infections, but adenovirus and other non-routinely screened viruses may be undergoing a selection process making them common causative agents for gastroenteritis.

Global epidemiology of campylobacteriosis and the impact of COVID-19

“…examined the evolving epidemiology on acute gastroenteritis in hospitalised children in Italy. Among the 74 stool samples from 2019 subjected for examination of aetiological agents, 8.1% (6/74) was positive for C. jejuni , similar to that from 2012 (12.5%, 8/64) ( Stanyevic et al., 2021 ). Other less prevalent enteric bacterial pathogens reported in 2019 included non-Typhi Salmonella (4/74), Yersinia enterocolitica (1/74) and E. coli (1/74).…”

“…Other less prevalent enteric bacterial pathogens reported in 2019 included non-Typhi Salmonella (4/74), Yersinia enterocolitica (1/74) and E. coli (1/74). Adenovirus (9/74), rotavirus (4/74), and norovirus (4/74) were the leading enteric viral pathogens causing paediatric gastroenteritis ( Stanyevic et al., 2021 ). A similar detection rate of Campylobacter was reported by another study performed between 2018 and 2020 in which among stool samples from 2,066 children with severe acute gastroenteritis, 9.21% were positive for Campylobacter , whereas enteropathogenic E. coli (EPEC) (19.14%), Clostridioides difficile (14.42%), norovirus (10.36%) and enterovirus (9.44%) were detected more frequently ( De Conto et al., 2022 ).…”

Acute Infectious Gastroenteritis: The Causative Agents, Omics-Based Detection of Antigens and Novel Biomarkers

“…Rotavirus is the most common agent causing AGE in children worldwide [ 10 , 11 , 12 , 13 , 14 , 15 ]. It has been suggested to be one of the most pathogenic causative agents in AGE which correlates with infectious diarrhoea, vomiting, and higher frequency of fever [ 13 , 16 , 17 , 18 ].…”

“…Rotavirus is the most common agent causing AGE in children worldwide [ 10 , 11 , 12 , 13 , 14 , 15 ]. It has been suggested to be one of the most pathogenic causative agents in AGE which correlates with infectious diarrhoea, vomiting, and higher frequency of fever [ 13 , 16 , 17 , 18 ]. It was mostly reported among children aged 0–14 years old, with the highest incidence among children less than 5 years [ 14 , 15 , 16 , 19 , 20 , 21 ].…”

“…As the most common inflicted pathogen causing AGE in children, several biomarkers have been developed and available commercially for the detection of rotavirus. The widely available biomarker platform utilized is the enzyme immunoassay (EIA) to screen for the rotavirus antigen [ 10 , 11 , 13 , 15 , 19 , 22 , 26 , 92 , 93 , 94 ]. Amongst EIA kit used were Premier Rotaclone, Meridian Bioscience Inc., Cincinnati, OH, USA [ 10 , 11 , 12 , 19 , 93 , 94 ], RIDASCREEN Rotavirus R Biopharm AG, Darmstadt, Germany [ 15 , 93 ], and ProSpect Rotavirus Test, Oxoid Ltd., UK [ 22 , 93 ].…”