Burden of viral gastroenteritis in children living in rural China: Population-based surveillance

Abstract

Background: Despite the considerable disease burden caused by the disease, rotavirus vaccine has not been introduced into routine national immunization schedule, and norovirus vaccines are being developed without a comprehensive understanding of gastroenteritis epidemiology. To bridge this knowledge gap, we investigated the disease burden of viral gastroenteritis in rural China. Methods: Between October 2011 and December 2013, population-based surveillance was conducted in Zhengding and Sanjiang counties in China. Stool samples were collected from children <5 years of age with diarrhea. All specimens were tested for rotaviruses, noroviruses, sapoviruses, enteric adenoviruses, and astroviruses. Results: The most common pathogen causing diarrhea was rotavirus (54.7 vs 45.6 cases/1,000 children/ year in Zhengding and Sanjiang, respectively), followed by norovirus (28.4 vs 19.3 cases/1,000 children/ year in Zhengding and Sanjiang, respectively). The highest incidence of these viruses was observed in children 6-18 months of age. Among the 5 viral pathogens, rotaviruses caused the most severe illness, followed by noroviruses. Conclusion: Rotavirus and norovirus are the 2 most important viral pathogens causing childhood diarrhea in both northern and southern China; they should be the major targets for viral gastroenteritis prevention strategies among children in China.

The epidemiology of norovirus gastroenteritis in China: disease burden and distribution of genotypes

“…Further evidence comes from abovementioned independent systems. An incidence of 4.7-11.7 per 100 per year in children aged 6-11 months and 4.0-6.6 per 100 per year in children 12-17 months were determined from a population-based surveillance conducted in Zhengding County, Hebei Province and Sanjiang County, Guangxi Zhuang Autonomous Region between 2011 and 2013 [18]. These findings suggest that considerable disease burden is caused by NoV in China.…”

“…A typical age distribution of rotavirus AGE in children < 5 years was also concluded from a population-based NoV AGE surveillance. The incidence was 4.7-11.7 cases, 4.0-6.6 cases, 2.5-2.9 cases, 1.3-1.9 cases and < 1.0 cases per 100 children per year in children aged 6-11 months, 12-17 months, 18-23 months, 24-29 months and ≥ 30 months, respectively [18]. Moreover, the severity of illness caused by NoVs is similar to that induced by rotavirus infection [18].…”

“…Population-based surveillance in children < 5-year conducted in Zhengding and Sanjiang County between 2011 and 2013 found a similar genotype distribution. In Zhengding, the predominant genotype were GII.3 (32.5%) and GII.4 (30.0%), followed by GII.2 (7.5%) and GII.6 (2.5%); in Sanjiang, majority infection were caused by GII.6 (39.3%) and GII.4 (37.7%), followed by GII.7 (4.9%) and GII.17 (3.3%) ( Table 1) [18].…”

Burden and etiology of moderate and severe diarrhea in children less than 5 years of age living in north and south of China: Prospective, population-based surveillance

“…As described elsewhere, in Sanjiang County, 3,613 children were monitored between January 1 and December 31, 2013. In Zhengding County, 6,443 children were followed from October 1, 2011 to March 31, 2012 [ 5 ]. Children who presented to a participating health care facility (including village clinics, township hospitals and county hospitals) with acute diarrhea and whose parents or guardians provided informed consent were enrolled.…”

“…The occurrence of rotavirus, noroviruses, sapoviruses, astroviruses, and enteric adenoviruses were analyzed. However, only a low percent (~ 25%) of diarrhea cases contained one of abovementioned 4 viruses during the 1-year surveillance period using PCR methods [ 5 ]. Even if the focus was on the epidemic season, no viral agents were detected in half of diarrhea episodes.…”