Clinical Profiles of Childhood Astrovirus-, Sapovirus-, and Norovirus-Associated Acute Gastroenteritis in Pediatric Emergency Departments in Alberta, 2014–2018

Abstract

Background Infections by previously under-diagnosed viruses astrovirus and sapovirus are poorly characterized compared to norovirus, the most common cause of acute gastroenteritis. Methods Children <18-years-old with acute gastroenteritis were recruited from pediatric emergency departments in Alberta, Canada, 2014-2018. We described and compared the clinical course of acute gastroenteritis in children with astrovirus, sapovirus, and norovirus. Results Astrovirus was detected in 56/2,688 children (2.1%), sapovirus in 146/2,688 (5.4%), and norovirus in 486/2,688 (18.1%). At illness onset, ~60% of astrovirus cases experienced each of diarrhea and vomiting. Among sapovirus and norovirus cases, 35% experienced diarrhea at onset and 80%/91% (sapovirus/norovirus) vomited; however, diarrhea became more prevalent than vomiting around day 4 of illness. Over the full course of illness, diarrhea was 18% (95% CI 8%, 29%) more prevalent among children with astrovirus than norovirus infections, as well as longer with greater maximal events; there were median 4.0 fewer maximal vomiting events (95% CI 2.0, 5.0). Vomiting continued median 24.8 hours longer (95% CI 9.6, 31.7) among children with sapovirus vs. norovirus. Differences between these viruses were otherwise minimal. Conclusion Sapovirus infections attended in the emergency department are more similar to norovirus than previously reported, while astrovirus infections have several distinguishable characteristics.

Detection and characterization of human astrovirus and sapovirus in outpatients with acute gastroenteritis in Guangzhou, China

“…Fever and vomiting were reported in 30% and 35% of HAstV infections and in 8.3% and 16.6% of SaV infections, respectively. In contrast to the study that reported greater diarrhea and fever prevalence, longer duration and greater intensity of diarrhea in HAstV infection compared to that in norovirus infections, our data did not show any significant difference in diarrhea frequency, fever prevalence between single HAstV infection and other virus infections [ 30 ]. Some reports suggest that coinfection may lead to more severe diarrhea [ 31 , 32 ].…”

“…Some reports suggest that coinfection may lead to more severe diarrhea [ 31 , 32 ]. However, we could not find any significant difference in the specific clinical severity of AGE between single HAstV/SaV infections and mixed HAstV/SaV infections, which is in accordance with the reports from India and other countries [ 30 , 33 , 34 ]. In one case of Campylobacter, Salmonella , rotavirus, and SaV coinfection, no fever or vomiting was observed; in addition, the test for the presence of white/red blood cell test in the stool was negative, with low degree of gastroenteritis symptoms.…”

Diversity of human astroviruses in Germany 2018 and 2019

“…The detection rate of 1.4% was lower than in the long-term study in Germany, which was conducted from 2010 to 2015 (2–12.1% per year) and slightly lower than in Canada (2.1%) was found in pediatric patients (2014–2018), similar to the detection rate of 2.6% in pediatric patients in Thailand (2017–2020) [ 7 , 17 , 18 ].…”

Sapovirus Infections in an Australian Community-Based Healthy Birth Cohort During the First 2 Years of Life

“…This variation may be due to differences in how symptomatic cases were identified, as vomiting as a sole symptom was not always adopted as a diagnostic criterion for AGE episodes. It seems that young children with sapovirus and norovirus are more likely to have a symptom profile of a vomiting-only illness than those infected with other enteric viruses [ 8 , 27 , 37 , 38 ]. This is supported by our results where we found that 52% of symptomatic sapovirus episodes were associated with vomiting as a sole symptom.…”