Healthcare-associated viral gastroenteritis among children in a large pediatric hospital, United Kingdom

Abstract

Viruses are the major pathogens of community-acquired (CA) acute gastroenteritis (AGE) in children, but their role in healthcare-associated (HA) AGE is poorly understood. Children with AGE hospitalized at Alder Hey Children's Hospital, Liverpool, UK, were enrolled over a 2-year period. AGE was classified as HA if diarrhea developed > or =48 hours after admission. Rotavirus, norovirus, adenovirus 40/41, astrovirus, and sapovirus were detected by PCR. A total of 225 children with HA-AGE and 351 with CA-AGE were enrolled in the study. HA viral gastroenteritis constituted one fifth of the diarrheal diseases among hospitalized children and commonly occurred in critical care areas. We detected > or =1 virus in 120 (53%) of HA-AGE cases; rotavirus (31%), norovirus (16%), and adenovirus 40/41 (15%) were the predominant viruses identified. Molecular evidence indicated rotaviruses and noroviruses were frequently introduced into the hospital from the community. Rotavirus vaccines could substantially reduce the incidence of HA-AGE in children.

Figure 1

Phylogenetic tree based on viral protein (VP) 7 nucleotide sequences of serotype G1 rotavirus strains from Royal Liverpool Children’s National Health Service Foundation Trust (Alder Hey Hospital), Liverpool, UK. For each strain the source (healthcare-associated [HA] or community-acquired [CA]), specimen number, month/year of detection, and name of the strain is indicated. Reference G1P[8] strain Wa is included. Horizontal lengths are proportional to the genetic distance calculated with Kimura’s 2-parameter method. Scale bar shows genetic distance expressed as nucleotide substitutions per site. Bootstrap probabilities >80% (>800 of 1,000 pseudoreplicate trials) are indicated at each node. Hatched VP7 sequences are from strains whose electropherotypes shared an identical L1 pattern. The VP7 nucleotide sequences used in the tree have been deposited under the strain name and accession number (in parentheses) as follows; 06AH001 (FJ797814), 06AH005 (FJ797815), 06AH033 (FJ797816), 06AH037 (FJ797817), 06AH041 (FJ797818), 06AH043 (FJ797819), 06AH047 (FJ797820), 06AH077 (FJ797821), 06AH083 (FJ797822), 06AH099 (FJ797823), 06AH143 (FJ797824), 06AH161 (FJ797825), 06AH167 (FJ797826), 06AH175 (FJ797827), 06AH218 (FJ797828), 07AH441 (FJ797829), 07AH451 (797830), 07AH466 (FJ797831), 07AH467 (FJ797832), 07AH468 (FJ797833) , 07AH490 (FJ797834), 07AH491 (FJ797835), 07AH500 (FJ797836), 07AH506 (FJ797837), 07AH508 (FJ797838), 07AH517 (FJ797839).

Figure 2

Phylogenetic tree based on 387 nucleotide sequences of the 5′ end of open reading frame 2 (encoding viral protein 1) of norovirus strains from Royal Liverpool Children’s National Health Service Foundation Trust (Alder Hey Hospital), Liverpool, UK. For each strain the source (healthcare-associated [HA] or community-acquired [CA]), specimen number, month/year of detection, and the name of the strain is indicated. Reference strains included on the tree are GII/1 U07611 Hawaii/71/US, GII/2 X81879 Melksham/89/UK, GII/3 U22498 Mexico/89/MX, GII/4 X86557 Lordsdale/93/UK, GII/5 AJ277607 Hillingdon/90/UK, GII/6AB039776 SaitamaU3/97/JP, GII/7 AJ277608 Leeds/90/UK, GII/8 AB067543 SaitamaU25/98/JP, GII/9 AY054299 IdahoFalls/378/96/US, GII/10 AY237415 Mc37/99/Thai, GII/11 AB112221 SaitamaT29GII/01/JP, GII/12 AB039775 SaitamaU1/97/JP, GII/13 AY130761 M7/99/US, GII/14 AB078334 Kashiwa47/00/JP, GII/15 AB058582 SaitamaKu80aGII/99/JP, GII/16 AB112260 SaitamaT53GII/02/JP, GII/17 AF195847 Alphatron/98/NE, GI/1 M87661 Norwalk/68/US, AJ313030 Queen’sArms/Leeds/92/UK, AJ277615 Sindlesham/95/UK. Horizontal lengths are proportional to the genetic distance calculated with the Kimura 2-parameter method. Scale bar shows genetic distance expressed as nucleotide substitutions per site. Bootstrap probabilities >80% (>800 of 1,000 pseudoreplicate trials) are indicated at each node. The nucleotide sequences used in the tree have been deposited under the strain name and accession number (in parentheses) as follows; 06AH107 (FJ797840), 06AH109 (FJ797841), 06AH187 (FJ797842), 06AH194 (FJ797843), 06AH225 (FJ797844), 06AH387 (FJ797845), 06AH395 (FJ797846), 06AH397 (FJ797847), 06AH040 (FJ797848), 06AH402 (FJ797849), 06AH406 (FJ797850), 06AH408 (FJ797851), 06AH410 (FJ797852), 07AH448 (FJ797853), 06AH050 (FJ797854), 07AH509 (FJ797855), 07AH517 (FJ797856) 07AH525 (FJ797857), 07AH551 (FJ797858), 07AH570 (FJ797859), 07AH571 (FJ797860), 07AH579 (FJ797861), 07AH590 (FJ797862), 07AH602 (FJ797863), 07AH604 (FJ797864), 07AH611 (FJ797865), 07AH612 (FJ797866), 07AH616 (FJ797867), 07AH619 (FJ797868), 07AH623 (FJ797869), 07AH633 (FJ797870), 07AH642 (FJ797871), 07AH643 (FJ797872), 07AH651 (FJ797873), 07AH653 (FJ797874), 07AH654 (FJ797875), 06AH097 (FJ797876).

Figure 3

Distribution of case-patients with A) community-acquired versus B) healthcare-associated acute gastroenteritis (AGE) in whom a virus was detected, by ward category and virus detected, Alder Hey Hospital, Liverpool, UK, 2006–2007. Rates were calculated as numbers of cases per 1,000 admissions to each ward throughout the study and are shown for each virus tested, with a comparison of all cases where at least 1 virus was detected (diamonds).