Prevalence of rotavirus, adenovirus, norovirus, and astrovirus infections and coinfections among hospitalized children in northern France

Abstract

From January to December 2007, 973 stool specimens were prospectively collected from children hospitalized for gastroenteritis signs or from neonates and premature cases who were born in two French hospital settings in the north of France. They were tested by rapid enzyme immunoassay (EIA) analyses for rotavirus and adenovirus and by two commercially available ELISA tests for the detection of norovirus and astrovirus. The overall rates of prevalence for rotavirus, norovirus, adenovirus, and astrovirus were 21, 13, 5, and 1.8%, respectively, and they did not significantly differ between the two hospital settings (P=0.12). Mixed virus infections were detected in 32 (3.3%) of the 973 study children and were associated with norovirus in 21 (66%) infants, including 5 premature cases. From fall to spring, norovirus infections accounted for 52% of documented gastroenteritidis viral infections at a time when rotavirus was epidemic, resulting in mixed norovirus and rotavirus gastrointestinal tract infections. Of the 367 documented viral gastroenteritis cases, 15 (4.1%) were identified as nosocomial infections, 5 of which occurred in premature cases. These findings highlight the need to implement norovirus and astrovirus ELISA detection assays in association with rapid EIA rotavirus and adenovirus detection assays for the clinical diagnosis and the nosocomial prevention of gastroenteritis viral infections in pediatric departments.

FIG. 1.

Distribution (A) or seasonality (B) of rotavirus-, norovirus-, astrovirus-, and adenovirus-positive antigenic detection by EIA or ELISA among 973 stool samples of hospitalized children in northern france. (A) Distribution (%) of the total numbers of single (n = 335) and mixed (n = 32) viral intestinal infections among 973 stool samples of hospitalized children in northern France. Using the combination of rapid EIAs and ELISAs, we identified 34% (335/973) of single infections and 3.2% (32/973) of multiple infections, resulting in 37.2% of positive viral detection in stools of infants with gastroenteritis signs during a 1-year prospective study. Only one stool sample was tested for each patient. Noro, norovirus; Rota, rotavirus; Adeno, adenovirus; Astro, astrovirus). (B) Monthly distribution of the numbers of rotavirus, adenovirus, astrovirus, norovirus, and multiple infections among the tested children. The total number (n) of tested children per month is indicated at the bottom of the graph.

FIG. 2.

Distribution of the number of children positive for enteric virus detection in stool samples from the following age groups: the number of norovirus-positive cases in children of ages 0 to 24 months appeared to be significantly higher than that observed in children of ages 25 to 28 months (*, P = 0.022); no other significant variation of frequency was observed for the other viral parameters between the age groups.