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. 2021 Aug 16;73(4):e913-e920.
doi: 10.1093/cid/ciab033.

Norovirus and Other Viral Causes of Medically Attended Acute Gastroenteritis Across the Age Spectrum: Results from the Medically Attended Acute Gastroenteritis Study in the United States

Rachel M Burke  1 , Claire P Mattison  1   2 , Zachary Marsh  1   2 , Kayoko Shioda  1   2 , Judy Donald  3 , S Bianca Salas  3 , Allison L Naleway  3 , Christianne Biggs  4 , Mark A Schmidt  3 , Aron J Hall  1
Affiliations

Norovirus and Other Viral Causes of Medically Attended Acute Gastroenteritis Across the Age Spectrum: Results from the Medically Attended Acute Gastroenteritis Study in the United States

Rachel M Burke et al. Clin Infect Dis. .

Abstract

Background: Acute gastroenteritis (AGE) causes a substantial burden in the United States, but its etiology frequently remains undetermined. Active surveillance within an integrated healthcare delivery system was used to estimate the prevalence and incidence of medically attended norovirus, rotavirus, sapovirus, and astrovirus.

Methods: Active surveillance was conducted among all enrolled members of Kaiser Permanente Northwest during July 2014-June 2016. An age-stratified, representative sample of AGE-associated medical encounters were recruited to provide a stool specimen to be tested for norovirus, rotavirus, sapovirus, and astrovirus. Medically attended AGE (MAAGE) encounters for a patient occurring within 30 days were grouped into 1 episode, and all-cause MAAGE incidence was calculated. Pathogen- and healthcare setting-specific incidence estimates were calculated using age-stratified bootstrapping.

Results: The overall incidence of MAAGE was 40.6 episodes per 1000 person-years (PY), with most episodes requiring no more than outpatient care. Norovirus was the most frequently detected pathogen, with an incidence of 5.5 medically attended episodes per 1000 PY. Incidence of norovirus MAAGE was highest among children aged < 5 years (20.4 episodes per 1000 PY), followed by adults aged ≥ 65 years (4.5 episodes per 1000 PY). Other study pathogens showed similar patterns by age, but lower overall incidence (sapovirus: 2.4 per 1000 PY; astrovirus: 1.3 per 1000 PY; rotavirus: 0.5 per 1000 PY).

Conclusions: Viral enteropathogens, particularly norovirus, are important contributors to MAAGE, especially among children < 5 years of age. The present findings underline the importance of judicious antibiotics use for pediatric AGE and suggest that an effective norovirus vaccine could substantially reduce MAAGE.

Keywords: acute gastroenteritis; disease burden; healthcare burden; population-based surveillance; viral gastroenteritis.

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Figures

Figure 1:
Figure 1:
Incidence of medically attended acute gastroenteritis by age group and healthcare setting, Kaiser Permanente Northwest, July 2014–June 2016. Remote healthcare setting is defined as a phone, email, or video encounter.
Figure 2:
Figure 2:
Prevalence of viruses among 2,633 patients with medically attended acute gastroenteritis by month of encounter, Kaiser Permanente Northwest, July 2014–June 2016. *Rotavirus positivity defined by both RT-PCR and EIA positivity.
Figure 3:
Figure 3:
Incidence of medically attended acute gastroenteritis by virus and healthcare setting, Kaiser Permanente Northwest, July 2014–June 2016. *Rotavirus positivity defined by both RT-PCR and EIA positivity.
Figure 4:
Figure 4:
Incidence of medically attended acute gastroenteritis by virus and age group, Kaiser Permanente Northwest, July 2014–June 2016. *Rotavirus positivity defined by both RT-PCR and EIA positivity.
See this image and copyright information in PMC

References

    1. Gastanaduy PA, Hall AJ, Curns AT, Parashar UD, Lopman BA. Burden of norovirus gastroenteritis in the ambulatory setting--United States, 2001–2009. J Infect Dis 2013; 207(7): 1058–65. - PubMed
    1. Lopman BA, Hall AJ, Curns AT, Parashar UD. Increasing rates of gastroenteritis hospital discharges in US adults and the contribution of norovirus, 1996–2007. Clin Infect Dis 2011; 52(4): 466–74. - PubMed
    1. Burke RM, Mattison C, Pindyck T, et al. The Burden of Norovirus in the United States, as Estimated Based on Administrative Data: Updates for Medically Attended Illness and Mortality, 2001 – 2015. Clin Infect Dis 2020. - PMC - PubMed
    1. Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States--major pathogens. Emerg Infect Dis 2011; 17(1): 7–15. - PMC - PubMed
    1. Scallan E, Griffin PM, Angulo FJ, Tauxe RV, Hoekstra RM. Foodborne illness acquired in the United States--unspecified agents. Emerg Infect Dis 2011; 17(1): 16–22. - PMC - PubMed

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