Etiology of acute gastroenteritis in hospitalized children in Melbourne, Australia, from April 1980 to March 1993

Abstract

Acute infectious diarrhea is common in children. Control requires knowledge of causes. Few comprehensive long-term studies of etiology have been undertaken in developed countries. This report is of a 13-year survey of 4,637 children from 0 to 14 years of age, admitted to a large children's hospital for treatment of gastroenteritis, in which viruses, bacteria, and parasites were sought. A recognized enteric pathogen was identified in 56.6% of children. Group A rotaviruses occurred in 39.6% of children overall and in 55% of children 12 to 23 months of age. They were a frequent cause (18.7%) of acute gastroenteritis in children under 6 months and in those aged 5 to 13 years (16%). Rotaviruses were almost entirely responsible for winter admission peaks. Enteric adenovirus types 40 and 41 (6% overall) were more frequent in children under 12 months (9.4%). Salmonella spp. (5.8%) and Campylobacter jejuni (3.4%) were more common in children over 5 years (13.1% and 6.7%, respectively). The 43.5% of cases (60% in children under 6 months) where no enteric pathogen was identified are cause for concern. The involvement of small viruses (including caliciviruses and astroviruses) may be clarified when molecular biology techniques are utilized to address this gap in our knowledge. This comprehensive 13-year study of the cause of acute infectious diarrhea in children in developed countries reinforces the importance of rotavirus and highlights a large group for whom the etiology remains unknown, an issue of particular concern with babies under 6 months of age. New techniques have the potential to identify old and new pathogens causing disease in these vulnerable infants.

FIG. 1

Admissions to hospital for treatment of acute gastroenteritis (1981 to 1992). The number of children with rotavirus diarrhea is shown.

FIG. 2

Cumulative monthly admissions of children with acute gastroenteritis during April 1980 to March 1993. Results of testing for rotavirus are shown. The seasonal swing is largely determined by rotavirus. neg, negative; pos, positive.

FIG. 3

Etiology of gastroenteritis in 3,785 hospitalized children in relation to age. Rota, rotavirus; Ent Ad, enteric adenovirus serotypes 40 and 41; Salm, Salmonella spp.; Campylo, C. jejuni; Other, other pathogens and mixtures.

FIG. 4

Monthly rotavirus isolations over the 13-year study period. Seasonal fluctuations are shown. Note the unusual summer pattern in 1983 to 1984.

FIG. 5

Monthly isolations of Salmonella spp. (top) and C. jejuni (bottom) over the 13-year study period. No seasonal pattern is apparent.