Multiplex PCR Pathogen Detection in Acute Gastroenteritis Among Hospitalized US Children Compared With Healthy Controls During 2011-2016 in the Post-Rotavirus Vaccine Era

Christopher J Harrison; Ferdaus Hassan; Brian Lee; Julie Boom; Leila C Sahni; Coreen Johnson; James Dunn; Daniel C Payne; Mary E Wikswo; Umesh Parashar; Rangaraj Selvarangan

doi:10.1093/ofid/ofab592

Multiplex PCR Pathogen Detection in Acute Gastroenteritis Among Hospitalized US Children Compared With Healthy Controls During 2011-2016 in the Post-Rotavirus Vaccine Era

Open Forum Infect Dis. 2021 Nov 24;8(12):ofab592. doi: 10.1093/ofid/ofab592. eCollection 2021 Dec.

Authors

Affiliations

¹ Children's Mercy Kansas City and University of Missouri Kansas City-School of Medicine, Missouri, USA.
² Texas Children's Hospital, Houston, Texas, USA.
³ Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
⁴ Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City and University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA.

Abstract

Background: Despite vaccine-induced decreases in US rotavirus (RV) disease, acute gastroenteritis (AGE) remains relatively common. We evaluated AGE pathogen distribution in hospitalized US children in the post-RV vaccine era.

Methods: From December 2011 to June 2016, the New Vaccine Surveillance Network (NVSN) conducted prospective, active, population-based surveillance in hospitalized children with AGE. We tested stools from 2 NVSN sites (Kansas City, Houston) with Luminex x-TAG Gastrointestinal Pathogen Panels (Luminex GPP) and analyzed selected signs and symptoms.

Results: For 660 pediatric AGE inpatients and 624 age-matched healthy controls (HCs), overall organism detection was 51.2% and 20.6%, respectively (P < .001). Among AGE subjects, GPP polymerase chain reaction detected >1 virus in 39% and >1 bacterium in 14% of specimens. Detection frequencies for AGE subjects vs HCs were norovirus (NoV) 18.5% vs 6.6%, RV 16.1% vs 9.8%, adenovirus 7.7% vs 1.4%, Shigella 4.8% vs 1.0%, Salmonella 3.1% vs 0.1%, and Clostridioides difficile in ≥2-year-olds 4.4% vs 2.4%. More co-detections occurred among AGE patients (37/660, 5.6%) than HCs (14/624, 2.2%; P = .0024). Per logistic regression analysis, ill contacts increased risk for NoV, RV, and Shigella (P < .001). More vomiting episodes occurred with NoV and RV, and more diarrheal episodes with Shigella and Salmonella. Modified Vesikari scores were highest for Shigella and lowest for C. difficile.

Conclusions: NoV detection was most frequent; however, RV remained important in hospitalized AGE in the post-RV vaccine era. Continued active surveillance is important to document ongoing vaccine effects, pathogen emergence, and baseline disease burden for new vaccines.

Keywords: Vesikari; multiplex; norovirus; pediatric gastroenteritis; rotavirus.