title: High detection rates of enteropathogens in asymptomatic children attending day care.
abstract: BACKGROUND
  Gastroenteritis morbidity is high among children under the age of four, especially amongst those who attend day care.
  
  
  OBJECTIVE
  To determine the prevalence of a range of enteropathogens in the intestinal flora of children attending day care and to relate their occurrence with characteristics of the sampled child and the sampling season.
  
  
  METHODS
  We performed three years of enteropathogen surveillance in a network of 29 child day care centers in the Netherlands. The centers were instructed to take one fecal sample from ten randomly chosen children each month, regardless of gastrointestinal symptoms at time of sampling. All samples were analyzed for the molecular detection of 16 enteropathogenic bacteria, parasites and viruses by real-time multiplex PCR.
  
  
  RESULTS
  Enteropathogens were detected in 78.0% of the 5197 fecal samples. Of the total, 95.4% of samples were obtained from children who had no gastroenteritis symptoms at time of sampling. Bacterial enteropathogens were detected most often (most prevalent EPEC, 19.9%), followed by parasitic enteropathogens (most prevalent: D. fragilis, 22.1%) and viral enteropathogens (most prevalent: norovirus, 9.5%). 4.6% of samples related to children that experienced symptoms of gastroenteritis at time of sampling. Only rotavirus and norovirus were significantly associated with gastroenteritis among day care attendees.
  
  
  CONCLUSIONS
  Our study indicates that asymptomatic infections with enteropathogens in day care attendees are not a rare event and that gastroenteritis caused by infections with these enteropathogens is only one expression of their presence.
authors.affiliation: Center for Infectious Disease Control (Epidemiology and Surveillance Unit), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands ; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Remko
authors.initials: R
authors.lastname: Enserink
authors.affiliation: Laboratory for Infectious Diseases, Department of Research and Development, Groningen, The Netherlands.
authors.forename: Rianne
authors.initials: R
authors.lastname: Scholts
authors.affiliation: Center for Infectious Disease Control (Epidemiology and Surveillance Unit), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands ; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Patricia
authors.initials: P
authors.lastname: Bruijning-Verhagen
authors.affiliation: Center for Infectious Disease Control (Laboratory for Infectious Diseases and Perinatal Screening), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Erwin
authors.initials: E
authors.lastname: Duizer
authors.affiliation: Center for Infectious Disease Control (Laboratory for Infectious Diseases and Perinatal Screening), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Harry
authors.initials: H
authors.lastname: Vennema
authors.affiliation: Laboratory for Infectious Diseases, Department of Research and Development, Groningen, The Netherlands.
authors.forename: Richard
authors.initials: R
authors.lastname: de Boer
authors.affiliation: Center for Infectious Disease Control (Laboratory for Infectious Diseases and Perinatal Screening), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Titia
authors.initials: T
authors.lastname: Kortbeek
authors.affiliation: Center for Infectious Disease Control (Laboratory for Infectious Diseases and Perinatal Screening), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Roelfsema
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Henriette
authors.initials: H
authors.lastname: Smit
authors.affiliation: Laboratory for Infectious Diseases, Department of Research and Development, Groningen, The Netherlands ; Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Kooistra-Smid
authors.affiliation: Center for Infectious Disease Control (Epidemiology and Surveillance Unit), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Wilfrid
authors.initials: W
authors.lastname: van Pelt
mesh_terms: D000818:Animals; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D002656:Child Day Care Centers; D002675:Child, Preschool; D004755:Enterobacteriaceae / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010271:Parasites / Q000302:isolation & purification; D010272:Parasitic Diseases / Q000453:epidemiology* / Q000382:microbiology; D015995:Prevalence; D012401:Rotavirus / Q000302:isolation & purification; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000382:microbiology