title: Acute diarrhea in adults consulting a general practitioner in France during winter: incidence, clinical characteristics, management and risk factors.
abstract: BACKGROUND
  Data describing the epidemiology and management of viral acute diarrhea (AD) in adults are scant. The objective of this study was to identify the incidence, clinical characteristics, management and risk factors of winter viral AD in adults.
  
  
  METHODS
  The incidence of AD in adults during two consecutive winters (from December 2010 to April 2011 and from December 2011 to April 2012) was estimated from the French Sentinelles network. During these two winters, a subset of Sentinelles general practitioners (GPs) identified and included adult patients who presented with AD and who filled out a questionnaire and returned a stool specimen for virological examination. All stool specimens were tested for astrovirus, group A rotavirus, human enteric adenovirus, and norovirus of genogroup I and genogroup II. Age- and sex-matched controls were included to permit a case-control analysis with the aim of identifying risk factors for viral AD.
  
  
  RESULTS
  During the studied winters, the average incidence of AD in adults was estimated to be 3,158 per 100,000 French adults (95% CI [2,321 - 3,997]). The most reported clinical signs were abdominal pain (91.1%), watery diarrhea (88.5%), and nausea (83.3%). GPs prescribed a treatment in 95% of the patients with AD, and 80% of the working patients with AD could not go to work. Stool examinations were positive for at least one enteric virus in 65% (95% CI [57 - 73]) of patients with AD with a predominance of noroviruses (49%). Having been in contact with a person who has suffered from AD in the last 7 days, whether within or outside the household, and having a job (or being a student) were risk factors significantly associated with acquiring viral AD.
  
  
  CONCLUSIONS
  During the winter, AD of viral origin is a frequent disease in adults, and noroviruses are most often the cause. No preventable risk factor was identified other than contact with a person with AD. Thus, at the present time, reinforcement of education related to hand hygiene remains the only way to reduce the burden of disease.
authors.forename: Christophe
authors.initials: C
authors.lastname: Arena
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Amoros
authors.forename: Véronique
authors.initials: V
authors.lastname: Vaillant
authors.forename: Katia
authors.initials: K
authors.lastname: Ambert-Balay
authors.forename: Roxane
authors.initials: R
authors.lastname: Chikhi-Brachet
authors.forename: Nathalie
authors.initials: N
authors.lastname: Jourdan-Da Silva
authors.forename: Laurent
authors.initials: L
authors.lastname: Varesi
authors.forename: Jean
authors.initials: J
authors.lastname: Arrighi
authors.forename: Cécile
authors.initials: C
authors.lastname: Souty
authors.forename: Thierry
authors.initials: T
authors.lastname: Blanchon
authors.forename: Alessandra
authors.initials: A
authors.lastname: Falchi
authors.forename: Thomas
authors.initials: T
authors.lastname: Hanslik
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D017250:Caliciviridae Infections / Q000453:epidemiology*; D003967:Diarrhea / Q000453:epidemiology* / Q000821:virology; D005260:Female; D005602:France / Q000453:epidemiology; D005759:Gastroenteritis / Q000453:epidemiology* / Q000821:virology; D058005:General Practitioners; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012621:Seasons; D055815:Young Adult