title: Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE): epidemiology, emerging organisms, and economics.
abstract: BACKGROUND
  Each year in Canada there are 5 million episodes of acute gastroenteritis (AGE) with up to 70% attributed to an unidentified pathogen. Moreover, 90% of individuals with AGE do not seek care when ill, thus, burden of disease estimates are limited by under-diagnosing and under-reporting. Further, little is known about the pathogens causing AGE as the majority of episodes are attributed to an "unidentified" etiology. Our team has two main objectives: 1) to improve health through enhanced enteric pathogen identification; 2) to develop economic models incorporating pathogen burden and societal preferences to inform enteric vaccine decision making.
  
  
  METHODS
  This project involves multiple stages: 1) Molecular microbiology experts will participate in a modified Delphi process designed to define criteria to aid in interpreting positive molecular enteric pathogen test results. 2) Clinical data and specimens will be collected from children aged 0-18 years, with vomiting and/or diarrhea who seek medical care in emergency departments, primary care clinics and from those who contact a provincial medical advice line but who do not seek care. Samples to be collected will include stool, rectal swabs (N = 2), and an oral swab. Specimens will be tested employing 1) stool culture; 2) in-house multiplex (N = 5) viral polymerase chain reaction (PCR) panel; and 3) multi-target (N = 15) PCR commercially available array. All participants will have follow-up data collected 14 days later to enable calculation of a Modified Vesikari Scale score and a Burden of Disease Index. Specimens will also be collected from asymptomatic children during their well child vaccination visits to a provincial public health clinic. Following the completion of the initial phases, discrete choice experiments will be conducted to enable a better understanding of societal preferences for diagnostic testing and vaccine policy. All of the results obtained will be integrated into economic models.
  
  
  CONCLUSIONS
  This study is collecting novel samples (e.g., oral swabs) from previously untested groups of children (e.g., those not seeking medical care) which are then undergoing extensive molecular testing to shed a new perspective on the epidemiology of AGE. The knowledge gained will provide the broadest understanding of the epidemiology of vomiting and diarrhea of children to date.
authors.affiliation: Department of Pediatrics, Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada. stephen.freedman@albertahealthservices.ca.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Freedman
authors.affiliation: Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada. bonita.lee@albertahealthservices.ca.
authors.forename: Bonita E
authors.initials: BE
authors.lastname: Lee
authors.affiliation: Provincial Laboratory for Public Health (ProvLab, Alberta Health Services), Departments of Microbiology, Immunology & Infectious Disease and Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada. marie.louie@albertahealthservices.ca.
authors.forename: Marie
authors.initials: M
authors.lastname: Louie
authors.affiliation: Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB, Canada. xiao-li.pang@albertahealthservices.ca.
authors.forename: Xiao-Li
authors.initials: XL
authors.lastname: Pang
authors.affiliation: Department of Pediatrics & Emergency Medicine, University of Alberta, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, Stollery Children's Hospital, Edmonton, AB, Canada. sali@ualberta.ca.
authors.forename: Samina
authors.initials: S
authors.lastname: Ali
authors.affiliation: Institute of Health Economics, Edmonton, AB, Canada. achuck@ihe.ca.
authors.forename: Andy
authors.initials: A
authors.lastname: Chuck
authors.affiliation: University of Alberta, Edmonton, AB, Canada. linda.chui@albertahealthservices.ca.
authors.forename: Linda
authors.initials: L
authors.lastname: Chui
authors.affiliation: Department of Pediatrics, Alberta Children's Hospital Research Institute, O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada. currie@ucalgary.ca.|Department of Community Health Sciences, Alberta Children's Hospital Research Institute, O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada. currie@ucalgary.ca.
authors.forename: Gillian R
authors.initials: GR
authors.lastname: Currie
authors.affiliation: Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada. dickinsj@ucalgary.ca.
authors.forename: James
authors.initials: J
authors.lastname: Dickinson
authors.affiliation: Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB, Canada. steven.drews@albertahealthservices.ca.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Drews
authors.affiliation: Department of Pediatrics, Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada. mohamed.eltorki@albertahealthservices.ca.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Eltorki
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada. tim.graham@albertahealthservices.ca.
authors.forename: Tim
authors.initials: T
authors.lastname: Graham
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, USA. jason.jiang@cchmc.org.
authors.forename: Xi
authors.initials: X
authors.lastname: Jiang
authors.affiliation: Departments of Pediatrics and Physiology and Pharmacology, Section of Pediatric Emergency Medicine, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada. david.johnson@albertahealthservices.ca.
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.affiliation: Department of Pediatrics, Section of Infectious Diseases, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada. jim.kellner@albertahealthservices.ca.
authors.forename: James
authors.initials: J
authors.lastname: Kellner
authors.affiliation: Alberta Health, University of Alberta, Edmonton, AB, Canada. martin.lavoie@gov.ab.ca.
authors.forename: Martin
authors.initials: M
authors.lastname: Lavoie
authors.affiliation: Alberta Health Services, Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. judy.macdonald@albertahealthservices.ca.
authors.forename: Judy
authors.initials: J
authors.lastname: MacDonald
authors.affiliation: Department of Pediatrics, University of Calgary, Edmonton, AB, Canada. smacdon@ualberta.ca.|Faculty of Nursing, University of Alberta, Edmonton, AB, Canada. smacdon@ualberta.ca.
authors.forename: Shannon
authors.initials: S
authors.lastname: MacDonald
authors.affiliation: Alberta Health Services, University of Calgary, Calgary, AB, Canada. larry.svenson@gov.ab.ca.
authors.forename: Lawrence W
authors.initials: LW
authors.lastname: Svenson
authors.affiliation: Alberta Health, University of Alberta, Edmonton, AB, Canada. james.talbot@gov.ab.ca.
authors.forename: James
authors.initials: J
authors.lastname: Talbot
authors.affiliation: Division of Gastroenterology, Washington University, St. Louis, MO, USA. tarr@kids.wustl.edu.
authors.forename: Phillip
authors.initials: P
authors.lastname: Tarr
authors.affiliation: Department of Microbiology, Immunology and Infectious Disease, University of Calgary, Calgary, AB, Canada. Raymond.tellier@albertahealthservices.ca.
authors.forename: Raymond
authors.initials: R
authors.lastname: Tellier
authors.affiliation: Department of Pediatrics, Section of Infectious Diseases, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada. o.vanderkooi@ucalgary.ca.|Department of Pathology and Laboratory Medicine, Section of Microbiology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada. o.vanderkooi@ucalgary.ca.|Department of Microbiology, Immunology & Infectious Diseases, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada. o.vanderkooi@ucalgary.ca.
authors.forename: Otto G
authors.initials: OG
authors.lastname: Vanderkooi
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000416:Alberta / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003967:Diarrhea / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005759:Gastroenteritis / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008828:Microbiological Techniques; D018803:Models, Economic; D012720:Severity of Illness Index; D013048:Specimen Handling; D014839:Vomiting / Q000382:microbiology