title: Potential causative agents of acute gastroenteritis in households with preschool children: prevalence, risk factors, clinical relevance and household transmission.
abstract: Acute gastroenteritis (AGE) morbidity remains high amongst preschool children, posing a significant societal burden. Empirical data on AGE-causing agents is needed to gauge their clinical relevance and identify agent-specific targets for control. We assessed the prevalence, risk factors and association with symptoms for enteropathogens in households with preschool children. A monthly-repeated cross-sectional survey of enteropathogens in households with preschool children was performed. A parent-child pair per household (n = 907 households) provided faecal samples and reported their symptoms and potential risk exposures. Samples were tested by multiplex reverse transcription polymerase chain reaction (RT-PCR) for 19 enteropathogens. Associations were assessed using logistic regression. 28.3 % of children (n = 981) and 15.6 % of parents (n = 971) carried pathogenic bacteria and/or Escherichia coli-associated pathogenicity genes, and 6.5 % and 3.3 % carried viruses, respectively. Giardia lamblia (4.6 % of children, 2.5 % of parents) and Dientamoeba fragilis (36 %, 39 %, respectively) were the main parasites, and were associated with pet exposure. Living in rural areas was associated with carriage of pathogenic E. coli, norovirus I and D. fragilis. Pathogenic E. coli was associated with summertime and livestock exposure. Attending day-care centres increased the risk of carrying norovirus, sapovirus and G. lamblia. Viruses occurred mainly in winter and were associated with AGE symptoms. Child-parent associations were found for bacterial pathogenicity genes, viruses, G. lamblia and D. fragilis. Enteropathogens spread widely in households with preschool children, particularly viruses, which more often cause symptoms. While bacteria predominate during summer and in those exposed to livestock, viruses predominate in wintertime and, like G. lamblia, are widespread amongst day-care centre attendees.
authors.affiliation: Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Heusinkveld
authors.affiliation: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands. lapo.mughini.gras@rivm.nl.|Department of Infectious Diseases and Immunology, Utrecht University, Utrecht, The Netherlands. lapo.mughini.gras@rivm.nl.
authors.forename: L
authors.initials: L
authors.lastname: Mughini-Gras
authors.affiliation: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Pijnacker
authors.affiliation: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Vennema
authors.affiliation: Certe Laboratory for Infectious Diseases, Groningen, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Scholts
authors.affiliation: Certe Laboratory for Infectious Diseases, Groningen, The Netherlands.
authors.forename: K W
authors.initials: KW
authors.lastname: van Huisstede-Vlaanderen
authors.affiliation: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Kortbeek
authors.affiliation: Certe Laboratory for Infectious Diseases, Groningen, The Netherlands.|Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Kooistra-Smid
authors.affiliation: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: van Pelt
mesh_terms: D000328:Adult; D000818:Animals; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D018562:Disease Transmission, Infectious; D005191:Family Characteristics; D005192:Family Health; D005243:Feces / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D007223:Infant; D008297:Male; D060885:Multiplex Polymerase Chain Reaction; D010271:Parasites / Q000145:classification / Q000302:isolation & purification*; D015995:Prevalence; D012307:Risk Factors; D012621:Seasons; D011795:Surveys and Questionnaires; D014780:Viruses / Q000145:classification / Q000302:isolation & purification*