Etiology of acute gastroenteritis in children requiring hospitalization in the Netherlands
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Infectious gastroenteritis causes a considerable burden of disease worldwide. Costs due to gastroenteritis are dominated by the hospitalized cases. Effective control of gastroenteritis should be targeted at the diseases with the highest burden and costs. For that, an accurate understanding of the relative importance of the different bacterial, viral, and parasitic pathogens is needed. The objective of the present study was to determine the incidence and etiology of gastroenteritis requiring hospital admission in the Netherlands. Six hospitals enrolled patients admitted with gastroenteritis for approximately one year over the period May 2008 to November 2009. Participants provided questionnaires and a fecal sample, and the hospital filled out a clinical questionnaire. In total, 143 children hospitalized for gastroenteritis and 64 matched controls were included in the study. Overall incidence of gastroenteritis requiring hospitalization was estimated at 2.92 per 1,000 children aged 0–17 years per year, with the highest incidence in children under the age of 5 years. The full diagnostic panel of pathogens could be studied in fecal samples of 96 cases. One or more pathogens were found in 98% of these cases. Co-infections were observed relatively often (40%). Viruses were detected in 82% of the samples, with rotavirus being most common (56%), bacteria in 32% and parasites in 10%. The present study emphasizes the importance of viral pathogens, especially rotavirus, in hospitalizations of children with gastroenteritis. Policies to reduce (costs of) hospitalizations due to gastroenteritis should therefore be first targeted at rotavirus.
The authors would like to thank the staff of the hospitals for inclusion of the patients in the present study. We thank Hein Sprong, Max Heck and Ed Kuijper for the subtyping of Cryptosporidium and G. lamblia, Salmonella, and C. difficile, respectively. We are grateful to Carolien de Jager for her assistance in the preparation and during the execution of the study. Finally the authors thank Wilfrid van Pelt for his help in calculating the incidence figures and for critically reading the manuscript.
Conflict of interest
The authors declare that they have no conflict of interest.
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