Multiplex PCR pathogen detection in acute gastroenteritis among hospitalized US children compared to healthy controls during 2011-2016 in the post rotavirus vaccine era

Abstract Background Despite vaccine-induced decreases in US rotavirus (RV) disease, acute gastroenteritis (AGE) remains relatively common. We evaluated AGE pathogen distribution in hospitalized US children in the post-RV-vaccine era. Methods From December 2011 to June 2016, the New Vaccine Surveillance Network (NVSN) conducted prospective, active, population-based surveillance in hospitalized children with AGE. We tested stools from two NVSN sites (Kansas City; Houston) with Luminex x-TAG Gastrointestinal Pathogen Panels (Luminex GPP) and analyzed selected signs and symptoms. Results For 660 pediatric AGE inpatients and 624 age-matched healthy controls (HC), overall organism detection was 51.2% and 20.6% respectively, p <0.001. Among AGE subjects, GPP PCR detected >1 virus in 39% and >1 bacteria in 14% of specimens. Detection frequencies for AGE subjects vs. HC were: norovirus (NoV) 18.5% vs 6.6%, rotavirus (RV) 16.1% vs 9.8%, adenovirus 7.7% vs 1.4%, Shigella 4.8% vs 1.0%, Salmonella 3.1% vs 0.1%, Clostridioides difficile in ≥2-year olds 4.4% vs 2.4%. More co-detections occurred among AGE (37/660, 5.6%) than HC (14/624, 2.2%), p=0.0024. Per logistic regression analysis, ill contacts increased risk for NoV, RV and Shigella, p<0.001. More vomiting episodes occurred with NoV and RV, and more diarrheal episodes with Shigella and Salmonella. Modified Vesikari scores were highest for Shigella and lowest for C. difficile. Conclusion NoV detection was most frequent, however RV remained important in hospitalized AGE in the post-RV-vaccine era. Continued active surveillance is important to document ongoing vaccine effects, pathogen emergence and baseline disease burden for new vaccines.

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Viral Etiology of Acute Gastroenteritis in <2-Year-Old US Children in the Post–Rotavirus Vaccine Era

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piy077 ◽

2018 ◽

Vol 8 (5) ◽

pp. 414-421 ◽

Cited By ~ 13

Author(s):

Ferdaus Hassan ◽

Neena Kanwar ◽

Christopher J Harrison ◽

Natasha B Halasa ◽

James D Chappell ◽

...

Keyword(s):

Acute Gastroenteritis ◽

Pediatric Population ◽

Adenovirus Type ◽

The United States ◽

Population Based ◽

Rotavirus Vaccine ◽

Viral Etiology ◽

Surveillance Network ◽

Detection Rates ◽

Us Children

Abstract Background The rotavirus disease burden has declined substantially since rotavirus vaccine was introduced in the United States in 2006. The aim of this study was to determine the viral etiology of acute gastroenteritis (AGE) in US children aged <2 years. Methods The New Vaccine Surveillance Network (NVSN) of geographically diverse US sites conducts active pediatric population-based surveillance in hospitals and emergency departments. Stool samples were collected from children aged <2 years with symptoms of AGE (n = 330) and age-matched healthy controls (HCs) (n = 272) between January and December 2012. Samples were tested by real-time reverse-transcriptase polymerase chain reaction assays {adenovirus (type 40 and 41), norovirus, parechovirus A, enterovirus, sapovirus, and astrovirus} and an enzyme immunoassay (rotavirus). All samples that tested positive were genotyped. Results Detection rates of pathogens in children with AGE versus those of HCs were, respectively, 23.0% versus 6.6% for norovirus (P < .01), 23.0% versus 16.0% for adenovirus (P = .08), 11.0% versus 16.0% for parechovirus A (P = .09), 11.0% versus 9.0% for enterovirus (P = .34), 7.0% versus 3.0% for sapovirus (P = .07), 3.0% versus 0.3% for astrovirus (P = .01), and 3.0% versus 0.4% for rotavirus (P = .01). A high prevalence of adenovirus was detected at 1 surveillance site (49.0% for children with AGE and 43.0% for HCs). Norovirus GII.4 New Orleans was the most frequently detected (33.0%) norovirus genotype. Codetection of >1 virus was more common in children with AGE (16.0%) than in HCs (10.0%) (P = .03). Conclusions Norovirus, astrovirus, sapovirus, and rotavirus were detected significantly more in children with AGE than in HCs, and norovirus was the leading AGE-causing pathogen in US children aged <2 years during the year 2012.

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Clostridioides difficile Infection in Children With Inflammatory Bowel Disease

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz285 ◽

2019 ◽

Vol 26 (11) ◽

pp. 1700-1706

Author(s):

Abin Chandrakumar ◽

Hussein Zohni ◽

Wael El-Matary

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Cox Regression ◽

Population Based ◽

Incidence Rates ◽

Categorical Variables ◽

Fisher Exact Test ◽

Clostridioides Difficile ◽

Increased Risk ◽

Inflammatory Bowel

Abstract Background The study’s objective was to investigate the incidence and risk factors associated with Clostridioides difficile (previously known as Clostridium) infection (CDI) in children with inflammatory bowel disease (IBD) in the province of Manitoba. Methods Our longitudinal population-based cohort was comprised of all children and young adults aged <17 years diagnosed with IBD in the Canadian province of Manitoba between 2011 and 2019. The diagnosis of CDI was confirmed based on the Triage C. difficile immunoassay and polymerase chain reaction assay to detect the presence of toxigenic C. difficile. The Fisher exact test was used to examine the relationship between categorical variables. A Cox regression model was used to estimate the risk of CDI development in IBD patients. Results Among 261 children with IBD, 20 (7.7%) developed CDI with an incidence rate of 5.04 cases per 1000 person-years, and the median age at diagnosis (interquartile range) was 12.96 (9.33–15.81) years. The incidence rates of CDI among UC and CD patients were 4.16 cases per 1000 person-years and 5.88 cases per 1000 person-years, respectively (P = 0.46). Compared with children without CDI, those who had CDI were at increased risk of future exposure to systemic corticosteroids (adjusted hazard ratio [aHR], 4.38; 95% confidence interval [CI], 1.46–13.10) and anti–tumor necrosis factor (anti-TNF) biologics (aHR, 3.31; 95% CI, 1.11–9.90). The recurrence rate of CDI in our pediatric IBD population was 25%. Conclusions Our findings confirm that children with IBD are at high risk of developing CDI, which may predict future escalation of IBD therapy.

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Evaluation of Connecticut medical providers’ concordance with 2017 IDSA/SHEA Clostridioides difficile treatment guidelines in New Haven County, 2018–2019

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1237 ◽

2020 ◽

pp. 1-8

Author(s):

Casey Morgan Luc ◽

Danyel Olson ◽

David B. Banach ◽

Paula Clogher ◽

James Hadler

Keyword(s):

Treatment Guidelines ◽

Severe Disease ◽

Recurrence Risk ◽

Population Based ◽

New Haven ◽

Emerging Infections ◽

Medical Providers ◽

First Line ◽

Clostridioides Difficile ◽

Increased Risk

Abstract Objectives: To assess Connecticut medical providers’ concordance (2018–2019) with the 2017 Clostridioides difficile infection (CDI) treatment update by the Infectious Disease Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). The effect of guideline concordance on CDI recurrence risk was also assessed. Design: Prospective, population-based study. Setting: New Haven County, Connecticut, from January 1, 2017, to December 31, 2019. Patients: CDI incident case (no positive tests in the prior 8 weeks), not limited by care setting. Methods: Using data from the Emerging Infections Program’s CDI surveillance, severity and concordance were defined. Presence of megacolon and/or ileus defined fulminant disease; absence defined nonsevere/severe disease. Using 2017 treatment as baseline, 2018–2019 concordance was defined as receiving the recommended first-line antibiotic (ie, vancomycin or fidaxomicin for adult patients, vancomycin or metronidazole for pediatric patients) for exactly 10 days. For all analyses, significance was P < .05. Results: Among 990 cases, concordance increased from 24.8% in 2018 to 37.0% in 2019. First-line antibiotic concordance increased from 61.2% in 2018 to 79.9% in 2019. Recurrence risk was significantly associated with patients aged ≥65 years and was highest for those aged 75–84 years, but this factor was not significantly associated with concordance. Conclusions: From 2018 through 2019, CDI treatment in New Haven County increasingly was concordant with the 2017 treatment update but remained low in 2019. Although concordance with treatment guidelines did not affect recurrence risk, close attention should be paid by medical providers to patients aged ≥65 years, specifically those aged 75–84 years because they are at an increased risk for recurrence.

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MRI CLINICAL RATINGS AND COGNITIVE FUNCTION IN A CROSS-SECTIONAL POPULATION STUDY OF DEMENTIA: THE CACHE COUNTY MEMORY STUDY

Journal of Prevention of Alzheimer's Disease ◽

10.14283/jpad.2019.1 ◽

2019 ◽

pp. 1-8

Author(s):

Y.H.W. Tsui-Caldwell ◽

T.J. Farrer ◽

Z. McDonnell ◽

Z. Christensen ◽

C. Finuf ◽

...

Keyword(s):

White Matter ◽

Rating Scale ◽

Population Sample ◽

Population Based ◽

White Matter Integrity ◽

Healthy Controls ◽

Cross Sectional ◽

Increased Risk ◽

Scale Scores ◽

Cache County

BACKGROUND: White matter integrity in aging populations is associated with increased risk of cognitive decline, dementia diagnosis, and mortality. Population-based data can elucidate this association. Objectives: To examine the association between white matter integrity, as measured by a clinical rating scale of hyperintensities, and mental status in older adults including advanced aging. Design: Scheltens Ratings Scale was used to qualitatively assess white matter (WM) hyperintensities in participants of the Cache County Memory Study (CCMS), an epidemiological study of Alzheimer’s disease in an exceptionally long-lived population. Further, the relation between Mini-Mental State Exam (MMSE) and WM hyperintensities were explored. Method: Participants consisted of 415 individuals with dementia and 22 healthy controls. Results: CCMS participants, including healthy controls, had high levels of WM pathology as measured by Scheltens Ratings Scale score. While age did not significantly relate to WM pathology, higher Scheltens Ratings Scale scores were associated with lower MMSE findings (correlation between -0.14 & -0.22; p < .05). Conclusions: WM pathology was common in this county-wide population sample of those ranging in age from 65 to 106. Increased WM burden was found to be significantly associated with decreased overall MMSE performance.

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P777 Clostridioides difficile infection in children with inflammatory bowel disease: A Canadian population-based study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.905 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S616-S616

Author(s):

W El-Matary ◽

A Chandrakumar ◽

H Zohni

Keyword(s):

Inflammatory Bowel Disease ◽

Incidence Rate ◽

Bowel Disease ◽

Cox Regression ◽

Population Based ◽

Categorical Variables ◽

Clostridioides Difficile ◽

Increased Risk ◽

Clostridioides Difficile Infection ◽

Inflammatory Bowel

Abstract Background Toxigenic Clostridioides difficile (C. difficile), previously known as Clostridium difficile, is an anaerobic gram-positive spore-forming opportunistic pathogen associated with profuse diarrhoea and gastroenteritis associated mortality, especially in children with inflammatory bowel disease (IBD). The aim of this work was to investigate the incidence and risk factors associated with Clostridioides difficile infection (CDI) in children with IBD in the province of Manitoba, Canada. Methods Our longitudinal population-based cohort comprised of all children and young adults <17 years diagnosed with IBD in the Canadian province of Manitoba between 2011 and 2019. The diagnosis of CDI was confirmed based on the Triage C. difficile immunoassay and polymerase chain reaction assay to detect the presence of toxigenic C. difficile. Fisher’s exact test was used to examine the relationship between categorical variables. Cox-regression model was used to estimate the risk of CDI development in IBD patients. Results Among the 261 children with IBD, 20 (7.7%) developed CDI with an incidence rate of 5.04 cases per 1000 person-years and the median age at diagnosis of 12.96 years (IQR: 9.33–15.81). The incidence rate of CDI among UC and CD patients were 4.16 cases per 1000 person-years and 5.88 cases per 1000 person-years, respectively (p = 0.46). Compared to children without CDI, those who had CDI were at increased risk of future exposure to systemic corticosteroids (hazard ratio (HR) = 4.30; 95% CI: 1.44–12.87) and anti-tumour necrosis factor (TNF) biologics (HR = 3.37; 95% CI: 1.13–10.09). Recurrence rate of CDI in our paediatric IBD population was 25%. Conclusion Our findings confirm that children with IBD are at a high risk of developing CDI, which may predict future escalation of IBD therapy.

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