Enteropathogenic viruses associated with acute gastroenteritis among African children under 5 years of age: A systematic review and meta-analysis

Rotavirus Infections: Pathophysiology, Symptoms, and Vaccination

Rotavirus (RV) is the most common cause of severe acute gastroenteritis (AGE) in children under five years of age. This review summarizes current knowledge on RV infections, with a particular focus on viral structure, pathophysiological mechanisms, and age-dependent clinical presentation. Special attention is given to systemic manifestations, including central nervous system involvement, autoimmune responses such as type 1 diabetes and celiac disease, and rare associations with biliary atresia. The mechanisms of RV-induced diarrhea and vomiting are discussed in detail. Clinical severity scoring systems-such as the Vesikari and Clark scales-and dehydration assessment tools-the Clinical Dehydration Scale (CDS) and the Dehydration: Assessing Kids Accurately (DHAKA) score-are compared. The review highlights differences in disease course between children under and over five years, emphasizing that RV is not limited to early childhood. A major section addresses the global effectiveness of vaccination programs, their role in reducing disease burden, coverage challenges, and decreased efficacy in low-income countries. Particular focus is placed on high-risk groups, including preterm and immunocompromised infants.

Is the repeat worth it? Optimizing syndromic panel pathogen detection protocols

OBJECTIVE

The aim of the study was to compare the cost and clinical impact of repeating BioFire FilmArray gastrointestinal (GI) and respiratory (RP) panel assays with 3 vs 4 pathogen targets positive.

METHOD

We analyzed 12,027 GI and RP panels to evaluate our retesting policy, which retested panels with 3 or more detected pathogens (3-pathogen protocol) compared with the manufacturer's 4-pathogen (4-pathogen protocol) recommendation. We compared the retesting results, calculated the cost implications, and reviewed the clinical impact on antibiotic prescriptions and patient outcomes.

RESULTS

Retesting with our 3-pathogen protocol revealed that 81% (39/48) of GI and 76% (26/34) of RP panels had identical results, whereas 19% (9/48) of GI and 24% (8/34) of RP panels showed discrepancies on retesting. The additional cost incurred by our protocol compared with the manufacturer's protocol was $9820.32. There was no evidence that our more stringent policy affected antibiotic prescription or clinical outcomes.

CONCLUSION

Our more stringent 3-pathogen protocol for retesting panels did not improve patient management compared with the manufacturer's 4-pathogen protocol but resulted in unnecessary costs and increased the risk of depleting testing kits during supply shortages. Consequently, we adopted the manufacturer's suggestions, highlighting the need to balance clinical rigor with cost-effectiveness in laboratory testing protocols.

Monkeypox Virus Occurrence in Wastewater Environment and Its Correlation with Incidence Cases of Mpox: A Systematic Review and Meta-Analytic Study

The COVID-19 pandemic has increased the interest in the use of wastewater-based surveillance (WBS) strategy for infectious disease monitoring, especially when clinical cases are underreported. The excretion of monkey virus (MPXV) in the feces of both symptomatic and preclinical individuals has further driven the interest in WBS applicability to MPXV monitoring in wastewater to support its mitigation efforts. We performed a systematic review with meta-analysis, using six databases to assess MPXV detection in wastewater. We performed a random-effects model meta-analysis to calculate the pooled prevalence at a 95% confidence interval (95% CI). Also, we carried out a subgroup analysis according to the country regions and a sensitivity analysis excluding studies classified as having a high risk of bias. The overall MPXV positivity rate in wastewater was estimated at 22% (95% CI: 14-30%; I2 = 94.8%), with more detection rate in North America (26%, 95% CI: 8-43%) compared to Europe and Asia (22%, 95% CI: 12-31%). The MPXV detection rate was significantly higher in 2022 studies (22%, 95% CI: 13-31%) compared to 2023 (19%, 95% CI: 14-25%). The real-time PCR platform significantly detected more MPXV (24%, 95% CI: 14-34%) than the digital droplet PCR-based studies (17%, 95% CI: 4-31%), which was used less frequently. Viral concentration with centrifugation procedure indicated higher detection rates (21%, 95% CI: 10-33%) than other known sample concentration protocols. Generally, MPXV detection rates in wastewater samples strongly correlate with incidence cases of mpox (range of R = 0.78-0.94; p < 0.05). Findings from this study suggest that WBS of MPXV could be employed as an epidemiological early warning tool for disease monitoring and mpox outbreak prediction similar to the clinical case-based surveillance strategies.

Prevalence of common diarrheagenic enterobacteriaceae in Iran (2000-2023): a systematic review and meta-analysis

OBJECTIVE

Bacterial gastroenteritis is a significant public health concern, capable of causing severe infections. Among the various pathogens involved, those belonging to the Enterobacteriaceae family are the most frequently isolated and associated with gastrointestinal disorders. This study aimed to investigate the prevalence of common diarrheagenic Enterobacteriaceae in Iran over the past two decades, from 2000 to 2023.

METHODS

A comprehensive systematic search was conducted across multiple databases, including EMBASE, HINARI, MEDLINE, PubMed, Google Scholar, and the Cochrane Library. The focus was on observational published studies reporting the prevalence of diarrheagenic Enterobacteriaceae in Iran during 2000 and 2023. The criteria did not restrict patient demographics such as age, gender, health conditions, or occupation. This meta-analysis employed a 95% confidence interval (CI) for analysis. Evidence of heterogeneity was determined using an I² value greater than 50%. To explore potential sources of heterogeneity, subgroup analysis and meta-regression analysis were performed. Statistical analyses were executed using R version 4.3.2 along with the meta package. A p-value less than 0.05 was considered statistically significant.

RESULTS

Out of 3,701 papers reviewed, 56 studies met the inclusion criteria and were analyzed. The overall pooled prevalence of diarrheagenic Enterobacteriaceae species from 2000 to 2023 was 14.0% (95% CI: 0.11-0.17). Subgroup analysis revealed Shigella spp. had the highest prevalence at 18.0% (95% CI: 0.13-0.24; I²=99%), followed by diarrheagenic Escherichia coli at 11.0% (95% CI: 0.09-0.15; I²=97%), Salmonella spp. at 9.0% (95% CI: 0.05-0.17; I²=99%), and Yersinia spp. at 2.0% (95% CI: 0.00-0.10; I²=94%). Prevalence trends showed Shigella spp. increasing from 4% (95% CI: 0.03-0.08) in 2000-2004 to 36% (95% CI: 0.20-0.55) in 2021-2023. Diarrheagenic E. coli (DEC) showed no clear pattern, ranging from 5% (95% CI: 0.01-0.24) to 17% (95% CI: 0.07-0.36). Salmonella spp. exhibited more significant fluctuations, rising from 6% (95% CI) in both 2000-2004 and 2005-2008 periods to 20% (95% CI: 0.03-0.66) in 2009-2012 and 30% (95% CI: 0.11-0.60) in 2017-2020. Yersinia spp. was only determined in 2000-2004 with a pool prevalence of 12% (95% CI: 0.00-0.91). Sub-species analysis revealed Shigella sonnei was the most prevalent species among Shigella spp. in Iran, accounting for 42% of cases (95% CI: 0.33-0.52). Regarding DEC species, Enteroaggregative E. coli (EAEC) and Enterotpathogenic E. coli (EPEC) had the highest rate at 15% (95% CI). Furthermore, a pool prevalence of 2% (95% CI: 0.00-0.89) was reported for Yersinia enterocolitica among diarrheagenic Enterobacteriaceae in Iran.

CONCLUSION

This meta-analysis provides valuable insights into the prevalence of diarrheagenic Enterobacteriaceae in Iran over the past two decades. The findings highlight the significant impact of these pathogens on public health, with Shigella spp. showing the highest prevalence and increasing trends. Further research should investigate the factors contributing to the prevalence of diarrheagenic Enterobacteriaceae, including genetic diversity of diarrheagenic Enterobacteriaceae isolates, molecular mechanisms underlying the virulence of these pathogens, or antibiotic resistance patterns.

Rotavirus-specific-IgA and cytokines responses in Ascaris lumbricoides-infected preschool-aged Nigerian children following rotavirus vaccination

Rotavirus diarrhea and Ascaris lumbricoides (Al) infection increase intestinal morbidity and were associated with altered immune responses that compromise the vaccine efficacy in children. The serum level of rotavirus specific IgA (RV-IgA) and cytokine profiles in A. lumbricoides (AI) infected preschool-aged Nigerian children were estimated following oral rotavirus vaccination. Nineteen of the 149 preschool-aged children (aged 6 to 60 months) with Ascaris lumbricoides infection paired with age and sex-matched helminth - free children were administered with oral rotavirus vaccine after intestinal helminth screening using stool sample concentration technique. Separated sera from 3 mL venous blood samples were collected and estimated for cytokines (IFN-γ, TNF-α, IL-4, IL-8 IL-6, IL-10) and RV-IgA before and three weeks after rotavirus vaccination using Enzyme Linked Immunosorbent Assay. IFN-γ, IL-8, IL-4 were significantly lower at post-vaccination in Al-infected children compared with pre-vaccination. Serum IL-10 was significantly higher at post-vaccination in both Al-infected children and helminth-free controls, compared with pre-vaccination levels (p < 0.05). Pre-vaccination IL-8 and IL-6 were significantly higher in Ascaris lumbricoides-infected children, while the post-vaccination IL-8 was significantly higher in Ascaris lumbricoides-infected compared with control. At post-vaccination period, RV-IgA level was lower in Al-infected children and significantly higher in helminth - free control group compared to pre-vaccination RV-IgA level. Ascaris lumbricoides infection contributed to down-regulation of some cytokines and antibody responses to oral rotavirus vaccine.

Epidemiology and Genotyping of Rotavirus Gastroenteritis in Children <5 Years in Sikkim, North East India

Introduction

Rotavirus is a frequent cause of gastroenteritis in young children. It is seasonal in many countries but occurs year-round in India.Since the launch of the Rotavirus Vaccine (RVV) morbidity and mortality in children have greatly decreased. This study was carried out prior to the inclusion of RVV in the state vaccination schedule in 2019. The objective of the study was to estimate the burden of Rota Virus Gastroeneteritis in kids under 5 years of age, attending a government tertiary care hospital in the state and to identify the common circulating genotypes of Rotavirus.

Methods

Stool samples from children with more than three episodes of loose stool that were negative for bacterial enteric pathogens were tested by Enzyme Linked Immunosorbent Assay (ELISA) for Rotavirus antigen. Positive stool samples were transported to the Regional Viral Research and Diagnostic Laboratory at National Institute for Cholera and Enteric Diseases for genotyping.

Results

200 stool samples were screened and 40 samples (20%) were positive for Rotavirus antigen by ELISA. G3P [8] - 33% (9/27), followed by G1P[8] -15%(4/27) and G2P4 - 11%( 3/27) were the most common genotypes.

Conclusion

Rotavirus is a significant cause of gastroenteritis in children under five years of age in the Indian state of Sikkim.

Frequency and genotyping of group A rotavirus among Egyptian children with acute gastroenteritis: a hospital-based cross-sectional study

BACKGROUND

This hospital-based cross-sectional study aims to investigate the epidemiologic and clinical characteristics of rotavirus group A (RVA) infection among children with acute gastroenteritis and to detect the most common G and P genotypes in Egypt.

METHODS

A total of 92 stool samples were collected from children under five who were diagnosed with acute gastroenteritis. RVA in stool samples was identified using ELISA and nested RT-PCR. Common G and P genotypes were identified utilizing multiplex nested RT-PCR assays.

RESULTS

RVA was detected at a rate of 24% (22 /92) using ELISA and 26.1% (24 /92) using VP6 nested RT-PCR. The ELISA test demonstrated diagnostic sensitivity, specificity, and accuracy of 91.7%, 100%, and 97.8%, respectively. G3 was the most prevalent G type (37.5%), followed by G1 (12.5%), whereas the most commonly detected P type were P[8] (41.7%) and P[6] (8.2%). RVA-positive samples were significantly associated with younger aged children (p = 0.026), and bottle-fed (p = 0.033) children. In addition, RVA-positive samples were more common during cooler seasons (p = 0.0001). Children with rotaviral gastroenteritis had significantly more frequent episodes of diarrhea (10.87 ± 3.63 times/day) and vomiting (8.79 ± 3.57 times/day) per day (p = 0.013 and p = 0.011, respectively). Moreover, they had a more severe Vesikari clinical score (p = 0.049).

CONCLUSION

RVA is a prevalent cause of acute gastroenteritis among Egyptian children in our locality. The discovery of various RVA genotypes in the local population, as well as the identification of common G and P untypeable strains, highlights the significance of implementing the rotavirus vaccine in Egyptian national immunization programs accompanied by continuous monitoring of strains.

Comparing the Efficacy of Ondansetron, Domperidone, and Metoclopramide in Treating Vomiting in Pediatric Patients With Acute Gastroenteritis: A Network Meta-Analysis

This network meta-analysis compared the efficacy of ondansetron, domperidone, and metoclopramide in managing vomiting in pediatric acute gastroenteritis. A comprehensive literature search was conducted across multiple databases, including PubMed, Cochrane Library, Web of Science, and Embase, from their inception to July 25, 2024. Additionally, Google Scholar was searched to identify further relevant studies. In total, 19 randomized controlled trials (RCTs) were included. The primary outcome was cessation of vomiting. The results indicated that ondansetron was significantly more effective than placebo in achieving cessation of vomiting. While domperidone and metoclopramide also showed improved efficacy compared to placebo, these differences were not statistically significant. Ondansetron emerged as the most effective intervention, followed by domperidone and metoclopramide. These findings have significant clinical implications, suggesting that ondansetron should be the preferred antiemetic for pediatric acute gastroenteritis. Its use may reduce the need for intravenous rehydration and hospitalization, potentially improving patient outcomes and reducing healthcare costs. However, the study has limitations, including a lack of data on secondary outcomes and safety profiles of the interventions. Future prospective, multicenter studies are needed to assess both the efficacy and safety of these antiemetics comprehensively in pediatric acute gastroenteritis.

Noroviruses: Evolutionary Dynamics, Epidemiology, Pathogenesis, and Vaccine Advances-A Comprehensive Review

Noroviruses constitute a significant aetiology of sporadic and epidemic gastroenteritis in human hosts worldwide, especially among young children, the elderly, and immunocompromised patients. The low infectious dose of the virus, protracted shedding in faeces, and the ability to persist in the environment promote viral transmission in different socioeconomic settings. Considering the substantial disease burden across healthcare and community settings and the difficulty in controlling the disease, we review aspects related to current knowledge about norovirus biology, mechanisms driving the evolutionary trends, epidemiology and molecular diversity, pathogenic mechanism, and immunity to viral infection. Additionally, we discuss the reservoir hosts, intra-inter host dynamics, and potential eco-evolutionary significance. Finally, we review norovirus vaccines in the development pipeline and further discuss the various host and pathogen factors that may complicate vaccine development.