Julius Centre for Health Science and Primary Care, Infectious Diseases Epidemiology, University Medical Centre Utrecht, Utrecht, Netherlands.
Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, Netherlands.
Lancet Infect Dis. 2020 May;20(5):598-606. doi: 10.1016/S1473-3099(20)30058-X. Epub 2020 Feb 20.
Norovirus and rotavirus are the dominant pathogens causing acute gastroenteritis in children. To quantify their natural disease burden and transmission, we prospectively monitored households in an endemic setting in the Netherlands, a high-income country that does not have a rotavirus vaccination programme.
We did a prospective, household survey-based cohort study in the Netherlands. Randomly selected households from the Dutch Population Register were invited to participate if they had at least three household members, including a child younger than 2 years. A member of each household was asked to record the gastrointestinal symptoms of all household members every day for 10 consecutie weeks using an interactive smartphone application. Real-time detection of acute gastroenteritis onset on the basis of entered symptoms activated requests for the case and one other household member to complete disease questionnaires and provide stool samples. Stool samples were analysed by real-time PCR for norovirus, rotavirus, adenovirus 40/41, and astrovirus. We calculated the per-pathogen proportion of households with at least one secondary acute gastroenteritis episode (epidemiologically but not microbiologically linked), the probability of a secondary episode in household members at risk (secondary attack rate), and the microbiologically confirmed symptomatic and asymptomatic transmission rates.
During two seasons (January to March) in 2016 and 2017, 30 660 households were invited to participate, of which 604 households including 2298 individuals were enrolled. 697 acute gastroenteritis episodes were detected in 358 households, with samples obtained from 609 (87%) of 697 episodes. Norovirus (150 [25%] of 609 cases) and rotavirus (91 [15%] cases) were most frequently detected. Astrovirus was detected in 50 (8%) samples and adenovirus 40/41 in 24 (4%) samples. Overall disease severity was higher in patients with rotavirus-positive acute gastroenteritis than those with norovirus-positive acute gastroenteritis. Norovirus led to higher disease burden in adults than did rotavirus. Following an index case, a secondary acute gastroenteritis episode occurred in 34 (35%) of 96 households for norovirus and 26 (46%) of 56 households for rotavirus. Secondary attack rates were 15% (37 of 244 participants) for norovirus and 28% (33 of 120 participants) for rotavirus and asymptomatic transmission rates were 51% (52 of 102 household members) for norovirus and 22% (12 of 55 household members) for rotavirus. The microbiologically confirmed symptomatic transmission rate for norovirus was 10% (25 of 254 household members) and 18% for rotavirus (21 of 119 household members).
In households with young family members in a setting without rotavirus vaccination, norovirus is the dominant acute gastroenteritis pathogen, but rotavirus is associated with more severe disease. There was substantial within-household transmission, both symptomatic and asymptomatic. The study provides key quantities on transmission, which can inform vaccine policy decisions and act as a baseline for impact evaluations in high-income settings.
The Netherlands Organisation for Health Research and Development (grant 91616158).
诺如病毒和轮状病毒是导致儿童急性肠胃炎的主要病原体。为了量化它们的自然疾病负担和传播，我们在荷兰的一个流行地区前瞻性监测了家庭，荷兰是一个高收入国家，没有轮状病毒疫苗接种计划。
我们在荷兰进行了一项前瞻性、基于家庭的队列研究。从荷兰人口登记册中随机选择有至少 3 名家庭成员的家庭参加，如果有 2 岁以下的儿童，则邀请他们参加。每个家庭的一名成员被要求使用交互式智能手机应用程序每天记录所有家庭成员的胃肠道症状，连续 10 周。基于输入症状的急性肠胃炎发病的实时检测会激活对病例和另一名家庭成员的请求，以完成疾病问卷并提供粪便样本。通过实时 PCR 分析粪便样本以检测诺如病毒、轮状病毒、腺病毒 40/41 和星状病毒。我们计算了至少有一个继发急性肠胃炎发作的家庭（在流行病学上但不是微生物学上有联系）的每个病原体比例、有风险的家庭成员中继发发作的概率（继发攻击率）以及微生物学确认的有症状和无症状传播率。
在 2016 年和 2017 年的两个季节（1 月至 3 月），邀请了 30660 个家庭参加，其中 604 个家庭包括 2298 人参加。在 358 个家庭中检测到 697 次急性肠胃炎发作，从 697 次发作中的 609 次（87%）获得了样本。诺如病毒（609 例中的 150 例[25%]）和轮状病毒（91 例[15%]）最常被检测到。在 50 份（8%）样本中检测到星状病毒，在 24 份（4%）样本中检测到腺病毒 40/41。轮状病毒阳性急性肠胃炎患者的疾病严重程度高于诺如病毒阳性急性肠胃炎患者。与轮状病毒相比，诺如病毒导致成人的疾病负担更高。在首例病例后，34 个（96 个家庭中的 35%）家庭发生了继发急性肠胃炎，56 个家庭中的 26 个（46%）家庭发生了继发轮状病毒肠胃炎。继发攻击率分别为 15%（244 名参与者中的 37 名）和 28%（120 名参与者中的 33 名），诺如病毒和轮状病毒的无症状传播率分别为 51%（102 名家庭成员中的 52 名）和 22%（55 名家庭成员中的 12 名）。诺如病毒的微生物学确认有症状传播率为 10%（254 名家庭成员中的 25 名），轮状病毒为 18%（119 名家庭成员中的 21 名）。
在没有轮状病毒疫苗接种的有年幼家庭成员的家庭中，诺如病毒是主要的急性肠胃炎病原体，但轮状病毒与更严重的疾病有关。存在大量的家庭内传播，包括有症状和无症状传播。该研究提供了传播的关键数量，这可以为疫苗政策决策提供信息，并作为高收入地区影响评估的基线。
荷兰健康研究与发展组织（授予 91616158 号）。
