128. Viral Etiologies among Children with Acute Gastroenteritis Presenting to Emergency Department and Outpatient Clinics in Davidson County, Tennessee
Session: Oral Abstract Session: Potpourri of Pediatric Infections
Thursday, October 3, 2013: 11:15 AM
Room: The Moscone Center: 250-262
Background: Norovirus, rotavirus, and other enteric viruses are leading causes of acute gastroenteritis (AGE). The frequency of these viruses detected in asymptomatic individuals is poorly characterized.

Methods: AGE surveillance, recruitment, and enrollment among children >15 days and <18 years were performed at Vanderbilt Children’s Hospital outpatient clinics (OP) and emergency department (ED). Davidson County residents enrolled with AGE were matched for age, race, and ethnicity to children without AGE (2 cases:1 control). Specimens were collected, aliquoted, and submitted to the TN Department of Health, where nucleic acid amplification assays for norovirus genogroups 1 (GI) and 2 (GII), sapovirus, and astrovirus were performed. Genotypes and strain identities of norovirus-positive specimens were ascertained by nucleotide sequence analysis using previously described CDC CaliciNet protocols. ELISA for rotavirus VP6 antigen (PremierTM Rotaclone@) was performed at Vanderbilt.


Results: From 12/1/12-3/26/13, 404 AGE cases (245 ED, 159 OP) and 196 controls were enrolled. 244 (60%) of AGE cases & 40 (20%) of controls had at least one of the viruses detected (153 ED, 91 OP). Among AGE cases, rotavirus (109) was  was most common, then norovirus G1 or G2 (87), sapovirus (53), & astrovirus (43). Among controls, norovirus GI or GII (22), sapovirus (13), astrovirus (10) & rotavirus (4) were detected. Both norovirus GI &GII were identified in four AGE cases. Sequence analysis of norovirus-positive specimens revealed GII.4 Sydney as the most common strain.



AGE cases (n=404)

Controls (n=196)



109 (27%)

4 (2%)


Norovirus GI/GII

87 (22%)

22 (11%)



53 (13%)

13 (7%)



43 (12%)

10 (5%)


Conclusion: Collectively, rotavirus, norovirus, sapovirus, & astrovirus were detected in 60% of AGE cases; rotavirus was most common. Each agent was also detected in lower proportions in healthy controls. Further studies are warranted to understand the roles of these viruses in pediatric AGE and asymptomatic viral shedding. Additionally, rotavirus vaccination histories of study subjects and serotype identification of rotavirus-positive specimens will provide valuable information about the effectiveness of current rotavirus vaccines and possibly impact requirements of future vaccines.

Natasha Halasa, MD MPH1, Katie Garman2, Amy Woron2, Rendi Mchenry3, Melanie Grigsby, M.S.3, James D. Chappell, MD, PhD4, Daniel Payne, PhD, MSPH5, Aron J. Hall, DVM, MSPH5 and John Dunn, DVM, PhD2, (1)Vanderbilt University Medical Center, Nashville, TN, (2)Tennessee Department of Health, Nashville, TN, (3)Vanderbilt University, Nashville, TN, (4)Vanderbilt University School of Medicine, Nashville, TN, (5)Centers for Disease Control and Prevention, Atlanta, GA


N. Halasa, None

K. Garman, None

A. Woron, None

R. Mchenry, None

M. Grigsby, None

J. D. Chappell, None

D. Payne, None

A. J. Hall, None

J. Dunn, None

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.