High detection rates of enteropathogens in asymptomatic children attending day care

• Published in: PloS one Vol. 9; no. 2; p. e89496
• Main Authors: Enserink, Remko, Scholts, Rianne, Bruijning-Verhagen, Patricia, Duizer, Erwin, Vennema, Harry, de Boer, Richard, Kortbeek, Titia, Roelfsema, Jeroen, Smit, Henriette, Kooistra-Smid, Mirjam, van Pelt, Wilfrid
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24.02.2014; Public Library of Science (PLoS)
• Subjects: Analysis; Animals; Bacteria; Carrier State - epidemiology; Carrier State - microbiology; Child Day Care Centers; Child, Preschool; Children; Children & youth; Day care centers; Disease control; Drug resistance; Enterobacteriaceae - isolation & purification; Enterobacteriaceae Infections - epidemiology; Enterobacteriaceae Infections - microbiology; Epidemiology; Families & family life; Feces - microbiology; Female; Flora; Gastroenteritis; Gastrointestinal symptoms; Health aspects; Health sciences; Health surveillance; Humans; Infections; Infectious diseases; Intestinal microflora; Intestine; Laboratories; Male; Medicine; Microbiota (Symbiotic organisms); Morbidity; Multiplexing; Netherlands - epidemiology; Parasites; Parasites - isolation & purification; Parasitic Diseases - epidemiology; Parasitic Diseases - microbiology; Prevalence; Primary care; Principal components analysis; Public health; R&D; Research & development; Rotavirus; Rotavirus - isolation & purification; Rotavirus Infections - epidemiology; Rotavirus Infections - microbiology; Sampling; Sampling methods; Studies; Virology; Viruses; Netherlands
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0089496

Gastroenteritis morbidity is high among children under the age of four, especially amongst those who attend day care. To determine the prevalence of a range of enteropathogens in the intestinal flora of children attending day care and to relate their occurrence with characteristics of the sampled child and the sampling season. We performed three years of enteropathogen surveillance in a network of 29 child day care centers in the Netherlands. The centers were instructed to take one fecal sample from ten randomly chosen children each month, regardless of gastrointestinal symptoms at time of sampling. All samples were analyzed for the molecular detection of 16 enteropathogenic bacteria, parasites and viruses by real-time multiplex PCR. Enteropathogens were detected in 78.0% of the 5197 fecal samples. Of the total, 95.4% of samples were obtained from children who had no gastroenteritis symptoms at time of sampling. Bacterial enteropathogens were detected most often (most prevalent EPEC, 19.9%), followed by parasitic enteropathogens (most prevalent: D. fragilis, 22.1%) and viral enteropathogens (most prevalent: norovirus, 9.5%). 4.6% of samples related to children that experienced symptoms of gastroenteritis at time of sampling. Only rotavirus and norovirus were significantly associated with gastroenteritis among day care attendees. Our study indicates that asymptomatic infections with enteropathogens in day care attendees are not a rare event and that gastroenteritis caused by infections with these enteropathogens is only one expression of their presence.