Risk Factors and Clinical Profile of Sapovirus-associated Acute Gastroenteritis in Early Childhood A Nicaraguan Birth Cohort Study

• Authors: Nadja A Vielot, University of North Carolina Chapel Hill; Fredman González, National Autonomous University of Nicaragua at León; Yoaska Reyes, National Autonomous University of Nicaragua at León; Omar Zepeda, National Autonomous University of Nicaragua at León; Bryan Blette, University of North Carolina Chapel Hill; Margarita Paniagua, National Autonomous University of Nicaragua at León; Christian Toval-Ruiz, Natl Autonomous Univ Nicaragua Leon; Marta Diez-Valcarce, Emory University; Michael G Hudgens, University of North Carolina Chapel Hill; Lester Gutierrez, National Autonomous University of Nicaragua at León; Patricia Blandon, National Autonomous University of Nicaragua at León; Roberto Herrera, National Autonomous University of Nicaragua at León; Edwing C Cuadra, National Autonomous University of Nicaragua at León; Natalie Bowman, University of North Carolina Chapel Hill; Samuel Vilchez, Natl Autonomous Univ Nicaragua Leon; Jan Vinjé, Centers for Disease Control and Prevention, Atlanta; Sylvia Becker-Dreps, University of North Carolina Chapel Hill; Filemón Bucardo, National Autonomous University of Nicaragua at León
• Journal Title: PEDIATRIC INFECTIOUS DISEASE JOURNAL
• Volume: Volume 40, Number 3
• Publisher: LIPPINCOTT WILLIAMS & WILKINS | 2021-03-01, Pages 220-226
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/INF.0000000000003015
• Subjects: Biology, Biostatistics; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Infectious Diseases; Pediatrics; sapovirus; diarrhea; gastroenteritis; children; Nicaragua

Abstract

Background: Sapovirus is increasingly recognized as an important cause of acute gastroenteritis (AGE) in children. We identified risk factors and characterized the clinical profile of sapovirus AGE in a birth cohort in León, Nicaragua. Methods: We conducted a case-control study nested within a birth cohort (n = 444). Fieldworkers conducted weekly household AGE surveillance. AGE stools were tested for sapovirus by reverse transcriptase quantitative polymerase chain reaction. For each first sapovirus episode, we selected 2 healthy age-matched controls and estimated independent risk factors of sapovirus AGE using conditional logistic regression. We compared clinical characteristics of sapovirus AGE episodes with episodes associated with other etiologies and identified co-infections with other enteric pathogens. Results: From June 2017 to July 2019, we identified 63 first sapovirus AGE episodes and selected 126 controls. Having contact with an individual with AGE symptoms and vaginal delivery were independent risk factors for sapovirus AGE. All cases experienced diarrhea, lasting a median 6 days; 23% experienced vomiting. Compared with children with AGE due to another etiology, sapovirus AGE was similar in severity, with less reported fever. Most cases experienced co-infections and were more likely than controls to be infected with diarrheagenic Escherichia coli or astrovirus. Conclusions: Sapovirus was a commonly identified AGE etiology in this Central American setting, and symptoms were similar to AGE associated with other etiologies. The association between vaginal delivery and sapovirus is a novel finding. Gut microbiome composition might mediate this relationship, or vaginal delivery might be a proxy for other risk factors. Further investigation into more specific biological mechanisms is warranted.