Page 55 - 15Diarrhoeaandvomiting

Diarrhoea and vomiting caused by gastroenteritis in children under 5 years

community incidence to general practice presentation was 5.8, suggesting that, for every case
presenting to general practice with intestinal disease, almost six more cases were present in the
community. The ratio was high for cases associated with E. coli non-O157, yersinia, rotavirus
group C, C. difficile cytotoxin, aeromonas and for cases where no organism was isolated. In
contrast, the ratio was lower for cases with salmonella and shigella infection, indicating that most
people having these infections present to their general practitioners (Table 3.4). On comparing the
results of the reporting system, it was found that cases of non-bacterial gastroenteritis were less
likely to be reported to national surveillance. The rate ratio of community cases of gastroenteritis
to the cases reaching national surveillance scheme was lower for bacterial pathogens (salmonella
3.2 : 1, campylobacter 7.6 : 1) compared with that of the viruses (rotavirus 35 : 1). [EL = 3]
The UK HPA is a non-departmental public body and its Centre for Infections carries out a range
of work on the prevention of infectious disease. The remit of this body includes infectious
disease surveillance, and it regularly updates data on enteric pathogens isolated in patients with
gastroenteritis. The data are based on submitted laboratory reports, are stratified by regions, age
group and year, and although incomplete can identify important trends. Table 3.5 lists the various
pathogens identified in the stool samples of children over the period 2002–2006.

Evidence summary
Although results from three hospital-based studies show variation in the proportion of children
with gastroenteritis (45%, 75% and 58%) who had pathogenic enteric organisms isolated from
their stool examination, rotavirus was detected as the most common cause of gastroenteritis in
children in all the studies. Bacterial and protozoal organisms were detected less commonly.
Other studies have identified norovirus and adenovirus as other common viral causes, with
norovirus being more common than adenovirus. However, rotavirus was identified about four
times more often and the results were similar from the community and from hospital settings.

Table 3.4 Incidence of infectious intestinal disease identified in patients from the community
and those presenting to general practice 11
Infectious agent Incidence in Incidence in GP Rate ratio of
community per 1000 practice per 1000 community cases to
person-years (95% CI) person-years (95% CI) GP cases (95% CI)
Viruses
Adenovirus group F 3.0 (1.7–5.4) 0.9 (0.7–1.1) 3.4 (1.8–6.3)
Astrovirus 3.8 (2.3–6.4) 0.9 (0.7–1.1) 4.4 (2.5–7.6)
Calicivirus 2.2 (1.1–4.3) 0.43 (0.27–0.60) 5.1 (2.4–10.7)
Rotavirus group A 7.1 (4.8–10.4) 2.3 (1.8–2.9) 3.1 (2.1–4.6)
Rotavirus group C 0.5 (0.1–2.2) 0.06 (0.02–0.17) 8.9 (1.9–41.3)
Small round structured viruses 12.5 (9.4–16.7) 2.0 (1.4–2.7) 6.3 (4.6–8.6)
Bacteria
Aeromonas spp. 12.4 (9.4–16.7) 1.9 (1.5–2.4) 6.7 (4.9–9.1)
Bacillus spp. 0 0.05 (0.01–0.15) –
Campylobacter spp. 8.7 (6.1–12.3) 4.1 (3.3–5.1) 2.1 (1.5–3.0)
Clostridium difficile 1.6 (0.7–3.6) 0.2 (0.1–0.3) 8.0 (3.4–19.3)
Clostridium perfringens 2.4 (1.3–4.7) 1.3 (1.0–1.7) 1.9 (1.0–3.7)
E. coli O157 0 0.03 (0.01–0.11) –
E. coli non-O157 0.8 (0.3–2.5) 0.06 (0.02–0.17) 13.4 (3.6–49.6)
Salmonella spp. 2.2 (1.1–4.3) 1.6 (1.2–2.1) 1.4 (0.7–2.8)
Shigella spp. 0.3 (0.04–1.9) 0.3 (0.2–0.5) 1.0 (0.1–7.3)
Staphylococcus aureus 0.3 (0.04–1.9) 0.1 (0.05–0.2) 2.5 (0.3–19.0)
Vibrio spp. 0 0.01 (0.001–0.05) –
Yersinia spp. 6.8 (4.6–10) 0.6 (0.4–0.9) 11.7 (7.5–18.3)
Protozoa
Cryptosporidium parvum 0.8 (0.3–2.5) 0.43 (0.3–0.6) 1.9 (0.6–6.1)
Giardia lamblia 0.5 (0.1–2.2) 0.3 (0.2–0.5) 1.9 (0.5–7.9)
No organism identified 117 (107–129) 14.8 (12.8–17.2) 7.9 (7.1–8.8)
Total 194 (181–208) 33.1 (29.4–37.5) 5.8 (5.4–6.3)

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