We aimed to investigate
epidemiology and host- and pathogen-related factors associated with clinical severity of acute
gastroenteritis (AGE) in
children after
rotavirus vaccination introduction. Factors assessed included age,
co-infection with more than 2
viruses , and
virus -toxigenic
Clostridium difficile co-
detection . Fecal samples and clinical information, including modified Vesikari scores, were collected from
hospitalized children with AGE. The presence of enteric
viruses and
bacteria , including toxigenic C. difficile, was detected by
polymerase chain reaction (
PCR ). Among the 415
children included,
virus was detected in stool of 282 (68.0%)
children .
Co-infection with more than 2
viruses and toxigenic C. difficile were found in 24 (8.5%) and 26 (9.2%)
children with viral AGE, respectively.
Norovirus (n = 130)
infection , including
norovirus -associated
co-infection , was the most frequent
infection , especially in
children aged < 24 months (P < 0.001). In the severity-related
analysis , age < 24 months was associated with greater diarrheal severity (P < 0.001) and modified Vesikari score (P = 0.001), after
adjustment for other severity-related factors including
rotavirus status. Although the age at
infection with
rotavirus was higher than that for other
viruses (P = 0.001),
rotavirus detection was the most significant
risk factor for all severity
parameters , including modified Vesikari score (P < 0.001). Viral
co-infection and toxigenic C. difficile co-
detection were not associated with any severity-related parameter. This information
will be helpful in the management of childhood AGE in this era of
rotavirus vaccination and availability of
molecular diagnostic tests, which often
lead to the simultaneous
detection of multiple pathogens.