Paediatric gastroenteritis disease characteristics, management and seasonal variation in one region of Ireland: prospective study.

Background: Acute gastroenteritis (GE) is a clinical syndrome and harbours a significant global burden. Nosocomial acquisition of gastroenteritis results in a significant economic burden. We aim to determine gastroenteritis frequency, disease severity, nosocomial acquisition and clinical spectrum in our region for 2016-2017. Methods: This is a prospective study of all children up to 3 years of age who presented to Mayo University Hospital with vomiting and diarrhoea, from 18 November 2016 to 18 November 2017. All children had their clinical severity of gastroenteritis assessed using the internationally recognised Vesikari scoring system. Results: A total of 159 cases were detected, 157 were studied, 87 were male (55%) and 90 were severe (57%). Nosocomial gastroenteritis is rare (2 cases) (1.1%); 129 cases were admitted and the majority of paediatric gastroenteritis cases (68%) stayed between 1 and 2 days. Diarrhoea was noted in all cases, vomiting in 130 cases (82%), fever in 136 cases (86%) and dehydration in 89 cases (56%). Oral rehydration therapy was successful in 33 cases (21%). The fourth week of June was the peak week of the year for gastroenteritis (7 cases). The largest number of presentations with GE was noted in May (20 cases), followed by December and June (18 cases each) with the largest number of severe GE noted in June (12 cases), followed by December and May (11 cases each). Conclusion: Diarrhoea is the most predominant feature of gastroenteritis. Acute viral gastroenteritis occurs throughout the year. Seasonal variations of gastroenteritis were noted throughout the year. Nosocomial infection is rare.

Regional hospitalisation and seasonal variations of Pediatric rotavirus gastroenteritis pre- and post-RV vaccination: a prospective and retrospective study.

BACKGROUND: Rotavirus is the primary cause of gastroenteritis in children worldwide and is a leading cause of gastroenteritis in children, with a significant burden. Rotavirus vaccine became available in Ireland in 2016. This study aimed to investigate hospital admissions and seasonal characteristics of rotavirus gastroenteritis in a pre- and post-vaccination period in a single district general hospital. METHODS: In the post-vaccination year, from November 18th 2016 to November 18th 2017, all children up to 3 years of age who presented to Mayo University Hospital with vomiting and diarrhea, were recruited and had their stool tested for rotavirus. Retrospective analysis of hospital data of children of the same age during pre-vaccination years (2014-2016) were used for comparison. RESULTS: Compared with the pre-vaccination years (2014-2016), the median percentages of reduction of rotavirus positive stool requests and hospital admissions were high, 48.5% and 73%, respectively. In the post-vaccination year, the median percentage of reduction of emergency department presentation (stool requests) with gastroenteritis was 9%. No delay in the onset of RV season or reduction of the peak of RV infection was noted in the post-vaccination year. The duration of rotavirus season in 2016/2017 was short. CONCLUSIONS: Compared with 3 pre-vaccination years, the total number of gastroenteritis presentations, gastroenteritis hospital admissions, and rotavirus positive gastroenteritis cases were all reduced, and the duration of the rotavirus season was shorter.

Paediatric rotavirus gastroenteritis: A prospective study of regional prevalent genotypes, genotype correlation with disease severity and viral co-infection in County Mayo, Ireland, in the year following rotavirus vaccine introduction in Ireland.

Rotavirus A (RV) is the primary cause of gastroenteritis in children worldwide and a leading cause of gastroenteritis in children younger than three years, with a significant burden both globally and in Ireland. Rotavirus vaccine (Rotarix™) was introduced into Ireland in 2016. The aim of this study was to determine the diversity and frequency of, and predominant, RV genotypes, nosocomial acquisition, viral co-infections and severity of RV infection in Ireland in the post-vaccination year, from November 18th 2016 to November 18th 2017. The study included all children up to 3 years of age who had presented to Mayo University Hospital or were admitted with vomiting and diarrhoea, and had their stool tested for rotavirus and other viruses by real-time PCR in the National Virus Reference Laboratory. The Vesikari Scoring System was used to assess disease severity. The results showed that rotavirus was a leading cause of gastroenteritis (37 patients, 24.6 % of a total of 150 patients) and gastroenteritis-related hospitalisation (27 patients were admitted, 21 % of a total of 128 patients). Severe rotaviral gastroenteritis was noted in 78 % of all RV gastroenteritis (37 patients). The RV strain G1P[8], including the vaccine G1P[8] strain (Rotarix™), was the most predominant genotype (47 %), followed by G2P[4] (31 %), G4P[8] (8%), G12P[8] (8%) and G9P[8] (6%). RV co-infection with other viruses was detected in four cases (11 %), of whom three cases (75 %) were severe. Rotarix™ was detected in six vaccinated patients (35 %), 50 % were mild disease. Nosocomial infection was detected in one case. These results indicated that RV remained the leading cause of paediatric gastroenteritis during the post vaccination year in Ireland.

Paediatric viral gastroenteritis and regional predominant viral pathogens in the post-rotavirus vaccination year: prospective Irish regional study.

Acute gastroenteritis harbours a significant global burden. Rotavirus is the primary cause of gastroenteritis in children worldwide. We aim to determine the predominant enteric viral pathogens detected in the post-rotavirus vaccine period (2016-2017) in our region in county Mayo (west of Ireland), United Kingdom. All children up to 3 years old, who presented to Mayo University Hospital with vomiting and diarrhoea, from November 18th, 2016, to November 18th, 2017, had their stools tested by real-time reverse transcription polymerase chain reaction for viral pathogens. A total of 150 stool samples were tested, and 90 (60%) tested positive for a single viral pathogen. Rotavirus was the leading cause of gastroenteritis (37 patients, 24.6%; including 6 rotavirus vaccinated infants), followed by human adenovirus F (19 patients, 13%), norovirus (18 patients, 12%), sapovirus (9 patients, 6%) and astrovirus (7 patients, 5%). Rotavirus remained the predominant cause of gastroenteritis in the first year post-rotavirus vaccination, similar to the national Irish data from the pre vaccination years (July 2014-June 2015).

Pediatric Norovirus Gastroenteritis in Ireland: Seasonal Trends, Correlation with Disease Severity, Nosocomial Acquisition and Viral Co-Infection.

OBJECTIVES: To determine norovirus frequency, seasonal trends, disease severity and nosocomial acquisition in a region of Ireland. METHODS: From November 18th 2016 to November 18th 2017, all children up to 3 y of age who presented to Mayo University Hospital with vomiting and diarrhea, had their stool tested for norovirus and other viruses. Each week of the year was studied in relation to the total number of stool samples requested for norovirus testing, the number of positive stool samples, the calculated median of positive stool samples in two consecutive weeks and their calculated median percentage of positive stool samples in each two consecutive week period. RESULTS: During the study period, norovirus was the third leading cause of gastroenteritis (12%), norovirus G2 was the predominant strain; 61% were male; 56% older than 1 y, 78% of cases were severe. No nosocomial disease was detected. The fifth week of January was the week peak. Viral Co- infection was confirmed in four cases of which astrovirus was confirmed in two cases. Three seasons of norovirus gastroenteritis and four short episodes of norovirus infection were noted during 2016/2017. CONCLUSIONS: Norovirus is a predominant cause of gastroenteritis. Co- infection with other viruses, mainly astrovirus may occur. Norovirus infections occur throughout the year with a peak in winter.

Rotavirus and adenovirus detecting method: sensitivity and specificity of rapid antigen testing: prospective study in one region of Ireland.

Rotavirus and Adenovirus are common causes of gastroenteritis in children younger than 3 years worldwide. Rapid Antigen Testing (RAT) is a quick and easy tool to detect virus antigen in stool samples and is more specific than sensitive (higher specificity and lesser sensitivity). Reverse transcription-polymerase chain reaction (RT-PCR) and PCR are more sensitive and specific than RAT. Sensitive and specific tools are required for true diagnosis. We aim to determine sensitivity and specificity of RAT versus PCR testing of rotavirus and adenovirus. From November 18th 2016 to November 18th 2017, all children up to 3 years of age who presented to Mayo University Hospital with vomiting and diarrhoea had their stool tested for rotavirus and adenovirus by RAT in Galway University Hospital Laboratory (GUHL) and by PCR testing in the National Virus Reference Laboratory (NVRL) in Dublin; 143 stool samples were tested for Adenovirus, 126 (88%) tested negative at NVRL, two false positive at GUHL, specificity (98.5%). Seventeen were adenovirus positive in the NVRL, two false negative in GUHL, sensitivity (88%); 144 samples were tested for rotavirus, 108 (75%) were RV negative in the NVRL, one false positive at GUHL, specificity (99%); 36 samples were rotavirus positive in the NVRL, ten (28%) false negative in GUHL, sensitivity (72%). RAT has higher specificity than sensitivity and may be useful for mass screening at times of rotavirus or adenovirus outbreaks. PCR remains more sensitive and specific than RAT and is still required for true diagnosis.

Pediatric Asthma & Coronavirus (COVID-19)-Clinical Presentation in an Asthmatic Child-Case Report.

Pandemic coronavirus (COVID-19) is a novel virus that causes severe pneumonia. Elderly people with co-morbidities are at risk of severe disease. Symptoms are generally milder in children. We present an asthmatic 12-year old girl with cough, wheeze, and mild pneumonia due to COVID-19. Reverse transcription (RT) polymerase chain reaction (PCR) confirmed COVID-19 on nasopharyngeal sample. Chest radiograph revealed bronchopneumonia. Frequent salbutamol inhalers were administered for treatment. Case was discharged home 2 days following hospitalization. COVID-19 may present with mild pneumonia in children or with an exacerbation of asthma in asthmatic children. Additional observations of clinical presentations of COVID-19 in children are recommended.

Coronavirus (COVID-19) Pandemic and Health Workers of an Ethnic Group-A Slant on a Shocking Report.

The coronavirus (COVID-19) pandemic is an unprecedented challenge to all health care professionals. I present a brief report on a shocking report, released recently in the UK on this matter.