Etiology of Acute Gastroenteritis in Hospitalized Children?

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Presentation transcript:

Etiology of Acute Gastroenteritis in Hospitalized Children? Hadi Fakih, M.D. Associate Professor Pediatrics Department, Faculty of Medical Sciences, Lebanese University, Lebanon NICU division Director , Sheikh Ragheb Harb Hospital, Nabatieh, Lebanon hadifakih75@gmail.com Sheikh Ragheb Harb Hospital ` Lebanese University Faculty of Medical Sciences

Disclosure Nothing to disclose

Plan Definition & Classification Burden of AGE Middle east data Lebanese studies The SAGE 1 study Design Results Discussion Conclusion

Definition WHO 2012 Diarrhea is defined as the passage of three or more loose or watery stools per day (or more frequent passage of stool than is normal for the individual).

Classification WHO 2012 There are three clinical classifications of diarrheal conditions: Acute diarrhea, lasting several hours or days Acute bloody diarrhea or dysentery Persistent diarrhea, lasting 14 days or longer

The burden Parashar UD. JAMA. 2015 Annual hospitalization: 3-5/ 1000 US children <5 YO AGE: top 10 reasons for pediatric hospitalization nationwide.

The Burden BMJ 2007 Developing Countries: Diarrhea is a common cause of mortality among children younger than age 5 years, with an estimated 2 million deaths each year.

Mean overall proportion of rotavirus gastroenteritis by country BMC Infectious Diseases, 2011

Mortality due to rotavirus in the Middle East and North Africa by country BMC Infectious Diseases 2011

Lebanese data: Common Enteropathogens Naous, et al. N Am J Med Sci. 2013

Lebanese Studies Period Study Title Location 1997-2001 April -May 2010 Corresp. Author 1 - Prevalence of infection by intestinal parasites in north Lebanon 1997-2001 North Lebanon Hamze M 2 - First description of gastroenteritis viruses in Lebanese children: A pilot study April -May 2010 Tripoli (North Lebanon) Randa Meraabi Al-Ali 3 - Management of acute gastroenteritis in healthy children in Lebanon - A national survey 2010 Phone survey Aouni Alameddine 4 - Intestinal amebiasis: A concerning cause of acute gastroenteritis among hospitalized Lebanese children 2008-2012 Makassed Hospital Beirut Amal Naous Mariam Rajab 5 - Rotavirus genotypes and vaccine effectiveness from a sentinel, hospital-based, surveillance study for three consecutive rotavirus seasons in Lebanon 2011-2013 AUBMC, Beirut Ghassan Dbaibo 6 - Clinical and epidemiological characteristics of norovirus gastroenteritis among hospitalized children in Lebanon 2011 – 2013 AUBMC Beirut, Lebanon

1,2 3,4,5,6 SAGE

Official Study title Surveillance of Acute GastroEnteritis in Hospitalized Children in South-Lebanon ( SAGE study I )

SAGE study I Indications & Preconditions Wide variation in AGE management among providers and hospitals Laboratory investigation for viral, bacterial and parasitic agents is helpful for: Improving management of AGE Monitoring and controlling infections No Previous similar study in south Lebanon

Proposed Questions? Q1: Primary Outcome: Q2: Secondary Outcomes: What are the Common Pathogens causing hospitalization for AGE? Q2: Secondary Outcomes: Demographic data? Protective Factors? Burden of Hospitalization?

Study design Prospective cohort Hospital based Summer 2014 between July & September. Nabatieh district

Inclusion & Exclusion criteria Inclusion Criteria: Exclusion Criteria: Children hospitalized Dg: Acute gastroenteritis Rotavirus Diarrhea Diarrhea & vomiting < 7 days duration Malnutrition Chronic diarrhea Immunodeficiency Congenital malformations Syndromic patients

I- Demographic Data Total number enrolled: 198 patients Results Analysis I- Demographic Data Total number enrolled: 198 patients

Monthly distribution

Percentage of AGE admissions

Age group distribution Age average: 2 years 5 months

Sex distribution

Percentage of BF > 1 month

Percentage of RV vaccination

II- Clinical data

Percentage of Enteropathogens

Enteropathogens / Age group

The Percentage of RV AGE in RV Vaccinated patients

Effect of rotavirus vaccination on different pathogens OR: 0.3 CI: [0.08-1.3] OR: 0.6 CI [ 0.1-3.5]

IS BF protective? P < 0.05 P = 0.06

RV vaccination effect on LOS & Age P < 0.05 Vaccination status Age LOS RV/ Vaccinated 2Y10M 3.4 Days RV/ not Vaccinated 2Y5M 3.6 Days

Symptoms prevalence

Average of WBC counts and CRP level per enteropathogens Nl CRP< 10 mg/dl

Relevant Data AGE remains a major health burden 40% of hospital Pediatric load Routinely laboratory methods 56% of pathogens identified Entamoeba histolytica: 26% Rotavirus:19% Unidentified: 44%

Relevant Points: High Amaebiasis infestations  Contamination of water sources Low Rotavirus vaccination rate 43% RV vaccine protection: 81% BF protective Average LOS: 3.5 days (high) Age average: 2y5mo

Limitation Short Period Single center No bacterial detection Lack of universal bacterial culture medium Parasites identification: lab. Experience Vesicari score,missed

Ongoing & Future Studies Surveillance of acute gastroenteritis in Hospitalized children = SAGE II (recruiting) Epidemiological Status of Acute Gastroenteritis Among Hospitalized Children : A Prospective Study from the Lebanese Population (ESAGE-HCL) ( 2 years, PCR)

Contact hadifakih75@gmail.com Thank You Contact hadifakih75@gmail.com