1. 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
Sheikh Ragheb Harb Hospital ` Lebanese University
Faculty of Medical Sciences

2. Disclosure
Nothing to disclose

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

4. 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).

5. 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

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

7. 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. 

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

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

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

11. Lebanese Studies Period Study Title Location 1997-2001 April -May 2010
Corresp. Author
1 - Prevalence of infection by intestinal parasites in north Lebanon
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
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
AUBMC, Beirut
Ghassan Dbaibo
6 - Clinical and epidemiological characteristics of norovirus gastroenteritis among hospitalized children in Lebanon
2011 – 2013
AUBMC Beirut, Lebanon

12. 1,2
3,4,5,6
SAGE

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

15. 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

16. 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?

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

18. 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

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

20. Monthly distribution

21. Percentage of AGE admissions

22. Age group distribution
Age average: 2 years 5 months

23. Sex distribution

24. Percentage of BF > 1 month

25. Percentage of RV vaccination

26. II- Clinical data

27. Percentage of Enteropathogens

28. Enteropathogens / Age group

29. The Percentage of RV AGE in RV Vaccinated patients

30. Effect of rotavirus vaccination on different pathogens
OR: 0.3
CI:
[ ]
OR: 0.6 CI
[ ]

31. IS BF protective?
P < 0.05
P = 0.06

32. 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

33. Symptoms prevalence

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

36. 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%

37. 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

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

39. 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)

40. Contact hadifakih75@gmail.com
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