Norwalk-like virus as a cause of diarrhea in a pediatric hospital

ObjectiveTo describe the role of Norwalk-like virus in pediatric diarrhea, since relatively little is known about it in this age group.MethodsWe reviewed all 77 hospitalized cases of diarrhea related to Norwalk-like virus at St Göran's Children's Hospital from 1987 to 1993. Electron microscopy of feces was used routinely, and performed at the former Central Microbiology Laboratory of the Stockholm County Council.ResultsForty-seven children (61%) had nosocomial diarrhea. Their median age was 9 months. Most nosocomial cases occurred singly or in small clusters during periods when there were also community-acquired cases. However, during the first half of 1992, there was a larger cluster of eight community-acquired and 19 nosocomial cases. Both vomiting and diarrhea were present in the majority of patients. The symptoms were typically mild, and only 14% needed intravenous fluids. Five of 17 children examined repeatedly excreted virus after the symptoms had subsided. We used detection of Norwalk-like virus in fecal samples as an indication of infectiousness and then observed no further nosocomial spread. There was a seasonal variation with a predilection for the winter months.ConclusionNorwalk-like virus should also be considered as a cause in cases of nosocomial diarrhea in young children

What can we learn from the past?—A pediatrician's view

When the tuberculosis epidemic reached its peak in central Europe in the 1900s (not until the 2000s in sub-Saharan Africa), both contained and disseminated tuberculosis was mainly regarded as a childhood disease. From 1920, before the use of the Bacillus Calmette–Guérin (BCG) vaccine and the possibility of drug treatment, there was a drastic decline in the rate of tuberculosis incidence in the Western world. In 1970, the case rate had declined in Sweden from 500/100,000 individuals to 1/100,000 individuals. We recently studied childhood tuberculosis in the Stockholm area from 1971 to 2015. During this period the case rate had increased from 1/100,000 individuals to 8/100,000 individuals. A major contributing factor has been increased immigration and, more recently, from high incidence countries. While there are very few cases in Swedish children whose parents are also born in Sweden, the case rate is still high in foreign-born children, for example, 450/100,000 foreign-born Somali children. At the beginning of the past 45 years, sentinel (infected in Sweden with no known source person) cases were a reality but they are rarely seen today. This may be attributed to better organization, contact tracing, screening, and early diagnosis in the adult population

Respiratory Viruses in Hospitalized Children with Influenza-Like Illness during the H1n1 2009 Pandemic in Sweden

<div><h3>Background</h3><p>The swine-origin influenza A(H1N1)pdm09 pandemic of 2009 had a slower spread in Europe than expected. The human rhinovirus (HRV) has been suggested to have delayed the pandemic through viral interference. The importance of co-infections over time during the pandemic and in terms of severity of the disease needs to be assessed.</p> <h3>Objective</h3><p>The aim of this study was to investigate respiratory viruses and specifically the presence of co-infections with influenza A(H1N1)pdm09 (H1N1) in hospitalized children during the H1N1 pandemic. A secondary aim was to investigate if co-infections were associated with severity of disease.</p> <h3>Methods</h3><p>A retrospective study was performed on 502 children with influenza-like illness admitted to inpatient care at a pediatric hospital in Stockholm, Sweden during the 6 months spanning the H1N1 pandemic in 2009. Respiratory samples were analyzed for a panel of 16 viruses by real-time polymerase chain reaction.</p> <h3>Results</h3><p>One or more viruses were detected in 61.6% of the samples. Of these, 85.4% were single infections and 14.6% co-infections (2–4 viruses). The number of co-infections increased throughout the study period. H1N1 was found in 83 (16.5%) children and of these 12 (14.5%) were co-infections. HRV and H1N1 circulated to a large extent at the same time and 6.0% of the H1N1-positive children were also positive for HRV. There was no correlation between co-infections and severity of disease in children with H1N1.</p> <h3>Conclusions</h3><p>Viral co-infections were relatively common in H1N1 infected hospitalized children and need to be considered when estimating morbidity attributed to H1N1. Population-based longitudinal studies with repeated sampling are needed to improve the understanding of the importance of co-infections and viral interference.</p> </div

Severity of disease and underlying conditions in children admitted with influenza-like illness.

a<p>Renal, metabolic and gastrointestinal diseases.</p>b<p>Including gastroenteritis, ileus, metabolic acidosis, myocarditis, renal failure, encephalitis, viral meningitis and myositis.</p

Prevalence over time.

<p>Total number of detected viruses among children with influenza-like illness at Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm during the influenza A(H1N1)pdm09 pandemic. Included is also the number of PCR-negative children (neg, n = 193) as well as total number of sampled children (n = 502).</p

Distribution of virus in H1N1-positive and H1N1-negative samples.

<p>Distribution of virus in H1N1-positive and H1N1-negative samples.</p

Viral co-detection among PCR-positive samples.

a<p>Number in brackets representing percentage of total children (n = 502).</p>b<p>Triple and quadruple infections counted as multiple double infections.</p

Co-infections over time.

<p>Number of children with co-infections over time in (a) all children and (b) H1N1-positive children. H1N1-positive co-infected children divided into co-infection with HRV (H1N1/HRV) and co-infection with other viruses (H1N1/other).</p