To the Editor:
Viral gastroenteritis is caused by many pathogens, each with unique characteristics requiring different laboratory test for identification1,2. In our country several groups emphasizes the role of the viral gastroenteritis in children3-4. Similar studies have been done in the european countries5-7, Asia8, America9 and Oceania10.
In relation to these contributions and since we are geographically related and have a similar context we could like to point out three aspects: first, to bring forward or 16 years of experience in systematic detection of Rotavirus in children; second, to show our findings in detecting other virus causing gastroenteritis (Adenovirus and Astrovirus) and finally, to mark that both Rotavirus infection and that caused by the aforementioned virus are reported to National Epidemiological Surveillance System.
Since 1986 we systematically search for Rotavirus in fecal samples from children under seven years. At that time Rotavirus antigen detection by means of a latex technique (Rotalex, Orion Diagnostica, Spoo, Finland) was incorporated to our routine. Two years later, in 1988, we added Adenovirus antigen detection using a double latex technique (Diarlex, Orion Diagnostica, Spoo, Finland) which replaced the former one as it could detect both virus at the same time. All positive samples were confirmed by a different method, beging this, one step Immunochromatographic assay for Rotavirus (Simple RTV, Operon, Zaragoza, Spain) and a different latex specific for Adenovirus (Adenolex, Orion Diagnostica, Spoo, Finland). This diagnostic algorithm was maintained during the period 1988-1996. From 1997 on all samples that turned out to be negative for Rotavirus or Adenovirus that had liquid or semiliquid consistence were also processed by an ELISA for Astrovirus (IDEIA Astrovirus, Dako Diagnostics, Ely, UK).
Globally were we have studied 7865 fecal specimens searching for Rotavirus and in 6989 of them the presence of Adenovirus antigen was also investigated. The prevalences found were 7.2% (CI 95% 6.54-7.71) for rotavirus; 1.8% (CI 95% 1.51-2.17) for Adenovirus and 3.4% (CI 95% 1.39-5.28) for Astrovirus. These findings reveal that search for diarrhea virus for which commercial techniques of easy application are already available offers good profit in health care practice5-11. Rotavirus, despite the bias that could be committed by showing data from the diagnosis routine of a hospital laboratory, remain the most important viral agent in terms of frequency, and its global prevalence falls within those reported in several national series of the last two decades12, 13. Since the last eighties we also look for Adenovirus and our group has been able to report from the very start of latex agglutination techniques incorporation to our routine, the excellent accordance between these and Electron Microscopy14, not pleading for the incorporation of the latter to medical attendance routine.
Our results of the detection of these agents as well as those from other Spanish laboratories are systematically recorded in a National Epidemiological Surveillance System15.
In our opinion in the context of documenting viral gastroenteritis two challenges are posed, on the one hand to contribute to specify the clinical significance of diarrhea virus findings in fecal samples, and on the other hand, to optimize systems of case declaration and notification, principally making the most of the great impulse given to diagnosis technology, due to the recent enlargement of the spectrum of agents detected, such as Astrovirus.
1.- Koopman JS, Monto AS, Longini IM Jr. The Tecumseh study. XVI: Family and coomunity sources of rotavirus infection. Am J Epidemiol 1989; 130: 760-768.
2.- Vinje J, Koopmans MPG. Moleular detection and epidemiology of small round structured viruses in outbreaks of gastroenteritis in the Netherlands. J Infect Dis 1996; 174: 610-615.
3.- Cilla G, Pérez-Trallero E, Piñeiro LD, Iturzaeta A, Vicente D. Hospitalizations for Rotavirus gastroenteritis in Guipuzkoa (Basque Country), Spain. Emerg Infect Dis 1999; 5: 834-835.
4.- Román E, Negredo A, Dalton RM, Wihelmi I, Sánchez-Fauquier A. Molecular detection of human calicivirus among Spanish children with acute gastroenteritis. J Clin Microbiol 2002; 40: 3857-3959.
5.- Bon F, Fascia P, Dauvergne M, Tenenbaum D, Planson H, Petion AM et al. Prevalence of group rotavirus, human calicivirus, astrovirus, and adenovirus type 40 and 41 infections among children with acute gastroenteritis in Dijon, France. J Clin Microbiol 1999; 37: 3055-3058
6.- Wheeler JG, Sethi D, Cowden JM, Wall PG, Rodrigues LC, Tompkins DS et al. Study of infectious intestinal disease in England: rates in the community, presenting to general practice, and reported to national surveillance. The Infectious Intestinal Disease Study Executive. BMJ 1999; 318:1046-1050.
7.- Lopman B, Vennema H, Kohli E, Pothier P, Sánchez-Fauquier A, Negredo A et al. Increase in viral gastroenteritis outbreaks in Europe and epidemic spread of a new norovirus variant. Lancet 2004; 363: 682-688.
8.- Hansman GS, Koramitsu M, Yoshida H, Katayama K, Takeda N, Ushijima H et al. Viral gastroenteritis in Mongolian infants. Emerg Infect Dis 2005; 11: 180-182.
9.- Noyola DE, Herrera IF. Rotavirus epidemiology in San Luis Potosi, Mexico. Pediatr Infect Dis J 2005; 24: 646-648.
10.- Webb A, Starr M. Acute gastroenteritis in children. Aust Fam Physician 2005; 34: 227-231.
11.- Brandt CD, Kim HW, Rodríguez WJ, Arrobio JO, Jeffries BC, Stallings EP et al. Pediatric viral gastroenteritis during eight years of study. J Clin Microbiol 1983; 18: 71-78.
12.- De la Loma Danilova A, Sánchez-Fauquier A, Carrasco Gandía S, Herrera Calvet I. Virus en síndromes diarreicos agudos en la infancia. Inmunológica 1982; 4: 203-209.
13.- Rabella N, Maragall N, Concom MJ, Carbó LL. Estudio de la incidencia de Rotavirus por microscopía electrónica. Comparación de los rsultados con las pruebas de enzimoinmunoensayo y látex. Enf Infecc Microbiol Clin 1987; 5: 17-19.
14.- Ortiz de Lejarazu R, Reguera Useros JI, Eiros Bouza JM, Rodríguez Torres A. Detección de Adenovirus en heces mediante látex y comprobación mediante microscopía electrónica. Enf Infecc Microbiol Clin 1990; 8: 468-469.
15.- http:// www.isciii.es/cne [visitado el 19 de julio de 2005]
Correspondence: JM Eiros Bouza. Microbiología. Sexta Planta. Facultad de Medicina. Avda Ramón y Cajal, 7. 47005 Valladolid. Phone: + 34 983 423063. Fax + 34 983 423022. Email: eiros @ med.uva.es
Received July 28, 2005.
Published July 31, 2005.