DOI QR코드

DOI QR Code

Causes of acute gastroenteritis in Korean children between 2004 and 2019

  • Ryoo, Eell (Department of Pediatrics, Gachon University Gil Medical Center)
  • Received : 2020.07.17
  • Accepted : 2020.08.31
  • Published : 2021.06.15

Abstract

Since the 2000s, the major causes of acute gastroenteritis in children in Korea have been identified by classifying the pathogens into viruses, bacteria, and protozoa. For viruses, the detection rate is 20%-30%, and norovirus is being increasingly detected to account for the majority of viral gastroenteritis cases. In addition, despite the dissemination of the rotavirus vaccine, many rotavirus infections persist, and its seasonal distribution is changing. The detection rate of bacterial pathogens is 3%-20%, with Escherichia coli and Salmonella spp. infections being the most common, while the incidences of Bacillus cereus and Campylobacter spp. infections are gradually increasing. Owing to intermittent outbreaks of gastroenteritis caused by individual bacteria as well as the inflow of causative bacteria, such as E. coli, Vibrio spp., and Campylobacter spp., from overseas, continuous surveillance of and research into the characteristics and serotypes of each bacterium are needed.

Keywords

References

  1. Kotloff KL. Acute gastroenteritis in children. In: Kliegman R, Stanton B, St. Geme JW, Schor NF, Behrman RE, Nelson WE, editors. Nelson textbook of pediatrics. 20th ed. Philadelphia (PA): Elsevier Health Sciences, 2019:2012-33.
  2. Levels and trends in child mortality report 2019. Estimates developed by the UN Inter-agency Group for Child Mortality Estimation [Internet]. Geneva (Switzerland): World Health Organization; c2021 [cited 2020 Jul 3]. Available from: https://www.who.int/maternal_child_adolescent/documents/levels_trends_child_mortality_2019/en/.
  3. Korea National Institute of Health. Laboratory prevalence of norovirus infections in Korea and sensitive monitoring system for norovirus related outbreak combined automated diagnostic process and web-based reporting. Public Health Wkly Rep, KCDC 2009;2:229-32.
  4. Korea National Institute of Health. Current status of selected infectious diseases. Public Health Wkly Rep, PHWR 2008;1:11.
  5. Korea National Institute of Health. The analysis on the prevalence status and characteristics of bacterial pathogens causing acute diarrhea in Korea, 2007. Public Health Wkly Rep, KCDC 2008;1:116-22.
  6. Korea National Institute of Health. Weekly status of acute diarrheal disease-causing virus and bacteria. Weekly sentinel surveillance report. Cheongwon (Korea): Korea Centers for Disease Control and Prevention, 2009;1(52).
  7. Jeong HJ, Hwang BM, Lee DY, Kwak HS. Laboratory surveillance of viral acute gastroenteritis in Korea, 2015. Public Health Wkly Rep, KCDC 2017;10:498-503.
  8. Korea National Institute of Health. Statistics of selected infectious diseases. Public Health Wkly Rep, PHWR 2020;13:1697.
  9. Banyai K, Estes MK, Martella V, Parashar UD. Viral gastroenteritis. Lancet 2018;392:175-86. https://doi.org/10.1016/S0140-6736(18)31128-0
  10. Korea National Institute of Health. Acute gastroenteritis causing viruses and bacteria, Republic of Korea. Public Health Wkly Rep, PHWR 2020; 13:1-59.
  11. Park SH, Kim EJ, Oh SA, Kim CK, Choi SS, Cho SJ, et al. Viral agents associated with acute gastroenteritis in Seoul, Korea. Clin Lab 2011;57: 59-65.
  12. Cho SR, Chae SJ, Lee DY, Choi W. Pathogen Surveillance of acute viral gastroenteritis in Korea, 2018. Public Health Wkly Rep, PHWR 2020; 13:201-7.
  13. Lee DH, Kweon DH, Park KS, Park SJ, Hwang KJ, Yu JI, et al. Weekly status of acute diarrheal disease-causing virus and bacteria. Weekly sentinel surveillance report. Cheongwon (Korea): Korea Centers for Disease Control and Prevention, 2019;1(52).
  14. Park O, Kim YA, Seo SY, Lee YH, Kim MY, Park SJ, et al. Weekly status of acute diarrheal disease-causing virus and bacteria. Weekly sentinel surveillance report. Cheongwon (Korea): Korea Centers for Disease Control and Prevention, 2018;1(52).
  15. Yu JI, Kang BH, Hong SH, Hong MU, Choi WY, Lee DY, et al. Weekly status of acute diarrheal disease-causing virus and bacteria pathogens & vector surveillance weekly report. Cheongwon (Korea): Korea Centers for Disease Control and Prevention, 2017;1(52).
  16. Korea National Institute of Health. Acute diarrheal disease-causing virus and bacteria detection status. Weekly sentinel surveillance report. Cheongwon (Korea): Korea Centers for Disease Control and Prevention, 2016;1(53).
  17. Korea National Institute of Health. Weekly status of acute diarrheal disease-causing virus and bacteria. Weekly sentinel surveillance report. Cheongwon (Korea): Korea Centers for Disease Control and Prevention, 2015;1(52).
  18. Korea National Institute of Health. Weekly status of acute diarrheal disease-causing virus and bacteria. Weekly sentinel surveillance report. Cheongwon (Korea): Korea Centers for Disease Control and Prevention, 2014;1(52).
  19. Korea National Institute of Health. Weekly status of acute diarrheal disease-causing virus and bacteria. Weekly sentinel surveillance report. Cheongwon (Korea): Korea Centers for Disease Control and Prevention, 2013;1(52).
  20. Korea National Institute of Health. Weekly status of acute diarrheal disease-causing virus and bacteria. Weekly sentinel surveillance report. Cheongwon (Korea): Korea Centers for Disease Control and Prevention, 2012.
  21. Korea National Institute of Health. Weekly status of acute diarrheal disease-causing virus and bacteria. Weekly sentinel surveillance report. Cheongwon (Korea): Korea Centers for Disease Control and Prevention, 2011;1(53).
  22. Korea National Institute of Health. Weekly status of acute diarrheal disease-causing virus and bacteria. Weekly sentinel surveillance report. Cheongwon (Korea): Korea Centers for Disease Control and Prevention, 2010;1(52).
  23. Lee HS, Kim DY, Kim JA, Choi SH. The Epidemiological trend of rotavirus gastroenteritis in children in a single center from 2004 to 2012: a retrospective study. Korean J Pediatr Infect Dis 2014;21:181-90. https://doi.org/10.14776/kjpid.2014.21.3.181
  24. Sohn TY, Lee CJ, Kim YJ, Kang MJ, Kim SH, Lee SY, et al. Clinical and epidemiological study of 1,165 hospitalized cases of rotaviral gastroenteritis before and after the introduction of rotavirus vaccine, 2006-2013. Korean J Pediatr Infect Dis 2014;21:174-80. https://doi.org/10.14776/kjpid.2014.21.3.174
  25. Sung K, Kim JY, Lee YJ, Hwang EH, Park JH. High incidence of Staphylococcus aureus and norovirus gastroenteritis in infancy: a single-center, 1-year experience. Pediatr Gastroenterol Hepatol Nutr 2014;17:140-6. https://doi.org/10.5223/pghn.2014.17.3.140
  26. Kim A, Chang JY, Shin S, Yi H, Moon JS, Ko JS, et al. Epidemiology and factors related to clinical severity of acute gastroenteritis in hospitalized children after the introduction of rotavirus vaccination. J Korean Med Sci 2017;32:465-74. https://doi.org/10.3346/jkms.2017.32.3.465
  27. Kim BH, Kim TH, Lee MK. A clinico-epidemiological comparison study of pediatric acute viral gastroenteritis at a tertiary care hospital. Ann Clin Microbiol 2016;19:33-8. https://doi.org/10.5145/ACM.2016.19.2.33
  28. Jin HI, Lee YM, Choi YJ, Jeong SJ. Recent viral pathogen in acute gastroenteritis: a retrospective study at a tertiary hospital for 1 year. Korean J Pediatr 2016;59:120-5. https://doi.org/10.3345/kjp.2016.59.3.120
  29. Clark B, McKendrick M. A review of viral gastroenteritis. Curr Opin Infect Dis 2004;17:461-9. https://doi.org/10.1097/00001432-200410000-00011
  30. Karst SM, Baric RS. What is the reservoir of emergent human norovirus strains? J Virol 2015;89:5756-9. https://doi.org/10.1128/JVI.03063-14
  31. Korea National Institute of Health. Norovirus outbreak in Cheorwon, Feb. 2008. Public Health Wkly Rep, KCDC 2008;1:10.
  32. Korea National Institute of Health. Water & foodborne diseases outbreaks in Korea, 2008. Public Health Wkly Rep, KCDC 2009;2:584-90.
  33. Korea National Institute of Health. Water and foodborne disease outbreaks in Korea, 2007-2009. Public Health Wkly Rep, KCDC 2010;3:428-32.
  34. Korea National Institute of Health. Laboratory surveillance of viral acute gastroenteritidis, 2005-2008. Public Health Wkly Rep, KCDC 2010;3: 90-2.
  35. Jeong HJ, Lee DY. Laboratory surveillance of viral acute gastroenteritis in Korea, 2012. Public Health Wkly Rep, KCDC 2013;6:925-30.
  36. Yoon JS, Lee SG, Hong SK, Lee SA, Jheong WH, Oh SS, et al. Molecular epidemiology of norovirus infections in children with acute gastroenteritis in South Korea in November 2005 through November 2006. J Clin Microbiol 2008;46:1474-7. https://doi.org/10.1128/JCM.02282-07
  37. Park K, Yeo S, Jeong H, Baek K, Kim D, Shin M, et al. Updates on the genetic variations of norovirus in sporadic gastroenteritis in Chungnam Korea, 2009-2010. Virol J 2012;9:29. https://doi.org/10.1186/1743-422X-9-29
  38. Park S, Jung J, Oh S, Jung H, Oh Y, Cho S, et al. Characterization of norovirus infections in Seoul, Korea. Microbiol Immunol 2012;56:700-7. https://doi.org/10.1111/j.1348-0421.2012.00494.x
  39. Chung JY, Han TH, Park SH, Kim SW, Hwang ES. Detection of GII-4/2006b variant and recombinant noroviruses in children with acute gastroenteritis, South Korea. J Med Virol 2010;82:146-52. https://doi.org/10.1002/jmv.21650
  40. Park KS, Jeong HS, Baek KA, Lee CG, Park SM, Park JS, et al. Genetic analysis of norovirus GII.4 variants circulating in Korea in 2008. Arch Virol 2010;155:635-41. https://doi.org/10.1007/s00705-010-0627-y
  41. Le VP, Jung YC, Kang KS, Lim I, Myung SC, Kim W. Genetic characterization of norovirus GII.4 2006b variants from Jeju island, South Korea. J Med Virol 2010;82:1065-70. https://doi.org/10.1002/jmv.21761
  42. Han TH, Kim CH, Chung JY, Park SH, Hwang ES. Emergence of norovirus GII-4/2008 variant and recombinant strains in Seoul, Korea. Arch Virol 2011;156:323-9. https://doi.org/10.1007/s00705-010-0844-4
  43. Korea Centers for Disease Control and Prevention. Intestinal infection. Weekly sentinel surveillance report. Cheongwon (Korea): Korea Centers for Disease Control and Prevention, 2020;1:13-9.
  44. Doro R, Farkas SL, Martella V, Banyai K. Zoonotic transmission of rotavirus: surveillance and control. Expert Rev Anti Infect Ther 2015;13: 1337-50. https://doi.org/10.1586/14787210.2015.1089171
  45. Korea National Institute of Health. Molecular epidemiology of group A rotavirus infection in Korea. Public Health Wkly Rep, KCDC 2008;1: 325-8.
  46. Park S, Oh S, Lee J, Park G, Choi S, Chae Y, et al. Genotypes of rotavirus associated with acute gastroenteritis in Seoul, Korea. Microbiol Immunol 2011;55:641-4. https://doi.org/10.1111/j.1348-0421.2011.00366.x
  47. Chung JY, Kim MS, Jung TW, Kim SJ, Kang JH, Han SB, et al. Detection of rotavirus genotypes in Korea 5 years after the introduction of rotavirus vaccines. J Korean Med Sci 2015;30:1471-5. https://doi.org/10.3346/jkms.2015.30.10.1471
  48. Shim JO, Son DW, Shim SY, Ryoo E, Kim W, Jung YC. Clinical characteristics and genotypes of rotaviruses in a neonatal intensive care unit. Pediatr Neonatol 2012;53:18-23. https://doi.org/10.1016/j.pedneo.2011.11.005
  49. Yoon JM, Han TH, Yoon SW, Kim YJ, Oh SH. Changes in the occurrence of rotavirus gastroenteritis before and after the introduction of rotavirus vaccine among hospitalized pediatric patients and estimates of rotavirus vaccine effectiveness. Pediatr Infect Vaccine 2018;25:26-34. https://doi.org/10.14776/piv.2018.25.1.26
  50. Kim JS, Lee SK, Ko DH, Hyun J, Kim HS, Song W, et al. Associations of adenovirus genotypes in Korean acute gastroenteritis patients with respiratory symptoms and intussusception. Biomed Res Int 2017;2017:1602054. https://doi.org/10.1155/2017/1602054
  51. Lee JI, Lee GC, Chung JY, Han TH, Lee YK, Kim MS, et al. Detection and molecular characterization of adenoviruses in Korean children hospitalized with acute gastroenteritis. Microbiol Immunol 2012;56:523-8. https://doi.org/10.1111/j.1348-0421.2012.00469.x
  52. Bosch A, Pinto RM, Guix S. Human astroviruses. Clin Microbiol Rev 2014;27:1048-74. https://doi.org/10.1128/CMR.00013-14
  53. Kim JS, Lee WJ, Lee SK, Lee EJ, Hyun J, Kim HS, et al. Molecular epidemiology of human astrovirus in stool samples from patients with acute gastroenteritis in Korea, 2013-2017. Ann Lab Med 2019;39:367-72. https://doi.org/10.3343/alm.2019.39.4.367
  54. Ham H, Oh S, Jang J, Jo S, Choi S, Pak S. Prevalence of human astrovirus in patients with acute gastroenteritis. Ann Lab Med 2014;34:145-7. https://doi.org/10.3343/alm.2014.34.2.145
  55. Jeong HS, Jeong A, Cheon DS. Epidemiology of astrovirus infection in children. Clin Exp Pediatr 2012;55:77-82. https://doi.org/10.3345/kjp.2012.55.3.77
  56. Moreno-Espinosa S, Farkas T, Jiang X. Human caliciviruses and pediatric gastroenteritis. Semin Pediatr Infect Dis 2004;15:237-45. https://doi.org/10.1053/j.spid.2004.07.004
  57. Kim S. Prevalence of human bocavirus 1 among people without gastroenteritis symptoms in South Korea between 2008 and 2010. Arch Virol 2014;159:2741-4. https://doi.org/10.1007/s00705-014-2125-0
  58. Park S, Oh S, Cho S, Lee J, Ryu S, Song M, et al. Genetic characterization of sapovirus detected in hospitalized children with acute gastroenteritis in Korea. Clin Lab 2012;58:1219-24.
  59. Han TH, Kim CH, Chung JY, Park SH, Hwang ES. Klassevirus infection in children, South Korea. Emerg Infect Dis 2010;16:1623-5. https://doi.org/10.3201/eid1610.100539
  60. Korea Centers for Disease Control and Prevention. Pathogens and vector surveillance weekly report, PVSWR 1st week. Cheongwon (Korea): Korea Centers for Disease Control and Prevention, 2020
  61. Kim NO, Hong S, Kwak HS. Prevalence and characteristics of bacteria causing acute diarrhea in Korea, 2012-2015. Public Health Wkly Rep, KCDC 2016;9:922-8.
  62. Jung SM, Kim NO, Na HY, Hong SH, Chung GT. Prevalence of Campylobacter causing acute diarrhea in Korea, 2012-2015. Public Health Wkly Rep 2016;9:526-30.
  63. Le Loir Y, Baron F, Gautier M. Staphylococcus aureus and food poisoning. Genet Mol Res 2003;2:63-76.
  64. Shin EH, Eun BW, An YM, Song MO. Characteristics and clinical correlations of Staphylococcus aureus discovered in stools from children hospitalized at a secondary hospital. Pediatr Infect Vaccine 2018;25:61-71. https://doi.org/10.14776/piv.2018.25.e1
  65. Kim SY, Kim HJ, Shin EH, Eun BW, Ahn YM, Song MO. Etiology and clinical features of acute bacterial gastroenteritis in children mananged at a secondary hospital. Pediatr Infect Vaccine 2017;24:95-101. https://doi.org/10.14776/piv.2017.24.2.95
  66. Kim Y, Kim HJ, Lim S, Bae KS, Han SB, Jeong DC, et al. Community-acquired Escherichia coli enteritis in Korean children: the clinical application of a stool polymerase chain reaction assay. Infect Chemother 2017; 49:275-81. https://doi.org/10.3947/ic.2017.49.4.275
  67. Kang BH, Kwak HS. 2015 Annual report on Salmonella spp. laboratory surveillance in the Republic of Korea. Public Health Wkly Rep, KCDC 2017;10:693-9.
  68. Park HK, Rhie K, Yeom JS, Park JS, Park ES, Seo JH, et al. Differences in clinical and laboratory findings between group D and non-group D nontyphoidal Salmonella gastroenteritis in children. Pediatr Gastroenterol Hepatol Nutr 2015;18:85-93. https://doi.org/10.5223/pghn.2015.18.2.85
  69. Feodoroff B, Lauhio A, Ellstrom P, Rautelin H. A nationwide study of Campylobacter jejuni and Campylobacter coli bacteremia in Finland over a 10-year period, 1998-2007, with special reference to clinical characteristics and antimicrobial susceptibility. Clin Infect Dis 2011;53:e99-106. https://doi.org/10.1093/cid/cir509
  70. Korea National Institute of Health. Prevalence, contaminant and prevention of food-borne disease by Campylobacter spp. in Korea. Public Health Wkly Rep, KCDC 2010;3:511-6.
  71. Park SH, Kim BJ, Kwon YH, Hwang IY, Sung GH, Park EH, et al. Antimicrobial susceptibility and genetic analysis of Campylobacter jejuni isolated from diarrhea patients in Busan. Ann Clin Microbiol 2019;22:42-9. https://doi.org/10.5145/acm.2019.22.2.42
  72. Jang WT, Jo NH, Song MO, Eun BW, Ahn YM. Campylobacter Enteritis: clinical features and laboratory findings in children treated at a single hospital. Pediatr Infect Vaccine 2019;26:22-31. https://doi.org/10.14776/piv.2019.26.e3
  73. Korea Ministry of Food and Drug Safety. Food poisoning. Cheongju (Korea): Korea Ministry of Food and Drug Safety, 2019.
  74. Jung SM, Hong S, Kang BH, Kim JO. Genetic analysis of Campylobacter jejuni isolates from diarrheal patients in South Korea (Jan. 2012-Feb. 2017). Public Health Wkly Rep, KCDC 2018;11:280-5.
  75. Lindstrom M, Heikinheimo A, Lahti P, Korkeala H. Novel insights into the epidemiology of Clostridium perfringens type A food poisoning. Food Microbiol 2011;28:192-8. https://doi.org/10.1016/j.fm.2010.03.020
  76. Miyamoto K, Li J, McClane BA. Enterotoxigenic Clostridium perfringens: detection and identification. Microbes Environ 2012;27:343-9. https://doi.org/10.1264/jsme2.ME12002
  77. Collie RE, McClane BA. Evidence that the enterotoxin gene can be episomal in Clostridium perfringens isolates associated with non-food-borne human gastrointestinal diseases. J Clin Microbiol 1998;36:30-6. https://doi.org/10.1128/JCM.36.1.30-36.1998
  78. Li J, McClane BA. Further comparison of temperature effects on growth and survival of Clostridium perfringens type A isolates carrying a chromosomal or plasmid-borne enterotoxin gene. Appl Environ Microbiol 2006; 72:4561-8. https://doi.org/10.1128/AEM.00177-06
  79. Jung SM, Hong SH, Kwak HS. Genetic analysis of cpe-carrying Clostridium perfringens strains isolated in Korea. Public Health Wkly Rep, KCDC 2016;9:627-31.
  80. Korea National Institute of Health. Surveillance and toxin profile of emetic toxin producing Bacillus cereus in Korea. Public Health Wkly Rep, KCDC 2010;3:189-92.
  81. Jung SM, Kim NO, Hong SH, Kang BH, Kwak HS. The prevalence and characteristics of Bacillus cereus in Korea, 2012-2015. Public Health Wkly Rep, KCDC 2017;10:179-84.
  82. Korea National Institute of Health. Shigellosis in winter. Public Health Wkly Rep, KCDC 2008;1:625.
  83. Kim NO, Hong S, Chun JH, Hwang KJ. Laboratory-based surveillance of water- and food-borne infectious disease-causing bacteria in the Republic of Korea, 2016-2018. Public Health Wkly Rep, KCDC 2019;12:898-903.
  84. Na HY, Hong SH, Kwak HS. Genetic diversity of Vibiro parahaemolyticus strains isolated in Korea. Public Health Wkly Rep, KCDC 2016;9:712-5.
  85. Kim KM, Na KI, Cho EH. Case reports and antibody confirmation of Yersinia pseudotuberculosis. Public Health Wkly Rep, KCDC 2017;10: 1292-7.
  86. Jeon HI. Prevalence and mixed infection of diarrheal outpatients with gastrointestinal protozoa, bacteria and viruses. Public Health Wkly Rep, KCDC 2011;4:37-43.
  87. Ma DW, Ju JW, Cho SH. Current status of surveillance of protozoa infection, 2015-2018. Public Health Wkly Rep, PHWR 2019;12:1202-2111.
  88. Lee SE, Park MY. Prevalence of enteric protozoan infection among diarrheal patients in Korea, 2013. Public Health Wkly Rep, PHWR 2015;8: 145-9.
  89. Jeon HI. Prevalence of infection of diarrheal outpatients with gastrointestinal protozoa in Korea. Public Health Wkly Rep, KCDC 2012;5:88-9.
  90. Lee SE. Prevalence of enteric protozoan infection in Korea, 2012. Public Health Wkly Rep, KCDC 2013;6:509-12.
  91. Sim S, Won J, Kim JW, Kim K, Park WY, Yu JR. Simultaneous molecular detection of Cryptosporidium and Cyclospora from raw vegetables in Korea. Korean J Parasitol 2017;55:137-42. https://doi.org/10.3347/kjp.2017.55.2.137
  92. Ma DW, Lee MR, Hong SH, Cho SH, Lee SE. Molecular prevalence and genotypes of Cryptosporidium parvum and Giardia duodenalis in patients with acute diarrhea in Korea, 2013-2016. Korean J Parasitol 2019;57: 531-6. https://doi.org/10.3347/kjp.2019.57.5.531
  93. Cheun HI, Kim K, Yoon S, Lee WJ, Park WY, Sim S, et al. Cryptosporidium hominis infection diagnosed by real-time PCR-RFLP. Korean J Parasitol 2013;51:353-5. https://doi.org/10.3347/kjp.2013.51.3.353
  94. Nam JK. Prevalence and characteristic of enteric bacterial pathogens isolated from foreign traveler's diarrhea in Korea, 2011. Public Health Wkly Rep, KCDC 2012;5:504-10.
  95. Choi ES. Prevalence of enteric bacterial pathogens isolated from foreign traveler's diarrhea, January 1-June 30, 2013. Public Health Wkly Rep, KCDC 2013;6:801-5.
  96. Na HY, Kim NO, Hong SH, Kang BH, Kwak HS, Nam JK, et al. Prevalence of enteric bacterial pathogens isolated from overseas travelassociated cases, 2014-2016. Public Health Wkly Rep, KCDC 2017;10:660-5.
  97. Park HM, Lee DY. Prevalence and characteristics of Salmonella spp. in Korea, 2011. Public Health Wkly Rep, KCDC 2012;5:461-6.
  98. Korea National Institute of Health. Case report about first isolation of imported Salmonella Wandsworth in Korea. Public Health Wkly Rep, KCDC 2011;4:790-2.
  99. Lee EJ. The first case of Salmonella Hvittingfoss isolation during Quarantine procedure in Republic of Korea. Public Health Wkly Rep, KCDC 2016;9:50-3.
  100. Kim HS, Ryu KH, Kim JY, Jeong KT, Yu CK. A case report foreign travel-associated plesiomonas shigelloides infection. Public Health Wkly Rep, KCDC 2015;8:886-8.