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Epidemiol Infect. 2009 Jul;137(7):922-31. doi: 10.1017/S0950268808001556. Epub 2008 Nov 19.

Structured surveillance of infectious intestinal disease in pre-school children in the community: 'The Nappy Study'.

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Enteric Virus Unit, Health Protection Agency Centre for Infections, London, UK.


The incidence and causes of infectious intestinal disease (IID) in children aged <5 years presenting to general practitioners (GPs) were estimated. During a 12-month period, soiled nappies were collected from children presenting with symptoms suggestive of IID in a network of 65 GPs located across England. Molecular methods were used to detect a range of enteric pathogens including viruses, bacteria and parasites. Genotyping was performed on rotavirus and norovirus isolates. A total of 583 nappies were collected from 554 children; a pathogen was detected in 361 (62%) specimens. In the 43 practices 1584 new episodes of IID were recorded in a population averaging 19774; the specimen capture rate was 28%. IID incidence peaked during March and April. Norovirus (24.5%), rotavirus (19.0%) and sapovirus (12.7%) were most commonly detected, and mixed infections were detected in 11.7% of cases. Strain characterization revealed G1P[8] (65.8%), G4P[4] (8.1%) and G9P[8] (8.1%) as the most common rotavirus genotypes, similar to the UK national distribution. GII-3 (42.9%) and GII-4 (39.7%) were the most common norovirus genotypes; this was significantly different (P<0.005) to the national distribution.

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