Clinical Profiles of Childhood Astrovirus-, Sapovirus-, and Norovirus-Associated Acute Gastroenteritis in Pediatric Emergency Departments in Alberta, 2014-2018.

BACKGROUND Infections by previously under-diagnosed viruses astrovirus and sapovirus are poorly characterized compared to norovirus, the most common cause of acute gastroenteritis. METHODS Children <18-years-old with acute gastroenteritis were recruited from pediatric emergency departments in Alberta, Canada, 2014-2018. We described and compared the clinical course of acute gastroenteritis in children with astrovirus, sapovirus, and norovirus. RESULTS Astrovirus was detected in 56/2,688 children (2.1%), sapovirus in 146/2,688 (5.4%), and norovirus in 486/2,688 (18.1%). At illness onset, ~60% of astrovirus cases experienced each of diarrhea and vomiting. Among sapovirus and norovirus cases, 35% experienced diarrhea at onset and 80%/91% (sapovirus/norovirus) vomited; however, diarrhea became more prevalent than vomiting around day 4 of illness. Over the full course of illness, diarrhea was 18% (95% CI 8%, 29%) more prevalent among children with astrovirus than norovirus infections, as well as longer with greater maximal events; there were median 4.0 fewer maximal vomiting events (95% CI 2.0, 5.0). Vomiting continued median 24.8 hours longer (95% CI 9.6, 31.7) among children with sapovirus vs. norovirus. Differences between these viruses were otherwise minimal. CONCLUSION Sapovirus infections attended in the emergency department are more similar to norovirus than previously reported, while astrovirus infections have several distinguishable characteristics.