Vaginal delivery linked to sapovirus-related acute gastroenteritis in early childhood

Sapovirus is a common aetiology of acute gastroenteritis (AGE), suggests a study in a Central American setting. Symptoms are akin to AGE associated with other aetiologies.

Moreover, the “association between vaginal delivery and sapovirus is a novel finding,” the investigators said. “Gut microbiome composition might mediate this relationship, or vaginal delivery might be a proxy for other risk factors.”

A case-control study nested within a birth cohort (n=444) was conducted to identify risk factors and characterize the clinical profile of sapovirus AGE in a birth cohort in León, Nicaragua. Fieldworkers carried out weekly household AGE surveillance. AGE stools were tested for sapovirus using reverse transcriptase quantitative polymerase chain reaction.

The investigators selected two health age-matched controls for each first sapovirus episode and estimated independent risk factors of sapovirus AGE using conditional logistic regression. Clinical characteristics of sapovirus AGE episodes were compared with those associated with other aetiologies. Finally, co-infections were identified with other enteric pathogens.

Sixty-three first sapovirus AGE episodes were identified from June 2017 to July 2019 and were matched with 126 controls. Having contact with an individual with AGE symptoms and vaginal delivery were independently associated with sapovirus AGE.

All patients had diarrhoea, lasting a median 6 days, while 23 percent experienced vomiting. Sapovirus AGE was similar in severity, with less reported fever, when compared to children with AGE due to other aetiologies. Most patients had co-infections and were more likely to be infected with diarrhoeagenic Escherichia coli or astrovirus than controls.

“Further investigation into more specific biological mechanisms is warranted,” the investigators said.