Diarrheal pathogens in children under five: a cross-sectional study from Children's Hospital 1, Vietnam.

BACKGROUND

Acute diarrhea remains a major cause of mortality in children under five, with over 40 known enteropathogens. In Vietnam, most studies have focused on individual pathogens or pathogen groups.

OBJECTIVES

This study aimed to characterize the etiological profile of children with acute watery and acute bloody diarrhea, describe epidemiological and clinical characteristics across pathogen groups, and examine the characteristics of Rotavirus-infected children.

METHODOLOGY: From 10 December 2022 to 30 April 2023, 382 children under five hospitalized with acute diarrhea at the Gastroenterology Department, Children's Hospital 1, Vietnam, were tested for enteric pathogens using multiplex real-time RT-PCR.

RESULTS

Fifteen pathogens, including viruses, bacteria, and parasites, were identified among 382 cases. Group A Rotavirus (55.2%), Adenovirus (20.9%), Norovirus II (13.9%), and diarrheagenic Escherichia coli (DEC) (9.2%) were the most frequently detected pathogens. Coinfections were observed in 39.0% of cases. Vomiting, watery diarrhea, and vomiting at onset were more common in viral infections, whereas bloody stools, high-grade fever, and fever at onset predominated in bacterial infections. Unvaccinated children with Rotavirus infection experienced higher diarrhea frequency and longer durations of diarrhea, vomiting, fever, and hospitalization.

CONCLUSION

The microorganisms associated with acute diarrhea are diverse, with 15 pathogens identified, Group A Rotavirus, Adenovirus, Norovirus II, and DEC being the top four most common. Clinical features showed differences among pathogen groups. Understanding epidemiological and clinical information may support early clinical decision-making in Vietnam in the absence of diagnostic testing. Further studies are needed to assess their similarity and applicability in low- and middle-income countries.