No guts, no glory in the twenty-tens: A snapshot of the burden, etiology and epidemiology of gastroenteritis during the preschool years

Gastroenteritis (GE) is an inflammation of the gastrointestinal tract that is often caused by infectious agents. GE is characterized by diarrhea and/or vomiting. In the Netherlands, GE is rarely life threatening, but it causes a significant burden in terms of societal costs due to its high frequency of occurrence, particularly in children below five years of age. This thesis aims at improving our understanding of the aetiology, epidemiology and burden of GE in preschool children and their parents/caretakers in the Netherlands.

We estimated that the incidence of GE in the Netherlands’ general population was highest in children younger than 5 years of age and their parents. Several child groups had an increased risk for GE, such as children with chronic enteropathies or respiratory diseases, and children using gastric antacid. Interestingly, day-care centre attendance was only a risk factor for GE up to 12 months of attendance, possibly indicating that they may acquire some immunity to GE. Most bacteria, viruses and protozoa were found just as much in stool samples of children and parents with GE as in those without GE, indicating that not all enteropathogen infections may be clinically relevant. Furthermore, we describe a remarkable rotavirus seasonal pattern in recent years in the Netherlands in absence of rotavirus vaccination, which has previously only been observed in countries with universal rotavirus vaccination. Results in this thesis highlight new areas for research into GE and provide possible targets to reduce the burden of GE in preschool children.