Acute Viral Gastroenteritis in France

A study by Santé publique France conducted among the general population from May 2009 to April 2010 in metropolitan France estimated that more than 21 million episodes of acute viral gastroenteritis (AVG) occurred each year in France (Van Cauteren D et al. 2012). During each winter season in France, an increase in AGE cases is observed, as in all European countries. Acute winter gastroenteritis is primarily viral in origin, with noroviruses and rotaviruses being the predominant circulating viruses. Noroviruses cause AGE in people of all ages, whereas rotaviruses primarily affect children under 5 years of age. A viral cause is frequently identified among children hospitalized for acute gastroenteritis. A study conducted among children under 15 years of age hospitalized for acute gastroenteritis from 1997 to 2000 at Saint-Vincent de Paul Hospital showed that 51% of these infections were caused by rotavirus (Moulin F et al. 2001).

Data from the Sentinelles Network suggest that, each winter, these cases of acute gastroenteritis result in 1.4 to 4.0 million visits to primary care physicians. The number of visits for acute gastroenteritis typically increases between December and April. A peak is often observed during the first two weeks of January. During this peak, the incidence of visits for AGE is estimated at between 200 and 600 visits per 100,000 people per week.

Santé publique France, in collaboration with its partners (the Sentinelles Network and the National Reference Center for Gastroenteritis Viruses), monitors the epidemiological trends of acute viral gastroenteritis and informs the general public about preventive measures to reduce the risk of infection.

Transmission is primarily person-to-person

The transmission of acute viral gastroenteritis in winter is primarily person-to-person. Communities are particularly at risk of outbreaks due to person-to-person transmission, as evidenced by the numerous outbreaks occurring in hospitals, long-term care facilities, nursing homes, and vacation resorts (hotels, cruise ships). Transmission via staff hands plays a significant role, as does persistent environmental contamination, particularly for noroviruses (Cheesbrough JS et al. 2000).

Other modes of transmission also exist, particularly regarding noroviruses. These viruses can be transmitted through food when ingesting water or food consumed raw or undercooked. These foods are contaminated either directly during production, through contact with water contaminated by feces (oysters, berries, etc.), or secondarily during handling by a person carrying the virus. This food- or water-borne transmission route can lead to outbreaks with a large number of cases.

Prevention Based on Hygiene

Since the transmission of acute viral gastroenteritis is primarily person-to-person, prevention and control measures for these infections are based primarily on the practice of hand hygiene and measures to be followed during meal preparation.

• Hands are the primary vector for the transmission of acute viral gastroenteritis. To limit the risk of transmission, thorough and frequent handwashing with soap is necessary.

• Since certain viruses (rotavirus and norovirus) are highly resistant in the environment and present on surfaces, these surfaces must be cleaned thoroughly and regularly in high-risk settings (childcare facilities, nursing homes).

• When preparing meals, strict hand hygiene measures must be followed before handling food and after using the restroom. This is particularly important in group settings (facilities for the elderly, hospital wards, daycare centers) where keeping sick staff (kitchen staff, caregivers, etc.) away also reduces the risk of foodborne outbreaks.

Rotavirus vaccination is now recommended in France for all infants. The two available vaccines have demonstrated, in real-world settings, their high efficacy in reducing rotavirus-associated gastroenteritis and hospitalizations in industrialized countries that have been using them for many years. Their oral administration makes them easy to administer. Vaccination requires two or three doses, depending on the vaccine. It should begin at two months of age and be completed by six or eight months at the latest, depending on the vaccine.

For more information:

• https://vaccination-info-service.fr/La-vaccination-au-cours-de-la-vie/Nourrissons-et-enfants-de-la-naissance-a-13-ans

• https://vaccination-info-service.fr/Les-maladies-et-leurs-vaccins/Gastro-enterite-a-rotavirus

Gastrointestinal symptoms

After an incubation period of 24 to 72 hours, acute viral gastroenteritis presents with diarrhea and/or vomiting, which may or may not be accompanied by nausea, abdominal pain, and sometimes fever.

Acute viral gastroenteritis is generally short-lived, lasting only a few days. Acute dehydration is the main complication. It most often occurs at the extremes of life, in young children and the elderly.

Symptomatic treatment

In children, as in adults, the goal of managing gastroenteritis is to prevent dehydration and the spread of infection to others. Antibiotics are not used to treat viral gastroenteritis.

To prevent complications from acute diarrhea, early rehydration using oral rehydration solutions (ORS) is the best preventive measure. Covered by health insurance for children under 5 years of age, the effectiveness of oral rehydration solutions has been well established.