Sapovirus prevalence in children less than five years of age hospitalised for diarrhoeal disease in South Africa, 2009–2013

•Sapovirus was detected in children hospitalised with acute diarrhoea and in deaths Sapoviruses are common in males, in the second year of life during summer and autumn.•Factors associated with SaV detection included overcrowding and norovirus infections.•HIV-infected children with SaV had bloody stool and poor access to sanitation.

BackgroundAlthough sapovirus (SaV) has been detected in 2.2–12.7% of gastroenteritis cases globally, there are limited data on SaV epidemiology.ObjectivesDescribe the epidemiology, clinical characteristics and factors associated with SaV gastroenteritis in hospitalised children <5 years of age in South Africa.Study designBetween 2009 and 2013 during prospective diarrhoeal surveillance, stool specimens were collected from four sites and screened for SaVs and associated enteric pathogens using ELISA, microscopy, conventional and real-time PCR. Epidemiological and clinical data were compared in patients with or without SaV. Odds ratios were assessed by bivariate and stepwise multivariable logistic regression analysis.ResultsSapoviruses were detected in 7.7% (238/3103) of children admitted to hospital and 11.4% (9/79) of deaths. Sapovirus was detected more commonly in children 19–24 months compared to <6 months (aOR = 2.3; p = 0.018) and in males (aOR = 2.0; p = 0.001). Additional factors associated with SaV detection included residing with ≥ 7 inhabitants compared to ≤3 (aOR = 2.2; p = 0.011) and concomitant norovirus infections (aOR = 3.0; p = 0.003). HIV-infected children with SaV were more likely to have bloody stools (aOR = 16.8; p < 0.001), low birth weight (<2.5 kg; aOR = 5.8; p = 0.007) and live in environments without flush toilets (aOR = 8.1; p = 0.003) compared to HIV-uninfected children.ConclusionsSapoviruses, which are perceived to cause mild diarrhoea, were detected in hospitalised children and diarrhoeal deaths in South Africa. Determinants increasing the odds of SaV included overcrowding and concomitant infections while HIV-infected children with SaV displayed bloody stools, low birth weight and reduced access to proper sanitation. Mitigation strategies against SaV infections include improved sanitation.