APPETITE Study

Study Summary

Current epidemiologic knowledge of acute gastroenteritis (AGE) pathogens is limited to subsets of children with select clinical presentations and by testing capable of identifying only a limited number of pathogens. APPETITE (The Alberta Provincial Pediatric EnTeric Infection TEam) strives to develop a better understanding of the infectious causes of AGE by proposing a paradigm shift in specimen collection and testing. We will move from: 1) stool collection (usually at home, if done at all, and returned to facility) to point of care swabs (oral/rectal done by health-care provider), 2) multiple labour intensive tests (e.g. culture, microscopy, electron microscopy with poor sensitivity) to a single device, which employs polymerase chain reaction (PCR) technology to target multiple pathogens with high sensitivity and has the potential to be integrated into point of care testing technology.

This study includes three activities that are chronologically inter-woven and interconnected to maximize the conduct of integrated knowledge translation. Activity 1: burden of disease assessment through broad population surveillance with expanded data collection, activity 2: enhanced pathogen identification through improved specimen collection (oral and rectal swabs) and molecular diagnostic technology, and activity 3: preference elicitation and economic modeling which will be planned, and interpreted alongside our decision-makers.

Activity 1 consists of two main projects (project: case definitions, project 2: specimen collection/testing) and it focuses on identifying the etiology of disease in situations in which diagnostic microbiology has been rarely utilized (i.e. patients with vomiting but no diarrhea) or deemed unnecessary (those not seeking care).

Objectives

1. To improve health through enhanced pathogen identification
2. To develop with team member policy-makers economic models incorporating pathogen burden and societal preferences to inform decision making about potential new enteric vaccine programs

Principal Study Investigator: Dr. Stephen Freedman

Project Lead: Karen Lowerison, Kelly Kim

Study Team: Dr. Bonita Lee, Dr. Marie Louie, Dr. Xiao-Li Pang, Dr. Samina Ali, Dr. Andy Chuck, Dr. Linda Chui, Dr. Gillian Currie, Dr. James Dickenson, Dr. Steve Drews, Dr. Mohamed Eltorki, Dr. Tim Graham, Dr. Jason Jiang, Dr. James Kellner, Dr. Martin Lavoie, Dr. Judy MacDonald, Dr. Shannon MacDonald, Dr. Alberto Nettel-Aguirre, Dr. Kimberley Simmonds, Dr. Larry Svenson, Dr. James Talbot, Dr. Phillip Tarr, Dr. Raymond Tellier, Dr. Otto G. Vanderkooi