I.E.A. van Oostrum, E.S.M. Goosen, D.G. Uitenbroek, H. Koppenaal, K. Stronks, Mortality and causes of death of asylum seekers in the Netherlands in 2002-2005. EUPHA, Lissabon, 2008 , Eur. J. Public Health 2008, Supplement 1 [Abstract]
Tijdschrift voor sociale gezondheidszorg: TSG: 14-daags blad van de Algemene Nederlandse Vereniging voor Sociale Gezondheidszorg
Sinds 2000 worden asielzoekers door praktijkverpleegkundigen van de Medische Opvang Asielzoekers ... more Sinds 2000 worden asielzoekers door praktijkverpleegkundigen van de Medische Opvang Asielzoekers (MOA) voor diagnostiek en behandeling 'toegeleid' naar reguliere huisartsen. Hierbij beoordeelt de praktijkverpleegkundige of de hulpvraag van de asielzoeker zogenaamde zelfzorg betreft of dat de asielzoeker doorverwezen moet worden naar de huisarts. Om te onderzoeken hoe de samenwerking in de toegeleiding verloopt en welke factoren hierop van invloed zijn, is een survey verricht onder huisartsen die zorg verlenen aan asielzoekers (N=342) en praktijkverpleegkundigen van de MOA (N=332). De samenwerking is geoperationaliseerd in termen van de hoeveelheid werkafspraken en besprekingen, en de waardering voor de samenwerking. Factoren die de samenwerking naar verwachting beïnvloeden zijn de lokale context, het draagvlak onder huisartsen en praktijkverpleegkundigen en hun persoonsgebonden kenmerken. Uit dit onderzoek komt naar voren dat huisartsen en praktijkverpleegkundigen gemiddeld ...
[Healthcare for asylum seekers and refugees: our country can do better]
Nederlands tijdschrift voor geneeskunde
The article 'Mental and physical health problems of and the use of healthcare by Afghan, Iran... more The article 'Mental and physical health problems of and the use of healthcare by Afghan, Iranian and Somali asylum seekers and refugees' in this issue shows, as expected, that the health status of all three groups is poorer than that of the Dutch population. Even worse is that the care offered is far from optimal. To interpret these results, it would be important to know who the asylum seekers and refugees are in comparison with their fellow countrymen in their countries of origin, to have a better understanding of the background of their health problems, and to view the care offered to these people critically. Since they are a very heterogeneous and relatively small group, it is not easy to organise appropriate care for asylum seekers and refugees. Although attempts are being made to improve the situation, Dutch society should invest more so as to provide the same quality of care to its guests as it provides for its own population.
In the Netherlands gastroenteritis belongs to the ten diseases with the highest incidence rates. ... more In the Netherlands gastroenteritis belongs to the ten diseases with the highest incidence rates. A sentinel study on the incidence of gastrointestinal complaints and the occurrence of the investigated pathogens (Campylobacter, Salmonella and Shigella) was carried out in about 40 general practices in 1992 and 1993. The sentinel stations were as representative as possible of the Dutch population. The study was undertaken by the National Institute of Public Health and Environmental Protection (RIVM) and the Netherlands Institute of Primary Health Care (NIVEL) in cooperation with the general practitioners who participated in the Dutch Sentinel Practice Network and 24 laboratories. Age and sex of patients who met the case definition were reported to the NIVEL. These patients were asked by their GP to provide a stool sample and to complete a questionnaire. The number of patients that were either reported to the NIVEL or have been given a questionnaire by their GP was estimated at about 23...
The main aim of this PhD thesis is to describe the distribution of diseases and conditions among ... more The main aim of this PhD thesis is to describe the distribution of diseases and conditions among asylum seekers in the Netherlands and to analyse a number of risk factors that affect their health. Based on this knowledge and the scientific literature, the thesis explores the implications for policies and practices aimed at the promotion of the health of asylum seekers and refugees. The thesis shows that asylum seekers and refugees are at increased risk of adverse outcomes with respect to sexual and reproductive health, mental health, and specific noncommunicable diseases when compared with the general population in the Netherlands. Within these groups, there are large risk differences when stratified by gender, age, family composition, country of origin and length of stay. The risk distribution varies between diseases and conditions. The reasons for the increased risks of health problems are diverse, and include exposure to violence, limited health literacy, genetic predisposition, ...
High HIV Prevalence among Asylum Seekers Who Gave Birth in the Netherlands: A Nationwide Study Based on Antenatal HIV Tests
PLOS ONE, 2015
Asylum seekers are considered to be a particularly vulnerable group with respect to HIV. Data on ... more Asylum seekers are considered to be a particularly vulnerable group with respect to HIV. Data on the HIV prevalence among asylum seekers, however, are scarce. The aim of this study is to map the HIV prevalence among asylum seekers who gave birth in The Netherlands. We used a nationwide electronic medical records database from the community health services for asylum seekers (MOA). The study population consisted of 4,854 women and girls who delivered in asylum reception between 2000 and 2008. A unique electronic health data base was used and case allocation was based on ICPC-codes. The number of women and girls that was HIV positive during their last pregnancy was 80, of which 79 originated from sub-Saharan Africa. The prevalence for women from this region of origin (3.4%) was high compared to women from all other regions of origin (0.04%; OR = 90.2; 95%CI 12.5-648.8). The highest HIV prevalence rates were found for women from Rwanda (17.0%) and Cameroon (13.2%). HIV prevalence rates were higher among women who arrived in reception without partner (OR = 1.82; 95%CI 0.75-4.44) and unaccompanied minors (OR = 2.59; 95%CI 0.79-8.49), compared to women who arrived in reception with partner. We conclude that, among asylum-seeking women from sub-Saharan Africa giving birth in The Netherlands, the HIV prevalence is high compared to the host population. For women from other regions of origin, the prevalence is at the same level as in the host population. The high HIV prevalence underlines the importance of preventive interventions and voluntary HIV testing for sub-Saharan African asylum seekers as from shortly after arrival.
High diabetes risk among asylum seekers in The Netherlands
Diabetic medicine : a journal of the British Diabetic Association, 2014
To map the prevalence and incidence of recorded diabetes among asylum seekers according to demogr... more To map the prevalence and incidence of recorded diabetes among asylum seekers according to demographic factors and length of stay in the host country. We used a nationwide database from the Community Health Services for Asylum Seekers. The study population included all asylum seekers aged 20-79 years who arrived in the Netherlands between 2000 and 2008. Case allocation was based on International Classification of Primary Care codes. A general practice registry was used to obtain reference data. Standardized prevalence and incidence ratios were calculated and their association with length of stay was explored with Cox regression. The study included 59 380 asylum seekers among whom there were 1227 recorded cases of diabetes. The prevalence of recorded diabetes was higher among asylum seekers compared with the reference population for both men (standardized prevalence ratio=1.85, 95% CI 1.71-1.91) and women (standardized prevalence ratio=2.26, 95% CI 2.08-2.45). The highest standardize...
To analyse whether specific attention is needed for the improvement of health for pregnant asylum... more To analyse whether specific attention is needed for the improvement of health for pregnant asylum seekers by producing an overview of obstetric outcomes, risk factors and expressed health needs of asylum seekers in the Netherlands and other Western host countries. Literature study. A search was performed in Medline, Embase and PsycInfo for empirical studies about pregnancy and delivery specifically among asylum seekers in Western host countries and published since 1995. Picarta and the authors' literature collections were used to find Dutch studies. Google was used to find grey literature. Published empirical studies on pregnancy outcome indicators specific for asylum seekers were scarce and limited to the Netherlands. The studies found revealed an increased risk of perinatal and maternal mortality and severe maternal morbidity. These studies, however, were based on small numbers of cases. Qualitative studies revealed that pregnant asylum seekers expressed the following needs: a...
[Reduction of the drowning risk for young children, but increased risk for children of recently immigrated non-Westerners]
Nederlands tijdschrift voor geneeskunde, Jan 23, 2008
To describe differences in the risk of drowning of young children (under 10 years) in the Netherl... more To describe differences in the risk of drowning of young children (under 10 years) in the Netherlands according to ethnicity and relevant trends since 996. Retrospective. We analysed the causes of death data for all 266 children aged 0 to 10 years who died of drowning between 1996 and 2005. Information for the cause of death was obtained from the cause of death data of Statistics Netherlands. Data about the size and composition of the population at risk (age, sex and ethnicity) were obtained from the municipal population registers. Young children's risk of drowning has decreased by about one-third since 1996. This decrease took place among native Dutch children and children of the major ethnic groups, notably Turkish, Moroccan and Surinamese. However for children of recently immigrated parents of non-Western ethnicity, mainly asylum seekers, the risk of drowning was 4 to 8 times higher than that of native children aged 3 to 10 years. Timely health education directed at newly arrived families with children could be an important measure to help them cope with the hazards of living in a water-rich environment such as the Netherlands. The education should point out the necessity of increased supervision of the youngest children and improved swimming skills for the slightly older ones.
s u m m a r y Asylum seekers often have complex medical needs. Little is known about the cultural... more s u m m a r y Asylum seekers often have complex medical needs. Little is known about the cultural competences health care providers should have in their contact with asylum seekers in order to meet their needs. Cultural competence is generally defined as a combination of knowledge about certain cultural groups, as well as attitudes towards and skills for dealing with cultural diversity. Given asylum seekers' specific care needs, it may be asked whether this set of general competences is adequate for the medical contact with asylum seekers. We explored the cultural competences that nurse practitioners working with asylum seekers thought were important. A purposive sample of 89 nurse practitioners in the Netherlands completed a questionnaire. In addition, six group interviews with nurse practitioners were also conducted. A framework analysis was used to analyse the data of the questionnaires and the interviews. From the analysis, several specific competences emerged, which were required for the medical contact with asylum seekers: knowledge of the political situation in the country of origin; knowledge with regard to diseases common in the country of origin; knowledge of the effects of refugeehood on health; awareness of the juridical context in the host country; ability to deal with asylum seekers' traumatic experiences; and skills to explain the host country's health care system. Apart from these cultural competences specific for the situation of asylum seekers, general cultural competences were also seen as important, such as the ability to use interpretation services. We conclude that insight into these cultural competences may help to develop related education and training for health care providers working with asylum seekers.
The first contacts between healthcare providers and newly-arrived asylum seekers: a qualitative study about which issues need to be addressed
Public Health, 2013
Asylum seekers have been recognized as having unique and complex health needs which require atten... more Asylum seekers have been recognized as having unique and complex health needs which require attention upon arrival in the host country. Not much is known about what issues to address in first contacts with asylum seekers. The purpose of this study is to give insight in the specific issues that healthcare providers need to address in the first contacts with newly arrived asylum seekers. A qualitative study using different types of data in 2007 and 2008. Questionnaires (n = 89) were used as input for seven group interviews with Dutch care providers (n = 46) working with asylum seekers in the Netherlands, were qualitatively analysed, using a framework method. Healthcare providers identified four issues they aimed to address in first contacts with asylum seekers: (1) assessing the current health condition; (2) health risk assessment; (3) providing information about the healthcare system of the host country; and (4) health education. The first contacts between healthcare providers and asylum seekers serve different goals, especially assessing health problems and risks, and providing health information. These issues may, however, be addressed differently by different healthcare providers, across different host countries, dependent on the way healthcare and medical insurance for asylum seekers are organized.
Association of torovirus with acute and persistent diarrhea in children
The Pediatric Infectious Disease Journal, 1997
To study the etiologic role of toroviruses as a cause of gastroenteritis in humans. The design wa... more To study the etiologic role of toroviruses as a cause of gastroenteritis in humans. The design was a case-control study. We compared the rate of torovirus detection in fecal specimens from a selection of children with acute or persistent diarrhea and controls without diarrhea from a study of childhood diarrhea in an urban Brazilian slum. Stool samples were coded and tested in a blinded fashion for the presence of torovirus antigen by enzyme-linked immunosorbent assay, other enteropathogens, toxins and fecal leukocytes. Thirty-three children with acute diarrhea, 41 children with persistent diarrhea and 17 controls were enlisted in the study. Torovirus antigen was detected in 9 (27%) samples from children with acute diarrhea, 11 (27%) samples from children with persistent diarrhea and none of the samples from controls (P < 0.05). In addition the presence of enteroaggregative E. coli was associated with persistent diarrhea and the presence of Cryptosporidium oocysts was common although not significant (P = 0.08); torovirus and Cryptosporidium occurred in different subsets of samples, whereas torovirus and enteroaggregative Escherichia coli were commonly found in combination. These data indicate that toroviruses, alone or in combination with enteroaggregative E. coli, may play a pathogenic role in acute and possibly persistent diarrhea. Further studies are warranted to determine the etiologic role of toroviruses in gastroenteritis.
I.E.A. van Oostrum, E.S.M. Goosen, D.G. Uitenbroek, H. Koppenaal, K. Stronks, Mortality and causes of death of asylum seekers in the Netherlands in 2002-2005. EUPHA, Lissabon, 2008 , Eur. J. Public Health 2008, Supplement 1 [Abstract]
Tijdschrift voor sociale gezondheidszorg: TSG: 14-daags blad van de Algemene Nederlandse Vereniging voor Sociale Gezondheidszorg
Sinds 2000 worden asielzoekers door praktijkverpleegkundigen van de Medische Opvang Asielzoekers ... more Sinds 2000 worden asielzoekers door praktijkverpleegkundigen van de Medische Opvang Asielzoekers (MOA) voor diagnostiek en behandeling 'toegeleid' naar reguliere huisartsen. Hierbij beoordeelt de praktijkverpleegkundige of de hulpvraag van de asielzoeker zogenaamde zelfzorg betreft of dat de asielzoeker doorverwezen moet worden naar de huisarts. Om te onderzoeken hoe de samenwerking in de toegeleiding verloopt en welke factoren hierop van invloed zijn, is een survey verricht onder huisartsen die zorg verlenen aan asielzoekers (N=342) en praktijkverpleegkundigen van de MOA (N=332). De samenwerking is geoperationaliseerd in termen van de hoeveelheid werkafspraken en besprekingen, en de waardering voor de samenwerking. Factoren die de samenwerking naar verwachting beïnvloeden zijn de lokale context, het draagvlak onder huisartsen en praktijkverpleegkundigen en hun persoonsgebonden kenmerken. Uit dit onderzoek komt naar voren dat huisartsen en praktijkverpleegkundigen gemiddeld ...
[Healthcare for asylum seekers and refugees: our country can do better]
Nederlands tijdschrift voor geneeskunde
The article 'Mental and physical health problems of and the use of healthcare by Afghan, Iran... more The article 'Mental and physical health problems of and the use of healthcare by Afghan, Iranian and Somali asylum seekers and refugees' in this issue shows, as expected, that the health status of all three groups is poorer than that of the Dutch population. Even worse is that the care offered is far from optimal. To interpret these results, it would be important to know who the asylum seekers and refugees are in comparison with their fellow countrymen in their countries of origin, to have a better understanding of the background of their health problems, and to view the care offered to these people critically. Since they are a very heterogeneous and relatively small group, it is not easy to organise appropriate care for asylum seekers and refugees. Although attempts are being made to improve the situation, Dutch society should invest more so as to provide the same quality of care to its guests as it provides for its own population.
In the Netherlands gastroenteritis belongs to the ten diseases with the highest incidence rates. ... more In the Netherlands gastroenteritis belongs to the ten diseases with the highest incidence rates. A sentinel study on the incidence of gastrointestinal complaints and the occurrence of the investigated pathogens (Campylobacter, Salmonella and Shigella) was carried out in about 40 general practices in 1992 and 1993. The sentinel stations were as representative as possible of the Dutch population. The study was undertaken by the National Institute of Public Health and Environmental Protection (RIVM) and the Netherlands Institute of Primary Health Care (NIVEL) in cooperation with the general practitioners who participated in the Dutch Sentinel Practice Network and 24 laboratories. Age and sex of patients who met the case definition were reported to the NIVEL. These patients were asked by their GP to provide a stool sample and to complete a questionnaire. The number of patients that were either reported to the NIVEL or have been given a questionnaire by their GP was estimated at about 23...
The main aim of this PhD thesis is to describe the distribution of diseases and conditions among ... more The main aim of this PhD thesis is to describe the distribution of diseases and conditions among asylum seekers in the Netherlands and to analyse a number of risk factors that affect their health. Based on this knowledge and the scientific literature, the thesis explores the implications for policies and practices aimed at the promotion of the health of asylum seekers and refugees. The thesis shows that asylum seekers and refugees are at increased risk of adverse outcomes with respect to sexual and reproductive health, mental health, and specific noncommunicable diseases when compared with the general population in the Netherlands. Within these groups, there are large risk differences when stratified by gender, age, family composition, country of origin and length of stay. The risk distribution varies between diseases and conditions. The reasons for the increased risks of health problems are diverse, and include exposure to violence, limited health literacy, genetic predisposition, ...
High HIV Prevalence among Asylum Seekers Who Gave Birth in the Netherlands: A Nationwide Study Based on Antenatal HIV Tests
PLOS ONE, 2015
Asylum seekers are considered to be a particularly vulnerable group with respect to HIV. Data on ... more Asylum seekers are considered to be a particularly vulnerable group with respect to HIV. Data on the HIV prevalence among asylum seekers, however, are scarce. The aim of this study is to map the HIV prevalence among asylum seekers who gave birth in The Netherlands. We used a nationwide electronic medical records database from the community health services for asylum seekers (MOA). The study population consisted of 4,854 women and girls who delivered in asylum reception between 2000 and 2008. A unique electronic health data base was used and case allocation was based on ICPC-codes. The number of women and girls that was HIV positive during their last pregnancy was 80, of which 79 originated from sub-Saharan Africa. The prevalence for women from this region of origin (3.4%) was high compared to women from all other regions of origin (0.04%; OR = 90.2; 95%CI 12.5-648.8). The highest HIV prevalence rates were found for women from Rwanda (17.0%) and Cameroon (13.2%). HIV prevalence rates were higher among women who arrived in reception without partner (OR = 1.82; 95%CI 0.75-4.44) and unaccompanied minors (OR = 2.59; 95%CI 0.79-8.49), compared to women who arrived in reception with partner. We conclude that, among asylum-seeking women from sub-Saharan Africa giving birth in The Netherlands, the HIV prevalence is high compared to the host population. For women from other regions of origin, the prevalence is at the same level as in the host population. The high HIV prevalence underlines the importance of preventive interventions and voluntary HIV testing for sub-Saharan African asylum seekers as from shortly after arrival.
High diabetes risk among asylum seekers in The Netherlands
Diabetic medicine : a journal of the British Diabetic Association, 2014
To map the prevalence and incidence of recorded diabetes among asylum seekers according to demogr... more To map the prevalence and incidence of recorded diabetes among asylum seekers according to demographic factors and length of stay in the host country. We used a nationwide database from the Community Health Services for Asylum Seekers. The study population included all asylum seekers aged 20-79 years who arrived in the Netherlands between 2000 and 2008. Case allocation was based on International Classification of Primary Care codes. A general practice registry was used to obtain reference data. Standardized prevalence and incidence ratios were calculated and their association with length of stay was explored with Cox regression. The study included 59 380 asylum seekers among whom there were 1227 recorded cases of diabetes. The prevalence of recorded diabetes was higher among asylum seekers compared with the reference population for both men (standardized prevalence ratio=1.85, 95% CI 1.71-1.91) and women (standardized prevalence ratio=2.26, 95% CI 2.08-2.45). The highest standardize...
To analyse whether specific attention is needed for the improvement of health for pregnant asylum... more To analyse whether specific attention is needed for the improvement of health for pregnant asylum seekers by producing an overview of obstetric outcomes, risk factors and expressed health needs of asylum seekers in the Netherlands and other Western host countries. Literature study. A search was performed in Medline, Embase and PsycInfo for empirical studies about pregnancy and delivery specifically among asylum seekers in Western host countries and published since 1995. Picarta and the authors' literature collections were used to find Dutch studies. Google was used to find grey literature. Published empirical studies on pregnancy outcome indicators specific for asylum seekers were scarce and limited to the Netherlands. The studies found revealed an increased risk of perinatal and maternal mortality and severe maternal morbidity. These studies, however, were based on small numbers of cases. Qualitative studies revealed that pregnant asylum seekers expressed the following needs: a...
[Reduction of the drowning risk for young children, but increased risk for children of recently immigrated non-Westerners]
Nederlands tijdschrift voor geneeskunde, Jan 23, 2008
To describe differences in the risk of drowning of young children (under 10 years) in the Netherl... more To describe differences in the risk of drowning of young children (under 10 years) in the Netherlands according to ethnicity and relevant trends since 996. Retrospective. We analysed the causes of death data for all 266 children aged 0 to 10 years who died of drowning between 1996 and 2005. Information for the cause of death was obtained from the cause of death data of Statistics Netherlands. Data about the size and composition of the population at risk (age, sex and ethnicity) were obtained from the municipal population registers. Young children's risk of drowning has decreased by about one-third since 1996. This decrease took place among native Dutch children and children of the major ethnic groups, notably Turkish, Moroccan and Surinamese. However for children of recently immigrated parents of non-Western ethnicity, mainly asylum seekers, the risk of drowning was 4 to 8 times higher than that of native children aged 3 to 10 years. Timely health education directed at newly arrived families with children could be an important measure to help them cope with the hazards of living in a water-rich environment such as the Netherlands. The education should point out the necessity of increased supervision of the youngest children and improved swimming skills for the slightly older ones.
s u m m a r y Asylum seekers often have complex medical needs. Little is known about the cultural... more s u m m a r y Asylum seekers often have complex medical needs. Little is known about the cultural competences health care providers should have in their contact with asylum seekers in order to meet their needs. Cultural competence is generally defined as a combination of knowledge about certain cultural groups, as well as attitudes towards and skills for dealing with cultural diversity. Given asylum seekers' specific care needs, it may be asked whether this set of general competences is adequate for the medical contact with asylum seekers. We explored the cultural competences that nurse practitioners working with asylum seekers thought were important. A purposive sample of 89 nurse practitioners in the Netherlands completed a questionnaire. In addition, six group interviews with nurse practitioners were also conducted. A framework analysis was used to analyse the data of the questionnaires and the interviews. From the analysis, several specific competences emerged, which were required for the medical contact with asylum seekers: knowledge of the political situation in the country of origin; knowledge with regard to diseases common in the country of origin; knowledge of the effects of refugeehood on health; awareness of the juridical context in the host country; ability to deal with asylum seekers' traumatic experiences; and skills to explain the host country's health care system. Apart from these cultural competences specific for the situation of asylum seekers, general cultural competences were also seen as important, such as the ability to use interpretation services. We conclude that insight into these cultural competences may help to develop related education and training for health care providers working with asylum seekers.
The first contacts between healthcare providers and newly-arrived asylum seekers: a qualitative study about which issues need to be addressed
Public Health, 2013
Asylum seekers have been recognized as having unique and complex health needs which require atten... more Asylum seekers have been recognized as having unique and complex health needs which require attention upon arrival in the host country. Not much is known about what issues to address in first contacts with asylum seekers. The purpose of this study is to give insight in the specific issues that healthcare providers need to address in the first contacts with newly arrived asylum seekers. A qualitative study using different types of data in 2007 and 2008. Questionnaires (n = 89) were used as input for seven group interviews with Dutch care providers (n = 46) working with asylum seekers in the Netherlands, were qualitatively analysed, using a framework method. Healthcare providers identified four issues they aimed to address in first contacts with asylum seekers: (1) assessing the current health condition; (2) health risk assessment; (3) providing information about the healthcare system of the host country; and (4) health education. The first contacts between healthcare providers and asylum seekers serve different goals, especially assessing health problems and risks, and providing health information. These issues may, however, be addressed differently by different healthcare providers, across different host countries, dependent on the way healthcare and medical insurance for asylum seekers are organized.
Association of torovirus with acute and persistent diarrhea in children
The Pediatric Infectious Disease Journal, 1997
To study the etiologic role of toroviruses as a cause of gastroenteritis in humans. The design wa... more To study the etiologic role of toroviruses as a cause of gastroenteritis in humans. The design was a case-control study. We compared the rate of torovirus detection in fecal specimens from a selection of children with acute or persistent diarrhea and controls without diarrhea from a study of childhood diarrhea in an urban Brazilian slum. Stool samples were coded and tested in a blinded fashion for the presence of torovirus antigen by enzyme-linked immunosorbent assay, other enteropathogens, toxins and fecal leukocytes. Thirty-three children with acute diarrhea, 41 children with persistent diarrhea and 17 controls were enlisted in the study. Torovirus antigen was detected in 9 (27%) samples from children with acute diarrhea, 11 (27%) samples from children with persistent diarrhea and none of the samples from controls (P < 0.05). In addition the presence of enteroaggregative E. coli was associated with persistent diarrhea and the presence of Cryptosporidium oocysts was common although not significant (P = 0.08); torovirus and Cryptosporidium occurred in different subsets of samples, whereas torovirus and enteroaggregative Escherichia coli were commonly found in combination. These data indicate that toroviruses, alone or in combination with enteroaggregative E. coli, may play a pathogenic role in acute and possibly persistent diarrhea. Further studies are warranted to determine the etiologic role of toroviruses in gastroenteritis.
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