A Rapid Epidemiological Tool to Measure the Burden of Norovirus Infection and Disease in Resource-Limited Settings

Abstract

Background.Rapid, cost-effective tools are needed to estimate the disease burden of acute gastroenteritis (AGE) and norovirus (NoV) in resource-limited settings.Methods.Households with children (6 weeks–17 years) in rural Guatemala were randomly enrolled into 2 parallel AGE surveillance systems: (1) a prospective cohort, which included an enrollment visit followed by 1 year of prospective observation using a smartphone-based weekly symptom diary; and (2) 2 sequential cross-sectional rapid active sampling (RAS) surveys. Norovirus testing was performed during enrollment (all subjects) and for prospective AGE episodes (prospective cohort only).Results.The prospective cohort enrolled 207 households (469 children) from April to September 2015 followed by 471 person-years of observation; RAS survey 1 enrolled 210 households (402 children) during October to November 2015, and RAS survey 2 enrolled 210 separate households (368 children) during January to February 2016. The prospective cohort detected a NoV+ AGE prevalence of 11% and a population-attributable fraction (PAF) of −1.6% at enrollment, followed by an incidence of 1.4 episodes/100 person-years. Rapid active sampling surveys 1 and 2 identified a NoV+ AGE prevalence of 14%–21% and a PAF of 3.2%–12.4%.Conclusions.Rapid active sampling surveys were practical and identified more cases of NoV infection and disease compared with a parallel prospective cohort in rural Guatemala.

Rapid Active Sampling Surveys as a Tool to Evaluate Factors Associated with Acute Gastroenteritis and Norovirus Infection among Children in Rural Guatemala

“…This analysis was performed within a larger study 6 comparing two surveillance methodologies to estimate NoV and AGE disease burden in resource-limited settings. The first system, a prospective participatory syndromic surveillance (PSS) cohort, obtained baseline data and stool samples from participating households, and then prospectively followed them for AGE using a smartphone-based symptom diary application (Integra IT, Bogota, Colombia).…”

Responding to the Zika Epidemic: Preparation of a Neurodevelopmental Testing Protocol to Evaluate Young Children in Rural Guatemala

“…The population suffers from high rates of food insecurity and child undernutrition, diarrheal disease, maternal depression, maternal and child morbidity, and mortality. 25 Recent studies have shown that the area is highly endemic for dengue, chikungunya, and ZIKV. 25,26 Research design.…”

“…25 Recent studies have shown that the area is highly endemic for dengue, chikungunya, and ZIKV. 25,26 Research design. In 2017, we launched a prospective, natural history study of postnatally acquired ZIKV infection in infants and young children at the University of Colorado Center for Human Development research and clinic site in Guatemala.…”

Knowledge of Norovirus and Attitudes toward a Potential Norovirus Vaccine in Rural Guatemala: A Cross-Sectional Exploratory Survey

“…which, after enrollment and baseline sampling, children were monitored for AGE using a weekly smartphone-based symptom diary, with diagnostic testing performed for self-reported AGE (norovirus); or 2) two separate rapid active cross-sectional sampling (RAS) surveys conducted in October-November 2015 and January-February 2016 in which children in randomly selected households were screened for AGE symptoms in the previous week and tested for AGE regardless of a symptom report. 12 Randomization and enrollment of the households were conducted using a two-stage cluster sampling strategy in which 30 clusters of seven households each were enrolled in the PSS cohort and each of the two RAS cycles separately, as previously described. 12 Households in both arms received an information brochure about norovirus at the time of enrollment.…”

“…12 Randomization and enrollment of the households were conducted using a two-stage cluster sampling strategy in which 30 clusters of seven households each were enrolled in the PSS cohort and each of the two RAS cycles separately, as previously described. 12 Households in both arms received an information brochure about norovirus at the time of enrollment. The vaccine knowledge and attitude survey was administered at the conclusion of this study, in September 2016.…”