Norovirus infection in children admitted to hospital for acute gastroenteritis in Belém, Pará, Northern Brazil

Abstract

Noroviruses are the leading cause of epidemic, non-bacterial outbreaks of acute gastroenteritis, and are also a major cause of sporadic acute gastroenteritis in infants. The aim of the present study was to identify norovirus infections in children not infected by rotavirus admitted to hospital for acute gastroenteritis in Belém. A total of 348 fecal specimens were obtained from children with diarrhea aged less than 5 years, all of whom had tested negative for rotavirus, between May 2008 and April 2010. Fecal samples were screened for norovirus antigen using enzyme-immunoassay (EIA). Specimens were subjected to reverse-transcription polymerase chain reaction (RT-PCR) using the primers Mon432/434-Mon431/433 for detection of the GI and GII norovirus strains, respectively. Based on both methods, the overall norovirus positivity rate was 36.5% (127/348). Of the 169 samples collected in the first year, 44.4% (n = 75) tested positive for norovirus using both methods, 35.5% (n = 60) by EIA and 40.8% (n = 69) by RT-PCR. Using RT-PCR as a reference standard, a sensitivity of 78.3%, specificity of 94%, and agreement of 87.6% were recorded. Genome sequencing was obtained for 22 (31.9%) of the 69 positive samples, of which 90.9% (20/22) were genotype GII.4d and 9.1% (2/22) were genotype GII.b. Norovirus infection was most frequent in children under 2 years of age (41.5%-115/277). The peak incidence (62.1%) of norovirus-related acute gastroenteritis in these patients (not infected by rotavirus) was observed in February 2010. These findings emphasize the importance of norovirus as a cause of severe acute gastroenteritis among children in Belém, Pará, Northern Brazil.

High prevalence of norovirus in children with sporadic acute gastroenteritis in Manaus, Amazon Region, northern Brazil

“…Statistical analyses supported the finding that children from Manaus under two years of age were eight times more likely to develop AGE caused by NoV than those of other ages [number needed to cause one adverse event at time t (NNH) = 8], considering a period of two years. Similar results were observed by Siqueira et al (2013) in children hospitalised in Belém, also in northern Brazil, where the age group most affected by NoV comprised children up to two years old; however, this group had a lower NNH (n = 3), showing a higher attack rate, with three times the likelihood of developing NoV disease. NoV had a predominant role in cases of AGE in recent years among people of all ages, but children under two years old are still the most vulnerable portion of the population (Patel et al 2008).…”

“…The combination of the two methods (EIA and RT-PCR) in the diagnosis of NoV provided a high percentage of detection (35.2%), which was similar or superior to those obtained in some previous studies conducted in Brazil, including those in Belém and Rio Branco, both in the Amazon Region, northern Brazil (da Silva et al 2013, Siqueira et al 2013). Studies performed around the world, using PCR targeting to the same region B, showed similar positivity percentages as the results of this study, ranging up to 33.3% (Castilho et al 2006).…”

“…In Brazil, several studies involving the detection and molecular characterisation of NoV from sporadic AGE cases, outbreaks, and hospitalisation from different places have been performed, demonstrating the importance of this virus as an aetiological agent of AGE (Castilho et al 2006, Barreira et al 2010, Fioretti et al 2011, da Silva et al 2013, Siqueira et al 2013). …”

Acute gastroenteritis and enteric viruses in hospitalised children in southern Brazil: aetiology, seasonality and clinical outcomes

“…Unlike the results of this study, Ferreira et al (2012) in the states of Rio de Janeiro and Ribeiro et al (2008) Espírito Santo identified this pathogen as the major viral agent in cases of gastrointestinal infections. Additionally, a study by Nakagomi et al (2008) identified NoV in 15% of samples from the municipality of Recife, with clinical severity similar to that for RV, while in the municipality of São Paulo, Castilho et al (2006) reported 33% positive cases of NoV and Siqueira et al (2013a) found 36.5% of positive samples in the municipality of Belém.…”

Norovirus y coinfección con parásitos intestinales en pacientes con diarrea en el Hospital San Rafael de Tunja, Colombia

“…Al comparar la prevalencia obtenida en el presente estudio, con otras investigaciones realizadas a nivel mundial, se encuentran valores que fluctúan entre 7,8 % y 62 %; la mayoría reportan alrededor de 13 %, valor muy cercano al obtenido en el presente estudio (5,7,8,16,18,20,(24)(25)(26)(27)(28)(29).…”