Risk Factors for Norovirus Gastroenteritis among Nicaraguan Children

Abstract

Norovirus is a leading cause of pediatric gastroenteritis. Understanding norovirus epidemiology is essential for reducing disease burden. We conducted a case-control study to describe the distribution, clinical features, and risk factors of norovirus gastroenteritis among children < 5 years of age in León, Nicaragua. Cases were children testing positive for norovirus and controls were children living in the cases' communities. Study staff interviewed mothers of enrolled cases and controls to obtain detailed exposure information including food, water, and sanitation sources; recent exposures; household characteristics; and handwashing practices. In addition, study staff requested stool samples to be tested for norovirus from select household members. We used descriptive statistics to understand the epidemiologic and clinical features of gastroenteritis episodes. To analyze potential risk factors, we used Firth's penalized logistic regression to estimate crude and adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs). There were 102 children with gastroenteritis, 18 cases of norovirus and 31 controls. Norovirus cases occurred later in the year, corresponding to a delay in the rainy season. Cases were more likely to have a household member with norovirus in their stool as compared with controls [crude OR: 13.3 (95% CI: 2.5, 136.2) and adjusted OR: 11.5 (95% CI: 1.6, 223.2)]. In addition, alcohol-based hand sanitizer use among household members was reported for 10 (32%) of controls and but never for cases. Further research is needed to understand household transmission of norovirus in low- and middle-income countries and the potential impact of hand sanitizer use.

Household Surveillance for Norovirus Gastroenteritis in a Nicaraguan Birth Cohort: A Nested Case—Control Analysis of Norovirus Risk Factors

“…In this population-based study of young Nicaraguan children, we confirmed some previously reported risk factors for norovirus AGE (i.e., dirt flooring in the household, low LAZ, contact with sick persons), and identified new risk factors (i.e., male sex, sharing drinks). For example, having contact with another person with diarrhea and/or vomiting in the past week, including household members and individuals outside the home, was the strongest risk factor for norovirus AGE in our study, as determined previously [ 8 , 9 , 11 ]. Additionally, the association of norovirus AGE and living in a household with dirt floors was not unexpected, as norovirus particles have been shown to persist on floors as dust [ 18 , 19 ], and it is conceivable that porous dirt floors would be harder to disinfect than tile or other hard-surface flooring.…”

“…Prior studies from LMIC using cross-sectional, cohort, and case–control designs have reported that younger age, larger households, household sanitation and socioeconomic factors, eating outside the household, and having contact with another household member with AGE symptoms were risks for norovirus AGE, while studies were mixed on the benefits of breastfeeding in reducing norovirus AGE [ 8 , 9 , 10 , 11 , 12 ]. The goal of this study was to identify modifiable risk factors for norovirus AGE in a population of young Nicaraguan children, using a larger sample of symptomatic norovirus-infected children than in previous studies and assessing previously unstudied risk factors.…”

Epidemiological investigation of norovirus infections in Punjab, Pakistan, through the One Health approach

“…The risk factors evaluated in this study were selected based on findings from previous studies ( 36 , 38 ), in which they were found to be associated with infection. While our study did not identify many statistically significant risk factors, but it is crucial that factors such as poor hand hygiene and consumption of contaminated water play a critical role in the transmission of noroviruses, particularly in low-income countries ( 37 , 39 ). In this study, results were also non-significant for breastfeeding; although, in literature, it has a protective role against norovirus infection due to the norovirus-specific immunoglobulin A antibody in breast milk ( 40 ).…”

Enteric Viral Co-Infections: Pathogenesis and Perspective

“…In a study investigating the extensive RV genomic variation during chronic infection in immunocompromised children, patients unable to clear their initial RV infection were subsequently co-infected with other circulating RV strains leading to prolonged life-threatening diarrhea [91]. Mixed co-infections with different NoV genogroups have also been reported, as young children may experience multiple and often repeated NoV infections with remarkable genetic diversity [92][93][94]. Mixed enterovirus co-infections have not been frequently detected in AGE [68,95], though they have in HFMD [96], but as enteroviruses are now increasingly appreciated as causative agents for AGE, increased testing may also increase co-infection detection rates.…”