1101. Comparison of Clinical Characteristics and Demographics of GII.4 vs. Other GII Noroviruses Associated With Sporadic Acute Gastroenteritis in Children in Nashville, TN, 2012–2015

Abstract Background Norovirus is a leading cause of acute gastroenteritis (AGE) in all age groups. Although at least 28 different genotypes infecting humans have been reported, most outbreaks over the last 15 years have been caused by genogroup II (GII) viruses, of which GII.4 viruses have caused more than 50%. Since clinical differences between different genotypes are poorly understood, we sought to compare clinical characteristics in children infected with GII.4 and non-GII.4 viruses. Methods Children between 15 days and 17 years who presented with AGE defined as diarrhea (≥3 loose stools in a 24 hour period) or vomiting (≥1 episodes in a 24 hour period) within 10 days duration were recruited in outpatient, emergency, and inpatient settings in Nashville, TN, during 2012–2015. Stool specimens were tested by RT-qPCR for GI and GII norovirus. Norovirus-positive specimens were genotyped by sequencing of a partial region of the capsid gene. In this study, we excluded children infected with GI, mixed GI/GII and non-typeable GII viruses. Results Of 3,705 AGE subjects enrolled, 2,892 (78%) specimens were collected, 637 (22%) tested norovirus-positive (567 [89%] GII, 62 [10%] GI, and 8 [1%] mixed GI/GII). Of the 567 GII viruses, 461 (81%) were able to be genotyped and of those 238/461 (51.6%) were typed as GII.4 and 223/461 (48.3%) were typed as other GII genotypes (non-GII.4, primarily GII.3 [65/ 461, 14.1%], GII.6 [48/461, 10.4%] and GII.7 [36/461, 7.8%]). Over three AGE seasons, GII.4 represented 64/117 (54%), 79/178 (44%), and 71/166 (57%), of the GII infections, respectively. Compared with non-GII.4 subjects, GII.4 subjects were more likely to be younger (15.5 vs. 21.3 months, P < 0.01), and less likely to attend daycare (23% vs. 39%, P < 0.01). GII.4 subjects also were more likely to present with diarrhea (75% vs. 57%, P < 0.01) and had higher median modified Vesikari score (7 vs. 6, P < 0.01). Conclusion Children infected with GII.4 viruses were younger, less likely to attend child care, more likely to present with diarrhea, and had a more severe illness compared with those with non-GII.4 infections. These data provide important information on the genotype distribution of norovirus in children with AGE in Tennessee and highlight GII.4 as the most prevalent strain. Disclosures N. Halasa, sanofi pasteur: Investigator, Research support. GSK: Consultant, Consulting fee. Moderna: Consultant, Consulting fee.

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Clinical Characteristics of Children with HIV Initiated on Antiretroviral Treatment at HIV Clinics in Bloemfontein, South Africa

International Journal of MCH and AIDS (IJMA) ◽

10.21106/ijma.471 ◽

2021 ◽

Vol 10 (1) ◽

pp. 146-155

Author(s):

Andrew Walubo ◽

Refuoe Baleni ◽

Hillary Mukudu ◽

Henry Kambafwile ◽

Mukesh Dhedha ◽

...

Keyword(s):

South Africa ◽

Global Health ◽

Clinical Characteristics ◽

Treatment Guidelines ◽

Age Groups ◽

World Health ◽

Severe Illness ◽

Age Group ◽

National Guidelines ◽

Number Of Children

Background and Objective: Over the past 15 years, there have been three major updates to the South African national guidelines for the management of human immunodeficiency virus (HIV) in children. The purpose of this study is to describe the clinical characteristics of children who were initiated on antiretroviral therapy (ART) in Bloemfontein, South Africa, following these national treatment guidelines. Methods: Clinical information during initiation of ART in children aged 0-13 years was obtained from five HIV clinics in Bloemfontein from 2004 to 2019 as part of the establishment of an antiretroviral (ARV) pediatric registry at the University of the Free State. Data were analyzed for patient demographics, clinical presentation (World Health Organization (WHO) HIV-staging, growth rate and comorbid conditions), types of investigations done, and medicines prescribed. Results: The number of children initiated on ART increased from 168 in the period 2004-2009 to 349 (107.8%) in 2010-2014, and then dropped to 162 in the period 2015-2019. The increase in 2010-2014 was mainly in the <2 years age group by 54.8%, and in the 5 to 10 years age group by 344.4%. In the same period, the number of children with severe illness (WHO HIV-stage 4) decreased by 20.7%, while those with mild to moderate illness (WHO HIV-stage 2 and 3) increased by 17.3%. HIV infection was more severe in children under two years as more patients in this age group presented with WHO HIV-stages 3 and 4, severe underweight (below 3rd percentile), severely suppressed CD4 count (< 25%), and a high viral load (> 1000 copies/ml). There was increased use of ABC/3TC/LPVr in the < 3-year age group and ABC/3TC/EFV in the > 3-year age group. There was reduced use of the stavudine and other regimens. Conclusion and Global Health Implications: More children were started on ART and safer ARV drugs. Children under 2 years were the most debilitated by HIV, and there was an increase in HIV prevalence among children > 5 years. New strategies for the prevention and management of HIV among children in these two age groups are needed. Copyright © 2021 Walubo et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

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Molecular Diagnostic Methods for Detection and Characterization of Human Noroviruses

The Open Microbiology Journal ◽

10.2174/1874285801610010078 ◽

2016 ◽

Vol 10 (1) ◽

pp. 78-89 ◽

Cited By ~ 3

Author(s):

Haifeng Chen ◽

Yuan Hu

Keyword(s):

Acute Gastroenteritis ◽

Disease Burden ◽

Age Groups ◽

Etiologic Agent ◽

Diagnostic Methods ◽

Molecular Diagnostic ◽

Human Noroviruses ◽

Viral Illness ◽

Sporadic Acute Gastroenteritis

Human noroviruses are a group of viral agents that afflict people of all age groups. The viruses are now recognized as the most common causative agent of nonbacterial acute gastroenteritis and foodborne viral illness worldwide. However, they have been considered to play insignificant roles in the disease burden of acute gastroenteritis for the past decades until the recent advent of new and more sensitive molecular diagnostic methods. The availability and application of the molecular diagnostic methods have led to enhanced detection of noroviruses in clinical, food and environmental samples, significantly increasing the recognition of noroviruses as an etiologic agent of epidemic and sporadic acute gastroenteritis. This article aims to summarize recent efforts made for the development of molecular methods for the detection and characterization of human noroviruses.

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Characteristics of GII.4 Norovirus Versus Other Genotypes in Sporadic Pediatric Infections in Davidson County, Tennessee, USA

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1001 ◽

2020 ◽

Author(s):

Zaid Haddadin ◽

Einas Batarseh ◽

Lubna Hamdan ◽

Laura S Stewart ◽

Bhinnata Piya ◽

...

Keyword(s):

Emergency Department ◽

Clinical Characteristics ◽

Partial Region ◽

Oral Rehydration ◽

Davidson County ◽

Qrt Pcr ◽

Inpatient Settings ◽

Stool Specimens ◽

Pediatric Infections ◽

To Receive

Abstract Background Norovirus is a leading cause of epidemic acute gastroenteritis (AGE), with most outbreaks occurring during winter. The majority of outbreaks are caused by GII.4 noroviruses; however, data to support whether this is true for sporadic medically attended AGE are limited. Therefore, we sought to compare the clinical characteristics and seasonality of GII.4 vs non-GII.4 viruses. Methods Children aged 15 days -17 years with AGE symptoms were recruited from the outpatient, emergency department, and inpatient settings at Vanderbilt Children’s Hospital, Davidson County, Nashville, Tennessee, from December 2012 -November 2015. Stool specimens were tested using qRT-PCR for GI and GII noroviruses and subsequently genotyped by sequencing a partial region of the capsid gene. Results A total of 3705 patients were enrolled, and stool specimens were collected and tested from 2885 (78%) enrollees. Overall, 636 (22%) samples were norovirus-positive, of which 567 (89%) were GII. Of the 460 (81%) genotyped GII-positive samples, 233 (51%) were typed as GII.4 and 227 (49%) as non-GII.4. Compared with children with non-GII.4 infections, children with GII.4 infections were younger, more likely to have diarrhea, and more likely to receive oral rehydration fluids. Norovirus was detected year-round and peaked during winter. Conclusions Approximately 40% of sporadic pediatric norovirus AGE cases were caused by GII.4 norovirus. Children infected with GII.4 had more severe symptoms that required more medical care. Seasonal variations were noticed among different genotypes. These data highlight the importance of continuous norovirus surveillance and provide important information on which strains pediatric norovirus vaccines should protect against.

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1112. Detection of Enteric Viruses in Children With Acute Gastroenteritis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.945 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S333-S334

Author(s):

Lubna Hamdan ◽

Einas Batarseh ◽

Bhinnata Piya ◽

Laura Stewart ◽

Chris Fonnesbeck ◽

...

Keyword(s):

Acute Gastroenteritis ◽

Infection Prevention ◽

Virus Detection ◽

Hospital Inpatient ◽

Infectious Agents ◽

Research Support ◽

Viral Pathogens ◽

Additional Testing ◽

Stool Specimens ◽

Outpatient Settings

Abstract Background Acute gastroenteritis (AGE) is a major cause of morbidity in children. Viral pathogens are the most common infectious agents. Differences in illness characteristics of AGE with and without virus detection are poorly defined. We compared AGE illness characteristics between children with and without any-virus detected, and with single vs. multiple viruses detected. Methods Children between 15 days and 17 years with AGE defined as diarrhea (>3 loose stools/24 hours) or any vomiting within 10 days duration were enrolled in Vanderbilt Children’s Hospital inpatient, ED, and outpatient settings from December 2012 to November 2015. Stool specimens were tested by RT-qPCR for norovirus, sapovirus, and astrovirus and by ELISA (VP6 antigen [Rotaclone®]) for rotavirus. Results Of 3,705 children enrolled, 2,892 (78%) specimens were collected. A single virus was detected in 1,109 (38%) stools [51% norovirus, 20% rotavirus, 21% sapovirus, and 8% astrovirus], viral co-detections were found in 115 (4%) stools, and 1,665 (58%) had no detected viruses. Table 1 compares children with and without any-virus detected. Children with a single-virus detected were older than those with >1 virus detected (1.8 vs. 1.5 years [P < 0.05]) with no other significant differences. Conclusion Children with any-virus detected had more severe symptoms, higher MVS, and more frequently reported sick contacts compared with no-virus detected. Children with no-virus detected were more likely to present with fever and higher temperatures, which may be due to bacterial organisms. These data highlight the importance of infection-prevention precautions in the community and the need for additional testing to define the etiologic spectrum of AGE in children. Disclosures N. Halasa, sanofi pasteur: Investigator, Research support. GSK: Consultant, Consulting fee. Moderna: Consultant, Consulting fee.

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Norovirus GII.4 antibodies in the Portuguese population

The Journal of Infection in Developing Countries ◽

10.3855/jidc.4616 ◽

2014 ◽

Vol 8 (09) ◽

pp. 1201-1204 ◽

Cited By ~ 4

Author(s):

João Rodrigo Mesquita ◽

Maria São José Nascimento

Keyword(s):

Acute Gastroenteritis ◽

Age Groups ◽

Serum Samples ◽

Portuguese Population ◽

Seropositivity Rate ◽

Virus Like Particle ◽

Norovirus Gii ◽

Sporadic Acute Gastroenteritis ◽

Immune Assay

Introduction: Norovirus GII.4 is the leading cause of outbreaks of acute and sporadic acute gastroenteritis worldwide. Information on the prevalence of norovirus in Portugal is scarce or null. Methodology: We used a GII.4 norovirus virus-like particle-based enzyme immune assay to measure the seropositivity rate of GII.4 norovirus. Results: A total of 342 (70%) out of 473 serum samples tested positive for anti-GII.4 norovirus IgG. No statistically significant differences were found between regions, sex and age groups. Conclusion: Norovirus GII.4 infections are frequent in Portugal.

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Aetiological importance of viruses causing acute gastroenteritis in humans

Microbiology Australia ◽

10.1071/ma12049 ◽

2012 ◽

Vol 33 (2) ◽

pp. 49

Author(s):

Geoffrey Higgins ◽

Sonia Schepetiuk ◽

Rod Ratcliff

Keyword(s):

Acute Gastroenteritis ◽

Age Groups ◽

Molecular Techniques ◽

Severe Illness ◽

Controlled Trials ◽

Enteric Adenoviruses

Acute gastroenteritis (AGE) is a common illness affecting all age groups worldwide causing 2.2 million deaths annually. Viruses including rotaviruses, noroviruses, enteric adenoviruses and astroviruses are the major cause of AGE, with rotavirus causing the majority of severe illness. Advances in molecular techniques have led to the identification of many more viruses in faeces. Proving an association with AGE will require prospective controlled trials which so far are few in number.

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Viral etiology of acute gastroenteritis among Forcibly Displaced Myanmar Nationals and adjacent host population in Bangladesh

The Journal of Infectious Diseases ◽

10.1093/infdis/jiab466 ◽

2021 ◽

Author(s):

Mohammad Enayet Hossian ◽

Md Muzahidul Islam ◽

Mojnu Miah ◽

Warda Haque ◽

Jan Vinjé ◽

...

Keyword(s):

Acute Gastroenteritis ◽

Bacterial Infections ◽

Viral Infections ◽

Age Groups ◽

Host Population ◽

Antibiotic Usage ◽

Viral Etiology ◽

Local Host ◽

Stool Specimens ◽

Significant Health

Abstract Background Since August 2017 Myanmar nationals from Rakhine state have crossed the border into Bangladesh and settled in Cox’s Bazar, the World's largest refugee camp. Due to overcrowding, poor sanitation, and hygienic practices they have been under significant health risks including diarrheal diseases. Objective To determine the viral etiology of acute gastroenteritis (AGE) among forcibly displaced Myanmar nationals (FDMN) and adjacent Bangladeshi local host population (AHP). Methods From April 2018 to April 2019, we collected stool specimens from 764 FDMN and 1159 AHP of all ages. We tested 100 randomly selected specimens from each group for the most common acute gastroenteritis viruses. Results Among 200 diarrhea patients, 55% and 64% of FDMN and AHP patients respectively had viral infections; the most common viruses were rotavirus (29% vs 44%), adenovirus (24% vs 31%) and norovirus (14% vs 10%). In both populations, viral infections were significantly higher in children less than five years; compared to bacterial infections which were higher in patients older than five years of age (p=<0.05). Conclusion Disparities in viral and bacterial prevalence among various age groups warrant careful antibiotic usage, especially in children less than five years.

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Diagnostic Accuracy of Immunochromatographic Tests for the Detection of Norovirus in Stool Specimens: a Systematic Review and Meta-Analysis

Microbiology Spectrum ◽

10.1128/spectrum.00467-21 ◽

2021 ◽

Author(s):

Seo Hee Yoon ◽

Hye Rim Kim ◽

Jong Gyun Ahn

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Economic Burden ◽

Acute Gastroenteritis ◽

Meta Analysis ◽

Age Groups ◽

Major Health ◽

Stool Specimens

Noroviruses are the leading cause of acute gastroenteritis in all age groups and constitute a major health and economic burden worldwide. This systematic review and meta-analysis aimed to determine the diagnostic accuracy of immunochromatographic tests (ICTs) for the detection of norovirus in stool specimens, which has not been performed previously.

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Characteristics of Campylobacter and Salmonella Infections and Acute Gastroenteritis in Older Adults in Australia, Canada, and the United States

Clinical Infectious Diseases ◽

10.1093/cid/ciy1142 ◽

2019 ◽

Vol 69 (9) ◽

pp. 1545-1552 ◽

Cited By ~ 5

Author(s):

Alice E White ◽

Nadia Ciampa ◽

Yingxi Chen ◽

Martyn Kirk ◽

Andrea Nesbitt ◽

...

Keyword(s):

United States ◽

Older Adults ◽

Acute Gastroenteritis ◽

Age Groups ◽

Signs And Symptoms ◽

The United States ◽

Bloody Diarrhea ◽

Severe Illness ◽

Salmonella Infections ◽

Enteric Infections

Abstract Background The early detection of enteric infections in older adults is challenging because typical signs and symptoms of disease may be less common, absent, or overlooked. Understanding illness characteristics of enteric infections among older adults could improve the timeliness and accuracy of clinical diagnoses, thereby improving patient outcomes and increasing cases reported to surveillance. Methods Here, we describe illness characteristics (percentage reporting bloody diarrhea, fever, vomiting, abdominal pain; percentage hospitalized; duration of hospitalization; and duration of illness) among older adults (≥65 years) with acute gastroenteritis and culture-confirmed Campylobacter and nontyphoidal Salmonella infections in Australia, Canada, and the United States and compare these characteristics with those among younger people (<5 years, 5–24 years, and 25–64 years). Results A significant negative correlation was found between all symptoms and increasing age group, except for bloody diarrhea in cases of acute gastroenteritis. Adults aged ≥85 years reported bloody diarrhea in only 9% of nontyphoidal Salmonella and 4% of Campylobacter infections compared with 59% and 55% among children aged <5 years. Conversely, a greater percentage of older adults (≥65) than younger persons (<5, 5–24, 25–64) reported being hospitalized, with an increasing linear relationship in age groups 65 years and older. Conclusions Although older adults are more likely to have severe illness and be hospitalized, we found that the proportion of persons reporting symptoms typically associated with enteric infections decreases with age. These findings have implications for clinical recognition and treatment of gastrointestinal illness, as well as for public health research.

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