Prevalence and genetic diversity of norovirus among patients with acute diarrhea in Guatemala

Abstract

Noroviruses (NoVs) are a leading cause of acute gastroenteritis outbreaks and sporadic cases of diarrhea in industrialized countries. To study the prevalence and genetic diversity of NoVs in Guatemala, stool specimens were collected from hospitalized and ambulatory patients presenting with diarrhea (≥3 loose or liquid stools in a 24-hr period) who were enrolled in a prospective surveillance system in the Departments of Santa Rosa (October 2007 to August 2010) and Quetzaltenango (August 2009 to August 2010), Guatemala. Specimens were tested for rotavirus, enteric bacteria, and parasites by routine methods and for genogroups I and II NoV by real-time reverse transcription-PCR. A total of 2,403 stool specimens were collected from hospitalized (n = 528) and ambulatory patients (n = 1,875). Overall, 341 (14%) samples tested positive for NoVs including 114 (22%) hospitalized and 227 (12%) ambulatory patients. NoVs disease peaked during the winter (November-January) months. Among the 341 NoVs-positive patients, 32 (9%) were also positive for rotavirus, 32 (9%) for bacteria, and 9 (3%) for protozoa. Nucleotide sequences were obtained from 84 samples collected from hospitalized children aged <5 years of age, which could be grouped into nine GII and three GI genotypes with GII.4 (74%) and GI.8 (10%) being the most common. This is the first study on the prevalence of NoVs among hospitalized and ambulatory patients with diarrhea in Guatemala. The findings highlight the need to implement laboratory diagnostics for NoVs to improve appropriate clinical management of diarrheal diseases and guide vaccine development.

Detection of human norovirus GIV.1 in China: A case report

“…Our study demonstrated a low prevalence of NoV GIV.1 as described in other studies [6,22,27,28]. Both the NoV GIV.1-positive patients were hospitalized with gastroenteritis in July of 2011 from Lulong County.…”

Diagnostic performance of rectal swab versus bulk stool specimens for the detection of rotavirus and norovirus: Implications for outbreak investigations

“…To compare the viral load between bulk stool and rectal swab specimens, the cycle threshold (Ct) values of each positive norovirus RT-qPCR result were compared. Details for the extraction of nucleic acids, Ct-value cut-offs for positive and negative specimens, and RT-qPCR detection limits are described elsewhere [11]. The laboratory testing procedures did not differ by specimen type.…”

Tropical and travel-associated norovirus

“…This likely represents a more diverse enteropathogen landscape in the context of higher overall diarrhea incidence in high-mortality settings [2■]. Prior to rotavirus vaccine implementation, norovirus was the most frequently identified pathogen in ambulatory [4] and community [5■■] diarrhea cases in certain LMIC settings. Rotavirus was usually reported more frequently in hospitalized children [4], although up to 55% of hospital diarrhea cases demonstrated human calicivirus (norovirus and/or sapovirus) infection when evaluated with both immunologic and molecular detection methods [6,7].…”

“…Prior to rotavirus vaccine implementation, norovirus was the most frequently identified pathogen in ambulatory [4] and community [5■■] diarrhea cases in certain LMIC settings. Rotavirus was usually reported more frequently in hospitalized children [4], although up to 55% of hospital diarrhea cases demonstrated human calicivirus (norovirus and/or sapovirus) infection when evaluated with both immunologic and molecular detection methods [6,7]. Following successful universal rotavirus vaccination in LMICs, norovirus is recognized as the predominant pathogen in hospitalized [8■], outpatient [4], and community [9■] diarrhea cases.…”

“…Rotavirus was usually reported more frequently in hospitalized children [4], although up to 55% of hospital diarrhea cases demonstrated human calicivirus (norovirus and/or sapovirus) infection when evaluated with both immunologic and molecular detection methods [6,7]. Following successful universal rotavirus vaccination in LMICs, norovirus is recognized as the predominant pathogen in hospitalized [8■], outpatient [4], and community [9■] diarrhea cases. Norovirus has also been associated with adult diarrhea in LMIC military service members [10■■].…”