Clinical and epidemiological characteristics of norovirus gastroenteritis among hospitalized children in Lebanon

Abstract

AIMTo assess the burden of norovirus (NoV) and to determine the diversity of circulating strains among hospitalized children in Lebanon.METHODSStool samples were collected from children presenting with acute gastroenteritis to six major hospitals in Lebanon. A total of 739 eligible stool samples, testing negative for diarrhea caused by rotavirus as a possible viral pathogen, were collected between January 2011 and June 2013. A standardized questionnaire including demographic, epidemiological and clinical observations was used at the time of hospitalization of children presenting with diarrhea. Viral RNA was extracted from stool samples followed by reverse transcription polymerase chain reaction and nucleotide sequencing of a fragment of the viral protein 1 capsid gene. Multiple sequence alignments were carried out and phylogenetic trees were constructed using the MEGA 6 software.RESULTSOverall, 11.2% of stool samples collected from children aged < 5 years tested positive for NoV genogroups I (GI) and II (GII). GII accounted for 10.6% of the gastroenteritis cases with only five samples being positive for GI (0.7%). The majority of hospitalized children showed symptoms of diarrhea, dehydration, vomiting and fever. Upon sequencing of positive samples and based on their clustering in the phylogenetic tree, 4/5 of GI gastroenteritis cases were designated GI.3 and one case as GI.4. GII.4 was predominantly detected in stool of our study participants (68%). We report a JB-15/KOR/2008 GII.4 Apeldoorn 2008-like variant strain circulating in 2011; this strain was replaced between 2012 and 2013 by a variant sharing homology with the Sydney/NSW0514/2012/AUS GII.4 Sydney 2012 and Sydney 2012/FRA GII.4 strains. We also report the co-circulation of non-GII.4 genotypes among hospitalized children. Our data show that NoV gastroenteritis can occur throughout the year with the highest number of cases detected during the hot months.CONCLUSIONThe majority of NoV-associated viral gastroenteritis cases among our participants are attributable to GII.4, which is compatible with results reported worldwide.

Rotavirus gastroenteritis among hospitalized children under 5 years of age in the Eastern Mediterranean Region: a review

“…Three studies provided us with data on the duration stay of hospitalized children with a minimum duration of three days. This finding is similar to another review conducted on data collected during 1999-2009 from the Eastern Mediterranean Region (49). Globally, this duration was decreased to 2.5 days in a study from Sweden (52).…”

“…The current review showed that the criteria of resource utilization used for patients infected with RV were similar in all countries. Also, the hospital admission and disease severity due to RV gastroenteritis were higher than those of non-RV gastroenteritis, which is similar to data reported in the region during 1999-2009 (49) and western Europe (53).…”

“…Finally, only one study from Tunisia conducted in 2015 contained data on health care utilization, where the medical cost of hospitalized children due to RV infection ranged from US$ 245 to $345 (33). This cost was lower than those costs reported during 1999-2009 in the studied region (ranging from US$ 467 to $1117) (49) and in western Europe (ranging from 2008 US$ 1949 to $2398 (54). Moreover, no data was available on the rotavirus fatalities in all our selected studies.…”

“…Moreover, no data was available on the rotavirus fatalities in all our selected studies. From a previous review, annual deaths rates due to RV gastroenteritis ranged from 0 to 112 per 10 000 children below 5 years of age in the Eastern Mediterranean Region during 1999-2009 (49).…”

Prevalence of noroviruses in children hospitalized for acute gastroenteritis in Hohhot, China, 2012-2017

“…Furthermore, 93% (1741/1863) of AGE cases were children aged 0 to 23 months, and NV positivity was higher in the 0-23month age group than in children older than 24 months, which implies that young children are more vulnerable to NV infection. This result is consistent with previous studies [15,22,30,31], indicating that intervention approaches such as a vaccine for NV infection should be implemented for children under 24 months of age.…”