Molecular epidemiology of human bocavirus infection in hospitalized children with acute gastroenteritis in South Africa, 2009‐2015

Abstract

Human bocavirus (HBoV) is known to be associated with a variety of clinical manifestation including acute gastroenteritis (AGE). Despite their global prevalence, no data is available on the epidemiology of HBoV associated with AGE in South Africa (SA). Between April 2009 and April 2015, 3765 stool specimens were collected from children less than 5 years of age hospitalized with diarrhea. Specimens were screened for selected enteric viruses by enzyme immunoassay and quantitative polymerase chain reaction, bacteria by culture and parasites by staining and microscopy. HBoV was detected in 5.63% (212 of 3765) of cases, the majority of which were children ≤2 years (92%, 195 of 212), and were common in the summer and autumn months (60%; 128 of 212). Further investigations of coinfections showed that bacteria (adjusted odds ratio [aOR] = 2.20; 95% confidence interval [CI], 1.41‐3.45; P = .001) and sapovirus (aOR = 2.05; 95% CI, 1.08‐3.86; P = .027) were significantly associated with HBoV in multivariate analysis. HBoV genotyping was successful in 191 of the 212 samples with HBoV‐1 being the most prevalent genotype observed (79.6%; 152 of 191) followed by HBoV‐3 (13.6%; 26 of 191), HBoV‐2 (5.2%; 10 of 191), and HBoV‐4 (1.6%; 3 of 191). The high prevalence of HBoV‐1, a virus known to be associated with respiratory infections, and the association between HBoV‐positive specimens and already established AGE agents, suggests that HBoV may play a limited role in the observed AGE cases in SA.

Predominance of Human Bocavirus Genotype 1 and 3 in Outpatient Children with Diarrhea from Rural Communities in South Africa, 2017–2018

“…This was also the case in several other recent studies [6,34,36,37], which makes the role of HBoV4 genotype unclear. The predominance of HBoV1 and HBoV3 in children with AGE in this study is similar to a previous report in SA, which also observed a high prevalence of HBoV1 and HBoV3 [10]. However, the study only investigated HBoV in hospitalized children with AGE from an urban area, compared to this study which investigated both hospitalized and outpatients.…”

“…Several studies have reported human bocavirus in children with respiratory tract infections and AGE in South Africa [7][8][9][10]. However, no data are available on the prevalence of HBoV and other enteric pathogens in children with AGE from rural communities, suggesting that cases from these rural areas are most likely to be underinvestigated and under-reported [14,15].…”

“…HBoV investigations in South Africa (SA) have previously reported on the detection of HBoV genotypes in children with respiratory tract infections and AGE [7][8][9][10]. There is no published work on the detection of this virus from stools in children with AGE or children living in rural communities with poor water and sanitation infrastructure in South Africa.…”

Human Bocavirus in Brazil: Molecular Epidemiology, Viral Load and Co-Infections

“…It has been described that HBoV most affected age group are children up to 24-months-old [17,19,37,42]. A large study performed in South Africa between 2009 and 2015 with 3765 stool specimens collected from hospitalized children for AGE demonstrated that the majority (92%) of HBoV-positive cases were children <2 years old [20]. Furthermore, the lower rates of HBoV infection among children aged <6 months found in our study and reported elsewhere are likely due to early protection by the maternal antibodies [43][44][45], and also because usually after six-months-old, children are more exposed to viral infections within childcare centers.…”

“…Currently, based on the genomic analysis of the two major structural proteins (VP1-2), HBoV is divided into four species or genotypes (HBoV-1 to 4) [12]. HBoV genotypes are globally distributed, and have been single or co-detected in AGE cases, with incidence varying from 0.5 to 25%, especially in children younger than two years old [10,16,[19][20][21].…”