Noroviruses as a Cause of Diarrhea in Travelers to Guatemala, India, and Mexico

Abstract

Noroviruses (NoVs) are increasingly being recognized as an important enteric pathogen of gastroenteritis worldwide. The prevalence of NoVs as a cause of diarrhea acquired by travelers in developing countries is not well known. We examined the prevalence and importance of NoV infection in three international traveler cohorts with diarrhea acquired in three developing regions of the world, Mexico, Guatemala, and India. We also characterized the demographics and symptoms associated with NoV diarrhea in these travelers. Stool samples from 571 international travelers with diarrhea were evaluated for traditional enteropathogens. NoVs were identified using reverse transcription-PCR and probe hybridization. NoVs were identified in 10.2% of cases of travelers' diarrhea and, overall, was the second most common pathogen, following diarrheagenic Escherichia coli. The detection of NoV diarrhea significantly varied over the three study time periods in Guadalajara, Mexico, ranging from 3 of 98 (3.0%) diarrheal stools to 12 of 100 (12.0%) fecal specimens (P ‫؍‬

Seroepidemiology of Norovirus‐Associated Travelers' Diarrhea

“…This observation is in line with our previous studies in travelers where rates of co-infections are found to be over 60% 7 . TD is characterized as multifactorial disease caused by a wide range of enteric pathogens including bacteria, viruses and parasites 24 .…”

“…NoVs are highly infectious, very stable and remarkably transmissible 4, 5 . Besides being a leading cause of epidemic acute gastroenteritis and an important cause of hospital acquired and sporadic infection, NoVs have also been described as a common etiology of travelers’ diarrhea (TD) 6, 7 . Interestingly, TD studies over time and in different locations have reported a marked diversity of GI- and GII-NoVs among cases 6, 8–10 .…”

Mapping Broadly Reactive Norovirus Genogroup I and II Monoclonal Antibodies

“…In the United States, NoVs cause 19 to 21 million cases each year (4,5). NoV outbreaks have been identified in children (6), the elderly (7), military personnel (8,9), immunocompromised individuals (10), restaurant patrons (11,12), travelers to developing countries (13,14), passengers of cruise ships (15), residents of health care facilities such as nursing homes (16,17) and hospitals (18), and other populations housed in close quarters (19). The increasing incidence of NoV infections emphasizes the need to quickly detect and identify the causative agent, because early diagnosis of NoV infection can be crucial in the effective control of outbreaks and can decrease the secondary attack rate (20).…”

Foodborne Infections and Intoxications Associated with International Travel

“…nursing homes but also on cruise ships. It has been detected as a cause of TD in up to 10-17% of travelers from different countries (Apelt et al, 2010;Hill and Beeching, 2010;Koo et al, 2010). Studies reporting prevalences as high as 65% have been published (Chapin et al, 2005).…”