Outbreak of Necrotizing Enterocolitis Caused by Norovirus in a Neonatal Intensive Care Unit

Abstract

This report associates NoV with NEC. NoV appeared to precipitate NEC in predisposed infants. Spatial clustering and epidemiologic links between cases and a health care worker with gastroenteritis suggests that NoV should be investigated among the etiologies of NEC outbreaks and that interventions targeted to interruption of NoV transmission should be considered.

The viral dsRNA analogue poly (I:C) induces necrotizing enterocolitis in neonatal mice

“…As the potential role of viral agents in the pathogenesis of NEC has only recently been recognized, we hypothesized that viral factors such as viral RNA could induce NEC in a neonate mouse model. Exclusively RNA viruses such as rota-, astro-, toro-, and norovirus have been associated with NEC (5,(8)(9)(10)(11)23). Among those, rotavirus, a dsRNA virus, is a well-known highly prevalent cause for severe diarrhea in infants and young children (24).…”

“…Several studies suggest that rotavirus in combination with other microorganisms can increase the intestinal vulnerability to bacterial invasion, leading to an exaggerated intestinal immune response, and therefore cause NEC (4)(5)(6)(7). Moreover, clinical reports indicate that the colonization or infection with astro-, toro-, or norovirus have an impact on NEC severity in preterm infants (8)(9)(10)(11). However, a possible involvement of viral vectors has not been studied in standardized mouse models so far.…”

Norovirus Genogroup II Gastroenteritis in Hospitalized Children in South India

“…6 There have been recent reports of NoV outbreaks in neonatal nurseries associated with clinical presentations such as necrotizing enterocolitis, diarrhea, vomiting, abdominal distension, and fever. [7][8][9] The primary objective of this study was to identify the prevalence of NoV GII among children 5 years of age admitted to the hospital with diarrhea.…”

Norovirus Gastroenteritis

“…38 Recent reports have suggested possible associations of norovirus infection with necrotizing enterocolitis in newborns, with benign seizures in infants, and with exacerbations of inflammatory bowel disease in pediatric patients; further study is needed to confirm these links. [39][40][41] …”