Abstract
Norovirus is one of the most common causes of gastroenteritis. Following infection, anti-norovirus salivary immunoglobulin G (IgG) rises steeply within 2 weeks and remains elevated for several months; this immunoconversion can serve as an indicator of infection. We used a multiplex salivary immunoassay to study norovirus infections among 483 visitors to a Lake Michigan beach in 2015. Saliva was collected on the day of the beach visit (S1); after 10–14 days (S2); and after 30–40 days (S3). Luminex microspheres were coupled to recombinant antigens of genogroup I (GI) and II (GII) noroviruses and incubated with saliva. Immunoconversion was defined as at least 4-fold increase in anti-norovirus IgG antibody response from S1 to S2 and a 3-fold increase from S1 to S3. Ten (2.1%) immunoconverted to either GI (2) or GII (8) norovirus. Among those who immunoconverted, 40% reported at least one gastrointestinal symptom and 33% reported diarrhea, compared to 15% (p = 0.06) and 8% (p = 0.04) among those who did not immunoconvert, respectively. The two participants who immunoconverted to GI norovirus both swallowed water during swimming (p = 0.08). This study demonstrated the utility of a non-invasive salivary immunoassay to detect norovirus infections and an efficient approach to study infectious agents in large cohorts.
Highlights
Norovirus is one of the most common causes of gastroenteritis
This paper presents the results of a designed study at a freshwater beach on Lake Michigan located in the State of Indiana in the United States in 2015
We modeled log[10] transformed anti-NoV immunoglobulin G (IgG)/anti-GST median fluorescence intensity (MFI) ratio as a natural cubic spline function of age and estimated the upper bound of the 90% prediction interval (Fig. 1)
Summary
Norovirus is one of the most common causes of gastroenteritis. Following infection, anti-norovirus salivary immunoglobulin G (IgG) rises steeply within 2 weeks and remains elevated for several months; this immunoconversion can serve as an indicator of infection. In a recently published study based at a marine beach in Puerto Rico, we used a multiplex salivary immunoassay designed to detect IgG responses to two common GI and GII NoV variants and found that infection risk was over 5 times higher among swimmers who immersed their head than those who did not[9]. These infections, were mostly asymptomatic and were not associated with self-reported gastrointestinal symptoms. The goal of this study was to continue developing approaches to detect incident NoV infections using salivary biomarkers, to explore associations between NoV infections and swimming at a freshwater temperate location, and between norovirus infections and symptoms in a different population to further describe risk factors for sporadic NoV infections
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