Abstract
Norovirus is a major pathogen identified in children with acute gastroenteritis (AGE), little is known about the strain’s diversity and their clinical severity. Stool and/or rectal swabs were collected from children ≤18 years of age recruited at emergency departments (ED), and a provincial nursing advice phone line due to AGE symptoms in the province of Alberta, Canada between December 2014 and August 2018. Specimens were tested using a reverse transcription real time PCR and genotyped by Sanger sequencing. The Modified Vesikari Scale score (MVS) was used to evaluate the disease severity. The objectives are to identify the Genogroup and Genotype distribution and to compare illness severity between the GI and GII genogroups and to complete further analyses comparing the GII genotypes identified. GII.4 was the genotype most commonly identified. Children with GII.4 had higher MVS scores (12.0 (10.0, 14.0; p = 0.002)) and more prolonged diarrheal (5 days (3.0, 7.8)) and vomiting (3.2 days (1.7, 5.3; p < 0.001)) durations compared to other non GII.4 strains. The predominant strain varied by year with GII.4 Sydney[P31] predominant in 2014/15, GII.4 Sydney[P16] in 2015/16 and 2017/18, and GII.3[P12] in 2016/17. Genogroup II norovirus strains predominated in children with AGE with variance between years; clinical severity associated with different strains varied with episodes being most severe among GII.4 infected children.
Highlights
Acute gastroenteritis (AGE) is associated with an estimated 500,000 deaths among children younger than five years globally [1]
The norovirus positivity rate was highest in children aged 1.0 to 3.0 years of age (393/1347, 29.2%; 95% CI: 18.7%, 34.3%) compared with younger (272/1028, 26.5%; 95% CI: 15.2%, 31.4%) and older (235/972, 24.2%; 95% CI 14.7%, 29.3%) children (Table 1)
Our study has provided a comprehensive view of norovirus genogroups causing AGE in children in the province of Alberta, Canada
Summary
Acute gastroenteritis (AGE) is associated with an estimated 500,000 deaths among children younger than five years globally [1]. Most infected individuals have mild illnesses of short duration characterized predominantly by vomiting [5], infants more often have severe disease and are more likely to seek medical care and be hospitalized [6]. Viruses of the GII. genotype are the leading cause of norovirus disease [7], with new variants emerging every two years to four years [8,9] In addition, the GII. genotype has been associated with greater symptom severity and health care resource consumption [10]. Outbreak reports have been analyzed to quantify hospitalization and mortality rates associated with GII. compared with non-GII. disease [10], no data has previously characterized illness severity for varying genotypes using commonly employed clinical disease severity measures
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