Abstract
BackgroundHuman Norovirus (NoV) is recognized as a major etiological agent of sporadic acute gastroenteritis worldwide. ObjectivesThis study describes the clinical features associated with Human NoV occurrence in children and determines the prevalence and estimated viral burden of NoV in symptomatic and asymptomatic children in rural South Africa. Study designBetween July 2014 and April 2015, outpatient children under 5 years of age from rural communities of Vhembe district, South Africa, were enrolled for the study. A total of 303 stool specimens were collected from those with diarrhea (n=253) and without (n=50) diarrhea. NoVs were identified using real-time one-step RT-PCR. ResultsOne hundred and four (41.1%) NoVs were detected (62[59.6%] GII, 16[15.4%] GI, and 26[25%] mixed GI/GII) in cases and 18 (36%) including 9(50%) GII, 2(11.1%) GI and 7(38.9%) mixed GI/GII in controls. NoV detection rates in symptomatic and asymptomatic children (OR=1.24; 95% CI 0.66⿿2.33) were not significantly different. Comparison of the median CT values for NoV in symptomatic and asymptomatic children revealed significant statistical difference of estimated GII viral load from both groups, with a much higher viral burden in symptomatic children. ConclusionsThough not proven predictive of diarrhea disease in this study, the high detection rate of NoV reflects the substantial exposure of children from rural communities to enteric pathogens possibly due to poor sanitation and hygiene practices. The results suggest that the difference between asymptomatic and symptomatic children with NoV may be at the level of the viral load of NoV genogroups involved.
Highlights
Human Norovirus (NoV) is recognized as a major etiological agent of sporadic acute gastroenteritis worldwide
The results of this study revealed that the detection rate of NoV in symptomatic cases was high (41.1%, 104/253) but was not statistically different when compared to the controls (36%, 18/50)
Evidence that NoV-positivity was more common in the symptomatic compared to the asymptomatic children was not established in this study
Summary
Human Norovirus (NoV) is recognized as a major etiological agent of sporadic acute gastroenteritis worldwide. Objectives: This study describes the clinical features associated with Human NoV occurrence in children and determines the prevalence and estimated viral burden of NoV in symptomatic and asymptomatic children in rural South Africa. NoV detection rates in symptomatic and asymptomatic children (OR = 1.24; 95% CI 0.66–2.33) were not significantly different. Conclusions: Though not proven predictive of diarrhea disease in this study, the high detection rate of NoV reflects the substantial exposure of children from rural communities to enteric pathogens possibly due to poor sanitation and hygiene practices. The results suggest that the difference between asymptomatic and symptomatic children with NoV may be at the level of the viral load of NoV genogroups involved. Illiteracy, malnutrition, inadequate water supplies and poor sanitation, as well as poor health and hygiene practices, affect a large proportion of rural communities in the African continent. Kabue et al / Journal of Clinical Virology 84 (2016) 12–18
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