Abstract Title
Symptom status and severity of norovirus infections among a cohort of young US children
Presenter
Jennifer L. Cannon, CDC Foundation
Co-Author(s)
Julia M. Baker1*, Jennifer L. Cannon2*, Claire P. Mattison1,3, Hannah Browne1, Kenny Nguyen1, Rachel M. Burke1, Eddie Bartlett1,3, Shannon C. Conrey4,5, Allison R. Burrell5, Mary Allen Staat5,6, Ardythe L. Morrow4,5, Umesh D. Parashar1, Jan Vinjé1, Sara A. Mirza1, Daniel C. Payne5,6
Affiliations:
1 Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
2 CDC Foundation, Atlanta, GA 30308, USA
3 Cherokee Nation Operational Solutions, Tulsa, OK 74103, USA
4 Department of Environmental and Public Health Sciences, Division of Epidemiology, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
5 Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
6 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
*These authors contributed equally
Abstract Category
Epidemology
Abstract
Background: Norovirus is a leading cause of severe acute gastroenteritis (AGE) in children. We describe symptom characteristics of norovirus infections among children under 2 years of age.
Design/Methods: The Pediatric Respiratory and Enteric Virus Acquisition and Immunogenesis Longitudinal (PREVAIL) birth cohort study collected symptom surveys and stool samples weekly and during AGE episodes (≥3 loose stools and/or ≥1 episode of vomiting in 24 hours). Norovirus was detected in stool via realtime RT-PCR and genotyped. Infections with AGE symptoms reported ≤3 days before or ≤13 days after initial viral detection were considered symptomatic. Infections were compared by genogroup and common genotypes for 101 children followed for ≥18 months with ≥70% sample submission.
Results: We identified 42 GI, 55 GII.4 Sydney, 41 GII.6 and 97 other GII infections. The median age at infection was similar across genogroups/genotypes (11-14 months). Symptoms were more common during GII.6 and GII.4 Sydney infections (GII.6=50.0%; GII.4 Sydney=41.2%; other GII=36.6%; GI=18.9%, p=0.021) and among older children (median age symptomatic=14 months [IQR: 10-19]; asymptomatic=12 months [IQR: 8-18], p=0.031). Median symptom duration was modestly longer for GII.4 Sydney (4 days, [IQR:2-5]) compared to other genotypes (2-3 days, p=0.256). Nearly half (42.9%) of symptomatic GII.4 Sydney infections resulted in clinical care (outpatient/ED/hospitalization); fewer for GI (14.3%), GII.6 (20.0%) and other GII infections (39.3%, p=0.254). Neither viral load nor age were associated with seeking clinical care for symptomatic infections.
Conclusions: Symptomatic norovirus illness was most common with GII infections. GII.4 Sydney may cause more prolonged and severe symptoms compared with other genotypes.
Design/Methods: The Pediatric Respiratory and Enteric Virus Acquisition and Immunogenesis Longitudinal (PREVAIL) birth cohort study collected symptom surveys and stool samples weekly and during AGE episodes (≥3 loose stools and/or ≥1 episode of vomiting in 24 hours). Norovirus was detected in stool via realtime RT-PCR and genotyped. Infections with AGE symptoms reported ≤3 days before or ≤13 days after initial viral detection were considered symptomatic. Infections were compared by genogroup and common genotypes for 101 children followed for ≥18 months with ≥70% sample submission.
Results: We identified 42 GI, 55 GII.4 Sydney, 41 GII.6 and 97 other GII infections. The median age at infection was similar across genogroups/genotypes (11-14 months). Symptoms were more common during GII.6 and GII.4 Sydney infections (GII.6=50.0%; GII.4 Sydney=41.2%; other GII=36.6%; GI=18.9%, p=0.021) and among older children (median age symptomatic=14 months [IQR: 10-19]; asymptomatic=12 months [IQR: 8-18], p=0.031). Median symptom duration was modestly longer for GII.4 Sydney (4 days, [IQR:2-5]) compared to other genotypes (2-3 days, p=0.256). Nearly half (42.9%) of symptomatic GII.4 Sydney infections resulted in clinical care (outpatient/ED/hospitalization); fewer for GI (14.3%), GII.6 (20.0%) and other GII infections (39.3%, p=0.254). Neither viral load nor age were associated with seeking clinical care for symptomatic infections.
Conclusions: Symptomatic norovirus illness was most common with GII infections. GII.4 Sydney may cause more prolonged and severe symptoms compared with other genotypes.