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Norovirus is underdiagnosed cause of pediatric gastroenteritis
Norovirus is a common, underdiagnosed cause of gastroenteritis among children, according to study findings in The Journal of the Pediatric Infectious Diseases Society.
Robin R. Chamberland, PhD, of the Saint Louis University School of Medicine, and colleagues studied 172 randomly selected stool samples submitted to the St. Louis Children’s Hospital for bacterial culture between January 2008 and March 2009. Samples were collected from patients with a mean age of 6.3 years.
Robin R. Chamberland
Thirty of 172 samples were positive for norovirus, indicating a norovirus prevalence of 17.4% (95% CI, 12.1%-24%). Of these, 15.7% (95% CI, 10.6-22) were genogroup II and 1.7% (95% CI, 0.4%-5%) were genogroup I isolates.
Regarding seasonal distribution, most genogroup II cases occurred in the winter and fall, 18.9% (95% CI, 12.1%-27.5%) and 20% (95% CI, 5.7%-43.7%), respectively. Ten percent (95% CI, 1.2%-31.7%) of summer samples were positive for genogroup II and no spring samples were positive for genogroup II. Genogroup I isolates represented 1.8% (95% CI, 0.2%-6.4%) of winter and 4.8% (95% CI, 0.1%-23.8%) of spring samples, respectively.
Eighty-eight percent of patients did not receive a microbiological diagnosis. Of the 12% of patients who did, 7% were positive for bacterial gastroenteritis; 4% were positive for Clostridium difficile; and 1% were positive for Giardia intestinalis.
“Based on the prevalence of norovirus, and potential for mortality and morbidity in vulnerable populations, we propose that norovirus testing is a useful addition to laboratory test menus both for the timely detection of outbreaks and for patient diagnosis when warranted,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Researchers from the St. Louis University School of Medicine, Washington University School of Medicine, and Virginia Commonwealth University noted that norovirus was detected in 17% of 172 retrospectively tested unique residual stool specimens collected from children with gastroenteritis between January 2008 and March 2009 in St. Louis. Sixteen percent (27/172) were Genogroup II (GII) and 2% (3/172) were Genogroup I. GII was detected during stools collected during the winter, summer, and fall months while GI was detected in the winter and spring months only. One stool specimen was notable for the co-detection of both norovirus and Salmonella.
These results contribute to the growing appreciation of the potential role of norovirus detection in the stools of symptomatic children. To date, the commercial unavailability of a sensitive and specific diagnostic test for norovirus has hindered our appreciation of the burden of pediatric norovirus endemic infections. As the authors suggest, norovirus may account for a notable proportion of previously uncharacterized pediatric acute gastroenteritis. While the detection of norovirus from stools of symptomatic children does not imply etiology, the absence of detection of co-pathogens does lend support to its role as a causative agent. Studies such as this one remind us of the need to devote resources to the development of rapid and reliable diagnostics as well as efforts to optimize preventive measures, including immunization. The success of rotavirus immunization in resource endowed settings is a hopeful reminder that the same achievements may be on the horizon for pediatric norovirus infections.