Norovirus Infection and Acquired Immunity in 8 Countries: Results From the MAL-ED Study. (24th March 2016)

• Record Type: Journal Article
• Authors: Rouhani, Saba; Peñataro Yori, Pablo; Paredes Olortegui, Maribel; Siguas Salas, Mery; Rengifo Trigoso, Dixner; Mondal, Dinesh; Bodhidatta, Ladaporn; Platts-Mills, James; Samie, Amidou; Kabir, Furqan; Lima, Aldo; Babji, Sudhir; Mason, Carl J.; Kalam, Adil; Bessong, Pascal; Ahmed, Tahmeed; Mduma, Estomih; Bhutta, Zulfiqar A.; Lima, Ila; Ramdass, Rakhi; Lang, Dennis; George, Ajila; Zaidi, Anita K. M.; Kang, Gagandeep; Houpt, Eric; Kosek, Margaret N.; Olotegui, Maribel Paredes; Chavez, Cesar Banda; Trigoso, Dixner Rengifo; Flores, Julian Torres; Vasquez, Angel Orbe; Pinedo, Silvia Rengifo; Acosta, Angel Mendez; Ahmed, Imran; Alam, Didar; Ali, Asad; Bhutta, Zulfiqar A.; Qureshi, Shahida; Rasheed, Muneera; Soofi, Sajid; Turab, Ali; Yousafzai, Aisha K; Zaidi, Anita K. M.; Bodhidatta, Ladaporn; Mason, Carl J.; Babji, Sudhir; Bose, Anuradha; Jennifer, M. Steffi; John, Sushil; Kang, Gagandeep; Kaki, Shiny; Koshy, Beena; Muliyil, Jayaprakash; Raghava, Mohan Venkata; Ramachandran, Anup; Rose, Anuradha; Sharma, Srujan L.; Thomas, Rahul J.; Pan, William; Ambikapathi, Ramya; Carreon, Danny; Charu, Vivek; Dabo, Leyfou; Doan, Viyada; Graham, Jhanelle; Hoest, Christel; Knobler, Stacey; Lang, Dennis; McCormick, Benjamin; McGrath, Monica; Miller, Mark; Mohale, Archana; Nayyar, Gaurvika; Psaki, Stephanie; Rasmussen, Zeba; Richard, Stephanie A.; Seidman, Jessica C; Wang, Vivian; Blank, Rebecca; Gottlieb, Michael; Tountas, Karen H.; Amour, Caroline; Mduma, Estomih; Swema, Buliga Mujaga; Yarrot, Ladislaus; Nshama, Rosemary; Ahmed, Tahmeed; Ahmed, A. M. Shamsir; Tofail, Fahmida; Haque, Rashidul; Hossain, Iqbal; Islam, Munirul; Mahfuz, Mustafa; Mondal, Dinesh; Chandyo, Ram Krishna; Shrestha, Prakash Sunder; Shrestha, Rita; Ulak, Manjeswori; Black, Robert; Caulfield, Laura; Checkley, William; Chen, Ping; Kosek, Margaret; Lee, Gwenyth; Yori, Pablo Peñataro; Murray-Kolb, Laura E.; Schaefer, Barbara; Pendergast, Laura; Abreu, Cláudia; Havt, Alexandre; Costa, Hilda; Di Moura, Alessandra; Filho, Jose Quirino; Leite, Álvaro; Lima, Aldo; Lima, Noélia; Lima, Ila; Maciel, Bruna; Moraes, Milena; Mota, Francisco; Oriá, Reinaldo; Quetz, Josiane; Soares, Alberto; Patil, Crystal L; Bessong, Pascal; Mahopo, Cloupas; Maphula, Angelina; Nesamvuni, Cebisa; Nyathi, Emanuel; Samie, Amidou; Barrett, Leah; Gratz, Jean; Guerrant, Richard; Houpt, Eric; Petri, William; Scharf, Rebecca; Platts-Mills, James; Shrestha, Binob; Shrestha, Sanjaya Kumar; Strand, Tor; Svensen, Erling;
• Is Part Of: Clinical infectious diseases. Volume 62:Number 10(2016)
• Page Start: 1210
• Page End: 1217
• Publication Date: 2016-03-24
• Subjects: norovirus -- diarrhea -- immunity; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciw072
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract : This longitudinal, multisite study reports a high prevalence of norovirus infection and norovirus-positive diarrhea and describes patterns of age acquisition, disease severity, genogroup-specific immunity, and relationships between norovirus and undernutrition in the first 2 years of life. Abstract: Background. Norovirus is an important cause of childhood diarrhea. We present data from a longitudinal, multicountry study describing norovirus epidemiology during the first 2 years of life. Methods. A birth cohort of 1457 children across 8 countries contributed 7077 diarrheal stools for norovirus testing. A subset of 199 children contributed additional asymptomatic samples (2307) and diarrheal stools (770), which were used to derive incidence rates and evaluate evidence for acquired immunity. Results. Across sites, 89% of children experienced at least 1 norovirus infection before 24 months, and 22.7% of all diarrheal stools were norovirus positive. Severity of norovirus-positive diarrhea was comparable to other enteropathogens, with the exception of rotavirus. Incidence of genogroup II (GII) infection was higher than genogroup I and peaked at 6–11 months across sites. Undernutrition was a risk factor for symptomatic norovirus infection, with an increase in 1 standard deviation of length-for-age z score associated with a 17% reduction (odds ratio, 0.83 [95% confidence interval, .72–.97]; P = .011) in the odds of experiencing diarrhea when norovirus was present, after accounting for genogroup, rotavirus vaccine, and age. Evidence of acquired immunity was observed among GII infections only: Children with prior GII infection were found to have a 27% reduction in the hazard of subsequent infection (hazard ratio, 0.727; P = .010). Conclusions. The high prevalence of norovirus across 8 sites in highly variable epidemiologic settings and demonstration of protective immunity for GII infections provide support for investment in vaccine development.