Incidence of Norovirus-Associated Diarrhea and Vomiting Disease Among Children and Adults in a Community Cohort in the Peruvian Amazon Basin

Clin Infect Dis. 2017 Sep 1;65(5):833-839. doi: 10.1093/cid/cix423.

Abstract

Background: Data on norovirus epidemiology among all ages in community settings are scarce, especially from tropical settings.

Methods: We implemented active surveillance in 297 households in Peru from October 2012 to August 2015 to assess the burden of diarrhea and acute gastroenteritis (AGE) due to norovirus in a lower-middle-income community. During period 1 (October 2012-May 2013), we used a "traditional" diarrhea case definition (≥3 loose/liquid stools within 24 hours). During period 2 (June 2013-August 2015), we used an expanded case definition of AGE (by adding ≥2 vomiting episodes without diarrhea or 1-2 vomiting episodes plus 1-2 loose/liquid stools within 24 hours). Stool samples were tested for norovirus by reverse-transcription polymerase chain reaction.

Results: During period 1, overall diarrhea and norovirus-associated diarrhea incidence was 37.2/100 person-years (PY) (95% confidence interval [CI], 33.2-41.7) and 5.7/100 PY (95% CI, 3.9-8.1), respectively. During period 2, overall AGE and norovirus-associated AGE incidence was 51.8/100 PY (95% CI, 48.8-54.9) and 6.5/100 PY (95% CI, 5.4-7.8), respectively. In both periods, children aged <2 years had the highest incidence of norovirus. Vomiting without diarrhea occurred among norovirus cases in participants <15 years old, but with a higher proportion among children <2 years, accounting for 35% (7/20) of all cases in this age group. Noroviruses were identified in 7% (23/335) of controls free of gastroenteric symptoms.

Conclusions: Norovirus was a significant cause of AGE in this community, especially among children <2 years of age. Inclusion of vomiting in the case definition resulted in a 20% improvement for detection of norovirus cases.

Keywords: Peru; acute gastroenteritis; incidence; norovirus.

MeSH terms

  • Adolescent
  • Adult
  • Caliciviridae Infections* / epidemiology
  • Caliciviridae Infections* / virology
  • Child
  • Child, Preschool
  • Diarrhea* / epidemiology
  • Diarrhea* / virology
  • Female
  • Gastroenteritis* / epidemiology
  • Gastroenteritis* / virology
  • Humans
  • Incidence
  • Infant
  • Male
  • Middle Aged
  • Norovirus*
  • Peru / epidemiology
  • Prospective Studies
  • Vomiting* / epidemiology
  • Vomiting* / virology
  • Young Adult