TY - JOUR
T1 - Norovirus infection and acquired immunity in 8 countries
T2 - Results from the MAL-ED study
AU - MAL-ED Network Investigators
AU - Rouhani, Saba
AU - Peñataro Yori, Pablo
AU - Paredes Olortegui, Maribel
AU - Siguas Salas, Mery
AU - Rengifo Trigoso, Dixner
AU - Mondal, Dinesh
AU - Bodhidatta, Ladaporn
AU - Platts-Mills, James
AU - Samie, Amidou
AU - Kabir, Furqan
AU - Lima, Aldo A.M.
AU - Babji, Sudhir
AU - Mason, Carl J.
AU - Kalam, Adil
AU - Bessong, Pascal
AU - Ahmed, Tahmeed
AU - Mduma, Estomih
AU - Bhutta, Zulfiqar A.
AU - Lima, Ila
AU - Ramdass, Rakhi
AU - Lang, Dennis
AU - George, Ajila
AU - Zaidi, Anita K.M.
AU - Kang, Gagandeep
AU - Houpt, Eric
AU - Kosek, Margaret N.
AU - Brett, N.
AU - Acosta, Angel Mendez
AU - de Burga, Rosa Rios
AU - Chavez, Cesar Banda
AU - Flores, Julian Torres
AU - Olotegui, Maribel Paredes
AU - Pinedo, Silvia Rengifo
AU - Salas, Mery Siguas
AU - Trigoso, Dixner Rengifo
AU - Vasquez, Angel Orbe
AU - Ahmed, Imran
AU - Alam, Didar
AU - Ali, Asad
AU - Qureshi, Shahida
AU - Rasheed, Muneera
AU - Soofi, Sajid
AU - Turab, Ali
AU - Bose, Anuradha
AU - Hariraju, Dinesh
AU - Jennifer, M. Steffi
AU - John, Sushil
AU - Murray-Kolb, Laura E.
AU - Ross, A. Catharine
AU - Schaefer, Barbara
N1 - Publisher Copyright:
© The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.
PY - 2016/5/15
Y1 - 2016/5/15
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84966429167&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84966429167&partnerID=8YFLogxK
U2 - 10.1093/cid/ciw072
DO - 10.1093/cid/ciw072
M3 - Article
C2 - 27013692
AN - SCOPUS:84966429167
SN - 1058-4838
VL - 62
SP - 1210
EP - 1217
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 10
ER -