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. 2018 Jun 1;66(12):1858-1863.
doi: 10.1093/cid/cix1103.

Epidemiology of Sapovirus Infections in a Birth Cohort in Peru

Gerardo J Sánchez  1 , Holger Mayta  1   2   3 , Monica J Pajuelo  1   2 , Karen Neira  1 , Liu Xiaofang  4 , Lilia Cabrera  3 , Sarah Blythe Ballard  2 , Jean E Crabtree  5 , Dermot Kelleher  6 , Vitaliano Cama  7 , Caryn Bern  8 , Hitoshi Oshitani  4 , Robert H Gilman  1   2   3 , Mayuko Saito  4 ; Sapovirus Working Group
Collaborators, Affiliations

Epidemiology of Sapovirus Infections in a Birth Cohort in Peru

Gerardo J Sánchez et al. Clin Infect Dis. .

Abstract

Background: Sapovirus is one of the primary viral causes of acute gastroenteritis (AGE), especially where rotavirus vaccination has been implemented. The characteristics and impact of natural infection at the community level, however, have not been well documented.

Methods: Stool samples were analyzed from 100 children randomly selected from a community-based birth cohort study in Peru. All diarrheal and 1 nondiarrheal stools collected trimonthly from children up to age 2 years (n = 1669) were tested for sapovirus detection. Viral shedding duration was determined by testing additional weekly samples (n = 440) collected before and after a sapovirus-positive sample.

Results: The incidence of sapovirus infection in the first and second years of life was 4.3 and 11.1 per 100 child-months, respectively. By age 2 years, 82% of children had at least 1 sapovirus infection, and 64% had at least 1 sapovirus-associated diarrhea episode. The median shedding period was 18.5 days. In 112 of 175 infections, 14 genotypes from 4 genogroups (GI, GII, GIV, and GV) were determined. Among genogroups, GI were more frequently found in symptomatic infections than in asymptomatic infections (odds ratio, 3.1; 95% confidence interval, 1.3-7.4). Fifty-nine children had serial sapovirus infections, but only 3 had repeated infection of the same genotype.

Conclusions: Sapovirus was frequently detected in children with AGE at the community level during the first 2 years of life. Serial sapovirus infections by multiple genotypes in a child suggest genotype-specific immunity from each infection, which needs to be taken into account for vaccine development.

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Figures

Figure 1.
Figure 1.
Prevalence of sapovirus in diarrheal and nondiarrheal stool samples by age group. Prevalences were based on cross-sectional analysis of sapovirus detected by reverse transcription real-time polymerase chain reaction in 877 diarrheal and 748 nondiarrheal stool samples. Forty-four nondiarrheal samples, which were missing symptom data within 7 days from the sampling date, were excluded.
Figure 2.
Figure 2.
Cumulative incidence of first and subsequent sapovirus infections (A) and sapovirus-associated diarrhea (B) in a birth cohort of 100 children. A, Survival curves show cumulative incidence of first through fifth sapovirus infection during the first 2 years of life. B, Curves show the cumulative incidence of the first through fifth infection of sapovirus-associated diarrhea. Of the 100 children, 23 had 1 sapovirus infection and 59 had more than 1 infection (34 had 2, 20 had 3, 3 had 4, 1 had 5, and 1 had 6).
Figure 3.
Figure 3.
Proportion (%) of sapovirus genotypes detected by symptomatic and asymptomatic infection. Proportions (%) were based on the number of sapovirus infections whose genotypes were identified. Abbreviations: GI, genogroup I; GII, genogroup II; GIV, genogroup IV; GV, genogroup V.
Figure 4.
Figure 4.
Duration of sapovirus shedding by reverse transcription real-time polymerase chain reaction in 61 infections. Sixty-one sapovirus infections in 47 children were tested to determine the duration of viral shedding. The boxes represent the 25th percentile, median, and 75th percentile, and the whiskers show the minimum and maximum value of the duration of shedding in days. For 2 infections for which the child’s last available specimen was positive, we estimated the duration of shedding based on the date of the last positive sample (28.5 days and 41.5 days). There were 8 infections with a shedding period of 30 days or longer, 2 of which were symptomatic. Abbreviations: GI, genogroup I; GII, genogroup II; GIV, genogroup IV; GV, genogroup V.
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