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. 2021 Oct 5;73(7):e1525-e1531.
doi: 10.1093/cid/ciaa1001.

Characteristics of GII.4 Norovirus Versus Other Genotypes in Sporadic Pediatric Infections in Davidson County, Tennessee, USA

Zaid Haddadin  1 , Einas Batarseh  1 , Lubna Hamdan  1 , Laura S Stewart  1 , Bhinnata Piya  1 , Herdi Rahman  1 , Andrew J Spieker  2 , James Chappell  1 , Mary E Wikswo  3 , John R Dunn  4 , Daniel C Payne  2 , Jan Vinjé  3 , Aron J Hall  3 , Natasha Halasa  1
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Characteristics of GII.4 Norovirus Versus Other Genotypes in Sporadic Pediatric Infections in Davidson County, Tennessee, USA

Zaid Haddadin et al. Clin Infect Dis. .

Abstract

Background: Norovirus is a leading cause of epidemic acute gastroenteritis (AGE), with most outbreaks occurring during winter. The majority of outbreaks are caused by GII.4 noroviruses; however, data to support whether this is true for sporadic medically attended AGE are limited. Therefore, we sought to compare the clinical characteristics and seasonality of GII.4 vs non-GII.4 viruses.

Methods: Children aged 15 days -17 years with AGE symptoms were recruited from the outpatient, emergency department, and inpatient settings at Vanderbilt Children's Hospital, Davidson County, Nashville, Tennessee, from December 2012 -November 2015. Stool specimens were tested using qRT-PCR for GI and GII noroviruses and subsequently genotyped by sequencing a partial region of the capsid gene.

Results: A total of 3705 patients were enrolled, and stool specimens were collected and tested from 2885 (78%) enrollees. Overall, 636 (22%) samples were norovirus-positive, of which 567 (89%) were GII. Of the 460 (81%) genotyped GII-positive samples, 233 (51%) were typed as GII.4 and 227 (49%) as non-GII.4. Compared with children with non-GII.4 infections, children with GII.4 infections were younger, more likely to have diarrhea, and more likely to receive oral rehydration fluids. Norovirus was detected year-round and peaked during winter.

Conclusions: Approximately 40% of sporadic pediatric norovirus AGE cases were caused by GII.4 norovirus. Children infected with GII.4 had more severe symptoms that required more medical care. Seasonal variations were noticed among different genotypes. These data highlight the importance of continuous norovirus surveillance and provide important information on which strains pediatric norovirus vaccines should protect against.

Keywords: norovirus; acute gastroenteritis; genotypes; sporadic; surveillance.

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Figures

Figure 1.
Figure 1.
Study enrollment algorithm for AGE cases and HC and results of norovirus protein capsid sequencing. Abbreviations: AGE, acute gastroenteritis; HC, healthy control.
Figure 2.
Figure 2.
Frequency of GII.4 vs non-GII.4 in children with acute gastroenteritis by age group.
Figure 3.
Figure 3.
Seasonal patterns of norovirus GII.4 vs non-GII.4 and all GII genotypes during 2012–2015.
See this image and copyright information in PMC

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