Norovirus infection in immunocompromised children and children with hospital‐acquired acute gastroenteritis

Center for Global Safe Water, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Journal of Medical Virology (Impact Factor: 2.35). 07/2014; 86(7). DOI: 10.1002/jmv.23774
Source: PubMed


Norovirus (NoV) is a leading cause of acute viral gastroenteritis among children, yet its burden of disease among immunocompromised hosts and its role in hospital acquired infections (HAI) is not well characterized. To determine the prevalence, genotypes, and NoV loads among immunocompromised children and children with HAI, residual stool samples, and clinical data were collected at two major pediatric hospitals in metropolitan Atlanta from 92 children that were immunocompromised and/or had a hospital acquired acute gastroenteritis. NoV was identified in 16.3% (15/92) of all stool specimens; 23.4% (11/47) in immunocompromised only children, and 13.3% (4/30) in children with HAI. All NoV positive cases were genogroup II (GII), and GII.4 was the predominant strain followed by GII.3, GII.12, and GII.13. The average NoV load for immunocompromised patients was 6.3 ± 1.4 log genome equivalent copies (GEC) per gram of stool compared to 5.8 ± 1.1 log GEC among patients with HAI. NoV infections are common among immunocompromised children and children with hospital-acquired gastroenteritis, underscoring the urgent need for rapid NoV detection system, and highlighting the importance of strict hospital hygiene practices. J. Med. Virol. © 2013 Wiley Periodicals, Inc.

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    • "In immunocompromised patients, norovirus can cause chronic dehydrating diarrhea, leading to severe disease complications and sometimes mortality (reported to be up to 25%) [12,14–16,56▪▪]. The evolution of GII.4 strains within a long-term shedding immunocompromised patient has been observed to lead to the generation of antigenically distinct strains, supporting the hypotheses that long-term shedders in healthcare settings may serve as a source for the emergence of epidemic strains [57▪▪]. "
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    ABSTRACT: Purpose of review To provide an overview of the burden of norovirus disease in healthcare settings and the factors responsible for outbreaks in these institutions; to assess progress on interventions aimed at reducing the burden of norovirus disease. Recent findings Norovirus outbreaks in healthcare settings are driven by confluence of viral diversity, the built environment, and host factors. Some of these characteristics may be modifiable and the target of successful interventions. Summary Most norovirus outbreaks in hospital and residential care institutions are associated with a particular genotype, known as GII.4. The persistence of norovirus is associated with strain diversity, which is driven by immune evasion and viral adaptation to interaction with a variety of human histo-blood group antigens. The healthcare environment presents serious challenges for control, both because of the physical structure of the built space and the high levels of contact among patient populations who may have compromised hygiene. Increased vulnerability among the populations in healthcare institutions is likely to be multifactorial and may include the following: nutritional status, immunodeficiency or senescence, chronic inflammation, and microbiome alterations. Current control measures are based on general infection control principles, and treatment is mainly supportive and nonspecific. Vaccines and antiviral agents are being developed with promising results, but none are currently available.
    Full-text · Article · Aug 2014 · Current Opinion in Infectious Diseases
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    ABSTRACT: Acute gastroenteritis caused by the noroviruses (NV) is often of 2-3 days duration and is characteristically self-limiting. In contrast, chronic infection caused by noroviruses in immunocompromised individuals can last from weeks to years, making clinical management difficult. The mechanisms by which noroviruses establish persistent infection, and the role of immunocompromised hosts as a reservoir for noroviruses in the general human population are not known. However, study of this patient cohort may lead to new insights into norovirus biology and approaches to treatment.This article is protected by copyright. All rights reserved.
    No preview · Article · Jul 2014 · Clinical Microbiology and Infection
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    ABSTRACT: Norovirus is the most frequently occurring cause of community-acquired acute gastroenteritis in people of all ages. It is also one of the most frequent causes of outbreaks in healthcare settings, affecting both long-term care facilities and acute care hospitals. Whereas norovirus gastroenteritis is typically mild and resolves without medical attention, healthcare-associated infections often affect vulnerable populations, resulting in severe infections and disruption of healthcare services. Globally, most norovirus outbreaks in hospitals and residential care institutions are associated with genogroup II type 4 (GII.4) strains. Recent data demonstrate that excess mortality occurs during outbreak periods in healthcare facilities. Nosocomial outbreaks can result in large economic and societal costs. Current control measures for norovirus are largely based on general infection control principles, and treatment is mainly supportive and non-specific. While neither vaccines nor antiviral agents are currently available, both are being developed with encouraging results. Published by Elsevier Ltd.
    No preview · Article · Feb 2015 · Journal of Hospital Infection
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