Epidemiology and risk factors for transmission of norovirus in resource-limited communities in Guatemala Pubblico

Patel, Jaymin (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/8910jt894?locale=it
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Abstract


Epidemiology and risk factors for transmission of norovirus in resource-limited
communities in Guatemala

By Jaymin Patel


Background: Noroviruses (NoVs) are the most common cause of epidemic, non-
bacterial gastroenteritis globally. They result in 900,000 clinic visits among children and
cause 64,000 episodes of diarrhea resulting in hospitalizations in industrialized countries.
In developing countries, they result in over 1 million hospitalizations and up to 200,000
deaths among children under the age of five. Despite the development of sensitive
diagnostic methods, there is little knowledge on risk factors associated with endemic
norovirus transmission in developing countries.

Methods: We analyzed diarrhea cases from a population based surveillance system in the
Department of Santa Rosa, Guatemala from June 2007 through November 2010. Enrolled
patients who provided whole stool samples were tested for norovirus via real-time reverse
transcriptase polymerase chain reaction (rRT-PCR). Samples were cultured for common
bacterial pathogens and tested by enzyme immunoassay for rotavirus. Information
regarding water sources and water treatment methods along with clinical and
demographic data were collected through interviews. Multivariate analysis was
conducted by performing logistic regression to study the effects of multiple risk factors
on the outcome using a hierarchical backwards elimination approach.


Results: Out of the 3508 eligible patients, 3048 (86.9%) provided stool samples, which
included 2089 patients who provided whole stool samples for norovirus testing.
Norovirus was detected in 306 (14.7%) patients, of which 55 (17.6%) were from
genogroup I (GI), 258 (82.4%) from genogroup II (GII) and seven cases were mixed
infections. An overwhelming majority of cases was presented in children as 70.9% of GI
cases (n=39) and 86.8% of GII cases (n=224) were detected in children under five.
Children under five also made up 95.4% of hospitalized and 77.3% of ambulatory cases.
Filtering water was identified as a risk factor for norovirus infection after controlling for
age, sex and assumed severity of illness (aOR: 2.44 [95% CI, 1.68-3.56]).


Conclusion: Norovirus is an emerging public health concern especially in developing
countries. Children under five are at higher risk for experiencing severe clinical
manifestation of diarrheal illness due to norovirus infections. Access to safe water
sources and appropriate water treatment methods are critical to reduce waterborne
transmission of endemic norovirus in rural communities.

Table of Contents

Table of Contents
BACKGROUND AND LITERATURE REVIEW ............................................................................. 1

Introduction ..................................................................................................................... 1
Background ...................................................................................................................... 1
History ............................................................................................................................ 2
Structure and Classification ................................................................................................ 3
Pathogenesis .................................................................................................................... 4
Transmission ................................................................................................................... 5
Clinical characteristics and Treatment ............................................................................ 6
Immunology .................................................................................................................... 7
Transmission route and outbreak settings ....................................................................... 8
Genogroup and transmission ........................................................................................... 9
Conclusion ..................................................................................................................... 10
Significance and Goals .................................................................................................. 11
MANUSCRIPT ............................................................................................................... 12
Abstract ......................................................................................................................... 12
Introduction ................................................................................................................... 13
Methods ......................................................................................................................... 16
Results ........................................................................................................................... 21
Discussion ..................................................................................................................... 24
PUBLIC HEALTH IMPLICATIONS .......................................................................... 29
REFERENCES ................................................................................................................ 31
Figures ........................................................................................................................... 38
Tables ............................................................................................................................ 40
APPENDICES ................................................................................................................. 46

APPENDIX A - Flow chart of the study ...................................................................... 47

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