Norovirus and Rotavirus Prevalence in Pediatric Patients with Underlying Gastrointestinal Dysfunction in Atlanta, GA, 2012-2013 Open Access

Wahl, Kelly Nicole (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/f4752h29j?locale=en
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Abstract

Norovirus (NoV) and Rotavirus (RoV) are the two major causes of acute viral gastroenteritis in children. Although the prevalence and symptomology of both viruses has been well-documented in pediatric populations, little is known about these viruses in vulnerable sub-populations such as children with underlying gastrointestinal dysfunction (G.D.) (e.g. Crohn's disease, intestinal malrotation, short gut syndrome).

To better understand the implications of G.D. on susceptibility to enteric viruses, stool samples submitted for bacterial stool testing at two large pediatric hospitals serving metropolitan Atlanta were prospectively collected between July 2012 and July 2013. RT-PCR was used to detect GI and GII NoVs and a commercially available EIA was used to detect RoV. All children had some type of underlying G.D. and symptoms of acute gastroenteritis (diarrhea and, or vomiting) for inclusion in this study.

Within the study, 22% (54/244) had a surgical and, or congenital condition of the gut, 7% (18/244) had inflammatory bowel disease (IBD), 49% (119/244) were tube fed, 19% (46/244) had both a surgical/congenital condition and were being tube fed, and 3% (7/244) had both a surgical/congenital condition and IBD. Sixteen percent (40/244) of samples were positive for RoV, 7.4% (18/244) samples were positive for GII NoV, and 1 sample was positive for GI NoV. There was a single NoV GII/RoV coinfection.

Children with a positive NoV/RoV stool sample were significantly younger (Mean: 4.2, 95% C.I.: 2.8, 5.6 years) than children with a negative stool sample (Mean; 6.1, 95% CI: 5.3, 6.9 years) (Wilcoxon T test, P = 0.0063). The duration of emesis was shorter in patients with NoV positive stool samples (Mean, 1.4 days) compared to RoV positive stool samples (2.5 days)(Wilcoxon T test, P= 0.0417). Rotavirus immunization was not protective against rotavirus infection when comparing full immunization vs. none (χ2, P= 0.3228).

Additional studies are needed to determine the clinical impact of NoV gastroenteritis in this vulnerable subpopulation. It is unknown if children with specific types of G.D. experience more frequent illness and, or have more severe bouts of disease of longer duration.

Table of Contents

Acknowledgements……………………..…………………………………………………2

Chapter 1:

Literature Review……………….………………..………………………………..3

Chapter 2:

Introduction…………………………………………..……………..……………19

Materials and Methods……………………….………………………..…………22

Results…………………………………………………..……..…………………27

Discussion…………………………………...…………...………………………32

Figures……………………………………………………………………………41

Chapter 3:

Future Directions and Broader Implications……....…..…………………………50

References…………………………..……………………………………………51

Appendix: Abstraction Form……..……….………………………………..……58

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