Prevalence of Norovirus among Rehabilitation Inpatients with Neurogenic Bowel Dysfunction due to Spinal Cord Injury or Traumatic Brain Injury: A Pilot Study Open Access

Abstract

Bowel dysfunction is a common condition among spinal cord injury and disease (SCI/D), traumatic brain injury (TBI), and stroke patients and can result in a lower quality of life. Diarrhea episodes are commonly attributed to neurogenic bowel dysfunction (NBD), and infectious agents are typically not considered to cause gastroenteritis in this population. Norovirus (NoV) is a leading cause of gastrointestinal illness worldwide and has been related to many outbreaks in health-care settings. This pilot study evaluated the prevalence of NoV (genogroups I and II) among rehabilitation inpatients with NBD due to a SCI/D, TBI, or stroke. Following a diarrhea or vomiting episode, stool samples, medical information, and demographic information were collected from 25 rehabilitation inpatients from the Shepherd Center in Atlanta, GA during the months of November 2014 through March 2015. No patients were found to be infected with NoV GI or GII. This provides evidence that there was not an outbreak of NoV at Shepherd Center during the 2014-2015 season. However, we cannot conclude that NoV does not affect this population due to small sample size and low study power. Other infectious agents affected the majority of study patients (92%), suggesting further analyses should be done to evaluate the immune response following an SCI/D or TBI. There should be future studies designed with enough power to detect the prevalence of NoV infections among SCI/D and TBI rehabilitation inpatients. Ultimately, such evaluations may lead to improvements of care and thus increased quality of life among SCI/D and TBI patients.

Table of Contents

Chapter I: Literature Review. 1

Spinal Cord Injury/Disease and Traumatic Brain Injury. 1

Neurogenic Bowel Dysfunction. 5

Norovirus. 8

Chapter II: Manuscript. 14

Title. 14

Authors. 14

Abstract. 14

Introduction. 16

Methods. 18

Study Design. 18

Microbiological Methods. 19

Statistical Analysis. 19

Results and Discussion. 21

Conclusion. 26

Figures and Tables. 27

Figure 1. 27

Table 1. 28

Table 2. 29

Table 3. 30

Table 4. 31

References. 32

Appendices. 43

A. Shepherd Center IRB Approval Letter. 43

B. Consent Document. 44

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Norovirus Neurogenic Bowel Dysfunction Traumatic Brain Injury SCI NBD Spinal Cord Injury TBI
Committee Chair / Thesis Advisor	Kirby, Amy, Emory University
Partnering Agencies	Hospital or other health care provider

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