Burden of Norovirus Disease and Risk factors for Infection Among Children in Rural Guatemala

Abstract

Background. Norovirus (NoV) acute gastroenteritis (AGE) is a common cause of morbidity and mortality in low and middle income countries. We examined the burden of disease and risk factors for NoV infection among children in rural Guatemala, using two novel and low‐cost surveillance systems. Methods. Children 6 weeks‐17 years were enrolled into either of 2 surveillance groups: (1) active AGE participatory surveillance (PSS), in which households were randomized by 2‐stage cluster sampling, prospectively followed by weekly smartphonebased symptom diaries (April 2015‐February 2016), and tested for NoV (rectal/ stool swab PCR) if self‐reported AGE; and (2) two cross‐sectional seroprevalence (RAS) surveys (October 2015‐November 2015 and January 2016‐February 2016) in which households were randomized by 2‐stage cluster sampling, interviewed for AGE in the last week, and tested for NoV. Results. The PSS group (466 children in 207 households) had 102 AGE episodes during enrollment and follow up (13.8 cases/100 person‐years); 15 (21%) of 70 samples available were NoV+. The combined RAS surveys (744 children in 412 households) had 85 AGE episodes, and 11 (17%) of 66 samples available were NoV+. Of 577 asymptomatic visits with samples collected, 61 (11%) were NoV+. Our univariate analysis suggested younger age, greater number of children <5 years in the household, having a well, not having a septic tank, and not breastfeeding may be associated with increased NoV infection (p < 0.2). Multivariate analysis adjusted showed that breastfeeding is significantly protective against NoV in children <2 (table). In a sub‐analysis of children with AGE, increased vomiting was associated with NoV+ (p = 0.02). Conclusion. Our smartphone‐based active surveillance (PSS) and rapid active cycle seroprevalence (RAS) systems demonstrated similar performance, and a high burden of NoV infection and risk factors in rural Guatemala. These systems may be useful in determining the community burden of NoV for upcoming vaccines. (Table Presented) .