Risk Factors for Norovirus Infections and Their Association with Childhood Growth: Findings from a Multi-Country Birth Cohort Study

Abstract

The prevalence of norovirus infections in different geographical locations and their attribu-tion to childhood diarrhea is well established. However, there are no reports showing possible rela-tionships of different norovirus genogroups with subsequent childhood malnutrition. In this study, we attempted to establish a potential association between asymptomatic norovirus infections with childhood growth faltering during. Non-diarrheal stools were collected from 1715 children enrolled in locations in a multi-county birth cohort study across eight different geographical locations and were assessed for norovirus genogroup I (GI) and norovirus genogroup II (GII). Asymptomatic norovirus GI infections were negatively associated with monthly length-for-age Z score/LAZ (β = −0.53, 95% CI: −0.73, −0.50) and weight-for-age Z score/WAZ (β = −0.39, 95% CI: −0.49, −0.28), respectively. The burden of asymptomatic norovirus GI infections was negatively associated with LAZ (β = −0.46, 95% CI: −0.67, −0.41) and WAZ (β = −0.66, 95% CI: −0.86, −0.53) at 2 years of age, whilst the burden of asymptomatic norovirus GII infections was negatively associated with WAZ (β = −0.27, 95% CI: −0.45, −0.25) at 2 years of age. Our findings warrant acceleration in attempts to develop vaccines against norovirus GI and norovirus GII, with the aim of minimizing the long-term sequelae on childhood growth.