Vielot Nadja Alexandra, Zepeda Omar, Reyes Yaoska, González Fredman, Vinjé Jan, Becker-Dreps Sylvia, Bucardo Filemón
Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Department of Microbiology, National Autonomous University of Nicaragua, Leon 21000, Nicaragua.
Pathogens. 2023 Mar 22;12(3):505. doi: 10.3390/pathogens12030505.
Norovirus causes a large proportion of pediatric acute gastroenteritis (AGE) worldwide, and no vaccines are currently available. To inform public health measures against norovirus gastroenteritis, we assessed risk factors in a case-control study nested in a birth cohort study in Nicaragua. Between June 2017 and January 2022, we followed children weekly for AGE episodes, and collected stool specimens from symptomatic children. Risk factors for AGE were collected during routine weekly visits. Norovirus was detected in stools using real-time reverse transcriptase polymerase chain reaction and positive specimens were genotyped using Sanger sequencing. We included 40 norovirus-positive AGE children matched 1:2 to controls and conducted bivariate and multivariable analyses of norovirus AGE risk factors. Among typeable norovirus infections, GII.4 were more severe than non-GII.4 (four/twenty-one vs. one/nine) and accounted for all emergency visits and hospitalizations. Adjusted conditional logistic regression found that female sex and higher length-for-age Z score were protective against norovirus AGE; a dirt floor in the home, sharing cups or bottles, and recent contact with someone with AGE symptoms were associated with norovirus AGE, though estimates were highly imprecise. Reducing contact with symptomatic persons and with saliva or other bodily fluids on cups or floors could reduce infant norovirus incidence.
诺如病毒在全球范围内导致了很大一部分儿童急性胃肠炎（AGE），目前尚无疫苗可用。为了为预防诺如病毒胃肠炎的公共卫生措施提供依据，我们在尼加拉瓜一项出生队列研究中的病例对照研究中评估了风险因素。在2017年6月至2022年1月期间，我们每周对儿童进行随访以了解AGE发作情况，并从有症状的儿童中采集粪便标本。在每周的常规访视期间收集AGE的风险因素。使用实时逆转录聚合酶链反应在粪便中检测诺如病毒，并使用桑格测序对阳性标本进行基因分型。我们纳入了40名诺如病毒阳性的AGE儿童，按1:2与对照匹配，并对诺如病毒AGE风险因素进行了双变量和多变量分析。在可分型的诺如病毒感染中，GII.4比非GII.4更严重（4/21 vs. 1/9），并且占所有急诊就诊和住院病例。调整后的条件逻辑回归发现，女性性别和较高的年龄别身长Z评分对诺如病毒AGE有保护作用；家中泥土地面、共用杯子或瓶子以及近期接触有AGE症状的人与诺如病毒AGE有关，尽管估计值非常不精确。减少与有症状的人的接触以及与杯子或地面上的唾液或其他体液的接触可能会降低婴儿诺如病毒的发病率。
