Norovirus infection and acquired immunity in 8 countries

Results from the MAL-ED study

MAL-ED Network Investigators

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background. Norovirus is an important cause of childhood diarrhea. We present data from a longitudinal, multicountry study describing norovirus epidemiology during the first 2 years of life. Methods. A birth cohort of 1457 children across 8 countries contributed 7077 diarrheal stools for norovirus testing. A subset of 199 children contributed additional asymptomatic samples (2307) and diarrheal stools (770), which were used to derive incidence rates and evaluate evidence for acquired immunity. Results. Across sites, 89% of children experienced at least 1 norovirus infection before 24 months, and 22.7% of all diarrheal stools were norovirus positive. Severity of norovirus-positive diarrhea was comparable to other enteropathogens, with the exception of rotavirus. Incidence of genogroup II (GII) infection was higher than genogroup I and peaked at 6-11 months across sites. Undernutrition was a risk factor for symptomatic norovirus infection, with an increase in 1 standard deviation of length-for-age z score associated with a 17% reduction (odds ratio, 0.83 [95% confidence interval,. 72-.97]; P =. 011) in the odds of experiencing diarrhea when norovirus was present, after accounting for genogroup, rotavirus vaccine, and age. Evidence of acquired immunity was observed among GII infections only: Children with prior GII infection were found to have a 27% reduction in the hazard of subsequent infection (hazard ratio, 0.727; P =. 010). Conclusions. The high prevalence of norovirus across 8 sites in highly variable epidemiologic settings and demonstration of protective immunity for GII infections provide support for investment in vaccine development.

Original languageEnglish (US)
Pages (from-to)1210-1217
Number of pages8
JournalClinical Infectious Diseases
Volume62
Issue number10
DOIs
StatePublished - May 15 2016

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Norovirus
Adaptive Immunity
Infection
Genotype
Diarrhea
Rotavirus Vaccines
Rotavirus
Incidence
Malnutrition
Longitudinal Studies
Immunity
Epidemiology
Vaccines
Odds Ratio
Parturition
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

MAL-ED Network Investigators. / Norovirus infection and acquired immunity in 8 countries : Results from the MAL-ED study. In: Clinical Infectious Diseases. 2016 ; Vol. 62, No. 10. pp. 1210-1217.
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abstract = "Background. Norovirus is an important cause of childhood diarrhea. We present data from a longitudinal, multicountry study describing norovirus epidemiology during the first 2 years of life. Methods. A birth cohort of 1457 children across 8 countries contributed 7077 diarrheal stools for norovirus testing. A subset of 199 children contributed additional asymptomatic samples (2307) and diarrheal stools (770), which were used to derive incidence rates and evaluate evidence for acquired immunity. Results. Across sites, 89{\%} of children experienced at least 1 norovirus infection before 24 months, and 22.7{\%} of all diarrheal stools were norovirus positive. Severity of norovirus-positive diarrhea was comparable to other enteropathogens, with the exception of rotavirus. Incidence of genogroup II (GII) infection was higher than genogroup I and peaked at 6-11 months across sites. Undernutrition was a risk factor for symptomatic norovirus infection, with an increase in 1 standard deviation of length-for-age z score associated with a 17{\%} reduction (odds ratio, 0.83 [95{\%} confidence interval,. 72-.97]; P =. 011) in the odds of experiencing diarrhea when norovirus was present, after accounting for genogroup, rotavirus vaccine, and age. Evidence of acquired immunity was observed among GII infections only: Children with prior GII infection were found to have a 27{\%} reduction in the hazard of subsequent infection (hazard ratio, 0.727; P =. 010). Conclusions. The high prevalence of norovirus across 8 sites in highly variable epidemiologic settings and demonstration of protective immunity for GII infections provide support for investment in vaccine development.",
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Norovirus infection and acquired immunity in 8 countries : Results from the MAL-ED study. / MAL-ED Network Investigators.

In: Clinical Infectious Diseases, Vol. 62, No. 10, 15.05.2016, p. 1210-1217.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Norovirus infection and acquired immunity in 8 countries

T2 - Results from the MAL-ED study

AU - MAL-ED Network Investigators

AU - Rouhani, Saba

AU - Peñataro Yori, Pablo

AU - Paredes Olortegui, Maribel

AU - Siguas Salas, Mery

AU - Rengifo Trigoso, Dixner

AU - Mondal, Dinesh

AU - Bodhidatta, Ladaporn

AU - Platts-Mills, James

AU - Samie, Amidou

AU - Kabir, Furqan

AU - Lima, Aldo A.M.

AU - Babji, Sudhir

AU - Mason, Carl J.

AU - Kalam, Adil

AU - Bessong, Pascal

AU - Ahmed, Tahmeed

AU - Mduma, Estomih

AU - Bhutta, Zulfiqar A.

AU - Lima, Ila

AU - Ramdass, Rakhi

AU - Lang, Dennis

AU - George, Ajila

AU - Zaidi, Anita K.M.

AU - Kang, Gagandeep

AU - Houpt, Eric

AU - Kosek, Margaret N.

AU - Brett, N.

AU - Acosta, Angel Mendez

AU - de Burga, Rosa Rios

AU - Chavez, Cesar Banda

AU - Flores, Julian Torres

AU - Olotegui, Maribel Paredes

AU - Pinedo, Silvia Rengifo

AU - Salas, Mery Siguas

AU - Trigoso, Dixner Rengifo

AU - Vasquez, Angel Orbe

AU - Ahmed, Imran

AU - Alam, Didar

AU - Ali, Asad

AU - Qureshi, Shahida

AU - Rasheed, Muneera

AU - Soofi, Sajid

AU - Turab, Ali

AU - Bose, Anuradha

AU - Hariraju, Dinesh

AU - Jennifer, M. Steffi

AU - John, Sushil

AU - Murray-Kolb, Laura E.

AU - Ross, A. Catharine

AU - Schaefer, Barbara

PY - 2016/5/15

Y1 - 2016/5/15

N2 - Background. Norovirus is an important cause of childhood diarrhea. We present data from a longitudinal, multicountry study describing norovirus epidemiology during the first 2 years of life. Methods. A birth cohort of 1457 children across 8 countries contributed 7077 diarrheal stools for norovirus testing. A subset of 199 children contributed additional asymptomatic samples (2307) and diarrheal stools (770), which were used to derive incidence rates and evaluate evidence for acquired immunity. Results. Across sites, 89% of children experienced at least 1 norovirus infection before 24 months, and 22.7% of all diarrheal stools were norovirus positive. Severity of norovirus-positive diarrhea was comparable to other enteropathogens, with the exception of rotavirus. Incidence of genogroup II (GII) infection was higher than genogroup I and peaked at 6-11 months across sites. Undernutrition was a risk factor for symptomatic norovirus infection, with an increase in 1 standard deviation of length-for-age z score associated with a 17% reduction (odds ratio, 0.83 [95% confidence interval,. 72-.97]; P =. 011) in the odds of experiencing diarrhea when norovirus was present, after accounting for genogroup, rotavirus vaccine, and age. Evidence of acquired immunity was observed among GII infections only: Children with prior GII infection were found to have a 27% reduction in the hazard of subsequent infection (hazard ratio, 0.727; P =. 010). Conclusions. The high prevalence of norovirus across 8 sites in highly variable epidemiologic settings and demonstration of protective immunity for GII infections provide support for investment in vaccine development.

AB - Background. Norovirus is an important cause of childhood diarrhea. We present data from a longitudinal, multicountry study describing norovirus epidemiology during the first 2 years of life. Methods. A birth cohort of 1457 children across 8 countries contributed 7077 diarrheal stools for norovirus testing. A subset of 199 children contributed additional asymptomatic samples (2307) and diarrheal stools (770), which were used to derive incidence rates and evaluate evidence for acquired immunity. Results. Across sites, 89% of children experienced at least 1 norovirus infection before 24 months, and 22.7% of all diarrheal stools were norovirus positive. Severity of norovirus-positive diarrhea was comparable to other enteropathogens, with the exception of rotavirus. Incidence of genogroup II (GII) infection was higher than genogroup I and peaked at 6-11 months across sites. Undernutrition was a risk factor for symptomatic norovirus infection, with an increase in 1 standard deviation of length-for-age z score associated with a 17% reduction (odds ratio, 0.83 [95% confidence interval,. 72-.97]; P =. 011) in the odds of experiencing diarrhea when norovirus was present, after accounting for genogroup, rotavirus vaccine, and age. Evidence of acquired immunity was observed among GII infections only: Children with prior GII infection were found to have a 27% reduction in the hazard of subsequent infection (hazard ratio, 0.727; P =. 010). Conclusions. The high prevalence of norovirus across 8 sites in highly variable epidemiologic settings and demonstration of protective immunity for GII infections provide support for investment in vaccine development.

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U2 - 10.1093/cid/ciw072

DO - 10.1093/cid/ciw072

M3 - Article

VL - 62

SP - 1210

EP - 1217

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 10

ER -