title: Diagnostic performance of rectal swab versus bulk stool specimens for the detection of rotavirus and norovirus: implications for outbreak investigations.
abstract: BACKGROUND
  In January of 2008, during the peak of the rotavirus season in Guatemala, a gastroenteritis outbreak with high mortality among infants was reported in Guatemala. Despite extensive efforts, the investigation was limited by the lack of bulk stool specimens collected, particularly from the more severely dehydrated or deceased children.
  
  
  OBJECTIVE
  We evaluated the diagnostic performance of rectal swab specimens compared with bulk stool for the detection of rotavirus and norovirus.
  
  
  METHODS
  Patients with diarrhea (≥3 loose stools in 24 h) were enrolled through an ongoing surveillance system in Guatemala. From January through March 2009, we attempted to enroll 100 patients <5 years old captured by the diarrhea surveillance, and collected paired bulk stool and rectal swabs specimens from them. Specimens were tested for norovirus using real-time reverse transcription-polymerase chain reaction and for rotavirus via enzyme immunoassay.
  
  
  RESULTS
  We enrolled 102 patients with paired specimens; 91% of 100 paired specimens tested for rotavirus yielded concordant results positive for rotavirus with a negativity rate of 83%. Among 100 paired specimens tested for norovirus, 86% were concordant norovirus detection and the negativity rate was 85%. The diagnostic performance for rotavirus and norovirus detection did not differ significantly between the two specimen types.
  
  
  CONCLUSIONS
  Testing of properly collected fecal specimens using rectal swabs may be a viable alternative to bulk stool for detection of rotavirus and norovirus, particularly during outbreaks where collection of bulk stool may be difficult.
authors.affiliation: International Emerging Infections Program, US Centers for Disease Control and Prevention, Regional Office for Central America and Panama, Guatemala City, Guatemala. Electronic address: dwi4@cdc.gov.
authors.forename: Wences
authors.initials: W
authors.lastname: Arvelo
authors.forename: Aron J
authors.initials: AJ
authors.lastname: Hall
authors.forename: Alejandra
authors.initials: A
authors.lastname: Estevez
authors.forename: Beatriz
authors.initials: B
authors.lastname: Lopez
authors.forename: Nicole
authors.initials: N
authors.lastname: Gregoricus
authors.forename: Jan
authors.initials: J
authors.lastname: Vinjé
authors.forename: Jon R
authors.initials: JR
authors.lastname: Gentsch
authors.forename: Umesh
authors.initials: U
authors.lastname: Parashar
authors.forename: Kim A
authors.initials: KA
authors.lastname: Lindblade
mesh_terms: D017250:Caliciviridae Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D002675:Child, Preschool; D015331:Cohort Studies; D004196:Disease Outbreaks; D005243:Feces / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D029322:Norovirus / Q000302:isolation & purification*; D012007:Rectum / Q000821:virology; D012401:Rotavirus / Q000302:isolation & purification*; D012400:Rotavirus Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology
keywords: Concordance; Diagnosis; Guatemala; Norovirus; Rotavirus; Surveillance