title: Sapovirus prevalence in children less than five years of age hospitalised for diarrhoeal disease in South Africa, 2009-2013.
abstract: BACKGROUND
  Although sapovirus (SaV) has been detected in 2.2-12.7% of gastroenteritis cases globally, there are limited data on SaV epidemiology.
  
  
  OBJECTIVE
  Describe the epidemiology, clinical characteristics and factors associated with SaV gastroenteritis in hospitalised children <5 years of age in South Africa.
  
  
  METHODS
  Between 2009 and 2013 during prospective diarrhoeal surveillance, stool specimens were collected from four sites and screened for SaVs and associated enteric pathogens using ELISA, microscopy, conventional and real-time PCR. Epidemiological and clinical data were compared in patients with or without SaV. Odds ratios were assessed by bivariate and stepwise multivariable logistic regression analysis.
  
  
  RESULTS
  Sapoviruses were detected in 7.7% (238/3103) of children admitted to hospital and 11.4% (9/79) of deaths. Sapovirus was detected more commonly in children 19-24 months compared to<6months (aOR=2.3; p=0.018) and in males (aOR=2.0; p=0.001). Additional factors associated with SaV detection included residing with≥7 inhabitants compared to ≤3 (aOR=2.2; p=0.011) and concomitant norovirus infections (aOR=3.0; p=0.003). HIV-infected children with SaV were more likely to have bloody stools (aOR=16.8; p<0.001), low birth weight (<2.5kg; aOR=5.8; p=0.007) and live in environments without flush toilets (aOR=8.1; p=0.003) compared to HIV-uninfected children.
  
  
  CONCLUSIONS
  Sapoviruses, which are perceived to cause mild diarrhoea, were detected in hospitalised children and diarrhoeal deaths in South Africa. Determinants increasing the odds of SaV included overcrowding and concomitant infections while HIV-infected children with SaV displayed bloody stools, low birth weight and reduced access to proper sanitation. Mitigation strategies against SaV infections include improved sanitation.
authors.affiliation: National Institute for Communicable Diseases, Private Bag x4, Sandringham, 2131, South Africa; School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Private Bag x20, Hatfield, 0028, South Africa; Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, Pretoria, 0007, South Africa. Electronic address: nicolap@nicd.ac.za.
authors.forename: Nicola
authors.initials: N
authors.lastname: Page
authors.affiliation: Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Groome
authors.affiliation: Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, Pretoria, 0007, South Africa.
authors.forename: Tanya
authors.initials: T
authors.lastname: Murray
authors.affiliation: National Institute for Communicable Diseases, Private Bag x4, Sandringham, 2131, South Africa; Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, Pretoria, 0007, South Africa.
authors.forename: Sandrama
authors.initials: S
authors.lastname: Nadan
authors.affiliation: National Institute for Communicable Diseases, Private Bag x4, Sandringham, 2131, South Africa; Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, Pretoria, 0007, South Africa.
authors.forename: Rembuluwani
authors.initials: R
authors.lastname: Netshikweta
authors.affiliation: National Institute for Communicable Diseases, Private Bag x4, Sandringham, 2131, South Africa; Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Karen H
authors.initials: KH
authors.lastname: Keddy
authors.affiliation: National Institute for Communicable Diseases, Private Bag x4, Sandringham, 2131, South Africa.
authors.forename: Bhavani
authors.initials: B
authors.lastname: Poonsamy
authors.affiliation: School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Moyes
authors.affiliation: National Institute for Communicable Diseases, Private Bag x4, Sandringham, 2131, South Africa.
authors.forename: Sibongile
authors.initials: S
authors.lastname: Walaza
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kahn
authors.affiliation: National Institute for Communicable Diseases, Private Bag x4, Sandringham, 2131, South Africa; School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Private Bag x20, Hatfield, 0028, South Africa.
authors.forename: Lazarus
authors.initials: L
authors.lastname: Kuonza
authors.affiliation: Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, Pretoria, 0007, South Africa.
authors.forename: Maureen B
authors.initials: MB
authors.lastname: Taylor
authors.affiliation: National Institute for Communicable Diseases, Private Bag x4, Sandringham, 2131, South Africa; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
authors.affiliation: National Institute for Communicable Diseases, Private Bag x4, Sandringham, 2131, South Africa.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Cohen
mesh_terms: D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening; D008853:Microscopy; D016133:Polymerase Chain Reaction; D015995:Prevalence; D011446:Prospective Studies; D029341:Sapovirus / Q000302:isolation & purification*; D013019:South Africa / Q000453:epidemiology
keywords: Caliciviruses; Children <5 years; Hospitalised; Sapoviruses; South Africa; Viral gastroenteritis