title: Clinical and epidemiological characteristics of norovirus gastroenteritis among hospitalized children in Lebanon.
abstract: OBJECTIVE
  To assess the burden of norovirus (NoV) and to determine the diversity of circulating strains among hospitalized children in Lebanon.
  
  
  METHODS
  Stool samples were collected from children presenting with acute gastroenteritis to six major hospitals in Lebanon. A total of 739 eligible stool samples, testing negative for diarrhea caused by rotavirus as a possible viral pathogen, were collected between January 2011 and June 2013. A standardized questionnaire including demographic, epidemiological and clinical observations was used at the time of hospitalization of children presenting with diarrhea. Viral RNA was extracted from stool samples followed by reverse transcription polymerase chain reaction and nucleotide sequencing of a fragment of the viral protein 1 capsid gene. Multiple sequence alignments were carried out and phylogenetic trees were constructed using the MEGA 6 software.
  
  
  RESULTS
  Overall, 11.2% of stool samples collected from children aged < 5 years tested positive for NoV genogroups I (GI) and II (GII). GII accounted for 10.6% of the gastroenteritis cases with only five samples being positive for GI (0.7%). The majority of hospitalized children showed symptoms of diarrhea, dehydration, vomiting and fever. Upon sequencing of positive samples and based on their clustering in the phylogenetic tree, 4/5 of GI gastroenteritis cases were designated GI.3 and one case as GI.4. GII.4 was predominantly detected in stool of our study participants (68%). We report a JB-15/KOR/2008 GII.4 Apeldoorn 2008-like variant strain circulating in 2011; this strain was replaced between 2012 and 2013 by a variant sharing homology with the Sydney/NSW0514/2012/AUS GII.4 Sydney 2012 and Sydney 2012/FRA GII.4 strains. We also report the co-circulation of non-GII.4 genotypes among hospitalized children. Our data show that NoV gastroenteritis can occur throughout the year with the highest number of cases detected during the hot months.
  
  
  CONCLUSIONS
  The majority of NoV-associated viral gastroenteritis cases among our participants are attributable to GII.4, which is compatible with results reported worldwide.
authors.affiliation: Nada M Melhem, Hassan Zaraket, Zeinab Ali, Moza Hammadi, Soha Ghanem, Farah Hajar, Amjad Haidar, Ghassan Dbaibo, Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut 1107-2020, Lebanon.
authors.forename: Nada M
authors.initials: NM
authors.lastname: Melhem
authors.affiliation: Nada M Melhem, Hassan Zaraket, Zeinab Ali, Moza Hammadi, Soha Ghanem, Farah Hajar, Amjad Haidar, Ghassan Dbaibo, Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut 1107-2020, Lebanon.
authors.forename: Hassan
authors.initials: H
authors.lastname: Zaraket
authors.affiliation: Nada M Melhem, Hassan Zaraket, Zeinab Ali, Moza Hammadi, Soha Ghanem, Farah Hajar, Amjad Haidar, Ghassan Dbaibo, Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut 1107-2020, Lebanon.
authors.forename: Khalil
authors.initials: K
authors.lastname: Kreidieh
authors.affiliation: Nada M Melhem, Hassan Zaraket, Zeinab Ali, Moza Hammadi, Soha Ghanem, Farah Hajar, Amjad Haidar, Ghassan Dbaibo, Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut 1107-2020, Lebanon.
authors.forename: Zeinab
authors.initials: Z
authors.lastname: Ali
authors.affiliation: Nada M Melhem, Hassan Zaraket, Zeinab Ali, Moza Hammadi, Soha Ghanem, Farah Hajar, Amjad Haidar, Ghassan Dbaibo, Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut 1107-2020, Lebanon.
authors.forename: Moza
authors.initials: M
authors.lastname: Hammadi
authors.affiliation: Nada M Melhem, Hassan Zaraket, Zeinab Ali, Moza Hammadi, Soha Ghanem, Farah Hajar, Amjad Haidar, Ghassan Dbaibo, Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut 1107-2020, Lebanon.
authors.forename: Soha
authors.initials: S
authors.lastname: Ghanem
authors.affiliation: Nada M Melhem, Hassan Zaraket, Zeinab Ali, Moza Hammadi, Soha Ghanem, Farah Hajar, Amjad Haidar, Ghassan Dbaibo, Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut 1107-2020, Lebanon.
authors.forename: Farah
authors.initials: F
authors.lastname: Hajar
authors.affiliation: Nada M Melhem, Hassan Zaraket, Zeinab Ali, Moza Hammadi, Soha Ghanem, Farah Hajar, Amjad Haidar, Ghassan Dbaibo, Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut 1107-2020, Lebanon.
authors.forename: Amjad
authors.initials: A
authors.lastname: Haidar
authors.affiliation: Nada M Melhem, Hassan Zaraket, Zeinab Ali, Moza Hammadi, Soha Ghanem, Farah Hajar, Amjad Haidar, Ghassan Dbaibo, Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut 1107-2020, Lebanon.
authors.forename: Adlette
authors.initials: A
authors.lastname: Inati
authors.affiliation: Nada M Melhem, Hassan Zaraket, Zeinab Ali, Moza Hammadi, Soha Ghanem, Farah Hajar, Amjad Haidar, Ghassan Dbaibo, Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut 1107-2020, Lebanon.
authors.forename: Mariam
authors.initials: M
authors.lastname: Rajab
authors.affiliation: Nada M Melhem, Hassan Zaraket, Zeinab Ali, Moza Hammadi, Soha Ghanem, Farah Hajar, Amjad Haidar, Ghassan Dbaibo, Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut 1107-2020, Lebanon.
authors.forename: Hassan
authors.initials: H
authors.lastname: Fakhouri
authors.affiliation: Nada M Melhem, Hassan Zaraket, Zeinab Ali, Moza Hammadi, Soha Ghanem, Farah Hajar, Amjad Haidar, Ghassan Dbaibo, Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut 1107-2020, Lebanon.
authors.forename: Bassam
authors.initials: B
authors.lastname: Ghanem
authors.affiliation: Nada M Melhem, Hassan Zaraket, Zeinab Ali, Moza Hammadi, Soha Ghanem, Farah Hajar, Amjad Haidar, Ghassan Dbaibo, Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut 1107-2020, Lebanon.
authors.forename: Ghassan
authors.initials: G
authors.lastname: Baasiri
authors.affiliation: Nada M Melhem, Hassan Zaraket, Zeinab Ali, Moza Hammadi, Soha Ghanem, Farah Hajar, Amjad Haidar, Ghassan Dbaibo, Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut 1107-2020, Lebanon.
authors.forename: Ghassan
authors.initials: G
authors.lastname: Dbaibo
mesh_terms: D000208:Acute Disease; D001483:Base Sequence; D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000821:virology*; D036022:Capsid Proteins / Q000235:genetics; D002675:Child, Preschool; D005243:Feces / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000821:virology*; D005838:Genotype; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D029322:Norovirus / Q000145:classification / Q000302:isolation & purification*; D010802:Phylogeny; D015995:Prevalence; D012367:RNA, Viral / Q000302:isolation & purification*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012401:Rotavirus / Q000302:isolation & purification*; D017422:Sequence Analysis, DNA; D011795:Surveys and Questionnaires
chemical_list: D036022:Capsid Proteins; D012367:RNA, Viral
keywords: Lebanon; Norovirus; Norovirus genogroup I; Norovirus genogroup II; Reverse transcription polymerase chain reaction; Sequencing