title: Environmental factors associated with childhood norovirus diarrhoea in León, Nicaragua.
abstract: Norovirus is detected in one in five diarrhoea episodes in children, yet little is known about environmental risk factors associated with this disease, especially in low-income settings. The objective of this study was to examine environmental risk factors, and spatial and seasonal patterns of norovirus diarrhoea episodes in children in León, Nicaragua. We followed a population-based cohort of children under age 5 years for norovirus diarrhoea over a 1-year period. At baseline, characteristics of each household were recorded. Households were geocoded and spatial locations of garbage dumps, rivers, and markets were collected. In bivariate analysis we observed younger children and those with animals in their households were more likely to have experienced norovirus episodes. In adjusted models, younger children remained at higher risk for norovirus episodes, but only modest associations were observed with family and environmental characteristics. We next identified symptomatic children living in the same household and within 500 m buffer zones around the household of another child infected with the same genotype. Norovirus diarrhoea episodes peaked early in the rainy season. These findings contribute to our understanding of environmental factors and norovirus infection.
authors.affiliation: Department of Family Medicine,University of North Carolina School of Medicine,Chapel Hill,North Carolina,USA.
authors.forename: S
authors.initials: S
authors.lastname: Becker-Dreps
authors.affiliation: Department of Epidemiology,UNC Gillings School of Global Public Health,Chapel Hill,North Carolina,USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Cuthbertson
authors.affiliation: Department of Microbiology and Parasitology, Faculty of Medical Sciences,Universidad Nacional Autónoma de Nicaragua,León,Nicaragua.
authors.forename: F
authors.initials: F
authors.lastname: Bucardo
authors.affiliation: Division of Viral Diseases,National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention,Atlanta,Georgia,USA.
authors.forename: J
authors.initials: J
authors.lastname: Vinje
authors.affiliation: Department of Microbiology and Parasitology, Faculty of Medical Sciences,Universidad Nacional Autónoma de Nicaragua,León,Nicaragua.
authors.forename: M
authors.initials: M
authors.lastname: Paniagua
authors.affiliation: Department of Family Medicine,School of Medicine, Oregon Health and Sciences University,Portland, OR,USA.
authors.forename: S
authors.initials: S
authors.lastname: Giebultowicz
authors.affiliation: Department of Microbiology and Parasitology, Faculty of Medical Sciences,Universidad Nacional Autónoma de Nicaragua,León,Nicaragua.
authors.forename: F
authors.initials: F
authors.lastname: Espinoza
authors.affiliation: Department of Geography,University of North Carolina at Chapel Hill,North Carolina,USA.
authors.forename: M
authors.initials: M
authors.lastname: Emch
mesh_terms: D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000821:virology; D002675:Child, Preschool; D015331:Cohort Studies; D003906:Developing Countries; D003967:Diarrhea / Q000453:epidemiology* / Q000821:virology; D004777:Environment; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009527:Nicaragua / Q000453:epidemiology; D029322:Norovirus / Q000502:physiology*; D012307:Risk Factors; D012621:Seasons; D012959:Socioeconomic Factors
keywords: Nicaragua; Norovirus; childhood diarrhoea; gastroenteritis; risk factors