title: Norovirus epidemiology in South African children <5 years hospitalised for diarrhoeal illness between 2009 and 2013.
abstract: Public health interest in norovirus (NoV) has increased in recent years following improved diagnostics, global burden estimates and the development of NoV vaccine candidates. This study aimed to describe the detection rate, clinical characteristics and environmental features associated with NoV detection in hospitalized children <5 years with diarrhoea in South Africa (SA). Between 2009 and 2013, prospective diarrhoeal surveillance was conducted at four sites in SA. Stool specimens were collected and screened for NoVs and other enteric pathogens using molecular and serological assays. Epidemiological and clinical data were compared in patients with or without detection of NoV. The study detected NoV in 15% (452/3103) of hospitalized children <5 years with diarrhoea with the majority of disease in children <2 years (92%; 417/452). NoV-positive children were more likely to present with diarrhoea and vomiting (odds ratio (OR) 1·3; 95% confidence interval (CI) 1·1-1·7; P = 0·011) with none-to-mild dehydration (adjusted OR 0·5; 95% CI 0·3-0·7) compared with NoV-negative children. Amongst children testing NoV positive, HIV-infected children were more likely to have prolonged hospitalization and increased mortality compared with HIV-uninfected children. Continued surveillance will be important to consider the epidemic trends and estimate the burden and risk of NoV infection in SA.
authors.affiliation: National Institute for Communicable Diseases,Private Bag x4, Sandringham, 2131,South Africa.
authors.forename: N A
authors.identifier: 0000-0001-5845-4417
authors.initials: NA
authors.lastname: Page
authors.affiliation: Medical Research Council: Respiratory and Meningeal Pathogens Research Unit,University of the Witwatersrand,Johannesburg,South Africa.
authors.forename: M J
authors.initials: MJ
authors.lastname: Groome
authors.affiliation: National Institute for Communicable Diseases,Private Bag x4, Sandringham, 2131,South Africa.
authors.forename: S
authors.initials: S
authors.lastname: Nadan
authors.affiliation: National Institute for Communicable Diseases,Private Bag x4, Sandringham, 2131,South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Netshikweta
authors.affiliation: National Institute for Communicable Diseases,Private Bag x4, Sandringham, 2131,South Africa.
authors.forename: K H
authors.initials: KH
authors.lastname: Keddy
authors.affiliation: National Institute for Communicable Diseases,Private Bag x4, Sandringham, 2131,South Africa.
authors.forename: B
authors.initials: B
authors.lastname: Poonsamy
authors.affiliation: School of Public Health,Faculty of Health Sciences,University of Witwatersrand,Johannesburg,South Africa.
authors.forename: J
authors.initials: J
authors.lastname: Moyes
authors.affiliation: National Institute for Communicable Diseases,Private Bag x4, Sandringham, 2131,South Africa.
authors.forename: S
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: K
authors.initials: K
authors.lastname: Kahn
authors.affiliation: National Institute for Communicable Diseases,Private Bag x4, Sandringham, 2131,South Africa.
authors.forename: S A
authors.initials: SA
authors.lastname: Madhi
authors.affiliation: Department of Medical Virology,Faculty of Health Sciences,University of Pretoria,Private Bag X323,Arcadia,Pretoria 0007,South Africa.
authors.forename: M B
authors.initials: MB
authors.lastname: Taylor
authors.affiliation: Department of Medical Virology,Faculty of Health Sciences,University of Pretoria,Private Bag X323,Arcadia,Pretoria 0007,South Africa.
authors.forename: J
authors.identifier: 0000-0001-6721-1177
authors.initials: J
authors.lastname: Mans
authors.affiliation: National Institute for Communicable Diseases,Private Bag x4, Sandringham, 2131,South Africa.
authors.forename: C
authors.initials: C
authors.lastname: Cohen
mesh_terms: D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000821:virology; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology* / Q000821:virology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D029322:Norovirus / Q000502:physiology*; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology
keywords: Caliciviruses; Norwalk agent and related viruses; diarrhoea; virology (human) and epidemiology