658. Burden of norovirus disease and risk factors for infection among children in rural Guatemala
Session: Poster Abstract Session: Oh, Those Pesky Viruses!
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • NoV RF poster Fixed - 10-5-16b.pdf (468.2 kB)
  • Background: Norovirus (NoV) acute gastroenteritis (AGE) is a common cause of morbidity and mortality in low and middle income countries. We examined the burden of disease and risk factors for NoV infection among children in rural Guatemala, using two novel and low-cost surveillance systems.

    Methods: Children 6 weeks-17 years were enrolled into either of 2 surveillance groups: 1) active AGE participatory surveillance (PSS), in which households were randomized by 2-stage cluster sampling, prospectively followed by weekly smartphone-based symptom diaries (4/2015-2/2016), and tested for NoV (rectal/stool swab PCR) if self-reported AGE; and 2) two cross-sectional seroprevalence (RAS) surveys (10/2015-11/2015 and 1/2016-2/2016) in which households were randomized by 2-stage cluster sampling, interviewed for AGE in the last week, and tested for NoV.

    Results: The PSS group (466 children in 207 households) had 102 AGE episodes during enrollment and follow up (13.8 cases/100 person-years); 15 (21%) of 70 samples available were NoV+. The combined RAS surveys (744 children in 412 households) had 85 AGE episodes, and 11 (17%) of 66 samples available were NoV+. Of 577 asymptomatic visits with samples collected, 61 (11%) were NoV+. Our univariate analysis suggested younger age, greater number of children <5 years in the household, having a well, not having a septic tank, and not breastfeeding may be associated with increased NoV infection (p<0.2). Multivariate analysis adjusted showed that breastfeeding is significantly protective against NoV in children < 2 (Table 1). In a sub-analysis of children with AGE, increased vomiting was associated with NoV+ (p=0.02).

    Table 1

    PSS

    OR (95% CI)

    p-value

    RAS 1 and 2

    OR (95% CI)

    p-value

    All subjects

    OR (95% CI)

    p-value

    Number of children in household <=5 years

    1.35

    (0.86 – 2.11 )

    0.19

    1.01

    (0.70 – 1.46)

    0.97

    1.12

    (0.85 – 1.48)

    0.43

    Well

    3.00

    (0.89 –10.15)

    0.08

    1.56

    (0.63 – 3.84)

    0.34

    2.04

    (0.99 – 4.20)

    0.052

    Septic tank

    0.46

    (0.23 – 0.94)

    0.03

    0.89

    (0.47 – 1.66)

    0.71

    0.72

    (0.45 – 1.15)

    0.17

    Breastfed (if <= 2 years)

    0.11

    (0.08 – 1.32)

    0.08

    0.23

    (0.06 – 0.80)

    0.02

    0.21

    (0.07 – 0.63)

    0.005

    Conclusion: Our smartphone-based active surveillance (PSS) and rapid active cycle seroprevalence (RAS) systems demonstrated similar performance, and a high burden of NoV infection and risk factors in rural Guatemala. These systems may be useful in determining the community burden of NoV for upcoming vaccines.

    Daniel Olson, MD1,2, Molly Lamb, PhD3, Alma Zacarias, MD4, Maria Renee Lopez, PhD5, Alejandra Paniagua, MD6, Gabriela Samayoa-Reyes, BS7, Ricardo Zambrano, MS8, Sergio Rodriguez, MBA8, Celia Cordon-Rosales, PhD5 and Edwin J. Asturias, MD9, (1)Pediatric Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, (2)Center for Global Health, University of Colorado School of Public Health, Aurora, CO, (3)Epidemiology, University of Colorado School of Public Health, Aurora, CO, (4)Centers for Disease Control and Prevention - Guatemala, Coatepeque, Guatemala, (5)Universidad del Valle de Guatemala, Guatemala City, Guatemala, (6)University of Pennsylvania, Philadelphia, PA, (7)University of Colorado - Denver, Aurora, CO, (8)Integra IT, Bogota, Colombia, (9)Department of Infectious Disease, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO

    Disclosures:

    D. Olson, None

    M. Lamb, None

    A. Zacarias, None

    M. R. Lopez, None

    A. Paniagua, None

    G. Samayoa-Reyes, None

    R. Zambrano, None

    S. Rodriguez, None

    C. Cordon-Rosales, None

    E. J. Asturias, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.