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Open Access 01-12-2016 | Research article

Complicated norovirus infection and assessment of severity by a modified Vesikari disease score system in hospitalized children

Authors: Pei-Lin Wang, Shih-Yen Chen, Chi-Neu Tsai, Hsun-Ching Chao, Ming-Wei Lai, Yi-Jung Chang, Chyi-Liang Chen, Cheng-Hsun Chiu

Published in: BMC Pediatrics | Issue 1/2016

Abstract

Background

Norovirus (NoV) GII.4 is the most common genotype for norovirus gastroenteritis worldwide. New variants or subgenotypes are continuously emerging, thus posing a serious threat to child health.

Methods

We compared retrospectively the clinical manifestations and complications of norovirus gastroenteritis in children from April, 2004 through December, 2012. NoV variants were analyzed to investigate the association of circulating viral strains with the complications. A modified disease severity score system based on Vesikari score system was devised and to evaluate disease severity.

Results

Compared to the outbreak in 2004/2005 winter, significant higher incidence of complications in the later periods are: convulsive disorder (p < 0.001) in 2006/2007 winter gastrointestinal hemorrhage (p = 0.047) and severe abdominal pain or irritability (p = 0.033) in 2008/09/10 winter; gastrointestinal hemorrhage (p = 0.030), severe abdominal pain or irritability (p = 0.014), and prominent hyperthermia (fever >39 °C, p = 0.001) in 2011/2012 winter. GII.4 Den_Haag_2006b, GII.4 2010, GII.4 Sydney 2012, and GII.4 2012b were the predominant strains in the outbreaks after 2006. By the modified severity score system, severe norovirus disease occurred in 28.5 %, 32 %, 33.3 %, and 30.2 % of the patients in the four periods. A longer duration of hospitalization (p = 0.02) were found in those with high score irrespective of the year of admission.

Conclusions

Our study demonstrated NoV outbreaks in northern Taiwan caused by different GII.4 variants that were associated with specific complications and uncommon clinical presentations. A modified severity score system first proposed in this study was able to identify severe cases with a longer hospital stay in NoV-infected children.

Matthews JE, Dickey BW, Miller RD, Felzer JR, Dawson BP, Lee AS, et al. The epidemiology of published norovirus outbreaks: a review of risk factors associated with attack rate and genogroup. Epidemiol Infect. 2012;140:1161–72.CrossRefPubMedPubMedCentral

Vinjé J. Advances in laboratory methods for detection and typing of norovirus. J Clin Microbiol. 2015;53:373–81.CrossRefPubMed

Desai R, Hembree CD, Handel A, Matthews JE, Dickey BW, McDonald S, et al. Severe outcomes are associated with genogroup 2 genotype 4 norovirus outbreaks: a systematic literature review. Clin Infect Dis. 2012;55:189–93.CrossRefPubMedPubMedCentral

Patel MM, Hall AJ, Vinje J, Parashar UD. Noroviruses. A comprehensive review. J Clin Virol. 2009;44:1–8.CrossRefPubMed

Chen SY, Tsai CN, Lai MW, Chen CY, Lin KL, Lin TY, et al. Norovirus infection as a cause of diarrhea-associated benign infantile seizures. Clin Infect Dis. 2009;48:849–55.CrossRefPubMed

Kawano G, Oshige K, Syutou S, Koteda Y, Yokoyama T, Kim BG, et al. Benign infantile convulsions associated with mild gastroenteritis: a retrospective study of 39 cases including virological tests and efficacy of anticonvulsants. Brain Dev. 2007;29:617–22.CrossRefPubMed

Tsai CN, Lin CY, Lin CW, Shih KC, Chiu CH, Chen S. Clinical relevance and genotypes of circulating noroviruses in northern Taiwan, 2006–2011. J Med Virol. 2014;86:335–46.CrossRefPubMed

Chen SY, Tsai CN, Chen CL, Chao HC, Lee YS, Lai MW, et al. Severe viral gastroenteritis in children after suboptimal rotavirus immunization in Taiwan. Pediatr Infect Dis J. 2013;32:1335–9.CrossRefPubMed

Vesikari T, Rautanen T, Varis T, Beards GM, Kapikian AZ. Rhesus Rotavirus candidate vaccine. Clinical trial in children vaccinated between 2 and 5 months of age. Am J Dis Child. 1990;144:285–9.CrossRefPubMed

10.

Bok K, Abente EJ, Realpe-Quintero M, Mitra T, Sosnovtsev SV, Kapikian AZ, et al. Evolutionary dynamics of GII.4 noroviruses over a 34-year period. J Virol. 2009;83:11890–901.CrossRefPubMedPubMedCentral

11.

Buesa J, Montava R, Abu-Mallouh R, Fos M, Ribes JM, Bartolome R, et al. Sequential evolution of genotype GII.4 norovirus variants causing gastroenteritis outbreaks from 2001 to 2006 in Eastern Spain. J Med Virol. 2008;80:1288–95.CrossRefPubMed

12.

Eden JS, Hewitt J, Lim KL, Boni MF, Merif J, Greening G, et al. The emergence and evolution of the novel epidemic norovirus GII.4 variant Sydney 2012. Virology. 2014;450–451:106–13.CrossRefPubMed

13.

Mahar JE, Bok K, Green KY, Kirkwood CD. The importance of intergenic recombination in norovirus GII.3 evolution. J Virol. 2013;87:3687–98.CrossRefPubMedPubMedCentral

14.

Zakikhany K, Allen DJ, Brown D, Iturriza-Gomara M. Molecular evolution of GII-4 Norovirus strains. PLoS One. 2012;7:e41625.CrossRefPubMedPubMedCentral

15.

Turcios-Ruiz RM, Axelrod P, St John K, Bullitt E, Donahue J, Robinson N, et al. Outbreak of necrotizing enterocolitis caused by norovirus in a neonatal intensive care unit. J Pediatr. 2008;153:339–44.CrossRefPubMed

16.

Khan RR, Lawson AD, Minnich LL, Martin K, Nasir A, Emmett MK, et al. Gastrointestinal norovirus infection associated with exacerbation of inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2009;48:328–33.CrossRefPubMed

17.

Atmar J, Mullen E. Norovirus in immunocompromised patients. Oncol Nurs Forum. 2013;40:434–6.CrossRefPubMed

18.

Bok K, Green KY. Norovirus gastroenteritis in immunocompromised patients. N Engl J Med. 2012;367:2126–32.CrossRefPubMedPubMedCentral

19.

Ruiz-Palacios GM, Perez-Schael I, Velazquez FR, Abate H, Breuer T, Clemens SC, et al. Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. N Engl J Med. 2006;354:11–22.CrossRefPubMed

20.

Vesikari T, Matson DO, Dennehy P, Van Damme P, Santosham M, Rodriguez Z, et al. Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. N Engl J Med. 2006;354:23–33.CrossRefPubMed

21.

Schnadower D, Tarr PI, Gorelick MH, O'Connell K, Roskind CG, Powell EC, et al. Validation of the modified Vesikari score in children with gastroenteritis in 5 US emergency departments. J Pediatr Gastroenterol Nutr. 2013;57:514–9.CrossRefPubMedPubMedCentral

22.

Guarino A, Ashkenazi S, Gendrel D, Lo Vecchio A, Shamir R, Szajewska H. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. J Pediatr Gastroenterol Nutr. 2014;59:132–52.CrossRefPubMed

23.

Atmar RL, Bernstein DI, Harro CD, Al-Ibrahim MS, Chen WH, Ferreira J, et al. Norovirus vaccine against experimental human Norwalk Virus illness. N Engl J Med. 2011;365:2178–87.CrossRefPubMedPubMedCentral

24.

Bok K, Parra GI, Mitra T, Abente E, Shaver CK, Boon D, et al. Chimpanzees as an animal model for human norovirus infection and vaccine development. Proc Natl Acad Sci U S A. 2011;108:325–30.CrossRefPubMed

25.

Tan M, Huang P, Xia M, Fang PA, Zhong W, McNeal M, et al. Norovirus P particle, a novel platform for vaccine development and antibody production. J Virol. 2011;85:753–64.CrossRefPubMed

26.

Tan M, Jiang X. Norovirus P particle: a subviral nanoparticle for vaccine development against norovirus, rotavirus and influenza virus. Nanomedicine (Lond). 2012;7:889–97.CrossRef

27.

Treanor JJ, Atmar RL, Frey SE, Gormley R, Chen WH, Ferreira J, et al. A novel intramuscular bivalent norovirus VLP vaccine candidate - reactogenicity, safety and immunogenicity in a phase I trial in healthy adults. J Infect Dis. 2014;210:1763–71.CrossRefPubMed

Title: Complicated norovirus infection and assessment of severity by a modified Vesikari disease score system in hospitalized children
Authors: Pei-Lin Wang
Shih-Yen Chen
Chi-Neu Tsai
Hsun-Ching Chao
Ming-Wei Lai
Yi-Jung Chang
Chyi-Liang Chen
Cheng-Hsun Chiu
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Pediatrics / Issue 1/2016
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/s12887-016-0699-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Complicated norovirus infection and assessment of severity by a modified Vesikari disease score system in hospitalized children

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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