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Calicivirus shedding in children after recovery from diarrhoeal disease

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Abstract

Background

Human norovirus is a major cause of acute gastroenteritis in all age groups. Recent evidence suggests that virus can be shed after resolution of disease symptoms, but little is known about duration of shedding.

Objectives

To investigate the duration of virus shedding in children after diarrhoeal illness.

Study design

We collected regular faecal specimens from 15 children followed prospectively for 18–36 months. To evaluate norovirus infections we conducted two distinct RT-PCR assays, and characterised isolates by sequence analysis.

Results

Norovirus infection was identified in 8 of the 15 children during the study period, with shedding was identified for at least 25 days in 3 children. In one child, virus shedding was detected for up to 100 days.

Conclusion

Human norovirus infections was detected frequently in children. The carriage of norovirus can occur for much longer than previously documented, and this finding shows that the potential for virus transmission within the community is much greater than previously understood.

Introduction

Noroviruses are a genetically diverse group of viruses in the family Caliciviridae, and are a major cause of viral gastroenteritis worldwide. Molecular epidemiological studies of sporadic and outbreak cases of gastroenteritis show that norovirus is a common cause of disease in all age groups of the community.1, 7 Noroviruses usually cause a short-term, self-limiting illness with diarrhoea and vomiting. Virus particles are shed in faeces and vomitus after the acute course of illness.9 There is evidence that virus can be detected after recovery from clinical disease, but little is known of the duration of shedding.8, 11

In this study we investigated the duration that calicivirus shedding could be detected in faeces collected longitudinally from 15 children after diarrhoeal illness using RT-PCR analysis.

Section snippets

Methods

We collected faecal specimens from 15 children admitted to the infectious disease ward of the Royal Children's Hospital (Melbourne, Australia) with acute rotavirus diarrhoea during 1984–1985. All children were kept under surveillance for 18–36 months. Surveillance included weekly collection of a faecal specimen. Additional faecal specimens were collected during and after any diarrhoeal episode. All of the secondary diarrhoeal episodes were mild to moderate. All faecal specimens were analysed

Results

Eight of the 15 children studied had at least 1 episode of calicivirus diarrhoea identified by RT-PCR during the study period (Table 1). No other enteric pathogens were identified during these diarrhoeal episodes.

Longitudinal studies of faecal specimens from five children obtained after diarrhoeal episodes showed calicivirus positive RT-PCR results could be detected for up to 15 days after disease onset (table). Norovirus was identified in four of the five children, including genotype GII.4 (n = 

Discussion

This study has shown that 8 of 15 young children studied had a calicivirus infection, and in each instance virus was shed in faeces after resolution of disease symptoms. In three children virus shedding was detected for at least 25 days after resolution of disease symptoms. In one of the eight children, multiple norovirus infections were identified over a 2-year period with virus shed for up to 70 and 100 days during two distinct infections. Thus prolonged virus excretion after resolution of

Acknowledgements

Ethical approval for the study was granted by the ethics in human research committee of the Royal Childrens Hospital, and written informed consent for surveillance was obtained from all parents.

This project was supported by a research grant from the Murdoch Childrens Research Institute. Dr. Kirkwood is supported by an NHMRC RD Wright Research Fellowship (334364). We thank Professor Ruth Bishop for the helpful comments.

References (11)

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