Hospital-based Surveillance for Pediatric Norovirus Gastroenteritis in Bangladesh, 2012-2016

Satter SM, Abdullah Z, Cardemil CV, Flora MS, Gurley ES, Rahman M, Talha M, Islam MD, Hossain ME, Balachandran N, Lopman B, Rahman M, Vinjé J, Hall AJ, Parashar UD


Globally, noroviruses are recognized as an important cause of acute gastroenteritis (AGE), but data from low and middle-income countries are limited.


To examine the epidemiology and strain diversity of norovirus infections among children hospitalized for AGE in Bangladesh.


We implemented active surveillance of children <5 years of age hospitalized with AGE at 8 geographically dispersed tertiary care hospitals in Bangladesh from July 2012 to June 2016. We tested random samples of AGE cases stratified by site and age group for norovirus by real-time RT-PCR. Noro-positive specimens were genotyped. Coinfection with rotavirus was assessed based on prior EIA testing.


We enrolled 5622 total AGE cases, of which 1008 were tested for norovirus. Total of 137 (14%) AGE cases tested positive for norovirus (range, 11%-17% by site). Most (94%) norovirus-associated hospitalizations were among children less than 2 years of age. Norovirus was detected year-round, with higher detection from March to June (20%-38%) and November to January (9%-18%). Genogroup II (GII) noroviruses were detected in 96% of cases, and the most frequent genotypes were GII.4 Sydney [P4 New Orleans] (33%), GII.3 [P16] (20%), and GII.4 Sydney [P16] (11%). The proportion of norovirus-positive specimens was significantly greater among rotavirus-negative AGE patients compared with rotavirus-positive AGE patients (27% vs. 5%, P < 0.001). As measured by the Vesikari severity score, a similar proportion of norovirus and rotavirus positive AGE patients were considered severe (68% vs. 70%, P = 0.86).


Norovirus is an important cause of AGE hospitalization in Bangladeshi children with most infections caused by GII viruses.