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We examined burden and factors associated with norovirus (NoV) acute gastroenteritis (AGE) among children in rural Guatemala. Children age 6 weeks to 17 years were enrolled into three AGE surveillance groups, using two-stage cluster sampling: a prospective participatory syndromic surveillance (PSS) cohort and two cross-sectional rapid active sampling (RAS) surveys, conducted from April 2015 to February 2016. Epidemiologic and NoV testing data were used to identify factors associated with NoV infection, AGE, and NoV+ AGE. The three cross-sectional surveys (PSS enrollment visit, RAS Survey 1, and RAS Survey 2) enrolled 1,239 children, who reported 134 (11%) AGE cases, with 20% of AGE and 11% of non-AGE samples positive for NoV. Adjusted analyses identified several modifiable factors associated with AGE and NoV infection. The cross-sectional RAS surveys were practical and cost-effective in identifying population-level risk factors for AGE and NoV, supporting their use as a tool to direct limited public health resources toward high-risk populations.
Financial support: This study was supported by an Investigator-Initiated Sponsored Research Grant from Takeda Pharmaceuticals (IISR-2014-100647). Olson is supported by NIH/NCATS Colorado CTSI Grant Number UL1 TR001082 and the Children’s Hospital of Colorado Research Scholar Award. Contents are the authors’ sole responsibility and do not necessarily represent official NIH view.
Authors’ addresses: Daniel Olson, Department of Pediatric Infectious Diseases, University of Colorado Denver School of Medicine, Aurora, CO, Center for Global Health, Colorado School of Public Health, Aurora, CO, and Department of Pediatric Infectious Diseases, Children’s Hospital Colorado, Aurora, CO, E-mail: firstname.lastname@example.org. Molly M. Lamb, Department of Epidemiology, Colorado School of Public Health, Aurora, CO, and Center for Global Health, Colorado School of Public Health, Aurora, CO, E-mail: email@example.com. Maria R. Lopez, Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala, E-mail: firstname.lastname@example.org. Maria A. Paniagua-Avila, Fundacion para la Salud Integral de los Guatemaltecos, Center for Human Development, Quetzaltenango, Guatemala, and Center for Public Health Initiatives, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, E-mail: email@example.com. Alma Zacarias, Fundacion para la Salud Integral de los Guatemaltecos, Center for Human Development, Quetzaltenango, Guatemala, E-mail: firstname.lastname@example.org. Gabriela Samayoa-Reyes, Center for Global Health, Colorado School of Public Health, Aurora, CO, and Department of Immunology and Microbiology, University of Colorado, Aurora, CO, E-mail: email@example.com. Celia Cordon-Rosales, Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala, E-mail: firstname.lastname@example.org. Edwin J. Asturias, Department of Pediatric Infectious Diseases, University of Colorado, Aurora, CO, Center for Global Health, Colorado School of Public Health, Aurora, CO, Department of Pediatric Infectious Diseases, Children’s Hospital Colorado, Aurora, CO, and Department of Epidemiology, Colorado School of Public Health, Aurora, CO, E-mail: email@example.com.