Norovirus infection: features of epidemiology and clinical and laboratory manifestations at the present stage

N.V. Pronko, Yu.P. Krasko


Background. Among most significant for practical medicine infections, acute intestinal infections of viral etiology are becoming increasingly topical [2, 4]. According to domestic and foreign literature, up to 70 % of gastroenteritis occur during cold seasons of the year and are induced by viruses [3, 5]. The range of the factors producing viral diarrheas is rather wide. One of the comparatively new acute intestinal infections (AII) producing factors is noroviruses [5, 6]. The prevalence of noroviruses has been little studied, and the clinical picture has been characterized insufficiently. This can be explained by insufficient diagnostics and registration of this infection [3, 6, 7]. Aim of the work: analysis of the morbidity and determination of clinical laboratory features of noroviral infection (NVI) in children according to the data of the Regional Clinical Infectious Di­seases Hospital in Grodno. Materials and methods. A comprehensive clinical laboratory analysis of 1,105 case histories of children aged 1 month to 14 years with verified viral intestinal infection, who were admitted to Grodno Regional Clinical Infectious Diseases Hospital from January 2013 to December 2016, was carried out. The patients were divided according to the final clinical diagnosis in the following way: rotaviral infection (RVI) was found in 676 (61.2 %) individuals, adenoviral intestinal infection (AVI) — in 212 (19.2 %), NVI was detected in 156 (14.1 %) and enteroviral infection — in 61 (5.5 %) persons. The examination was carried out according to the protocols approved by the Ministry of Health of the Republic of Belarus. Results. As our study showed, at the period analyzed the viral intestinal diseases amounted to 70.4 % of all the cases of diseases in the structure of AII in children. Patients hospitalized with viral diarrhea showed prevalence of RVI (61.2 %). NVI was the third by the incidence among viral diarrheas, and it was registered in 14.1 % of the cases. Among 156 patients with NVI, there were 75 boys (48.1 %) and 81 girls (51.9 %), and no significant differences were noticed in the sex of the patients. There were 95 organized (60.9 %) and 61 unorganized children (39.1 %). In the majority of cases, NVI manifes­ted itself as monoinfection (92.9 %), while mixed infection occurred in 7.1 % of the cases. The mixed infection was due to a combination of two viruses — norovirus-rotavirus associated with pathogenic flora (Staphylococcus, Proteus). The analysis of the age structure of the group of children with noroviral infection showed that children aged up to 1 year amounted to 31 patients (19.9 %), those of 1 to 3 years of age — to 93 patients (59.6 %), there were 21 children aged 4–6 years (13.5 %) and 7 patients aged 7–10 years (3.8 %), whereas the number of 1–14-year olds amounted to 5 patients (3.2 %). At the moment of disease, the majority of the children examined were at the age of the first three years of life (76.9 %). Acute gastroenteritis was diagnosed in 132 (84.6 %) patients, acute gastroenterocolitis — in 9 patients (5.8 %), and 15 patients had acute enteritis. The analysis of the clinical course of NVI enabled us to identify such symptoms, as general infectious and gastroenteritis. The clinical picture of NVI showed that the leading syndrome was that of acute gastroenteritis. The disease started from vomiting, changing of stool characteristics and frequency, and increasing of temperature. Manifestations of intoxication were noted in 136 (87.29 %) patients. The patients had also sluggishness, weakness, decreased appetite and I to II degree water-deficient exsicosis. The assessment of the premorbid background established that the majority of children with NVI had the appropriate pathology and a compromised premorbid background. Conclusions. Viral intestinal diseases are one of the leading causes of infectious gastroenteritis in children of the first three years of age in Grodno region. NVI were characterized by acute onset, moderate fever, watery diarrhea and cyclicality of the course of the disease. Water-deficient exsicosis was typical for patients aged up to 1 year. The at-risk group included children of the first three years of life. The clinical course of NVI depended on the age and the premorbid background, as well as on the predisposing factors: anemia, alimentary allergy, exudative diathesis, etc.


intestinal infection, norovirus infection, children


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