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Genetic Diversity of Norovirus Infections, Coinfections, and Undernutrition in Children From Brazilian Semiarid Region

Gondim, Rafhaella D.G.*; Pankov, Rafaela C.*; Prata, Mara M.G.*; Medeiros, Pedro H.Q.S.*; Veras, Herlice N.*; Santos, Ana K.S.*; Magalhães, Lyvia M.C.*; Havt, Alexandre*; Fumian, Tulio M.; Miagostovich, Marize P.; Leite, José P.G.; Lima, Aldo A.M.*

Journal of Pediatric Gastroenterology and Nutrition: December 2018 - Volume 67 - Issue 6 - p e117–e122
doi: 10.1097/MPG.0000000000002085
Original Article: Gastroenterology

Background and Objective: Norovirus (NoV) infections are known to have high-morbidity and mortality rates and are a major health problem globally. The impact of NoV on child development is, however, poorly understood. We evaluated the distribution of NoV genotypes in children from a low-income Brazilian semiarid region, in relation with their clinical symptoms, nutritional status, and co-pathogens.

Methods: The test population included children aged 2 to 36 months from 6 cities of the Brazilian semiarid region. Fecal samples were collected from each child, along with the information regarding their socioeconomic/clinical conditions using a standardized questionnaire. Detection and quantification of NoV were performed by reverse-transcription quantitative polymerase chain reaction, followed by molecular and phylogenetic analyses.

Results: The NoV detection rate was 45.2%. Presence of NoV was associated with lower z scores for weight-for-age (P = 0.03), weight-for-height (P = 0.03), and body mass index-for-age (P = 0.03). NoV infection was associated with more frequent respiratory illnesses (P < 0.01). GII.P7 (polymerase) and GII.3 (capsid) were the most frequent NoV genotypes. Analysis of the open reading frame (ORF)1-2 junction identified recombinant NoV strains in 80% of the sequenced samples. Enteroaggregative Escherichia coli coinfection was the major predictor for diarrhea in NoV-positive samples (P < 0.02). Moreover, Shigella spp was also associated with NoV-positive diagnosis (P = 0.02).

Conclusions: This study highlights the genetic variability of NoV and, associated co-infections and undernutrition in infants from low-income Brazilian semiarid region.

*National Institute of Science and Technology & Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza

Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.

Address correspondence and reprint requests to Rafhaella D.G. Gondim, MD, R. Cel. Nunes de Melo, 1315, Rodolfo Teófilo, Fortaleza, CEP 60.430-270, CE, Brazil, Institute of Biomedicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (e-mail:

Received 2 March, 2018

Accepted 15 June, 2018

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

This work was supported by the National Fund for Scientific and Technological Development (FNDCT; Finep no. 0460.08), the Excellence Program of Research (PROEP-CNPq/IOC), and the General Coordination of Laboratories/Secretary of Health Surveillance, Ministry of Health.

The authors report no conflicts of interest.

© 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,