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Volume 19, Number 10—October 2013

Letter

Clinical Profile of Children with Norovirus Disease in Rotavirus Vaccine Era

Mary E. WikswoComments to Author , Rishi Desai, Kathryn M. Edwards, Mary Allen Staat, Peter G. Szilagyi, Geoffrey A. Weinberg, Aaron T. Curns, Benjamin Lopman, Jan Vinjé, Umesh D. Parashar, Daniel C. Payne, and Aron J. Hall
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (M.E. Wikswo, R. Desai, A.T. Curns, B. Lopman, J. Vinjé, U.D. Parashar, D.C. Payne, A.J. Hall); Vanderbilt University Medical Center, Nashville, Tennessee, USA (K.M. Edwards); Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA (M.A. Staat); University of Rochester School of Medicine and Dentistry, Rochester, New York, USA (P.G. Szilagyi, G.A. Weinberg)

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Table

Clinical profile and severity score of norovirus case-patients compared with acute gastroenteritis control patients and unvaccinated rotavirus case-patients, New Vaccine Surveillance Network, United States, 2008–2010*

Severity score component Severity score Norovirus case-patients, n = 144 Unvaccinated rotavirus case-patients, n = 69 p value† AGE control patients, n = 334 p value†
Duration of diarrhea, d, no. (%) 0.003 0.19
0 0 32 (22) 3 (4) 82 (25)
1–4 1 87 (60) 55 (80) 171 (51)
5 2 13 (9) 7 (10) 33 (10)
≥6 3 12 (8) 4 (2) 48 (14)
Diarrhea episodes/24 h, no. (%) 0.0003 0.24
0 0 32 (22) 3 (4) 82 (25)
1–3 1 47 (33) 16 (23) 79 (24)
4–5 2 22 (15) 14 (20) 64 (19)
≥6 3 43 (30) 36 (52) 23 (33)
Duration of vomiting, h, no. (%) 0.43 0.003
0 0 7 (5) 2 (3) 54 (16)
1–23 (1 d) 1 28 (19) 10 (14) 64 (19)
24–47 (2 d) 2 33 (23) 12 (17) 74 (22)
≥48 (≥3 d) 3 76 (53) 45 (65) 142 (43)
Vomiting episodes/24 h, no. (%) 0.22 <0.0001
0 0 7 (5) 2 (3) 54 (16)
1 1 11 (8) 1 (1) 52 (16)
2–4 2 45 (31) 20 (29) 117 (35)
≥5 3 81 (56) 46 (67) 111 (33)
Fever, °F, no. (%) <0.0001 <0.0001
≤98.6 0 80 (56) 15 (22) 102 (31)
98.7–101.1 1 29 (20) 21 (30) 55 (16)
101.2–102 2 9 (6) 18 (26) 45 (13)
≥102.1 3 26 (18) 15 (22) 132 (40)
Signs, no. (%) <0.0001 0.65
Normal 0 12 (8) 2 (3) 35 (10)
Less playful/irritable 1 63 (44) 13 (19) 158 (47)
Lethargic/listless 2 67 (47) 54 (78) 138 (41)
Seizure 3 2 (1) 0 (0) 3 (1)
Treatment, no. (%) 0.02 0.16
None 0 50 (35) 12 (17) 135 (40)
Rehydration, no hospitalization 1 50 (35) 26 (38) 87 (26)
Hospitalization 2 44 (31) 31 (45) 112 (34)
Severity score, median NA 11 13 <0.0001 10 0.78

*AGE control patients with acute gastroenteritis (defined ≥3 more episodes of diarrhea or any episodes of vomiting within 24 h that lasted ≤10 d), but who were negative for norovirus and rotavirus. NA, not applicable.
†Severity scores were compared by Wilcoxon rank-sum test. All other components were compared by Fisher χ2 test. Significant findings are indicated in boldface.

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