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J Infect Dis. 2018 Jul 24;218(5):716-725. doi: 10.1093/infdis/jiy219.

The First Norovirus Longitudinal Seroepidemiological Study From Sub-Saharan Africa Reveals High Seroprevalence of Diverse Genotypes Associated With Host Susceptibility Factors.

Author information

Division of Virology, Department of Pathology, University of Cambridge, UK.
Division of Infection and Immunity, University College London, Medical Research Council Centre for Medical Molecular Virology, UK.
Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit, Entebbe, Uganda.
Wellcome Trust Centre for Human Genetics, University of Oxford, UK.
Centre National de Référence des Virus Entériques, Laboratoire de Virologie-Sérologie, Centre Hospitalier Universitaire de Dijon, France.
L'Unité Mixte de Recherche Procédés Alimentaires et Microbiologiques, Université de Bourgogne Franche-Comté/AgroSup Dijon, France.
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK.
Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK.
The Jenner Institute, University of Oxford, UK.
Department of Clinical Research, London School of Hygiene and Tropical Medicine, UK.
School of Public Health, University of Makeni, Sierra Leone.



Human noroviruses (HuNoVs) are a prominent cause of gastroenteritis, yet fundamental questions remain regarding epidemiology, diversity, and immunity in sub-Saharan African children. We investigated HuNoV seroprevalence and genetic and sociodemographic risk factors in Ugandan children.


We randomly screened 797 participants of a longitudinal birth cohort (Entebbe, EMaBS) and 378 from a cross-sectional survey (rural Lake Victoria, LaVIISWA), for antibodies against HuNoV genotypes by ELISA. We used linear regression modeling to test for associations between HuNoV antibody levels and sociodemographic factors, and with the human susceptibility rs601338 FUT2 secretor SNP and histo-blood group antigens (A/B/O).


Of EMaBS participants, 76.6% were seropositive by age 1, rising to 94.5% by age 2 years. Seroprevalence in 1 year olds of the rural LaVIISWA survey was even higher (95%). In the birth cohort, 99% of seropositive 2 year olds had responses to multiple HuNoV genotypes. We identified associations between secretor status and genogroup GII antibody levels (GII.4 P = 3.1 × 10-52), as well as ABO and GI (GI.2 P = 2.1 × 10-12).


HuNoVs are highly prevalent in Ugandan children, indicating a substantial burden of diarrhea-associated morbidity with recurrent infections. Public health interventions, including vaccination, and increased surveillance are urgently needed.

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