Clinical severity of human calicivirus gastroenteritis in children

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Caliciviruses in animals and in humans are now classified in four Genera by ICTV in 1999. In humans, the Genus "Norwalk-like viruses" represented by Norwalk virus (NV) and the Genus "Sapporo-like viruses" represented by Sapporo virus (SV) are approved. To clarify the clinical significance and etiologic impact of NV and SV in viral gastroenteritis in Japanese children, two outbreaks each of NV gastroenteritis and SV gastroenteritis occurring in an infant home in Sapporo, Japan, as well as 95 hospitalized children with acute gastroenteritis were retrospectively evaluated using a 0 to 20 point clinical severity scoring system. The mean severity scores for NV and SV gastroenteritis outbreaks were 7.9 and 5.2, respectively, as compared to 8.4 for rotavirus A (RV-A) gastroenteritis that occurred in the same infant home. Among 95 hospitalized children with acute gastroenteritis, RV-A was detected in 47% followed by NV in 18%. SV was not found. The severity score of 13.2 in RV cases was the highest, followed by 12.3 in NV cases and ll.3 in unknown etiology cases, and they were judged as severe cases irrespective of the etiologic agents. In the extremely severe cases, in which the score was ≧14, a viral etiology was established in 78%; RV in 56% and NV in 22%. Our data indicate that NV can cause severe gastroenteritis and is an important etiologic agent in hospitalized cases while SV causes mild gastroenteritis in children in Japan.