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Journals / Pediatric Practice and Research / 2026 / Volume: 8 Issue: 1

Detection of Human Norovirus among Children with Gastroenteritis in Diyala Governorate

Diyala Valiliğinde Gastroenteritli Çocuklarda İnsan Norovirüsünün Saptanması

Marwa Diraa(College of Medicine , University of Diyala)
Jalil İbrahim Al-ezzi(University of Diyala /College of Medicine)0000-0002-7541-4852
Areej Hussein(College of Medicine, University of Diyala)0000-0002-4284-9104
Pages
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Publication Date
2020-04-30
DOI
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Conclusion: Human norovirus genogroup II appear to play a major role in acute gastroenteritis among children.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Background: Acute gastroenteritis remains a global public health problem and human noroviruses persist a cause of gastroenteritis.
📊
Key Findings & Data:Objectives: To determine the rate of human norovirus infections among children with gastroenteritis in Diyala governorate by enzyme linked immunosorbent assay and immuneochromatography, also to assess genogroup 1(GGI) and genogroup 2(GGII) by nested polymerase chain reaction among study population.
💡
Conclusion & Impact:Conclusion: Human norovirus genogroup II appear to play a major role in acute gastroenteritis among children.
🔬Design:Research Article
📍Scope:2018 Verileri
⚙️Variables:Gastroenteritis · human norovirus · PCR

Abstract

Background: Acute gastroenteritis remains a global public health problem and human noroviruses persist a cause of gastroenteritis. Objectives: To determine the rate of human norovirus infections among children with gastroenteritis in Diyala governorate by enzyme linked immunosorbent assay and immuneochromatography, also to assess genogroup 1(GGI) and genogroup 2(GGII) by nested polymerase chain reaction among study population. Patients and methods: Cross sectional study were carried out on 182 children under five years old with acute gastroenteritis who attended the emergency department of pediatrics in Al-Batool Teaching Hospital in Baqubah city, during the period from 6th September 2018 till 4th of March 2019. Stool samples were collected from each participant and stored as frozen at -70 °C to use for enzyme linked immunosorbent assay and quick qualitative immunochromatographic test, finally positive results for human norovirus was used for RNA extraction and nested polymerase chain reaction. Results: The rate of human norovirus infection was 6.04%, most common among females 6 (54.55%). Age group (1-12) months showed highest frequency 8 (72.73%). The primary education of the mothers was noted in (54.55 %) followed by (18.18 %) for each secondary and higher education. Children with artificial milk feeding constituted (81.82%) and (18.18%) were mixed feeding, while no positive results recorded among children with breast feeding. The highest infection rate was noticed among patients used filtered and boiled water (54.54 %) followed by filtered water (27.28 %). Among clinical features caused by virus infection, abdominal pain constituted 11(100%), vomiting 10(90.09%), and nausea was noted in 7(63.63%). The results of nested polymerase chain reaction demonstrated that only one case was positive for human norovirus genogroup 2(GGII). Conclusion: Human norovirus genogroup II appear to play a major role in acute gastroenteritis among children.

Özet

Amaçlar: Akut gastroenterit, küresel bir halk sağlığı sorunu olmaya devam etmektedir ve insan norovirüsleri, gastroenterit nedenidir. Diyala vilayetinde gastroenteritli çocuklar arasında insan norovirüs enfeksiyonlarının oranını enzim bağlantılı immünosorbent testi ve immünokromatografi ile belirlemek, ayrıca çalışma popülasyonunda nested polimeraz zincir reaksiyonu ile genogrup 1 (GGI) ve genogrup 2’yi (GGII) değerlendirmek. Gereç ve Yöntem: 6 Eylül 2018 - 4 Eylül tarihleri arasında Bakuba ilinde Al-Batool Kadın Doğum ve Çocuk Eğitim Hastanesi pediatri acil servisine başvuran 5 yaş altı 182 çocuk üzerinde kesitsel çalışma yapılmıştır. Her bir katılımcıdan dışkı örnekleri toplandı ve enzime bağlı immünosorbent testi (ELISA) ve hızlı kalitatif immünokromatografik test için kullanılmak üzere -70 ° C’de dondurulmuş olarak saklandı, son olarak insan norovirüsü için pozitif sonuçlar RNA ekstraksiyonu ve nested polimeraz zincir reaksiyonu (PCR)için kullanıldı. Bulgular: İnsan norovirüs enfeksiyonu oranı %6.04, en yaygın kızlarda 6 (%54.55) bulundu. 1-12 aylık yaş grubu en yüksek frekansı 8 (%72.73) gösterdi. Annelerin eğitim düzeyi ilköğretim %54,55 olarak kaydedildi, ardından orta öğretim %18,18 ve yüksek öğrenim için %18,18 izlendi. Formül mama ile beslenenler çocukların %81,82’sini oluştururken,%18,18’inde karma beslenme belirlenmiş, emzirilen çocuklarda norovirus saptanmamıştır. En yüksek enfeksiyon oranı filtrelenmiş ve kaynatılmış su (%54,54) ve ardından filtrelenmiş su (%27,28) kullanan hastalarda görüldü. Virüs enfeksiyonunun neden olduğu klinik özellikler arasında karın ağrısı 11 (%100), kusma 10 (%90.09) ve bulantı 7 (%63.63) olarak belirlendi. Nested polimeraz zincir reaksiyonunun sonuçları, insan norovirüs genogrup 2 (GGII) için yalnızca bir vakanın pozitif olduğunu gösterdi. Sonuç: İnsan norovirüs genogrup II’nin, çocuklar arasında akut gastroenteritte önemli bir rol oynadığı görülmektedir.

🔖

Cite This Article

Diraa, M., Al-ezzi, J. İ., Hussein, A. (2020). Detection of Human Norovirus among Children with Gastroenteritis in Diyala Governorate. Pediatric Practice and Research, Volume: 8 Issue: 1. https://ajindex.com/articles/1535172

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References (80)

  1. Plants-Paris, K., Bishoff, D., Oyaro, M.O., Mwinyi, B., Chappell, C., Kituyi, A., Nyangao, J., Mbatha, D. and Darkoh, C. (2019). Prevalence of Clostridium difficile infections among kenyan children with diarrhea. Pubmed-NCBI; (19)30035-9
  2. Dennehy, P.H. (2005). Acute diarrheal disease in children: epidemiology, prevention, and treatment. Infect. Dis. Clin. North. Am., 19(3): 585-602
  3. Kabayiza, J.C. (2014). Acute gastroenteritis in Rwandan children under five years of age investigated by real-time PCR, M.Sc. Thesis, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg
  4. Trang, N.V., Tamura, T. and Garcia, C. (2012). Detection and molecular characterization of noroviruses and sapoviruses in children admitted to hospital with acute gastroenteritis in Vietnam, J. Med. Virol., 84: (2) 290-297
  5. Krisztián, B., Mary, K., Vito, M. and Umesh, D. (2018). Viral gastroenteritis, Lancet, 392(10142):175-186
  6. Green, K.Y. (2013). Caliciviridae: the noroviruses. In Knipe, D.M., Howley, P.M., Cohen, J.I., Griffin, D.E., Lamb, R.A., Martin, M.A., Racaniello, V.R. and Roizman, B. (ed), Fields Virology, 6th Ed., Lippincott Williams and Wilkins, Philadelphia, PA; 1: 582-608
  7. Vinjé, J. (2015). Advances in laboratory methods for detection and typing of Human norovirus, J. Clin. Microbiol., 53:373-381
  8. Lias, C., Paul, D., Michael, L., Boyd, Y., Matthew, H., Kari D., Rachel, L., and Ralph,S. (2019). Human norovirus epitope D plasticity allows escape from antibody immunity without loss of capacity for binding cellular Ligands, J. Virol., 15; 93(2): e01813-18
  9. Centers for Disease Control and Prevention. (2011). Updated norovirus outbreak management and disease prevention guidelines. Morbidity and mortality weekend report. 60(3):1-15.
  10. Sattar, B. and Shashank, S. (2018). Bacterial gastroenteritis. Stat Pearls Publishing - Bookshelf - NCBI, available
  11. Bartsch, S.M., Lopman, B.A., Ozawa, S., Hall, A.J. and Lee, B.Y. (2016). Global economic burden of norovirus gastroenteritis, PLoS ONE, 26;11(4): e0151219
  12. Kitajima, M., Oka, T., Haramoto, E., Phanuwan, C., Takeda, N. and Katayama, K. (2012). Genetic diversity of genogroup IV noroviruses in wastewater in Japan. Letters in Applied Microbiology., 2011;52:181–184
  13. Al-Ali, R.M., Chehadeh, W., Hamze, M., Dabboussi, F., Hlais, S. and Mallat, H. (2011). First description of gastroenteritis viruses in Lebanese children: a pilot study, J. Infect. Public. Health., 4(2):59-64
  14. Thwiny, H.T., Hassan, J.H. (2015). Detection of norovirus in stool samples by RT-PCR from under five years age children hospitalized for acute gastroenteritis in Basrah, Iraq, Journal of Thi-Qar Science, 5(2): 47-53
  15. Ben Salem-Ben Nejma, I., Hassine, Z.M., Hassine, F., Sdiri-Loulizi, K., Ben Said, M. and Aouni, M. (2014). Etiology of acute diarrhea in Tunisian children with emphasis on diarrheagenic Escherichia coli: Prevalence and identification of E. Coli virulence markers. Iran, J. Public Health., 43(7):947-960
  16. Tayeb, H.T., Dela-Cruz, D.M., Al-Qahtani, A., Al-Ahdal, M.N. and Carter, M.J. (2008). Enteric viruses in pediatric diarrhea in Saudi Arabia, J. Med. Virol., 80 (11):1919-1929
  17. Al-Moussawi, D.K., Rahman, L.C. and Basim, A.J. (2018). Genotyping and phylogenic of norovirus as main cause of children gastritis in Thi Qar province, University of Thi - Qar Journal of Science, 6(4):35-41
  18. Mohammed, N.S., Mohammed, F.H. and Haider, K.A. (2016). Detection of norovirus and rotavirus in children under five years during winter 2012-2013 in Mosul province, I.A.S.J., 19(3): 101-107
  19. Al-Marsome, H.T., Jabbar, S.H., Hala, S.A., and Abdulrhman M.H.H. (2016). Diagnosis of noroviruses in Iraqi children suffering from gastroenteritis by enzyme linked assay and conventional PCR, I.A.S.J., 34(1): 42-49
  20. Al-Mashhadani, M.N., Nakagomi, O., Dove, W., Ahmed, H., Nakagomi T., Hart C.A. and Cunliffe N.A. (2008). Norovirus gastroenteritis among children in Iraqi Kurdistan, J. Med. Virol., 80 (3): 506-9
  21. Al-Khoweledy, A.J.S. (2015). Investigation of norovirus among diarrheal children in Al-Najaf province. IASJ., 8(3): 1-6
  22. Lorrot, M., Bon, F., El Hajje, M.J., Aho, S., Wolfer, M. and Giraudon, H. (2011). Epidemiology and clinical features of gastroenteritis in hospitalised children: prospective survey during a 2-year period in a Parisian hospital, France, Eur. J. Clin. Microbiol. Infect. Dis., 30 (3):361-368
  23. Huynen, P., Mauroy, A., Martin, C., Savadogo, L.GB., Boreux, R., Thiry, E. and De Mol, P. (2019). Molecular epidemiology of norovirus infections in symptomatic and asymptomatic children from Bobo Dioulasso, Burkina Faso, J. Clin. Virol., 58(3), 515-521
  24. Qi, L.M., Xinzhi, X., Ying, X., Hua, L., Huangcheng, S., Wenwen, D., Wenge, T., Tao, S., and Qin, L. (2017). Outbreak of acute gastroenteritis caused by norovirus genogroup II attributed to contaminated cold dishes on a cruise ship in Chongqing, China. Int. J. Environ. Res. Public Health., 15: 2823
  25. Hussein, A.A., Rawaa, A.H. and Mohammed, J.S. (2018). Enteric Viruses co-infection with giardiasis among diarrheal children in Diyala province – Iraq, J. Pure Appl. Microbiol., 12(2): 793-799
  26. Mahmood, D.B., Raghad, A., Faisal, G.A. and Rafah, A.S. (2015). Detection of Adenovirus antigen and its correlation with clinical signs among children with gastroenteritis, IJS, 56(2): 1633-1638
  27. Webb, A. and Starr, M. (2005). Acute gastroenteritis in children. Australian family physician, 34(4): 227-231
  28. Castilho,J.R., Veridiana, M., Hugo, R.R., Ulysses, F., Jan, V. and Maria, L. (2006). Genetic diversity of norovirus among children with gastroenteritis in São Paulo state, Brazil. JCM (Journal of clinical microbiology)
  29. Al-Yassin, S.T. (1999). A study of cryptosporidiosis in immunocompromised patients, M.Sc. Thesis, College of Medicine, Tikrit University
  30. Debasism, B. and Ahemed, T. (2013). Study of knowledge, attitude and practice among mothers towards acute respiratory infection in urban and rural communitiesof burdwan district, West Bengal, India. Rev Progr., 1(8):1-6
  31. Ujunwa, F. (2014). Ezeonu C. risk factors for acute respiratory tract infections in under-five children in Enugu Southeast Nigeria. Ann Med Health Sci Res., 4(1):95–9
  32. Makita, K., Hayakawa, Y., Okame, M., Homma, K., Phan, T.G., Okitsu, S., and Ushijima, H. (2006). First detection of IgA against norovirus in breast milk, Clin. lab., 53(3-4): 125-128
  33. Al-Ameedi, R.A and Al-Amar, M.H. (2015). Detection of norovirus and adenovirus type 40/41 in diarrhea among children aged 1-60 months, in Al-Najaf province, Iraq, I.J.A.R., 3(11), 1391-1398
  34. Eftim, S.E., Hong, T., Soller, J., Boehm, A., Warren, I., Ichida, A., and Nappier, S.P. (2017). Occurrence of norovirus in raw sewage - A systematic literature review and meta-analysis, Water Res., 111:366-374
  35. Lopman, B., Paul, G., Geun, W., Aron, J., Umesh, D. and Jan, V. (2012). Environmental transmission of human norovirus gastroenteritis, Science Direct, 2(1): 96-102
  36. Wang, Y., Lipengm H., Lifeng, P., Caoyi, X., Qing, L., Xuetao, Z., and Weiping, Z. (2018). Age, primary symptoms, and genotype characteristics of norovirus outbreaks in Shanghai schools in 2017, Sci. Rep., 8: 15238
  37. Timurkan, M., Aydin, H. and Aktaş, O. (2017). Frequency and molecular characterization of human norovirus in Erzurum- Turkey, Turk. J. Med. Sci., 47(3):960-966
  38. Mathew, J.L., Patwari, A.K., Gupta, P., Shah, D., Gera, T. and Gogia, S. (2019). Acute respiratory infection and pneumonia in India: a systematic review of literature for advocacy and action: UNICEF-PHFI series on newborn and child health, India. Indian Pediatr.,48(3):191–218
  39. Nirwati, H., Donato, C.M, Mawarti, Y., Mulyani, N.S., Ikram, A., Aman, A.T., Peppelenbosch, M.P., Soenarto, Y., Pan, Q. and Hakim, M.S. (2019). Norovirus and rotavirus infections in children less than five years of age hospitalized with acute gastroenteritis in Indonesia, Arch. Virol., 164(6):1515-1525
  40. Lauring, A.S., Frydman, J. and Andino, R. (2013). The role of mutation load robustness in RNA virus evolution. Nature Reviews, Microbiology, 11(5), 327-336
  41. Plants-Paris, K., Bishoff, D., Oyaro, M.O., Mwinyi, B., Chappell, C., Kituyi, A., Nyangao, J., Mbatha, D. and Darkoh, C. (2019). Prevalence of Clostridium difficile infections among kenyan children with diarrhea. Pubmed-NCBI; (19)30035-9
  42. Dennehy, P.H. (2005). Acute diarrheal disease in children: epidemiology, prevention, and treatment. Infect. Dis. Clin. North. Am., 19(3): 585-602
  43. Kabayiza, J.C. (2014). Acute gastroenteritis in Rwandan children under five years of age investigated by real-time PCR, M.Sc. Thesis, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg
  44. Trang, N.V., Tamura, T. and Garcia, C. (2012). Detection and molecular characterization of noroviruses and sapoviruses in children admitted to hospital with acute gastroenteritis in Vietnam, J. Med. Virol., 84: (2) 290-297
  45. Krisztián, B., Mary, K., Vito, M. and Umesh, D. (2018). Viral gastroenteritis, Lancet, 392(10142):175-186
  46. Green, K.Y. (2013). Caliciviridae: the noroviruses. In Knipe, D.M., Howley, P.M., Cohen, J.I., Griffin, D.E., Lamb, R.A., Martin, M.A., Racaniello, V.R. and Roizman, B. (ed), Fields Virology, 6th Ed., Lippincott Williams and Wilkins, Philadelphia, PA; 1: 582-608
  47. Vinjé, J. (2015). Advances in laboratory methods for detection and typing of Human norovirus, J. Clin. Microbiol., 53:373-381
  48. Lias, C., Paul, D., Michael, L., Boyd, Y., Matthew, H., Kari D., Rachel, L., and Ralph,S. (2019). Human norovirus epitope D plasticity allows escape from antibody immunity without loss of capacity for binding cellular Ligands, J. Virol., 15; 93(2): e01813-18
  49. Centers for Disease Control and Prevention. (2011). Updated norovirus outbreak management and disease prevention guidelines. Morbidity and mortality weekend report. 60(3):1-15.
  50. Sattar, B. and Shashank, S. (2018). Bacterial gastroenteritis. Stat Pearls Publishing - Bookshelf - NCBI, available
  51. Bartsch, S.M., Lopman, B.A., Ozawa, S., Hall, A.J. and Lee, B.Y. (2016). Global economic burden of norovirus gastroenteritis, PLoS ONE, 26;11(4): e0151219
  52. Kitajima, M., Oka, T., Haramoto, E., Phanuwan, C., Takeda, N. and Katayama, K. (2012). Genetic diversity of genogroup IV noroviruses in wastewater in Japan. Letters in Applied Microbiology., 2011;52:181–184
  53. Al-Ali, R.M., Chehadeh, W., Hamze, M., Dabboussi, F., Hlais, S. and Mallat, H. (2011). First description of gastroenteritis viruses in Lebanese children: a pilot study, J. Infect. Public. Health., 4(2):59-64
  54. Thwiny, H.T., Hassan, J.H. (2015). Detection of norovirus in stool samples by RT-PCR from under five years age children hospitalized for acute gastroenteritis in Basrah, Iraq, Journal of Thi-Qar Science, 5(2): 47-53
  55. Ben Salem-Ben Nejma, I., Hassine, Z.M., Hassine, F., Sdiri-Loulizi, K., Ben Said, M. and Aouni, M. (2014). Etiology of acute diarrhea in Tunisian children with emphasis on diarrheagenic Escherichia coli: Prevalence and identification of E. Coli virulence markers. Iran, J. Public Health., 43(7):947-960
  56. Tayeb, H.T., Dela-Cruz, D.M., Al-Qahtani, A., Al-Ahdal, M.N. and Carter, M.J. (2008). Enteric viruses in pediatric diarrhea in Saudi Arabia, J. Med. Virol., 80 (11):1919-1929
  57. Al-Moussawi, D.K., Rahman, L.C. and Basim, A.J. (2018). Genotyping and phylogenic of norovirus as main cause of children gastritis in Thi Qar province, University of Thi - Qar Journal of Science, 6(4):35-41
  58. Mohammed, N.S., Mohammed, F.H. and Haider, K.A. (2016). Detection of norovirus and rotavirus in children under five years during winter 2012-2013 in Mosul province, I.A.S.J., 19(3): 101-107
  59. Al-Marsome, H.T., Jabbar, S.H., Hala, S.A., and Abdulrhman M.H.H. (2016). Diagnosis of noroviruses in Iraqi children suffering from gastroenteritis by enzyme linked assay and conventional PCR, I.A.S.J., 34(1): 42-49
  60. Al-Mashhadani, M.N., Nakagomi, O., Dove, W., Ahmed, H., Nakagomi T., Hart C.A. and Cunliffe N.A. (2008). Norovirus gastroenteritis among children in Iraqi Kurdistan, J. Med. Virol., 80 (3): 506-9
  61. Al-Khoweledy, A.J.S. (2015). Investigation of norovirus among diarrheal children in Al-Najaf province. IASJ., 8(3): 1-6
  62. Lorrot, M., Bon, F., El Hajje, M.J., Aho, S., Wolfer, M. and Giraudon, H. (2011). Epidemiology and clinical features of gastroenteritis in hospitalised children: prospective survey during a 2-year period in a Parisian hospital, France, Eur. J. Clin. Microbiol. Infect. Dis., 30 (3):361-368
  63. Huynen, P., Mauroy, A., Martin, C., Savadogo, L.GB., Boreux, R., Thiry, E. and De Mol, P. (2019). Molecular epidemiology of norovirus infections in symptomatic and asymptomatic children from Bobo Dioulasso, Burkina Faso, J. Clin. Virol., 58(3), 515-521
  64. Qi, L.M., Xinzhi, X., Ying, X., Hua, L., Huangcheng, S., Wenwen, D., Wenge, T., Tao, S., and Qin, L. (2017). Outbreak of acute gastroenteritis caused by norovirus genogroup II attributed to contaminated cold dishes on a cruise ship in Chongqing, China. Int. J. Environ. Res. Public Health., 15: 2823
  65. Hussein, A.A., Rawaa, A.H. and Mohammed, J.S. (2018). Enteric Viruses co-infection with giardiasis among diarrheal children in Diyala province – Iraq, J. Pure Appl. Microbiol., 12(2): 793-799
  66. Mahmood, D.B., Raghad, A., Faisal, G.A. and Rafah, A.S. (2015). Detection of Adenovirus antigen and its correlation with clinical signs among children with gastroenteritis, IJS, 56(2): 1633-1638
  67. Webb, A. and Starr, M. (2005). Acute gastroenteritis in children. Australian family physician, 34(4): 227-231
  68. Castilho,J.R., Veridiana, M., Hugo, R.R., Ulysses, F., Jan, V. and Maria, L. (2006). Genetic diversity of norovirus among children with gastroenteritis in São Paulo state, Brazil. JCM (Journal of clinical microbiology)
  69. Al-Yassin, S.T. (1999). A study of cryptosporidiosis in immunocompromised patients, M.Sc. Thesis, College of Medicine, Tikrit University
  70. Debasism, B. and Ahemed, T. (2013). Study of knowledge, attitude and practice among mothers towards acute respiratory infection in urban and rural communitiesof burdwan district, West Bengal, India. Rev Progr., 1(8):1-6
  71. Ujunwa, F. (2014). Ezeonu C. risk factors for acute respiratory tract infections in under-five children in Enugu Southeast Nigeria. Ann Med Health Sci Res., 4(1):95–9
  72. Makita, K., Hayakawa, Y., Okame, M., Homma, K., Phan, T.G., Okitsu, S., and Ushijima, H. (2006). First detection of IgA against norovirus in breast milk, Clin. lab., 53(3-4): 125-128
  73. Al-Ameedi, R.A and Al-Amar, M.H. (2015). Detection of norovirus and adenovirus type 40/41 in diarrhea among children aged 1-60 months, in Al-Najaf province, Iraq, I.J.A.R., 3(11), 1391-1398
  74. Eftim, S.E., Hong, T., Soller, J., Boehm, A., Warren, I., Ichida, A., and Nappier, S.P. (2017). Occurrence of norovirus in raw sewage - A systematic literature review and meta-analysis, Water Res., 111:366-374
  75. Lopman, B., Paul, G., Geun, W., Aron, J., Umesh, D. and Jan, V. (2012). Environmental transmission of human norovirus gastroenteritis, Science Direct, 2(1): 96-102
  76. Wang, Y., Lipengm H., Lifeng, P., Caoyi, X., Qing, L., Xuetao, Z., and Weiping, Z. (2018). Age, primary symptoms, and genotype characteristics of norovirus outbreaks in Shanghai schools in 2017, Sci. Rep., 8: 15238
  77. Timurkan, M., Aydin, H. and Aktaş, O. (2017). Frequency and molecular characterization of human norovirus in Erzurum- Turkey, Turk. J. Med. Sci., 47(3):960-966
  78. Mathew, J.L., Patwari, A.K., Gupta, P., Shah, D., Gera, T. and Gogia, S. (2019). Acute respiratory infection and pneumonia in India: a systematic review of literature for advocacy and action: UNICEF-PHFI series on newborn and child health, India. Indian Pediatr.,48(3):191–218
  79. Nirwati, H., Donato, C.M, Mawarti, Y., Mulyani, N.S., Ikram, A., Aman, A.T., Peppelenbosch, M.P., Soenarto, Y., Pan, Q. and Hakim, M.S. (2019). Norovirus and rotavirus infections in children less than five years of age hospitalized with acute gastroenteritis in Indonesia, Arch. Virol., 164(6):1515-1525
  80. Lauring, A.S., Frydman, J. and Andino, R. (2013). The role of mutation load robustness in RNA virus evolution. Nature Reviews, Microbiology, 11(5), 327-336.