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Volume 43, Number 6, December 2010

Epidemiology and Clinical Peculiarities of Norovirus and Rotavirus Infection in Hospitalized Young Children with Acute Diarrhea in Taiwan, 2009

Shu-Yan Yang, Kao-Pin Hwang, Fang-Tzy Wu, Ho-Sheng Wu, Chao Agnes Hsiung, Wan-Chi Chang, Jen-Shiou Lin, Shun-Cheng Yang, Sun-Lin Huang, Yhu-Chering Huang

Received: April 20, 2010    Revised: June 1, 2010    Accepted: June 20, 2010   


Corresponding author:

Division of Pediatric Infectious Disease, China Medical University Hospital, 2 Yuh Der Road, 40447 Taichung, Taiwan. E-mail: 
Shu-Yan Yang and Kao-Pin Hwang contributed equally to this work.


Background and purpose: 

Acute diarrhea is one of the most common morbidities in pediatrics worldwide. We conducted a study to investigate the incidence of norovirus in young children hospitalized with acute diarrhea in Taiwan and its clinical peculiarity compared with rotavirus gastroenteritis.



Between January and December, 2009, patients younger than 5 years and admitted to hospital with acute diarrhea were randomly selected; and their stool samples were collected and tested for presence of rotavirus and norovirus by enzyme immunoassay and reverse transcription-polymerase chain reaction, respectively. The clinical manifestations and laboratory findings of the enrolled patients were analyzed.



A total of 989 cases were enrolled with a mean age of 21.6 ± 13.7 months and a male proportion of 56.0%. Rotavirus and norovirus was detected in 20.2% and 14.6% of all patients, respectively. Genogroup II was the predominant strain of norovirus (80.6%). Children aged 6–36 months accounted for the majority
of patients positive for rotavirus and norovirus (73.0% and 81.3%, respectively). The incidences of norovirus  and rotavirus infection were higher during winter and early spring. Most patients with rotavirus and norovirus diarrhea experienced vomiting (74.9% vs.74.8%, respectively) and fever (94.7% vs. 71.3%, respectively).



Most young diarrheal patients presenting with vomiting were likely to have norovirus or rotavirus infection. Patients with norovirus diarrhea experienced an absence of, or low-grade fever and longer duration of vomiting compared with those positive for rotavirus infection. A family history of current gastroenteritis may suggest the possibility of norovirus infection.


Key words:

acute diarrhea, norovirus, rotavirus, Taiwan, young children