Minimally Invasive Saliva Testing to Monitor Norovirus Infection in Community Settings

Nora Pisanic, Sarah Blythe Ballard, Fabiola D. Colquechagua, Ruthly François, Natalie Exum, Pablo Peñataro Yori, Kellogg Schwab, Douglas A. Granger, Barbara Detrick, Maribel Paredes Olortegui, Holger Mayta, Gerardo J. Sánchez, Robert H Gilman, Christopher David Heaney, Jan Vinjé, Margaret Kosek

Research output: Contribution to journalArticle


BACKGROUND: Norovirus is a leading cause of acute gastroenteritis worldwide. Routine norovirus diagnosis requires stool collection. The goal of this study was to develop and validate a noninvasive method to diagnose norovirus to complement stool diagnostics and to facilitate studies on transmission. METHODS: A multiplex immunoassay to measure salivary immunoglobulin G (IgG) responses to 5 common norovirus genotypes (GI.1, GII.2, GII.4, GII.6, and GII.17) was developed. The assay was validated using acute and convalescent saliva samples collected from Peruvian children <5 years of age with polymerase chain reaction (PCR)-diagnosed norovirus infections (n = 175) and controls (n = 32). The assay sensitivity and specificity were calculated to determine infection status based on fold rise of salivary norovirus genotype-specific IgG using norovirus genotype from stool as reference. RESULTS: The salivary assay detected recent norovirus infections and correctly assigned the infecting genotype. Sensitivity was 71% and specificity was 96% across the evaluated genotypes compared to PCR-diagnosed norovirus infection. CONCLUSIONS: This saliva-based assay will be a useful tool to monitor norovirus transmission in high-risk settings such as daycare centers or hospitals. Cross-reactivity is limited between the tested genotypes, which represent the most commonly circulating genotypes.

Original languageEnglish (US)
Pages (from-to)1234-1242
Number of pages9
JournalThe Journal of infectious diseases
Issue number8
StatePublished - Apr 8 2019


  • MAL-ED
  • multiplex immunoassay
  • noninvasive diagnostics
  • norovirus
  • saliva

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases

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    Pisanic, N., Ballard, S. B., Colquechagua, F. D., François, R., Exum, N., Yori, P. P., Schwab, K., Granger, D. A., Detrick, B., Olortegui, M. P., Mayta, H., Sánchez, G. J., Gilman, R. H., Heaney, C. D., Vinjé, J., & Kosek, M. (2019). Minimally Invasive Saliva Testing to Monitor Norovirus Infection in Community Settings. The Journal of infectious diseases, 219(8), 1234-1242.