Minimally Invasive Saliva Testing to Monitor Norovirus Infection in Community Settings

J Infect Dis. 2019 Apr 8;219(8):1234-1242. doi: 10.1093/infdis/jiy638.


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.

Keywords: MAL-ED; multiplex immunoassay; noninvasive diagnostics; norovirus; saliva.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibodies, Viral / immunology
  • Caliciviridae Infections / diagnosis*
  • Caliciviridae Infections / epidemiology
  • Caliciviridae Infections / virology
  • Case-Control Studies
  • Child, Preschool
  • Feces / virology
  • Humans
  • Immunoglobulin G / immunology
  • Norovirus / genetics
  • Norovirus / immunology
  • Peru / epidemiology
  • ROC Curve
  • Reverse Transcriptase Polymerase Chain Reaction
  • Saliva / immunology
  • Saliva / virology*
  • Sensitivity and Specificity


  • Antibodies, Viral
  • Immunoglobulin G