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Brewer-Jensen PD, Reyes Y, Becker-Dreps S, González F, Mallory ML, Gutiérrez L, Zepeda O, Centeno E, Vielot N, Diez-Valcarce M, Vinjé J, Baric R, Lindesmith LC, Bucardo F. Norovirus Infection in Young Nicaraguan Children Induces Durable and Genotype-Specific Antibody Immunity. Viruses 2022; 14:v14092053. [PMID: 36146859 PMCID: PMC9501366 DOI: 10.3390/v14092053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 11/22/2022] Open
Abstract
There are significant challenges to the development of a pediatric norovirus vaccine, mainly due to the antigenic diversity among strains infecting young children. Characterizing human norovirus serotypes and understanding norovirus immunity in naïve children would provide key information for designing rational vaccine platforms. In this study, 26 Nicaraguan children experiencing their first norovirus acute gastroenteritis (AGE) episode during the first 18 months of life were investigated. We used a surrogate neutralization assay that measured antibodies blocking the binding of 13 different norovirus virus-like particles (VLPs) to histo-blood group antigens (HBGAs) in pre- and post-infection sera. To assess for asymptomatic norovirus infections, stools from asymptomatic children were collected monthly, screened for norovirus by RT-qPCR and genotyped by sequencing. Seroconversion of an HBGA-blocking antibody matched the infecting genotype in 25 (96%) of the 26 children. A subset of 13 (50%) and 4 (15%) of the 26 children experienced monotypic GII and GI seroconversion, respectively, strongly suggesting a type-specific response in naïve children, and 9 (35%) showed multitypic seroconversion. The most frequent pairing in multitypic seroconversion (8/12) were GII.4 Sydney and GII.12 noroviruses, both co-circulating at the time. Blocking antibody titers to these two genotypes did not correlate with each other, suggesting multiple exposure rather than cross-reactivity between genotypes. In addition, GII titers remained consistent for at least 19 months post-infection, demonstrating durable immunity. In conclusion, the first natural norovirus gastroenteritis episodes in these young children were dominated by a limited number of genotypes and induced responses of antibodies blocking binding of norovirus VLPs in a genotype-specific manner, suggesting that an effective pediatric norovirus vaccine likely needs to be multivalent and include globally dominant genotypes. The duration of protection from natural infections provides optimism for pediatric norovirus vaccines administered early in life.
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Affiliation(s)
- Paul D. Brewer-Jensen
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Yaoska Reyes
- Department of Microbiology, Faculty of Medical Sciences, National Autonomous University of Nicaragua, León 21000, Nicaragua
- Division of Molecular Medicine and Virology, Department of Clinical and Experimental Medicine, Linköping University, SE-581 83 Linköping, Sweden
| | - Sylvia Becker-Dreps
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Fredman González
- Department of Microbiology, Faculty of Medical Sciences, National Autonomous University of Nicaragua, León 21000, Nicaragua
| | - Michael L. Mallory
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Lester Gutiérrez
- Department of Microbiology, Faculty of Medical Sciences, National Autonomous University of Nicaragua, León 21000, Nicaragua
| | - Omar Zepeda
- Department of Microbiology, Faculty of Medical Sciences, National Autonomous University of Nicaragua, León 21000, Nicaragua
| | - Edwing Centeno
- Department of Microbiology, Faculty of Medical Sciences, National Autonomous University of Nicaragua, León 21000, Nicaragua
| | - Nadja Vielot
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Marta Diez-Valcarce
- Division of Viral Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Jan Vinjé
- Division of Viral Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Ralph Baric
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Lisa C. Lindesmith
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Filemon Bucardo
- Department of Microbiology, Faculty of Medical Sciences, National Autonomous University of Nicaragua, León 21000, Nicaragua
- Correspondence: ; Tel.: +505-89040938
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2
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Liu P, Rahman M, Leon J, Moe C. Less severe clinical symptoms of Norwalk virus 8fIIb inoculum compared to its precursor 8fIIa from human challenge studies. J Med Virol 2021; 93:3557-3563. [PMID: 33017074 DOI: 10.1002/jmv.26578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 09/07/2020] [Accepted: 09/28/2020] [Indexed: 11/10/2022]
Abstract
Noroviruses (NoV) are a leading cause of epidemic gastroenteritis. Human challenge studies have been used to examine the infectivity, pathogenicity, and host immune response to NoV as well as vaccine efficacy. The goal of this study was to conduct a meta-analysis of data from five previously completed human challenge trials and compare the response to the secondary NV inoculum (8fIIb) to its precursor (8fIIa). We investigated a total of 158 subjects: 76 subjects were experimentally challenged with NV inoculum 8fIIa, and 82 subjects were challenged with 8fIIb. We compared demographic characteristics, infection, illness, mean severity score, blood types, and duration of viral shedding between the two groups of subjects. There were no statistically significant differences in overall infection and illness rates between subjects inoculated with 8fIIa and 8fIIb. However, individuals challenged with 8fIIa had significantly higher severity scores (5.05 vs. 3.22, p = .008) compared with those challenged with 8fIIb. We also observed that infection with 8fIIb was associated with significantly longer duration of viral shedding compared with 8fIIa (11.0 days vs. 5.0 days, p = .0005). These results have serious implications for the development of new NoV inocula for human challenge studies to test candidate vaccine efficacy-where illness severity and duration of viral shedding are important outcomes.
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Affiliation(s)
- Pengbo Liu
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mumu Rahman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Juan Leon
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Christine Moe
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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3
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Mateo R, Lindesmith LC, Garg SJ, Gottlieb K, Lin K, Said S, Leon JS, Sims AC, Weber DJ, Baric RS, Tucker SN, Taylor DN. Production and Clinical Evaluation of Norwalk GI.1 Virus Lot 001-09NV in Norovirus Vaccine Development. J Infect Dis 2020; 221:919-926. [PMID: 31628848 PMCID: PMC7050988 DOI: 10.1093/infdis/jiz540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/12/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Human noroviruses (HuNoV) are the leading cause of gastroenteritis. No vaccine is currently available to prevent norovirus illness or infection. Safe, infectious challenge strains are needed to assess vaccine efficacy in the controlled human infection model (CHIM). METHODS A stock of HuNoV strain Norwalk virus ([NV] GI.1) was prepared. Healthy, genetically susceptible adults were inoculated with NV Lot 001-09NV and monitored for infection, gastroenteritis symptoms, and immune responses. RESULTS Lot 001-09NV induced gastroenteritis in 9 (56%) and infection in 11 (69%) of 16 genetically susceptible subjects. All infected subjects developed strong immune responses to GI.1 with a 30-fold (geometric mean titer) increase in blocking titers (BT50) and a 161-fold increase in GI.1-specific immunoglobulin (Ig)G titers when compared with baseline. GI.1-specific cellular responses in peripheral blood were observed 9 days postchallenge with an average of 3253 IgA and 1227 IgG antibody-secreting cells per million peripheral blood mononuclear cells. CONCLUSIONS GI.1 Lot 001-09NV appears to be similar in virulence to previous passages of NV strain 8fIIa. The safety profile, attack rate, and duration of illness make GI.1 Lot 001-09NV a useful challenge strain for future vaccine studies aimed at establishing immune correlates.
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Affiliation(s)
| | - Lisa C Lindesmith
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | - Karen Lin
- Vaxart, Inc., South San Francisco, California, USA
| | - Sara Said
- Vaxart, Inc., South San Francisco, California, USA
| | - Juan S Leon
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Amy C Sims
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ralph S Baric
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
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4
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Berendes D, Kirby A, Clennon JA, Raj S, Yakubu H, Leon J, Robb K, Kartikeyan A, Hemavathy P, Gunasekaran A, Ghale B, Kumar JS, Mohan VR, Kang G, Moe C. The Influence of Household- and Community-Level Sanitation and Fecal Sludge Management on Urban Fecal Contamination in Households and Drains and Enteric Infection in Children. Am J Trop Med Hyg 2017; 96:1404-1414. [PMID: 28719269 PMCID: PMC5462580 DOI: 10.4269/ajtmh.16-0170] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Urban sanitation necessitates management of fecal sludge inside and outside the household. This study examined associations between household sanitation, fecal contamination, and enteric infection in two low-income neighborhoods in Vellore, India. Surveys and spatial analysis assessed the presence and clustering of toilets and fecal sludge management (FSM) practices in 200 households. Fecal contamination was measured in environmental samples from 50 households and household drains. Enteric infection was assessed from stool specimens from children under 5 years of age in these households. The two neighborhoods differed significantly in toilet coverage (78% versus 33%) and spatial clustering. Overall, 49% of toilets discharged directly into open drains (“poor FSM”). Children in households with poor FSM had 3.78 times higher prevalence of enteric infection when compared with children in other households, even those without toilets. In the neighborhood with high coverage of household toilets, children in households with poor FSM had 10 times higher prevalence of enteric infection than other children in the neighborhood and drains in poor FSM clusters who had significantly higher concentrations of genogroup II norovirus. Conversely, children in households with a toilet that contained excreta in a tank onsite had 55% lower prevalence of enteric infection compared with the rest of the study area. Notably, households with a toilet in the neighborhood with low toilet coverage had more fecal contamination on floors where children played compared with those without a toilet. Overall, both toilet coverage levels and FSM were associated with environmental fecal contamination and, subsequently, enteric infection prevalence in this urban setting.
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Affiliation(s)
- David Berendes
- Department of Environmental Engineering, School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia.,Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Atlanta, Georgia
| | - Amy Kirby
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Atlanta, Georgia
| | - Julie A Clennon
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Atlanta, Georgia
| | - Suraja Raj
- Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Atlanta, Georgia
| | - Habib Yakubu
- Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Atlanta, Georgia
| | - Juan Leon
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Atlanta, Georgia
| | - Katharine Robb
- Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Atlanta, Georgia
| | - Arun Kartikeyan
- Wellcome Research Laboratory, Christian Medical College, Vellore, India
| | - Priya Hemavathy
- Wellcome Research Laboratory, Christian Medical College, Vellore, India
| | - Annai Gunasekaran
- Wellcome Research Laboratory, Christian Medical College, Vellore, India
| | - Ben Ghale
- Wellcome Research Laboratory, Christian Medical College, Vellore, India
| | - J Senthil Kumar
- Department of Community Health, Christian Medical College, Vellore, India
| | | | - Gagandeep Kang
- Wellcome Research Laboratory, Christian Medical College, Vellore, India
| | - Christine Moe
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Atlanta, Georgia
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5
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Khanyaghma M, Milanizadeh S, Mostafavi PG, Mohebbi SR, Valinassab T, Azimzadeh P, Romani S, Zali MR. Distribution of Norovirus in Fecal-Contaminated Oyster ( Saccostrea cucullataand Solen roseomaculatus) Tissues in Vitro. JOURNAL OF AQUATIC FOOD PRODUCT TECHNOLOGY 2016. [DOI: 10.1080/10498850.2013.860510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mahsa Khanyaghma
- Department of Marine Biology, Graduate School of Marine Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Saman Milanizadeh
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pargol Ghavam Mostafavi
- Department of Marine Biology, Graduate School of Marine Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Seyed Reza Mohebbi
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tooraj Valinassab
- Department of Resource Management, Iranian Fisheries Research Organization, Tehran, Iran
| | - Pedram Azimzadeh
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Romani
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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6
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Kirby AE, Streby A, Moe CL. Vomiting as a Symptom and Transmission Risk in Norovirus Illness: Evidence from Human Challenge Studies. PLoS One 2016; 11:e0143759. [PMID: 27116105 PMCID: PMC4845978 DOI: 10.1371/journal.pone.0143759] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/09/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In the US, noroviruses are estimated to cause 21 million cases annually with economic losses reaching $2 billion. Outbreak investigations frequently implicate vomiting as a major transmission risk. However, little is known about the characteristics of vomiting as a symptom or the amount of virus present in emesis. METHODOLOGY AND PRINCIPAL FINDINGS Emesis samples and symptomology data were obtained from previous norovirus human challenge studies with GI.1 Norwalk virus, GII.2 Snow Mountain virus, and a pilot study with GII.1 Hawaii virus. Viral titers in emesis were determined using strain-specific quantitative RT-PCR. In all four studies, vomiting was common with 40-100% of infected subjects vomiting at least once. However, only 45% of subjects with vomiting also had diarrhea. Most of the emesis samples had detectable virus and the mean viral titers were 8.0 x 105 and 3.9 x 104 genomic equivalent copies (GEC)/ml for GI and GII viruses, respectively (p = 0.02). Sample pH was correlated with GII.2 Snow Mountain virus detection. CONCLUSIONS AND SIGNIFICANCE Half of all subjects with symptomatic infection experienced vomiting and the average subject shed 1.7 x 108 GEC in emesis. Unlike shedding through stool, vomiting is more likely to result in significant environmental contamination, leading to transmission through fomites and airborne droplets. This quantitative data will be critical for risk assessment studies to further understand norovirus transmission and develop effective control measures. The correlation between sample pH and virus detection is consistent with a single site of virus replication in the small intestine and stomach contents becoming contaminated by intestinal reflux. Additionally, the frequency of vomiting without concurrent diarrhea suggests that epidemiology studies that enroll subjects based on the presence of diarrhea may be significantly underestimating the true burden of norovirus disease.
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Affiliation(s)
- Amy E. Kirby
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Ashleigh Streby
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Christine L. Moe
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
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7
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Newman KL, Moe CL, Kirby AE, Flanders WD, Parkos CA, Leon JS. Norovirus in symptomatic and asymptomatic individuals: cytokines and viral shedding. Clin Exp Immunol 2016; 184:347-57. [PMID: 26822517 DOI: 10.1111/cei.12772] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/30/2015] [Accepted: 01/21/2016] [Indexed: 11/29/2022] Open
Abstract
Noroviruses (NoV) are the most common cause of epidemic gastroenteritis world-wide. NoV infections are often asymptomatic, although individuals still shed large amounts of NoV in their stool. Understanding the differences between asymptomatic and symptomatic individuals would help in elucidating mechanisms of NoV pathogenesis. Our goal was to compare the serum cytokine responses and faecal viral RNA titres of asymptomatic and symptomatic NoV-infected individuals. We tested serum samples from infected subjects (n = 26; 19 symptomatic, seven asymptomatic) from two human challenge studies of GI.1 NoV for 16 cytokines. Samples from prechallenge and days 1-4 post-challenge were tested for these cytokines. Cytokine levels were compared to stool NoV RNA titres quantified previously by reverse transcription-polymerase chain reaction (RT-qPCR). While both symptomatic and asymptomatic groups had similar patterns of cytokine responses, the symptomatic group generally exhibited a greater elevation of T helper type 1 (Th1) and Th2 cytokines and IL-8 post-challenge compared to the asymptomatic group (all P < 0·01). Daily viral RNA titre was associated positively with daily IL-6 concentration and negatively with daily IL-12p40 concentration (all P < 0·05). Symptoms were not associated significantly with daily viral RNA titre, duration of viral shedding or cumulative shedding. Symptomatic individuals, compared to asymptomatic, have greater immune system activation, as measured by serum cytokines, but they do not have greater viral burden, as measured by titre and shedding, suggesting that symptoms may be immune-mediated in NoV infection.
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Affiliation(s)
- K L Newman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Medical Scientist Training Program, Emory University School of Medicine, Atlanta, GA, USA
| | - C L Moe
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - A E Kirby
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - W D Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - C A Parkos
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - J S Leon
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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8
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Antwi-Agyei P, Cairncross S, Peasey A, Price V, Bruce J, Baker K, Moe C, Ampofo J, Armah G, Ensink J. A Farm to Fork Risk Assessment for the Use of Wastewater in Agriculture in Accra, Ghana. PLoS One 2015; 10:e0142346. [PMID: 26556044 PMCID: PMC4640866 DOI: 10.1371/journal.pone.0142346] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/20/2015] [Indexed: 12/03/2022] Open
Abstract
The need to minimise consumer risk, especially for food that can be consumed uncooked, is a continuing public health concern, particularly in places where safe sanitation and hygienic practices are absent. The use of wastewater in agriculture has been associated with disease risks, though its relative significance in disease transmission remains unclear. This study aimed at identifying key risk factors for produce contamination at different entry points of the food chain. Over 500 produce and ready-to-eat salad samples were collected from fields, markets, and kitchens during the dry and wet seasons in Accra, Ghana, and over 300 soil and irrigation water samples were collected. All samples were analysed for E. coli, human adenovirus and norovirus using standard microbiological procedures, and real time RT-PCR. Finally, critical exposures associated with microbial quality of produce were assessed through observations and interviews. The study found that over 80% of produce samples were contaminated with E. coli, with median concentrations ranging from 0.64 to 3.84 Log E. coli/g produce. Prepared salad from street food vendors was found to be the most contaminated (4.23 Log E. coli/g), and that consumption of salad exceeded acceptable health limits. Key risk factors identified for produce contamination were irrigation water and soil at the farm level. Storage duration and temperature of produce had a significant influence on the quality of produce sold at markets, while observations revealed that the washed water used to rinse produce before sale was dirty. The source of produce and operating with a hygiene permit were found to influence salad microbial quality at kitchens. This study argues for a need to manage produce risk factors at all domains along the food chain, though it would be more effective to prioritise at markets and kitchens due to cost, ease of implementation and public health significance.
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Affiliation(s)
- Prince Antwi-Agyei
- Environmental Health Group, Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel street, WC1E 7HT, London, United Kingdom
- * E-mail:
| | - Sandy Cairncross
- Environmental Health Group, Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel street, WC1E 7HT, London, United Kingdom
| | - Anne Peasey
- Department of Epidemiology and Public Health, University College of London, 1-19 Torrington Place, London, United Kingdom
| | - Vivien Price
- London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
| | - Jane Bruce
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel street, London, United Kingdom
| | - Kelly Baker
- Center for Global Safe Water, Emory University, Atlanta, Georgia, United States of America
| | - Christine Moe
- Center for Global Safe Water, Emory University, Atlanta, Georgia, United States of America
| | - Joseph Ampofo
- Water Research Institute (WRI), Council for Scientific and Industrial Research (CSIR), Accra, Ghana
| | - George Armah
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana – Legon, Accra, Ghana
| | - Jeroen Ensink
- Environmental Health Group, Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel street, WC1E 7HT, London, United Kingdom
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9
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Immunomagnetic separation combined with RT-qPCR for determining the efficacy of disinfectants against human noroviruses. J Infect Public Health 2015; 8:145-54. [DOI: 10.1016/j.jiph.2014.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/09/2014] [Accepted: 08/22/2014] [Indexed: 01/28/2023] Open
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10
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Liu P, Wang X, Lee JC, Teunis P, Hu S, Paradise HT, Moe C. Genetic susceptibility to norovirus GII.3 and GII.4 infections in Chinese pediatric diarrheal disease. Pediatr Infect Dis J 2014; 33:e305-9. [PMID: 25037042 PMCID: PMC4392756 DOI: 10.1097/inf.0000000000000443] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Noroviruses (NoVs) are a leading cause of viral diarrhea in young children. Secretor status has been confirmed to be linked with Norwalk virus (NoV GI.1) infection but there is limited information about whether secretor genotypes are associated with pediatric NoV epidemic strains in vivo. METHODS In this study, fecal specimens and serum samples were collected from 124 hospitalized children with acute diarrhea in Xi'an, China. TaqMan real-time reverse transcription polymerase chain reaction was used to detect NoVs in fecal samples, and NoV-positive samples were further verified using conventional reverse transcription polymerase chain reaction and sequenced. DNA was extracted from sera and TaqMan single-nucleotide polymorphism genotyping assay was applied to determine the FUT2 A385T polymorphism. RESULTS Only NoV GII.3 and GII.4 genotypes were found in NoV-positive samples, and NoVs were detected in 25% (15/60), 40.5% (17/42) and 9.1% (2/22) of children with homozygous secretor genotype (Se 385 Se 385), heterozygous secretor genotype (Se 385 se 385) and homozygous weak secretor genotype (se 385 se 385), respectively. Children with secretor genotypes Se 385 Se 385 and Se 385 se 385 were significantly (P < 0.05) more susceptible to combined NoV GII.3 and GII.4 infections than children with weak secretor genotype se 385 se 385. CONCLUSIONS These findings indicate that secretor positivity is significantly associated with GII.3 and GII.4 infections in Chinese pediatric diarrheal disease and the weak secretor phenotype does not completely protect children from GII.3 and GII.4 infections.
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Affiliation(s)
- Pengbo Liu
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Xiaoqin Wang
- School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Joong-Chul Lee
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Peter Teunis
- National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Senke Hu
- School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | | | - Christine Moe
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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11
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Kirby A, Shi J, Montes J, Lichtenstein M, Moe C. Disease course and viral shedding in experimental Norwalk virus and Snow Mountain virus infection. J Med Virol 2014; 86:2055-64. [DOI: 10.1002/jmv.23905] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 01/24/2014] [Indexed: 12/16/2022]
Affiliation(s)
- A.E. Kirby
- Hubert Department of Global Health; Rollins School of Public Health; Emory University; Atlanta Georgia
| | - J. Shi
- Hubert Department of Global Health; Rollins School of Public Health; Emory University; Atlanta Georgia
| | - J. Montes
- Hubert Department of Global Health; Rollins School of Public Health; Emory University; Atlanta Georgia
| | - M. Lichtenstein
- Hubert Department of Global Health; Rollins School of Public Health; Emory University; Atlanta Georgia
| | - C.L. Moe
- Hubert Department of Global Health; Rollins School of Public Health; Emory University; Atlanta Georgia
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12
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Laboratory evidence of norwalk virus contamination on the hands of infected individuals. Appl Environ Microbiol 2013; 79:7875-81. [PMID: 24123733 DOI: 10.1128/aem.02576-13] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Human norovirus (NoV) outbreak investigations suggest that the hands of infected individuals play an important role in NoV transmission. However, there is no experimental evidence documenting the likelihood and degree of NoV contamination on hands. As part of a clinical trial designed to evaluate the efficacy of high-pressure processing for Norwalk virus (NV) inactivation in oysters, 159 hand rinse samples were collected from 6 infected and 6 uninfected subjects. NV was concentrated from the samples by polyethylene glycol precipitation, followed by RNA extraction using an automated guanidinium isothiocyanate-silica method. NV RNA was detected and quantified using multiple NV-specific reverse transcription-quantitative PCR (RT-qPCR) assays. A total of 25.4% (18/71) of the hand rinse samples collected from 6 infected volunteers were presumptively positive for NV, with an average of 3.86 log10 genomic equivalent copies (GEC) per hand. Dot blot hybridization of PCR products obtained using a different primer set, and DNA sequencing of selected amplicons, provided further confirmation of the presence of NV in the hand rinses. NV contamination was also detected in two hand rinse samples obtained from one uninfected subject. These findings provide definitive evidence of NV contamination on the hands of infected subjects observed under controlled clinical research conditions. Such data support the need for better hand hygiene strategies to prevent NoV transmission.
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Papafragkou E, Hewitt J, Park GW, Greening G, Vinjé J. Challenges of culturing human norovirus in three-dimensional organoid intestinal cell culture models. PLoS One 2013; 8:e63485. [PMID: 23755105 PMCID: PMC3670855 DOI: 10.1371/journal.pone.0063485] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 04/03/2013] [Indexed: 12/22/2022] Open
Abstract
Human noroviruses are the most common cause of acute gastroenteritis worldwide. Recently, cell culture systems have been described using either human embryonic intestinal epithelial cells (Int-407) or human epithelial colorectal adenocarcinoma cells (Caco-2) growing on collagen-I porous micro carrier beads in a rotating bioreactor under conditions of physiological fluid shear. Here, we describe the efforts from two independent laboratories to implement this three dimensional (3D) cell culture system for the replication of norovirus. Int-407 and Caco-2 were grown in a rotating bioreactor for up to 28 days. Prior to infection, cells were screened for the presence of microvilli by electron microscopy and stained for junction proteins (zonula occludens-1, claudin-1, and β-catenin). Differentiated 3D cells were transferred to 24-well plates and infected with bacteria-free filtrates of various norovirus genotypes (GI.1, GI.3, GI.8, GII.2, GII.4, GII.7, and GII.8). At 12 h, 24 h, and 48 h post inoculation, viral RNA from both cells and supernatants were collected and analyzed for norovirus RNA by real-time reverse transcription PCR. Despite observations of high expression of junction proteins and microvilli development in stained thin sections, our data suggest no significant increase in viral titer based on norovirus RNA copy number during the first 48 h after inoculation for the different samples and virus culture conditions tested. Our combined efforts demonstrate that 3D cell culture models using Int-407 or Caco-2 cells do not support norovirus replication and highlight the complexity and difficulty of developing a reproducible in vitro cell culture system for human norovirus.
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Affiliation(s)
- Efstathia Papafragkou
- Division of Viral Diseases, Center for Disease Control and Prevention, Atlanta, Georgia United States of America
- Center for Food Safety and Applied Nutrition, Division of Molecular Biology, Food and Drug Administration, Laurel, Maryland, United States of America
| | - Joanne Hewitt
- Institute of Environmental Science and Research Ltd, Kenepuru Science Centre, Porirua, New Zealand
| | - Geun Woo Park
- Division of Viral Diseases, Center for Disease Control and Prevention, Atlanta, Georgia United States of America
| | - Gail Greening
- Institute of Environmental Science and Research Ltd, Kenepuru Science Centre, Porirua, New Zealand
| | - Jan Vinjé
- Division of Viral Diseases, Center for Disease Control and Prevention, Atlanta, Georgia United States of America
- * E-mail:
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Liu P, Jaykus LA, Wong E, Moe C. Persistence of Norwalk virus, male-specific coliphage, and Escherichia coli on stainless steel coupons and in phosphate-buffered saline. J Food Prot 2012; 75:2151-7. [PMID: 23212011 DOI: 10.4315/0362-028x.jfp-12-197] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Human noroviruses (NoVs) are a leading cause of acute gastroenteritis and are frequently transmitted by contaminated food, water, hands, and environmental surfaces. Little is known about their environmental stability and/or which alternative microorganisms can serve as effective surrogates. To examine whether Escherichia coli and male-specific coliphage MS2 can be appropriate surrogates for NoVs, approximately 6.8 log genomic equivalent copies of Norwalk virus (NV), and 6.0 to 6.5 log PFU or CFU of MS2 and E. coli, respectively, were inoculated onto stainless steel coupons and held at 4°C, room temperature (RT), or 37°C over a period of 75 min (E. coli and MS2) to 4 weeks. These three microorganisms were also seeded into phosphate-buffered saline (PBS) and sampled at different time intervals for up to 6 weeks. MS2 and E. coli survived approximately 15 min at 37°C, 45 min at RT, and 60 min at 4°C on the stainless steel surfaces. In contrast, NV RNA titers were reduced by only 2.4 log at 37°C, 1.5 log at RT, and 0.9 log at 4°C after 4 weeks. MS2 and E. coli were able to survive at least 5 weeks in PBS at 4°C and RT, and NV was stable in PBS at 4°C and RT for at least 6 weeks. However, E. coli, MS2, and NV were completely inactivated after 1-, 4-, and 5-week incubations in PBS at 37°C, respectively. These findings indicate that NoVs are highly persistent on environmental surfaces and in PBS solution at different temperatures. While E. coli does not appear to be an appropriate surrogate for NoVs, MS2 could be more relevant for modeling the environmental persistence of NoVs under wet conditions, but not under dry conditions.
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Affiliation(s)
- Pengbo Liu
- Center for Global Safe Water, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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Liu P, Hill VR, Hahn D, Johnson TB, Pan Y, Jothikumar N, Moe CL. Hollow-fiber ultrafiltration for simultaneous recovery of viruses, bacteria and parasites from reclaimed water. J Microbiol Methods 2012; 88:155-61. [DOI: 10.1016/j.mimet.2011.11.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 11/02/2011] [Accepted: 11/02/2011] [Indexed: 10/15/2022]
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Trang NV, Luan LT, Kim-Anh LT, Hau VT, Nhung LT, Phasuk P, Setrabutr O, Shirley H, Vinjé J, Anh DD, Mason CJ. Detection and molecular characterization of noroviruses and sapoviruses in children admitted to hospital with acute gastroenteritis in Vietnam. J Med Virol 2011; 84:290-7. [DOI: 10.1002/jmv.23185] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Pérez-Sautu U, Sano D, Guix S, Kasimir G, Pintó RM, Bosch A. Human norovirus occurrence and diversity in the Llobregat river catchment, Spain. Environ Microbiol 2011; 14:494-502. [DOI: 10.1111/j.1462-2920.2011.02642.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
To examine the long-term infectivity of human norovirus in water, 13 study subjects were challenged at different time points with groundwater spiked with the prototype human norovirus, Norwalk virus. Norwalk virus spiked in groundwater remained infectious after storage at room temperature in the dark for 61 days (the last time point tested). The Norwalk virus-seeded groundwater was stored for 1,266 days and analyzed, after RNase treatment, by reverse transcription-quantitative PCR (RT-qPCR) to detect Norwalk virus RNA contained within intact capsids. Norwalk virus RNA within intact capsids was detected in groundwater for 1,266 days, with no significant log(10) reduction throughout 427 days and a significant 1.10-log(10) reduction by day 1266. Purified Norwalk virus RNA (extracted from Norwalk virus virions) persisted for 14 days in groundwater, tap water, and reagent-grade water. This study demonstrates that Norwalk virus in groundwater can remain detectable for over 3 years and can remain infectious for at least 61 days. (ClinicalTrials.gov identifier NCT00313404.).
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Randomized, double-blinded clinical trial for human norovirus inactivation in oysters by high hydrostatic pressure processing. Appl Environ Microbiol 2011; 77:5476-82. [PMID: 21705552 DOI: 10.1128/aem.02801-10] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Contamination of oysters with human noroviruses (HuNoV) constitutes a human health risk and may lead to severe economic losses in the shellfish industry. There is a need to identify a technology that can inactivate HuNoV in oysters. In this study, we conducted a randomized, double-blinded clinical trial to assess the effect of high hydrostatic pressure processing (HPP) on Norwalk virus (HuNoV genogroup I.1) inactivation in virus-seeded oysters ingested by subjects. Forty-four healthy, positive-secretor adults were divided into three study phases. Subjects in each phase were randomized into control and intervention groups. Subjects received Norwalk virus (8FIIb, 1.0 × 10(4) genomic equivalent copies) in artificially seeded oysters with or without HPP treatment (400 MPa at 25°C, 600 MPa at 6°C, or 400 MPa at 6°C for 5 min). HPP at 600 MPa, but not 400 MPa (at 6° or 25°C), completely inactivated HuNoV in seeded oysters and resulted in no HuNoV infection among these subjects, as determined by reverse transcription-PCR detection of HuNoV RNA in subjects' stool or vomitus samples. Interestingly, a white blood cell (granulocyte) shift was identified in 92% of the infected subjects and was significantly associated with infection (P = 0.0014). In summary, these data suggest that HPP is effective at inactivating HuNoV in contaminated whole oysters and suggest a potential intervention to inactivate infectious HuNoV in oysters for the commercial shellfish industry.
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Zhang S, Chen TH, Wang J, Dong C, Pan J, Moe C, Chen W, Yang L, Wang X, Tang H, Li X, Liu P. Symptomatic and asymptomatic infections of rotavirus, norovirus, and adenovirus among hospitalized children in Xi'an, China. J Med Virol 2011; 83:1476-84. [DOI: 10.1002/jmv.22108] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2011] [Indexed: 12/13/2022]
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