1
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Mariita RM, Wilson Miller AC, Randive RV. Evaluation of the virucidal efficacy of Klaran UVC LEDs against surface-dried norovirus. Access Microbiol 2022; 4:000323. [PMID: 35252757 PMCID: PMC8895607 DOI: 10.1099/acmi.0.000323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/16/2021] [Indexed: 11/21/2022] Open
Abstract
Human norovirus (HuNoV) is a highly contagious pathogenic virus that is transmitted through contaminated food, water, high-touch surfaces and aerosols. Globally, there are an estimated 685 million infections annually due to norovirus, including 200 million affecting children under the age of 5. HuNoV causes approximately 50, 000 child deaths per year and costs an estimated USD $60 billion annually in healthcare. This study sought to determine the inactivation profile of ultraviolet subtype C (UVC) against norovirus using a UVC light-emitting diode (LED) array, KL265-50V-SM-WD. The array emitted radiation at 269 nm peak wavelength and a measured fluence of 1.25 mW cm−2 at a 7 cm source–surface distance. Since the HuNoV is not cultivable, the study utilized feline calicivirus (FCV) ATCC VR-782, a recommended surrogate as challenge organism. The test followed modified ASTM E2197. Assessment of virus inactivation was performed using a plaque assay method. With irradiance at a UVC dose of 22.5 mJ cm−2, the study obtained 99.9 % virus reduction (3 log reduction). The results demonstrate that the UVC LED array can provide effective inactivation of HuNoV.
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Affiliation(s)
- Richard M. Mariita
- Crystal IS, Inc., an Asahi Kasei company, 70 Cohoes Avenue, Green Island, New York, 12183, USA
- *Correspondence: Richard M. Mariita,
| | - Amy C. Wilson Miller
- Crystal IS, Inc., an Asahi Kasei company, 70 Cohoes Avenue, Green Island, New York, 12183, USA
| | - Rajul V. Randive
- Crystal IS, Inc., an Asahi Kasei company, 70 Cohoes Avenue, Green Island, New York, 12183, USA
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2
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Liu GD, Wang N, Wang HM, Li X, Shao JJ, Liu ZF, Jiang M, Wang L, Wang ZK, Li M, Cao XY, Wang J, Zhang R, Chen YD. Military medical research on internal diseases in modern warfare: new concepts, demands, challenges, and opportunities. Mil Med Res 2021; 8:20. [PMID: 33712087 PMCID: PMC7953602 DOI: 10.1186/s40779-021-00313-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 03/05/2021] [Indexed: 12/25/2022] Open
Abstract
Battlefield internal medicine aims at the treatment of combatants and noncombatants with various internal diseases on the battlefield. The military medical research on battlefield internal diseases focuses on the pathogenesis, clinical management, and prevention of internal diseases under military war conditions. In both wartime and peacetime, the soldiers suffer from more internal diseases than surgical wounds. With the introduction of high-tech weapons, including chemical, physical, and biological agents, a large number of special internal illnesses and casualties will appear in future wars. The battles often occur in special environments, such as high or low temperatures, plateau or polar areas, and micro- or hyper-gravity. The current theories of battlefield internal medicine are mainly derived from wars decades ago and cannot meet the needs of military medical support under the conditions of modern warfare. Therefore, the military medical research on battlefield internal medicine should be based on contemporary military situations, focus on the purpose of treating battlefield internal diseases, and adhere to the actual needs of the troops in peacetime and wartime. We should investigate the pathogenesis of battlefield internal diseases and explore the threats that may arise in future wars to ensure the advancement of battlefield internal medicine. This review highlights new concepts, demands, challenges, and opportunities for the further development of military medical research on battlefield internal medicine.
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Affiliation(s)
- Guang-Dong Liu
- Division of Health Services, Chinese PLA General Hospital & Chinese PLA Medical School, Beijing, 100853, China
| | - Nan Wang
- Division of Health Services, Chinese PLA General Hospital & Chinese PLA Medical School, Beijing, 100853, China
| | - Hai-Ming Wang
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Xin Li
- Department of Health Services, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Jun-Jie Shao
- The First Clinical Medical College of Inner Mongolia Medical University, Hohhot, 010059, China
| | - Zi-Fan Liu
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Min Jiang
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Lin Wang
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Zi-Kai Wang
- Department of Gastroenterology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Meng Li
- Department of Hematology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Xue-Ying Cao
- Department of Nephrology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Jiang Wang
- Department of Respiratory and Intensive Medicine, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ran Zhang
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China.
| | - Yun-Dai Chen
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China.
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3
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Okumus B. Norovirus and Coronavirus Risks in Food Service Settings: A Systematic Review for Future Research. JOURNAL OF CULINARY SCIENCE & TECHNOLOGY 2021. [DOI: 10.1080/15428052.2021.1888835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Bendegul Okumus
- Food Service and Lodging Management Department, Rosen College of Hospitality Management, University of Central Florida, Orlando, FL USA
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4
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Ashbaugh HR, Early JM, Johnson ME, Simons MP, Graf PCF, Riddle MS, Swierczewski BE, For The Gtd Study Team. A Multisite Network Assessment of the Epidemiology and Etiology of Acquired Diarrhea among U.S. Military and Western Travelers (Global Travelers' Diarrhea Study): A Principal Role of Norovirus among Travelers with Gastrointestinal Illness. Am J Trop Med Hyg 2020; 103:1855-1863. [PMID: 32959765 PMCID: PMC7646805 DOI: 10.4269/ajtmh.20-0053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
U.S. military personnel must be ready to deploy to locations worldwide, including environments with heightened risk of infectious disease. Diarrheal illnesses continue to be among the most significant infectious disease threats to operational capability. To better prevent, detect, and respond to these threats and improve synchronization across the Department of Defense (DoD) overseas laboratory network, a multisite Global Travelers’ Diarrhea protocol was implemented with standardized case definitions and harmonized laboratory methods to identify enteric pathogens. Harmonized laboratory procedures for detection of Norovirus (NoV), enterotoxigenic Escherichia coli (ETEC), enteroaggregative E. coli, Shiga toxin–producing E. coli, enteropathogenic E. coli, Salmonella enterica, Shigella/enteroinvasive E. coli, and Campylobacter jejuni have been implemented at six DoD laboratories with surveillance sites in Egypt, Honduras, Peru, Nepal, Thailand, and Kenya. Samples from individuals traveling from wealthy to poorer countries were collected between June 2012 and May 2018, and of samples with all variables of interest available (n = 410), most participants enrolled were students (46%), tourists (26%), U.S. military personnel (13%), or other unspecified travelers (11%). One or more pathogens were detected in 59% of samples tested. Of samples tested, the most commonly detected pathogens were NoV (24%), ETEC (16%), and C. jejuni (14%), suggesting that NoV plays a larger role in travelers’ diarrhea than has previously been described. Harmonized data collection and methods will ensure identification and characterization of enteric pathogens are consistent across the DoD laboratory network, ultimately resulting in more comparable data for global assessments, preventive measures, and treatment recommendations.
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Affiliation(s)
- Hayley R Ashbaugh
- Public Health Directorate, Armed Forces Health Surveillance Division, Global Emerging Infections Surveillance, Silver Spring, Maryland
| | - June M Early
- General Dynamics Information Technology, Silver Spring, Maryland.,Public Health Directorate, Armed Forces Health Surveillance Division, Global Emerging Infections Surveillance, Silver Spring, Maryland
| | - Myles E Johnson
- General Dynamics Information Technology, Silver Spring, Maryland.,Public Health Directorate, Armed Forces Health Surveillance Division, Global Emerging Infections Surveillance, Silver Spring, Maryland
| | - Mark P Simons
- Naval Medical Research Center, Silver Spring, Maryland
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5
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Zemke JN, Sanchez JL, Pang J, Gray GC. The Double-Edged Sword of Military Response to Societal Disruptions: A Systematic Review of the Evidence for Military Personnel as Pathogen Transmitters. J Infect Dis 2020; 220:1873-1884. [PMID: 31519020 DOI: 10.1093/infdis/jiz400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/02/2019] [Indexed: 11/12/2022] Open
Abstract
Given their lack of immunity and increased exposure, military personnel have the potential to serve as carriers or reservoirs for infectious diseases into or out of the deployment areas, but, to our knowledge, the historical evidence for such transmission events has not previously been reviewed. Using PubMed, we performed a systematic review of published literature between 1955 and 2018, which documented evidence for military personnel transporting infectious pathogens into or out of deployment areas. Of the 439 articles screened, 67 were included for final qualitative and quantitative review. The data extracted from these articles described numerous instances in which thousands of military service members demonstrated potential or actual transmission and transportation of multiple diverse pathogens. These data underscore the immense importance preventive medical professionals play in mitigating such risk, how their public health efforts must be supported, and the importance of surveillance in protecting both military and civilian populations.
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Affiliation(s)
- Juliana N Zemke
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Jose L Sanchez
- Department of Defense, Defense Health Agency, Public Health Division, Armed Forces Health Surveillance Branch, Silver Spring, Maryland
| | - Junxiong Pang
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Centre for Infectious Disease Epidemiology & Research, Saw Swee Hock School of Public Health, National University of Singapore
| | - Gregory C Gray
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Division of Infectious Diseases, Duke University, Durham, North Carolina.,Emerging Infectious Disease Program, Duke-National University of Singapore Medical School, Singapore.,Global Health Research Center, Duke-Kunshan University, Kunshan, China
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6
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Queiros-Reis L, Lopes-João A, Mesquita JR, Penha-Gonçalves C, Nascimento MSJ. Norovirus gastroenteritis outbreaks in military units: a systematic review. BMJ Mil Health 2020; 167:59-62. [PMID: 32409618 DOI: 10.1136/bmjmilitary-2019-001341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Norovirus gastroenteritis is one of the most frequent causes of personnel unavailability in military units, being associated with significant morbidity and degradation of their operational effectiveness. The disease is usually mild but can be severe and life-threatening in young and healthy soldiers, who are prone to dehydration due to intensive daily activity. Despite its impact, the full extent of the norovirus gastroenteritis burden in military forces remains unclear. This systematic review aims to evaluate the impact and ascertain clinical and epidemiological features of norovirus outbreaks that have occurred in the military forces. METHODS The systematic review followed the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guidelines and used three databases: PubMed, Scopus, and LILACs. Papers published up to 1 September 2019 were included without restrictions if they reported one or more outbreaks in the military forces on active duty, either on national territories or deployed overseas. RESULTS A total of 343 papers were retrieved from the literature search. After inclusion/exclusion criteria a total of 39 eligible papers were considered. From 1988 (first reported outbreak in the military) to 2018 more than 101 norovirus outbreaks have been reported in the military, accounting for at least 24 332 cases. Secondary transmission was emphasised as the main route of norovirus transmission in the military forces, with eating outside the military setting an important route for the primary cases. CONCLUSIONS The present review highlights that norovirus gastroenteritis has been a burden to military troops both in combat and on peacekeeping operations. Norovirus disease has been shown to exact a substantial toll on mission readiness and operational effectiveness. It is noteworthy that the impact of norovirus outbreaks among military units is underestimated because the literature review retrieved information from the armed forces from only nine countries.
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Affiliation(s)
- Luis Queiros-Reis
- Laboratório de Microbiologia, Departamento de Ciências Biológicas, Faculdade de Farmácia da Universidade do Porto (FFUP), Porto, Portugal
| | - A Lopes-João
- Laboratório de Bromatologia e Defesa Biológica do Exército (LBDB), Lisboa, Portugal
| | - J R Mesquita
- Departamento de Ciências Veterinárias, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal .,Epidemiology Research Unit (EPIUnit), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - C Penha-Gonçalves
- Laboratório de Bromatologia e Defesa Biológica do Exército (LBDB), Lisboa, Portugal.,Fundacao Calouste Gulbenkian, Lisboa, Portugal
| | - M S J Nascimento
- Laboratório de Microbiologia, Departamento de Ciências Biológicas, Faculdade de Farmácia da Universidade do Porto (FFUP), Porto, Portugal.,Epidemiology Research Unit (EPIUnit), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
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7
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Lopes-João A, Mesquita JR, de Sousa R, Oleastro M, Penha-Gonçalves C, Nascimento MSJ. Simultaneous norovirus outbreak in three Portuguese army bases in the Lisbon region, December 2017. BMJ Mil Health 2019; 167:40-43. [PMID: 31278165 DOI: 10.1136/jramc-2019-001242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Norovirus outbreaks frequently occur in communities and institutional settings acquiring a particular significance in armed forces where prompt reporting is critical. Here we describe the epidemiological, clinical and laboratorial investigation of a multicentre gastroenteritis outbreak that was detected simultaneously in three Portuguese army units with a common food supplier, Lisbon region, between 5 and 6 December 2017. METHODS Questionnaires were distributed to all soldiers stationed in the three affected army units, and stool specimens were collected from soldiers with acute gastrointestinal illness. Stool specimens were tested for common enteropathogenic bacteria by standard methods and screened for a panel of enteric viruses using a multiplex real-time PCR assay. Food samples were also collected for microbiological analysis. Positive stool specimens for norovirus were further genotyped. RESULTS The three simultaneous acute gastroenteritis outbreaks affected a 31 (3.5%) soldiers from a total of 874 stationed at the three units and lasted for 2 days. No secondary cases were reported. Stool specimens (N=11) were negative for all studied enteropathogenic agents but tested positive for norovirus. The recombinant norovirus GII.P16-GII.4 Sydney was identified in all positive samples with 100% identity. CONCLUSIONS The results are suggestive of a common source of infection plausibly related to the food supplying chain. Although centralisation of food supplying in the army has economic advantages, it may contribute to the multifocal occurrence of outbreaks. A rapid intervention is key in the mitigation of outbreak consequences and in reducing secondary transmission.
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Affiliation(s)
- António Lopes-João
- Laboratório de Bromatologia e Defesa Biológica do Exército (LBDB), Lisboa, Portugal
| | - J R Mesquita
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal .,Epidemiology Research Unit (EPIUnit), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - R de Sousa
- Departamento de Doenças Infecciosas Lisboa, Portugal, Laboratório Nacional de Referência para as Infeções Gastrointestinais, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
| | - M Oleastro
- Departamento de Doenças Infecciosas Lisboa, Portugal, Laboratório Nacional de Referência para as Infeções Gastrointestinais, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
| | - C Penha-Gonçalves
- Laboratório de Bromatologia e Defesa Biológica do Exército (LBDB), Lisboa, Portugal
| | - M S J Nascimento
- Epidemiology Research Unit (EPIUnit), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Departamento de Ciências Biológicas, Laboratório de Microbiologia, Faculdade de Farmácia da Universidade do Porto (FFUP), Porto, Portugal
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8
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Abstract
Norovirus is the commonest cause of gastrointestinal disease worldwide in. Infections with norovirus occur in all age groups, however, the highest incidence is in children aged less than five years. Surveillance of norovirus is complicated because most people do not contact medical services when they are ill. Nevertheless, Public health laboratory surveillance worldwide has demonstrated the dominance of GII.4 viruses in the population. Better epidemiological surveillance and outbreak investigations, coupled with wider implementation of molecular-based laboratory diagnostics are leading to better estimates of the burden of norovirus infections as well as improved outbreak control. Recent advances in cell culture systems for norovirus and current research investigating the distribution of norovirus-associated disease in the population, for whom the disease burden is greatest, understanding host susceptibility factors, and methodologies for ascertaining cases, are important in increasing our understanding of norovirus. The key to surveillance of norovirus is allying the epidemiology with surveillance of virology. With recent advances in laboratory culture systems for norovirus, next generation sequencing technologies, improved diagnostics and measuring phenotypic characteristics of noroviruses, there are new opportunities to advance understanding of this common and important human pathogen that will help design strategies for vaccine and antiviral development, and how these might be best deployed to control norovirus infection.
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Affiliation(s)
- David J Allen
- a Department of Pathogen Molecular Biology , Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine , London , UK.,c NIHR Heath Protection Research Unit in Gastrointestinal Infections , Liverpool , UK
| | - John P Harris
- b Institute of Psychology Health and Society, Faculty of Health and Life Science, University of Liverpool , Liverpool , UK.,c NIHR Heath Protection Research Unit in Gastrointestinal Infections , Liverpool , UK
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9
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Almogy G, Stone L, Bernevig BA, Wolf DG, Dorozko M, Moses AE, Nir-Paz R. Analysis of Influenza and RSV dynamics in the community using a 'Local Transmission Zone' approach. Sci Rep 2017; 7:42012. [PMID: 28181554 PMCID: PMC5299452 DOI: 10.1038/srep42012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 01/03/2017] [Indexed: 12/31/2022] Open
Abstract
Understanding the dynamics of pathogen spread within urban areas is critical for the effective prevention and containment of communicable diseases. At these relatively small geographic scales, short-distance interactions and tightly knit sub-networks dominate the dynamics of pathogen transmission; yet, the effective boundaries of these micro-scale groups are generally not known and often ignored. Using clinical test results from hospital admitted patients we analyze the spatio-temporal distribution of Influenza Like Illness (ILI) in the city of Jerusalem over a period of three winter seasons. We demonstrate that this urban area is not a single, perfectly mixed ecology, but is in fact comprised of a set of more basic, relatively independent pathogen transmission units, which we term here Local Transmission Zones, LTZs. By identifying these LTZs, and using the dynamic pathogen-content information contained within them, we are able to differentiate between disease-causes at the individual patient level often with near-perfect predictive accuracy.
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Affiliation(s)
- Gal Almogy
- Flurensics Inc., Tel Aviv, 64101 Israel.,School of Mathematical and Geospatial Sciences, RMIT University, Melbourne, Australia
| | - Lewi Stone
- School of Mathematical and Geospatial Sciences, RMIT University, Melbourne, Australia.,Department of Zoology, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - B Andrei Bernevig
- Department of Physics, Princeton University, Princeton, NJ 08544, USA
| | - Dana G Wolf
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Isreal
| | - Marina Dorozko
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Isreal
| | - Allon E Moses
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Isreal
| | - Ran Nir-Paz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Isreal
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10
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Yaren O, Bradley KM, Moussatche P, Hoshika S, Yang Z, Zhu S, Karst SM, Benner SA. A norovirus detection architecture based on isothermal amplification and expanded genetic systems. J Virol Methods 2016; 237:64-71. [PMID: 27546345 DOI: 10.1016/j.jviromet.2016.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 01/15/2023]
Abstract
Noroviruses are the major cause of global viral gastroenteritis with short incubation times and small inoculums required for infection. This creates a need for a rapid molecular test for norovirus for early diagnosis, in the hope of preventing the spread of the disease. Non-chemists generally use off-the shelf reagents and natural DNA to create such tests, suffering from background noise that comes from adventitious DNA and RNA (collectively xNA) that is abundant in real biological samples, especially feces, a common location for norovirus. Here, we create an assay that combines artificially expanded genetic information systems (AEGIS, which adds nucleotides to the four in standard xNA, pairing orthogonally to A:T and G:C) with loop-mediated isothermal amplification (LAMP) to amplify norovirus RNA at constant temperatures, without the power or instrument requirements of PCR cycling. This assay was then validated using feces contaminated with murine norovirus (MNV). Treating stool samples with ammonia extracts the MNV RNA, which is then amplified in an AEGIS-RT-LAMP where AEGIS segments are incorporated both into an internal LAMP primer and into a molecular beacon stem, the second lowering background signaling noise. This is coupled with RNase H nicking during sample amplification, allowing detection of as few as 10 copies of noroviral RNA in a stool sample, generating a fluorescent signal visible to human eye, all in a closed reaction vessel.
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Affiliation(s)
- Ozlem Yaren
- Foundation for Applied Molecular Evolution (FfAME), 13709 Progress Boulevard, # 7, Alachua, FL 32615, USA
| | - Kevin M Bradley
- Foundation for Applied Molecular Evolution (FfAME), 13709 Progress Boulevard, # 7, Alachua, FL 32615, USA
| | - Patricia Moussatche
- Firebird Biomolecular Sciences LLC, 13709 Progress Boulevard, # 17, Alachua, FL 32615, USA
| | - Shuichi Hoshika
- Foundation for Applied Molecular Evolution (FfAME), 13709 Progress Boulevard, # 7, Alachua, FL 32615, USA
| | - Zunyi Yang
- Foundation for Applied Molecular Evolution (FfAME), 13709 Progress Boulevard, # 7, Alachua, FL 32615, USA
| | - Shu Zhu
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville FL 32611, USA; The Emerging Pathogens Institute, University of Florida, Gainesville FL 32611, USA
| | - Stephanie M Karst
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville FL 32611, USA; The Emerging Pathogens Institute, University of Florida, Gainesville FL 32611, USA
| | - Steven A Benner
- Firebird Biomolecular Sciences LLC, 13709 Progress Boulevard, # 17, Alachua, FL 32615, USA.
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11
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Abstract
PURPOSE OF REVIEW We highlight recent advances relevant to understanding norovirus infections in the tropics, both in populations living in developing settings and travelers to these regions. RECENT FINDINGS Because of the decrease in diarrheal disease associated with the global rollout of vaccines against rotavirus, norovirus is emerging as the predominant cause of diarrhea morbidity among children in the tropics, and evidence suggests that it contributes to adult disease in endemic populations and travelers. In addition to identifying potential target populations for preventive measures, we provide an update on norovirus vaccine development and concepts related to their implementation in low-income and middle-income countries. SUMMARY These current concepts related to norovirus-attributable disease burden, clinical significance, and economic impact can potentially be applied to tailoring efforts to prevent and mitigate the effects of this important enteropathogen.
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12
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Ho ZJM, Vithia G, Ng CG, Maurer-Stroh S, Tan CM, Loh J, Lin TPR, Lee JMV. Emergence of norovirus GI.2 outbreaks in military camps in Singapore. Int J Infect Dis 2015; 31:23-30. [DOI: 10.1016/j.ijid.2014.12.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 12/06/2014] [Accepted: 12/11/2014] [Indexed: 10/24/2022] Open
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13
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Zautner AE, Masanta WO, Hinz R, Hagen RM, Frickmann H. Artificially designed pathogens - a diagnostic option for future military deployments. Mil Med Res 2015; 2:17. [PMID: 26157585 PMCID: PMC4495699 DOI: 10.1186/s40779-015-0045-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 06/24/2015] [Indexed: 01/01/2023] Open
Abstract
Diagnostic microbial isolates of bio-safety levels 3 and 4 are difficult to handle in medical field camps under military deployment settings. International transport of such isolates is challenging due to restrictions by the International Air Transport Association. An alternative option might be inactivation and sequencing of the pathogen at the deployment site with subsequent sequence-based revitalization in well-equipped laboratories in the home country for further scientific assessment. A literature review was written based on a PubMed search. First described for poliovirus in 2002, de novo synthesis of pathogens based on their sequence information has become a well-established procedure in science. Successful syntheses have been demonstrated for both viruses and prokaryotes. However, the technology is not yet available for routine diagnostic purposes. Due to the potential utility of diagnostic sequencing and sequence-based de novo synthesis of pathogens, it seems worthwhile to establish the technology for diagnostic purposes over the intermediate term. This is particularly true for resource-restricted deployment settings, where safe handling of harmful pathogens cannot always be guaranteed.
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Affiliation(s)
- Andreas E Zautner
- Institut für Medizinische Mikrobiologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Wycliffe O Masanta
- Institut für Medizinische Mikrobiologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Rebecca Hinz
- Fachbereich Tropenmedizin am Bernhard-Nocht Institut, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - Ralf Matthias Hagen
- Fachbereich Tropenmedizin am Bernhard-Nocht Institut, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - Hagen Frickmann
- Fachbereich Tropenmedizin am Bernhard-Nocht Institut, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany ; Institut für Mikrobiologie, Virologie und Hygiene, Universitätsmedizin Rostock, Rostock, Germany
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14
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Abstract
Norovirus, an RNA virus of the family Caliciviridae, is a human enteric pathogen that causes substantial morbidity across both health care and community settings. Several factors enhance the transmissibility of norovirus, including the small inoculum required to produce infection (<100 viral particles), prolonged viral shedding, and its ability to survive in the environment. In this review, we describe the basic virology and immunology of noroviruses, the clinical disease resulting from infection and its diagnosis and management, as well as host and pathogen factors that complicate vaccine development. Additionally, we discuss overall epidemiology, infection control strategies, and global reporting efforts aimed at controlling this worldwide cause of acute gastroenteritis. Prompt implementation of infection control measures remains the mainstay of norovirus outbreak management.
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Affiliation(s)
- Elizabeth Robilotti
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Stan Deresinski
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Benjamin A Pinsky
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
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15
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Tallant A, Porter CK, Putnam SD, Tribble DR, Hooper TI, Riddle MS. Relative cost-effectiveness of a norovirus vaccine in the deployed military setting compared to a vaccine against Campylobacter sp., ETEC, and Shigella sp. Vaccine 2014; 32:5156-62. [PMID: 25086264 DOI: 10.1016/j.vaccine.2014.07.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/05/2014] [Accepted: 07/21/2014] [Indexed: 11/29/2022]
Abstract
Norovirus (NoV) has been identified as a significant cause of acute gastrointestinal illness among deployed military troops. We conducted a cost-effectiveness analysis for the use of a NoV vaccine in the military using a previously developed model that evaluated vaccines for ETEC, Campylobacter, and Shigella for prevention of non-outbreak associated travelers' diarrhea. Under conservative assumptions, acquisition of a NoV vaccine by the Department of Defense is estimated to result in a cost-effectiveness ratio per duty day lost to illness (CERDDL) of $1344 compared to a CERDDL of $776, $800, and $1275 for ETEC, Campylobacter sp., and Shigella sp., respectively compared to current management strategies. The absolute value of avoiding a duty day lost is likely to vary under different scenarios, and further study is needed to evaluate how improved diagnostics and prevention of outbreaks may impact the relative value of this vaccine. Overall, this study demonstrates the utility of a previously established evidence-based decision tool for prioritization of vaccine acquisition in an important target population.
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Affiliation(s)
- Aaron Tallant
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, United States
| | - Chad K Porter
- Naval Medical Research Center, Silver Spring, MD, United States
| | | | - David R Tribble
- Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Tomoko I Hooper
- Enteric Diseases Department, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, United States
| | - Mark S Riddle
- Enteric Diseases Department, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, United States.
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16
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Asymptomatic Carriers and Captive Audiences. Food Saf (Tokyo) 2014. [DOI: 10.1128/9781555816186.ch12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Ho ZJM, Hwang YFJ, Lee JMV. Emerging and re-emerging infectious diseases: challenges and opportunities for militaries. Mil Med Res 2014; 1:21. [PMID: 25722877 PMCID: PMC4341224 DOI: 10.1186/2054-9369-1-21] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 08/07/2014] [Indexed: 11/10/2022] Open
Abstract
The communal nature of living and training environments, alongside suboptimal hygiene and stressors in the field, place military personnel at higher risk of contracting emerging infectious diseases. Some of these diseases spread quickly within ranks resulting in large outbreaks, and personnel deployed are also often immunologically naïve to otherwise uncommonly-encountered pathogens. Furthermore, the chance of weaponised biological agents being used in conventional warfare or otherwise remains a very real, albeit often veiled, threat. However, such challenges also provide opportunities for the advancement of preventive and therapeutic military medicine, some of which have been later adopted in civilian settings. Some of these include improved surveillance, new vaccines and drugs, better public health interventions and inter-agency co-operations. The legacy of successes in dealing with infectious diseases is a reminder of the importance in sustaining efforts aimed at ensuring a safer environment for both military and the community at large.
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Affiliation(s)
- Zheng Jie Marc Ho
- Biodefence Centre, Headquarters of the Medical Corps, Singapore Armed Forces, 701 Transit Road, #04-01, Singapore, 778910 Singapore
| | - Yi Fu Jeff Hwang
- Biodefence Centre, Headquarters of the Medical Corps, Singapore Armed Forces, 701 Transit Road, #04-01, Singapore, 778910 Singapore
| | - Jian Ming Vernon Lee
- Biodefence Centre, Headquarters of the Medical Corps, Singapore Armed Forces, 701 Transit Road, #04-01, Singapore, 778910 Singapore
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18
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The feline calicivirus leader of the capsid protein is associated with cytopathic effect. J Virol 2012; 87:3003-17. [PMID: 23269802 DOI: 10.1128/jvi.02480-12] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Open reading frame 2 (ORF2) of the feline calicivirus (FCV) genome encodes a capsid precursor that is posttranslationally processed to release the mature capsid protein (VP1) and a small protein of 124 amino acids, designated the leader of the capsid (LC). To investigate the role of the LC protein in the virus life cycle, mutations and deletions were introduced into the LC coding region of an infectious FCV cDNA clone. Three cysteine residues that are conserved among all vesivirus LC sequences were found to be critical for the recovery of FCV with a characteristic cytopathic effect in feline kidney cells. A cell-rounding phenotype associated with the transient expression of wild-type and mutagenized forms of the LC correlated with the cytopathic and growth properties of the corresponding engineered viruses. The host cellular protein annexin A2 was identified as a binding partner of the LC protein, consistent with a role for the LC in mediating host cell interactions that alter the integrity of the cell and enable virus spread.
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19
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Horm KM, Davidson PM, Harte FM, D'Souza DH. Survival and inactivation of human norovirus surrogates in blueberry juice by high-pressure homogenization. Foodborne Pathog Dis 2012; 9:974-9. [PMID: 23113725 DOI: 10.1089/fpd.2012.1171] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Human noroviruses (HNoV) have been implicated in gastrointestinal outbreaks associated with fresh produce, juices, and ready-to-eat foods. In order to determine the risk of HNoV transmission by contaminated blueberry juice, survival characteristics of cultivable HNoV surrogates (murine norovirus, MNV-1; feline calicivirus, FCV-F9; and bacteriophage MS2) in blueberry juice (pH = 2.77) after 0, 1, 2, 7, 14, and 21 days at refrigeration temperatures (4°C) were studied. High-pressure homogenization (HPH) was studied as a novel processing method for noroviral surrogate inactivation in blueberry juice. Blueberry juice or phosphate-buffered saline (PBS; pH 7.2 as control) was inoculated with each virus, stored over 21 days at 4°C or subjected to HPH, and plaque assayed. FCV-F9 (∼5 log(10) PFU/mL) was undetectable after 1 day in blueberry juice at 4°C. MNV-1 (∼4 log(10) PFU/ml) showed minimal reduction (1 log(10) PFU/mL) after 14 days, with greater reduction (1.95 log(10) PFU/mL; p < 0.05) after 21 days in blueberry juice at 4°C. Bacteriophage MS2 (∼6 log(10) PFU/mL) showed significant reduction (1.93 log(10) PFU/mL; p < 0.05) after 2 days and was undetectable after 7 days in blueberry juice at 4°C. FCV-F9 remained viable in PBS for up to 21 days (2.28 log(10) PFU/mL reduction), while MNV-1 and MS2 survived after 21 days (1.08 and 0.56 log(10) PFU/mL reduction, respectively). Intriguingly, FCV-F9 and bacteriophage MS2 showed reduction after minimal homogenization pressures in blueberry juice (pH = 2.77), possibly due to the combination of juice pH, juice components, and mechanical effects. MNV-1 in blueberry juice was only slightly reduced at 250 (0.33 log(10) PFU/mL) and 300 MPa (0.71 log(10) PFU/mL). Virus surrogate survival in blueberry juice at 4°C correlates well with the ease of HNoV transmission via juices. HPH for viral inactivation in juices is dependent on virus type, and higher homogenization pressures may be needed for MNV-1 inactivation.
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Affiliation(s)
- Katie Marie Horm
- Department of Food Science and Technology, University of Tennessee, Knoxville, TN 37996-4591, USA
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20
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Ahmed SF, Klena JD, Mostafa M, Dogantemur J, Middleton T, Hanson J, Sebeny PJ. Viral gastroenteritis associated with genogroup II norovirus among U.S. military personnel in Turkey, 2009. PLoS One 2012; 7:e35791. [PMID: 22606235 PMCID: PMC3350499 DOI: 10.1371/journal.pone.0035791] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 03/22/2012] [Indexed: 12/25/2022] Open
Abstract
The present study demonstrates that multiple NoV genotypes belonging to genogroup II contributed to an acute gastroenteritis outbreak at a US military facility in Turkey that was associated with significant negative operational impact. Norovirus (NoV) is an important pathogen associated with acute gastroenteritis among military populations. We describe the genotypes of NoV outbreak occurred at a United States military facility in Turkey. Stool samples were collected from 37 out of 97 patients presenting to the clinic on base with acute gastroenteritis and evaluated for bacterial and viral pathogens. NoV genogroup II (GII) was identified by RT-PCR in 43% (16/37) stool samples. Phylogenetic analysis of a 260 base pair fragment of the NoV capsid gene from ten stool samples indicated the circulation of multiple and rare genotypes of GII NoV during the outbreak. We detected four GII.8 isolates, three GII.15, two GII.9 and a sole GII.10 NoV. Viral sequences could be grouped into four clusters, three of which have not been previously reported in Turkey. The fact that current NoV outbreak was caused by rare genotypes highlights the importance of norovirus strain typing. While NoV genogroup II is recognized as causative agent of outbreak, circulation of current genotypes has been rarely observed in large number of outbreaks.
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Affiliation(s)
- Salwa F Ahmed
- United States Naval Medical Research Unit No.3, Cairo, Egypt.
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21
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Comparative murine norovirus studies reveal a lack of correlation between intestinal virus titers and enteric pathology. Virology 2011; 421:202-10. [PMID: 22018636 DOI: 10.1016/j.virol.2011.09.030] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 09/02/2011] [Accepted: 09/13/2011] [Indexed: 11/24/2022]
Abstract
Human noroviruses are significant emerging pathogens, causing the majority of non-bacterial gastroenteritis outbreaks worldwide. The recent discovery of 30 murine norovirus strains is beginning to facilitate a detailed investigation of norovirus pathogenesis. Here, we have performed an in vivo comparative analysis of two murine norovirus strains, MNV-1 and MNV-3. In immunocompetent mice, MNV-1 caused modest intestinal pathology whereas MNV-3 was attenuated compared to MNV-1. Surprisingly though, MNV-3 reached higher titers in intestinal tissue than MNV-1. MNV-3 also displayed attenuation in mice deficient in the critical interferon signaling molecule STAT-1, demonstrating that MNV-3 attenuation is not a result of increased interferon sensitivity. Importantly, MNV-3-infected mice lost weight and developed gastric bloating and diarrhea in STAT1(-/-) mice, from which all animals recovered. This disease profile recapitulates several key features of acute gastroenteritis experienced by people infected with a human norovirus.
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22
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23
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Gonzaga VE, Ramos M, Maves RC, Freeman R, Montgomery JM. Concurrent outbreak of norovirus genotype I and enterotoxigenic Escherichia coli on a U.S. Navy ship following a visit to Lima, Peru. PLoS One 2011; 6:e20822. [PMID: 21713034 PMCID: PMC3119660 DOI: 10.1371/journal.pone.0020822] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 05/13/2011] [Indexed: 12/18/2022] Open
Abstract
An outbreak of norovirus (NoV) genotype I and Enterotoxigenic Escherichia coli (ETEC) occurred among US Navy Ship personnel following a visit to Lima, Peru, in June 2008. Visiting a specific area in Lima was significantly associated with illness. While ETEC and NoV are commonly recognized as causative agents of outbreaks, co-circulation of both pathogens has been rarely observed in shipboard outbreaks.
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Affiliation(s)
| | - Mariana Ramos
- United States Naval Medical Research Unit Six (NAMRU-6), Lima, Peru
| | - Ryan C. Maves
- United States Naval Medical Research Unit Six (NAMRU-6), Lima, Peru
| | - Randal Freeman
- United States Army, El Paso, Texas, United States of America
| | - Joel M. Montgomery
- United States Naval Medical Research Unit Six (NAMRU-6), Lima, Peru
- * E-mail:
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24
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Money NN, Maves RC, Sebeny P, Kasper MR, Riddle MS, Wu M, Lee JE, Schnabel D, Bowden R, Oaks EV, Ocaña V, Acosta L, Gotuzzo E, Lanata C, Ochoa T, Aguayo N, Bernal M, Meza R, Canal E, Gregory M, Cepeda D, Listiyaningsih E, Putnam SD, Young S, Mansour A, Nakhla I, Moustafa M, Hassan K, Klena J, Bruton J, Shaheen H, Farid S, Fouad S, El-Mohamady H, Styles T, Shiau LCDRD, Espinosa B, McMullen K, Reed E, Neil D, Searles D, Nevin R, Von Thun A, Sessions C. Enteric disease surveillance under the AFHSC-GEIS: current efforts, landscape analysis and vision forward. BMC Public Health 2011; 11 Suppl 2:S7. [PMID: 21388567 PMCID: PMC3092417 DOI: 10.1186/1471-2458-11-s2-s7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The mission of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) is to support global public health and to counter infectious disease threats to the United States Armed Forces, including newly identified agents or those increasing in incidence. Enteric diseases are a growing threat to U.S. forces, which must be ready to deploy to austere environments where the risk of exposure to enteropathogens may be significant and where routine prevention efforts may be impractical. In this report, the authors review the recent activities of AFHSC-GEIS partner laboratories in regards to enteric disease surveillance, prevention and response. Each partner identified recent accomplishments, including support for regional networks. AFHSC/GEIS partners also completed a Strengths, Weaknesses, Opportunities and Threats (SWOT) survey as part of a landscape analysis of global enteric surveillance efforts. The current strengths of this network include excellent laboratory infrastructure, equipment and personnel that provide the opportunity for high-quality epidemiological studies and test platforms for point-of-care diagnostics. Weaknesses include inconsistent guidance and a splintered reporting system that hampers the comparison of data across regions or longitudinally. The newly chartered Enterics Surveillance Steering Committee (ESSC) is intended to provide clear mission guidance, a structured project review process, and central data management and analysis in support of rationally directed enteric disease surveillance efforts.
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Affiliation(s)
- Nisha N Money
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
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25
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Liu P, Hsiao HM, Jaykus LA, Moe C. Quantification of Norwalk virus inocula: Comparison of endpoint titration and real-time reverse transcription-PCR methods. J Med Virol 2010; 82:1612-6. [PMID: 20648618 DOI: 10.1002/jmv.21851] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Human noroviruses (NoV) are the leading cause of epidemic acute gastroenteritis. In order to fully characterize features such as persistence and infectious dose, precise quantification of virus concentration is necessary. The purpose of this study was to compare two methods [endpoint titration RT-PCR and quantitative RT-PCR (RT-qPCR)] with respect to quantification of Norwalk virus (NV) in inocula made from purified stock suspensions of human fecal specimens. A full-length NV RNA transcript was developed to facilitate quantification using RT-qPCR and provided log linear detection in the range of 49-4.9 x 10(4) genome equivalent copies (GEC) per reaction. Endpoint titration RT-PCR was used to estimate PCR detection units, and RT-qPCR was used to estimate genome copies in two NV inocula (8fIIa and 8fIIb) used in previous human challenge studies. Overall, RT-qPCR was 1.1-1.6 log(10) more sensitive (lower detection limit) than endpoint titration RT-PCR when the same RNA release method, PCR primers and thermocycle program were used. These findings have important implications for many experimental interpretations, not the least of which is estimating the median infectious dose in human challenge studies.
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Affiliation(s)
- Pengbo Liu
- First Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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26
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[Communicable diseases prevention in the Serbian Army]. VOJNOSANIT PREGL 2010; 67:243-8. [PMID: 20361701 DOI: 10.2298/vsp1003243r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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27
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Karst SM. Pathogenesis of noroviruses, emerging RNA viruses. Viruses 2010; 2:748-781. [PMID: 21994656 PMCID: PMC3185648 DOI: 10.3390/v2030748] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 03/15/2010] [Accepted: 03/15/2010] [Indexed: 12/13/2022] Open
Abstract
Human noroviruses in the family Caliciviridae are a major cause of epidemic gastroenteritis. They are responsible for at least 95% of viral outbreaks and over 50% of all outbreaks worldwide. Transmission of these highly infectious plus-stranded RNA viruses occurs primarily through contaminated food or water, but also through person-to-person contact and exposure to fomites. Norovirus infections are typically acute and self-limited. However, disease can be much more severe and prolonged in infants, elderly, and immunocompromised individuals. Norovirus outbreaks frequently occur in semi-closed communities such as nursing homes, military settings, schools, hospitals, cruise ships, and disaster relief situations. Noroviruses are classified as Category B biodefense agents because they are highly contagious, extremely stable in the environment, resistant to common disinfectants, and associated with debilitating illness. The number of reported norovirus outbreaks has risen sharply since 2002 suggesting the emergence of more infectious strains. There has also been increased recognition that noroviruses are important causes of childhood hospitalization. Moreover, noroviruses have recently been associated with multiple clinical outcomes other than gastroenteritis. It is unclear whether these new observations are due to improved norovirus diagnostics or to the emergence of more virulent norovirus strains. Regardless, it is clear that human noroviruses cause considerable morbidity worldwide, have significant economic impact, and are clinically important emerging pathogens. Despite the impact of human norovirus-induced disease and the potential for emergence of highly virulent strains, the pathogenic features of infection are not well understood due to the lack of a cell culture system and previous lack of animal models. This review summarizes the current understanding of norovirus pathogenesis from the histological to the molecular level, including contributions from new model systems.
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Affiliation(s)
- Stephanie M. Karst
- Center for Molecular and Tumor Virology, Department of Microbiology and Immunology, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71130-3932, USA; E-Mail: ; Tel.: +1-318-675-8122; Fax: +1-318-675-5764
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28
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Primary high-dose murine norovirus 1 infection fails to protect from secondary challenge with homologous virus. J Virol 2009; 83:6963-8. [PMID: 19403675 DOI: 10.1128/jvi.00284-09] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Human noroviruses in the Caliciviridae family are the major cause of nonbacterial epidemic gastroenteritis worldwide. Primary human norovirus infection does not elicit lasting protective immunity, a fact that could greatly affect the efficacy of vaccination strategies. Little is known regarding the pathogenesis of human noroviruses or the immune responses that control them because there has previously been no small-animal model or cell culture system of infection. Using the only available small-animal model of norovirus infection, we found that primary high-dose murine norovirus 1 (MNV-1) infection fails to afford protection against a rechallenge with a homologous virus. Thus, MNV-1 represents a valuable model with which to dissect the pathophysiological basis for the lack of lasting protection against human norovirus infection. Interestingly, the magnitude of protection afforded by a primary MNV-1 infection inversely correlates with the inoculum dose. Future studies will elucidate the mechanisms by which noroviruses avoid the induction of protective immunity and the role played by the inoculum dose in this process, ultimately translating this knowledge into successful vaccination approaches.
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29
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Type I and type II interferons inhibit the translation of murine norovirus proteins. J Virol 2009; 83:5683-92. [PMID: 19297466 DOI: 10.1128/jvi.00231-09] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Human noroviruses are responsible for more than 95% of nonbacterial epidemic gastroenteritis worldwide. Both onset and resolution of disease symptoms are rapid, suggesting that components of the innate immune response are critical in norovirus control. While the study of the human noroviruses has been hampered by the lack of small animal and tissue culture systems, our recent discovery of a murine norovirus (MNV) and its in vitro propagation have allowed us to begin addressing norovirus replication strategies and immune responses to norovirus infection. We have previously demonstrated that interferon responses are critical to control MNV-1 infection in vivo and to directly inhibit viral replication in vitro. We now extend these studies to define the molecular basis for interferon-mediated inhibition. Viral replication intermediates were not detected in permissive cells pretreated with type I interferon after either infection or transfection of virion-associated RNA, demonstrating a very early block to virion production that is after virus entry and uncoating. A similar absence of viral replication intermediates was observed in infected primary macrophages and dendritic cells pretreated with type I IFN. This was not due to degradation of incoming genomes in interferon-pretreated cells since similar levels of genomes were present in untreated and pretreated cells through 6 h of infection, and these genomes retained their integrity. Surprisingly, this block to the translation of viral proteins was not dependent on the well-characterized interferon-induced antiviral molecule PKR. Similar results were observed in cells pretreated with type II interferon, except that the inhibition of viral translation was dependent on PKR. Thus, both type I and type II interferon signaling inhibit norovirus translation in permissive myeloid cells, but they display distinct dependence on PKR for this inhibition.
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30
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Bailey MS, Gallimore CI, Lines LD, Green AD, Lopman BA, Gray JJ, Brown DWG. Viral gastroenteritis outbreaks in deployed British troops during 2002-7. J ROY ARMY MED CORPS 2009; 154:156-9. [PMID: 19202819 DOI: 10.1136/jramc-154-03-04] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The aim of this study was to see what lessons could be learnt from the suspected viral gastroenteritis outbreaks that have occurred in deployed British troops during 2002-7. METHOD Epidemiological and laboratory data from identifiable outbreaks were reviewed, including epidemic curves and the results of PCR testing for enteropathic viruses. RESULTS The epidemic curves of outbreaks varied predictably in accordance with the size of the population at risk and whether this population was constant or expanding. Of 11 outbreaks identified, 10 (91%) had a proven viral cause and 10 (91%) occurred in Iraq. Of 84 enteropathic viruses identified, 61 (73%) were noroviruses and these included both unknown strains and those that were common in the UK and Europe. Of the 10 viral outbreaks, 3 (30%) occurred in medical units, 5 (50%) were associated with large-scale relief in place (RiP) deployments and 5 (50%) involved >3 different viruses, which is strongly suggestive of food or water contamination. CONCLUSION These findings can help to predict future viral gastroenteritis outbreaks and target improved prevention strategies appropriately. However, more systematic studies are now required.
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Affiliation(s)
- M S Bailey
- Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK.
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31
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Logan C, O’Sullivan N. Detection of viral agents of gastroenteritis: Norovirus, Sapovirus and Astrovirus. Future Virol 2008. [DOI: 10.2217/17460794.3.1.61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Norovirus, Sapovirus and Astrovirus are causative agents of viral gastroenteritis affecting all age groups, but most frequently the young, the elderly and persons in semi-closed communities such as hospitals, nursing homes, military bases and cruise ships. The sensitive and rapid detection of causative agents of viral gastroenteritis is key to the effective implementation of infection control systems. Traditional detection methods such as electron microscopy and antigen detection assays lack sensitivity. The detection of gastrointestinal viruses by molecular methods has resulted in increased levels of detection, and enables the epidemiological investigation of viral strains. The significant diversity of gastrointestinal viruses, in particular Norovirus and Sapovirus, are compounded by increasing reports of virus recombination, and pose an ongoing challenge to the development of sensitive and specific molecular detection assays.
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Affiliation(s)
- Catriona Logan
- Our Lady’s Children’s Hospital, Department of Microbiology, Crumlin, Dublin 12, Ireland
| | - Niamh O’Sullivan
- Our Lady’s Children’s Hospital, Department of Microbiology, Crumlin, Dublin 12, Ireland, and, Department of Pathology, Coombe Women’s Hospital, Dolphins Barn, Dublin 8, Ireland
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32
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Coyne KP, Edwards D, Radford AD, Cripps P, Jones D, Wood JLN, Gaskell RM, Dawson S. Longitudinal molecular epidemiological analysis of feline calicivirus infection in an animal shelter: a model for investigating calicivirus transmission within high-density, high-turnover populations. J Clin Microbiol 2007; 45:3239-44. [PMID: 17687017 PMCID: PMC2045375 DOI: 10.1128/jcm.01226-07] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The control of outbreaks of calicivirus infection in high-density, high-throughput populations is a challenge to both human and veterinary medicine. In such populations, the prevalence of infection is, in part, dependent on the levels of biosecurity and how this affects virus transmission. Here we show how longitudinal analysis of feline calicivirus (FCV) infection in an animal rescue shelter can be used as a model to examine the dynamics of calicivirus transmission and evolution in such environments. FCV was isolated from 33 of 116 cats sampled over a 15-month period (overall prevalence, 28%). Sequence analysis of the immunodominant variable regions of the viral capsid gene identified 16 strains circulating in the shelter, with no single strain appearing to predominate. The majority of these strains were introduced into the shelter from the community and did not appear to be transmitted within the population. However, for three of these strains, putative transmission events within the shelter were identified. The rates of evolution within hypervariable regions of the FCV capsid gene in individual cats ranged from 0.05 to 1.4% per week, with the highest rates generally being found in animals that either acquired the virus while in the shelter or were undergoing acute infection. These data suggest that despite the high prevalence and presence of multiple strains of FCV within the shelter, the spread of such pathogens may be restricted by various control measures, including good hygiene and biosecurity.
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Affiliation(s)
- Karen P Coyne
- Department of Veterinary Pathology, University of Liverpool, Leahurst, Chester High Road, South Wirral CH64 7TE, United Kingdom.
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33
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Abstract
Chemical, Biological, Radiological and Nuclear incidents are rare, but the likelihood of any medical facility having to deal with contaminated or contagious casualties is not, Health Care Workers (HCW) often being exposed to infectious or toxic substances. Although medical staff routinely take measures to protect themselves against exposure to infection by wearing protective clothing, they rarely consider the inhalational route as a threat. This paper presents a series of cases where HCW's have been exposed to toxic or infectious material through the respiratory route, discusses standards of respiratory protection and describes how this risk can be mitigated to protect medical personnel.
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Affiliation(s)
- M Byers
- Academic Dept of Emergency Medicine, James Cook University Hospital, University of Teeside.
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Patterson SS, Smith MW, Casper ET, Huffman D, Stark L, Fries D, Paul JH. A nucleic acid sequence-based amplification assay for real-time detection of norovirus genogroup II. J Appl Microbiol 2007; 101:956-63. [PMID: 16968307 DOI: 10.1111/j.1365-2672.2006.02934.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To use molecular beacon based nucleic acid sequence-based amplification (NASBA) to develop a rapid, sensitive, specific detection method for norovirus (NV) genogroupII (GII). METHODS AND RESULTS A method to detect NV GII from environmental samples using real-time NASBA was developed. This method was routinely sensitive to 100 copies of target RNA and intermittent amplification occurred with as few as 10 copies. Quantitative estimates of viral load were possible over at least four orders of magnitude. CONCLUSIONS The NASBA method described here is a reliable and sensitive assay for the detection of NV. This method has the potential to be linked to a handheld NASBA device that would make this real-time assay a portable and inexpensive alternative to bench-top, lab-based assays. SIGNIFICANCE AND IMPACT OF THE STUDY The development of the real-time NASBA assay described here has resulted in a simple, rapid (<1 h), convenient testing format for NV. To our knowledge, this is the first example of a molecular beacon based NASBA assay for NV.
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Affiliation(s)
- S S Patterson
- College of Marine Science, University of South Florida, St Petersburg, FL 33701, USA
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Mumphrey SM, Changotra H, Moore TN, Heimann-Nichols ER, Wobus CE, Reilly MJ, Moghadamfalahi M, Shukla D, Karst SM. Murine norovirus 1 infection is associated with histopathological changes in immunocompetent hosts, but clinical disease is prevented by STAT1-dependent interferon responses. J Virol 2007; 81:3251-63. [PMID: 17229692 PMCID: PMC1866040 DOI: 10.1128/jvi.02096-06] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Human noroviruses are the major cause of nonbacterial epidemic gastroenteritis worldwide. However, little is known regarding their pathogenesis or the immune responses that control them because until recently there has been no small animal model or cell culture system of norovirus infection. We recently reported the discovery of the first murine norovirus, murine norovirus 1 (MNV-1), and its cultivation in macrophages and dendritic cells in vitro. We further defined interferon receptors and the STAT-1 molecule as critical in both resistance to MNV-1-induced disease in vivo and control of virus growth in vitro. To date, neither histopathological changes upon infection nor viral replication in wild-type mice has been shown. Here we extend our studies to demonstrate that MNV-1 replicates and rapidly disseminates to various tissues in immunocompetent mice and that infection is restricted by STAT1-dependent interferon responses at the levels of viral replication and virus dissemination. Infection of wild-type mice is associated with histopathological alterations in the intestine (mild inflammation) and the spleen (red pulp hypertrophy and white pulp activation); viral dissemination to the spleen, liver, lung, and lymph nodes; and low-level persistent infection in the spleen. STAT-1 inhibits viral replication in the intestine, prevents virus-induced apoptosis of intestinal cells and splenocytes, and limits viral dissemination to peripheral tissues. These findings demonstrate that murine norovirus infection of wild-type mice is associated with initial enteric seeding and subsequent extraintestinal spread, and they provide mechanistic evidence of the role of STAT-1 in controlling clinical norovirus-induced disease.
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Affiliation(s)
- Shannon M Mumphrey
- Center for Molecular and Tumor Virology, Department of Microbiology and Immunology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130, USA
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Coyne KP, Gaskell RM, Dawson S, Porter CJ, Radford AD. Evolutionary mechanisms of persistence and diversification of a calicivirus within endemically infected natural host populations. J Virol 2006; 81:1961-71. [PMID: 17151126 PMCID: PMC1797550 DOI: 10.1128/jvi.01981-06] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In order to understand the evolutionary mechanisms of persistence and diversification within the Caliciviridae, we have been exploiting endemic infection of feline calicivirus within five geographically distinct household groups of cats. By sequencing immunodominant and variable regions of the capsid gene, we identified the relative contribution of the different evolutionary processes employed by the virus to ensure its long-term survival in the host population. Such strategies included progressive evolution of a given variant of a strain through mutation accumulation within an individual, sequential reinfection with either a variant of the same strain or with a different strain, and mixed infection. Recombination between different strains in this study has been reported in detail elsewhere (K. P. Coyne et al., J. Gen. Virol. 87:921-926, 2006). Here, we provide evidence to suggest that true long-term persistent infection in individuals is relatively rare, with the majority of apparent viral carriers undergoing a combination of progressive evolution and cyclical reinfection. Progressive evolution at the individual level and variant reinfection at both the individual and population levels were associated with positive selection. Two measures of evolution rate were determined; for a virus progressively evolving within an individual (1.32 x 10(-2) to 2.64 x 10(-2) substitutions per nucleotide per year, i.e., no transmission) and for a strain circulating within a population (3.84 x 10(-2) to 4.56 x 10(-2) substitutions per nucleotide per year, i.e., including transmission). Reiteration of both progressive evolution and variant reinfection appeared to lead to a gradual increase in the diversity of a given strain of virus, both in the individual and in the population, until eventually new strains emerged.
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Affiliation(s)
- Karen P Coyne
- Department of Veterinary Clinical Sciences, University of Liverpool, Leahurst, Chester High Road, South Wirral CH64 7TE, United Kingdom.
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Rossignol JF, El-Gohary YM. Nitazoxanide in the treatment of viral gastroenteritis: a randomized double-blind placebo-controlled clinical trial. Aliment Pharmacol Ther 2006; 24:1423-30. [PMID: 17081163 DOI: 10.1111/j.1365-2036.2006.03128.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND Enteric viruses including noroviruses and rotavirus are leading causes of diarrhoeal disease and gastroenteritis worldwide, and there is no effective treatment. AIM To evaluate nitazoxanide, a thiazolide anti-infective agent, in treating viral gastroenteritis in adults and adolescents. METHODS 50 out-patients at least 12 years of age (mean 33.5 years) presenting with diarrhoea and stool-positive by enzyme-linked immunosorbent assay for norovirus, rotavirus or adenovirus were enrolled in a double-blind, placebo-controlled clinical trial. Patients were randomly assigned either nitazoxanide 500 mg or placebo twice daily for 3 days. The primary end point was time from first dose to resolution of symptoms. Analysis was modified intent-to-treat for 45 patients, excluding five patients with other identified enteropathogens at baseline. RESULTS The median time from first dose to resolution of symptoms was 1.5 days (IQR: 0.5-2.5) for nitazoxanide-treated patients and 2.5 days (IQR: 1.5-4.5) for the placebo group. Significant reductions in time to resolution of symptoms were observed for all patients analysed (P < 0.0001) and for subsets of patients with rotavirus (P = 0.0052) and norovirus (P = 0.0295). The number of patients with adenovirus (n = 5) was too small to draw any conclusion. No significant adverse events were reported. CONCLUSIONS Nitazoxanide may play an important role in managing viral gastroenteritis in adults.
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Affiliation(s)
- J-F Rossignol
- The Romark Institute for Medical Research, Tampa, FL 33607, USA.
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Rutjes SA, Lodder-Verschoor F, van der Poel WHM, van Duijnhoven YTHP, de Roda Husman AM. Detection of noroviruses in foods: a study on virus extraction procedures in foods implicated in outbreaks of human gastroenteritis. J Food Prot 2006; 69:1949-56. [PMID: 16924922 DOI: 10.4315/0362-028x-69.8.1949] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Disease outbreaks in which foods are epidemiologically implicated as the common source are frequently reported. Noroviruses and enteric hepatitis A viruses are among the most prevalent causative agents of foodborne diseases. However, the detection of these viruses in foods other than shellfish is often time-consuming and unsuccessful. In this study, three virus concentration methods were compared: polyethylene glycol (PEG) plus NaCl, ultracentrifugation, and ultrafiltration. Two RNA extraction methods, TRIzol and RNeasy Mini Kit (Qiagen), were compared for detection of viruses in whipped cream and lettuce (as representatives of the dairy and vegetable-fruit food groups, respectively). A seeding experiment with canine calicivirus was conducted to determine the efficiency of each virus extraction procedure. The PEG-NaCl-TRIzol method was most efficient for the detection of viruses in whipped cream and the ultracentrifugation-RNeasy-Mini Kit procedure was best for detection on lettuce. Based on the seeding experiments, food items implicated in norovirus-associated gastroenteritis outbreaks were subjected to the optimal procedure for a specific composition and matrix. No noroviruses were detected in the implicated food items, possibly because the concentration of virus on the food item was too low or because of the presence of inhibitory factors. For each food group, a specific procedure is optimal. Inhibitory factors should be controlled in these procedures because they influence virus detection in food.
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Affiliation(s)
- Saskia A Rutjes
- Microbiological Laboratory for Health Protection, Centre for Infectious Disease Control, National Institute of Public Health and the Environment, P.O. Box 1/ Antonie van Leeuwenhoeklaan 9, 3720 BA Bilthoven, The Netherlands.
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Ausar SF, Foubert TR, Hudson MH, Vedvick TS, Middaugh CR. Conformational Stability and Disassembly of Norwalk Virus-like Particles. J Biol Chem 2006; 281:19478-88. [PMID: 16675449 DOI: 10.1074/jbc.m603313200] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Greater than 99% of the Norwalk virus (NV) capsid consists of 180 copies of a single 58-kDa protein. Recombinantly expressed monomers self-assemble into virus-like particles (VLPs) with a well defined icosahedral structure. NV-VLPs are an appropriate vaccine antigen since the antigenic determinants of the parent virion are preserved. They also constitute very simple models to study the mechanisms of assembly and disassembly of viral capsids. This work examines the inherent stability of NV-VLPs over a range of pH and temperature values and provides detailed insight into structural perturbations that accompany disassembly. The NV-VLP structure was monitored using a variety of biophysical techniques including intrinsic and extrinsic fluorescence, high resolution second-derivative UV absorption spectroscopy, circular dichroism (CD), dynamic light scattering, differential scanning calorimetry, and direct observation employing transmission electron microscopy. The data demonstrate that NV-VLPs are highly stable over a pH range of 3-7 and up to 55 degrees C. At pH 8, however, reversible capsid dissociation was correlated with increased solvent exposure of tyrosine residues and subtle changes in secondary structure. Above 60 degrees C NV-VLPs undergo distinct phase transitions arising from secondary-, tertiary-, and quaternary-level protein structural perturbations. By combining the spectroscopic data employing a multidimensional eigenvector phase space approach, an empirical phase diagram for NV-VLP was constructed. This strategy of visualization provides a comprehensive description of the physical stability of NV-VLP over a broad range of pH and temperature. Complementary, differential scanning calorimetric analyses suggest that the two domains of VP1 unfold independently in a pH-dependent manner.
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Affiliation(s)
- Salvador F Ausar
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, Kansas 66047, USA
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Riddle MS, Smoak BL, Thornton SA, Bresee JS, Faix DJ, Putnam SD. Epidemic infectious gastrointestinal illness aboard U.S. Navy ships deployed to the Middle East during peacetime operations--2000-2001. BMC Gastroenterol 2006; 6:9. [PMID: 16504135 PMCID: PMC1456974 DOI: 10.1186/1471-230x-6-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Accepted: 02/25/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infectious gastrointestinal illness (IGI) outbreaks have been reported in U.S. Navy ships and could potentially have an adverse mission impact. Studies to date have been anecdotal. METHODS We conducted a retrospective analysis of weekly reported disease and non-battle injury health data collected in 2000-2001 from 44 U.S. Navy ships while sailing in the 5th Fleet (Persian Gulf and nearby seas). RESULTS During this period, 11 possible IGI outbreaks were identified. Overall, we found 3.3 outbreaks per 100 ship-weeks, a mean outbreak duration of 4.4 weeks, and a mean cumulative ship population attack rate of 3.6%. Morbidity, represented by days lost due to personnel being placed on sick-in-quarters status, was higher during outbreak weeks compared to non-outbreak weeks (p = 0.002). No clear seasonal distribution was identified. CONCLUSION Explosive outbreaks due to viruses and bacteria with the potential of incapacitating large proportions of the crew raise serious concerns of mission impact and military readiness.
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Affiliation(s)
- Mark S Riddle
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Bonnie L Smoak
- Division of Preventive Medicine, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Scott A Thornton
- Navy Environmental and Preventive Medicine Unit #6, Pearl Harbor, HI, USA
| | - Joseph S Bresee
- National Center for Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dennis J Faix
- Navy Environmental and Preventive Medicine Unit #5, San Diego, CA, USA
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Bailey MS, Boos CJ, Vautier G, Green AD, Appleton H, Gallimore CI, Gray JJ, Beeching NJ. Gastroenteritis outbreak in British troops, Iraq. Emerg Infect Dis 2006; 11:1625-8. [PMID: 16318711 PMCID: PMC3366745 DOI: 10.3201/eid1110.050298] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Gastroenteritis affected many British military personnel during the war in Iraq. In the first month, 1,340 cases were seen; 73% of patients required hospital admission and 36% were hospital staff. In a survey of 500 hospital staff, 76% reported gastroenteritis, which was more likely in clinical workers. Investigations showed only caliciviruses.
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Halperin T, Yavzori M, Amitai A, Klement E, Kayouf R, Grotto I, Huerta M, Hadley LA, Monroe SS, Cohen D, Orr N. Molecular analysis of noroviruses involved in acute gastroenteritis outbreaks in military units in Israel, 1999–2004. Eur J Clin Microbiol Infect Dis 2005; 24:697-700. [PMID: 16231127 DOI: 10.1007/s10096-005-0002-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The study presented here was conducted to determine the genetic properties of noroviruses (NoVs) identified between 1999 and 2004 in army recruits with acute gastroenteritis. Partial sequence analysis of the RNA-dependent RNA polymerase gene revealed the presence of two major sub-genogroups, all of which were related to genogroup II of NoV. Serological analysis using recombinant antigens confirmed this observation. Local strains associated with a 1999 outbreak were closely related to GII-6 strains, while those identified later were very closely related to GII-4 strains. GII-4 strains were also associated with an outbreak in civilian nursing homes in Israel in 2002 and samples from this outbreak were included in this study for comparison. This is the first report describing the molecular properties of NoV strains associated with diarrhea-related morbidity in Israel.
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Affiliation(s)
- T Halperin
- Center for Vaccine Development and Evaluation, Medical Corps, M.P.O. Box 02149, IDF, Israel.
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Thornton SA, Sherman SS, Farkas T, Zhong W, Torres P, Jiang X. Gastroenteritis in US Marines during Operation Iraqi Freedom. Clin Infect Dis 2005; 40:519-25. [PMID: 15712073 DOI: 10.1086/427501] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2004] [Accepted: 10/14/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Approximately 83,000 US Marines participated in the opening phase of Operation Iraqi Freedom in Spring 2003. A Navy Preventive Medicine laboratory was set up in Ad Diwaniyah, Iraq, to provide clinical diagnostic support for Marine medical units during a period of repositioning in south-central Iraq. METHODS Specimen collection boxes were sent to >30 primary care medical stations handling 500-900 personnel each. The laboratory had capability to detect many different disease agents, especially those causing febrile illness. Diarrheal stool diagnostic evaluation included plating and biochemical identification, antigen serologic testing, fluorescent antibody antigen detection, disk diffusion antimicrobial susceptibility testing, enzyme immunoassay, and reverse-transcriptase polymerase chain reaction for norovirus (NV). Confirmation and sequencing work for NV was done at Cincinnati Children's Hospital Medical Center (Ohio). RESULTS By far the most common reason for infectious disease sick call visits was gastrointestinal illness; no other symptoms had equivalent impact. An enteropathogen was detected in 57 (44%) of 129 stool samples, with NV detected in 30 stool samples (23%) obtained from 14 different battalion or similar-sized units; next in frequency were Shigella flexneri and Shigella sonnei, which were isolated from 26 stool samples (20%) obtained from 15 units. Sequencing the NV RNA polymerase gene demonstrated that NV strains represented 7 genetic clusters, including 2 strains from genogroup I and 5 from genogroup II. Ciprofloxacin was effective in vitro against most bacterial agents, but neither doxycyline (which was taken daily as the antimalarial prophylaxis dose) nor trimethoprim-sulfamethoxazole were effective. CONCLUSIONS Multiple strains of Shigella species and NV predominated, probably because they do not require a large inoculum to cause infection. Otherwise, personnel remained free of infectious illness during this phase of the conflict, because other infectious agents were rare or absent.
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Affiliation(s)
- Scott A Thornton
- Navy Environmental and Preventive Medicine Unit No. 6, Pearl Harbor, Hawaii 96860, USA.
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Jean J, D'Souza DH, Jaykus LA. Multiplex nucleic acid sequence-based amplification for simultaneous detection of several enteric viruses in model ready-to-eat foods. Appl Environ Microbiol 2004; 70:6603-10. [PMID: 15528524 PMCID: PMC525130 DOI: 10.1128/aem.70.11.6603-6610.2004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2004] [Accepted: 06/25/2004] [Indexed: 11/20/2022] Open
Abstract
Human enteric viruses are currently recognized as one of the most important causes of food-borne disease. Implication of enteric viruses in food-borne outbreaks can be difficult to confirm due to the inadequacy of the detection methods available. In this study, a nucleic acid sequence-based amplification (NASBA) method was developed in a multiplex format for the specific, simultaneous, and rapid detection of epidemiologically relevant human enteric viruses. Three previously reported primer sets were used in a single reaction for the amplification of RNA target fragments of 474, 371, and 165 nucleotides for the detection of hepatitis A virus and genogroup I and genogroup II noroviruses, respectively. Amplicons were detected by agarose gel electrophoresis and confirmed by electrochemiluminescence and Northern hybridization. Endpoint detection sensitivity for the multiplex NASBA assay was approximately 10(-1) reverse transcription-PCR-detectable units (or PFU, as appropriate) per reaction. When representative ready-to-eat foods (deli sliced turkey and lettuce) were inoculated with various concentrations of each virus and processed for virus detection with the multiplex NASBA method, all three human enteric viruses were simultaneously detected at initial inoculum levels of 10(0) to 10(2) reverse transcription-PCR-detectable units (or PFU)/9 cm2 in both food commodities. The multiplex NASBA system provides rapid and simultaneous detection of clinically relevant food-borne viruses in a single reaction tube and may be a promising alternative to reverse transcription-PCR for the detection of viral contamination of foods.
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Affiliation(s)
- Julie Jean
- Food Science Department, College of Agriculture and Life Sciences, North Carolina State University, Raleigh, USA.
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Abstract
PURPOSE OF REVIEW Since Kapakian first identified a virus in the stool of a patient with diarrhoea in 1972, many viruses have been described that cause diarrhoea directly or indirectly. It is now appreciated that viruses are the most common cause of diarrhoeal illness worldwide. Although bacteria and other pathogens cause significant numbers of gastroenteritis, it is the viruses that are dealt with in this review. The viruses responsible will be discussed individually. RECENT FINDINGS Rotavirus remains the leading cause of diarrhoeal disease overall, with the newly designated calicivirus family causing the most outbreaks in the industrialized nations. As diagnostic techniques improve, however, the importance of astrovirus and other previously under-reported pathogens is becoming more apparent and the number of viruses associated with gastroenteritis continues to increase. The emergence of severe acute respiratory syndrome coronavirus, arguably the most important emerging infection of recent years and a cause of significant gastrointestinal disease, is also discussed. SUMMARY No effective treatments have been developed for viral gastroenteritis. Current efforts are targeted at the development of suitable vaccines and the implementation of infection control measures.
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Affiliation(s)
- Benjamin Clark
- Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
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Atreya CD. Major Foodborne Illness Causing Viruses and Current Status of Vaccines Against the Diseases. Foodborne Pathog Dis 2004; 1:89-96. [PMID: 15992267 DOI: 10.1089/153531404323143602] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Even though viruses, unlike bacteria, cannot grow in or on foods, foodborne illnesses are associated with viruses due to contamination of the fresh produce or processed food by virus-containing fecal material. The commonly reported major foodborne illnesses are due to Noroviruses, hepatitis A and E viruses, rotaviruses, and astroviruses. Among all illnesses caused by foodborne pathogens, recent estimates of as high as 67% have been attributed to viruses alone, and an upward trend in the of transmission of viruses by food and water has been recently acknowledged. Due to the highly infectious nature of these viruses and their survival under drastic conditions such as high acidic pH and low temperatures, it has long been recognized that immunization against such pathogens is the ideal solution to provide protection against the illness and disease outbreaks associated with these viruses. With an increased recognition of the clinical significance and impact of acute viral illness associated with food and water in humans of all ages, there has been a recent surge in developing prophylactic vaccines against such viruses. So far, except for hepatitis A virus, there are no vaccines available to prevent illness associated with foodborne viruses. Outbreaks of hepatitis A have been significantly reduced due to widespread immunization of some risk groups. It is clear from the literature that novel strategies currently in development may lead to vaccines against noroviruses and rotaviruses in the near future, offering hope that such vaccines will significantly reduce the burden associated with foodborne illnesses associated with these viruses.
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Affiliation(s)
- C D Atreya
- Division of Viral Products, Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Bethesda, Maryland, USA.
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Butt AA, Aldridge KE, Sanders CV. Infections related to the ingestion of seafood Part I: viral and bacterial infections. THE LANCET. INFECTIOUS DISEASES 2004; 4:201-12. [PMID: 15050937 DOI: 10.1016/s1473-3099(04)00969-7] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Foodborne diseases cause an estimated 76 million illnesses in the USA each year. Seafood is implicated in 10-19% of these illnesses. A causative agent can be traced in about 44% of seafood-related outbreaks, viruses accounting for around half of these illnesses. Although viruses are the most common cause of seafood-related infections, most hospitalisations and deaths are due to bacterial agents. A wide variety of viruses, bacteria, and parasites have been implicated in seafood-related outbreaks, which are reported worldwide. The factor most commonly associated with infection is consumption of raw or undercooked seafood. People with underlying disorders, particularly liver disease, are more susceptible to infection. The first part of this two-part review summarises the general incidence of seafood-related infections and discusses the common viral and bacterial causes of these infections. For each agent, the microbiology, epidemiology, mode of transmission, and treatment are discussed. In the May issue of the journal we will discuss parasites associated with seafood consumption, the safety of seafood, and the measures put in place in the USA to increase its safety.
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Affiliation(s)
- Adeel A Butt
- Division of Infectious Diseases, University of Pittsburgh, the VA Pittsburgh Healthcare System, and the Center for Health Equity Research and Promotion, Pittsburgh, PA 15213, USA.
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Greene SR, Moe CL, Jaykus LA, Cronin M, Grosso L, Aarle PV. Evaluation of the NucliSens Basic Kit assay for detection of Norwalk virus RNA in stool specimens. J Virol Methods 2003; 108:123-31. [PMID: 12565163 PMCID: PMC7119547 DOI: 10.1016/s0166-0934(02)00286-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Norwalk-like viruses (NLVs) are a genetically diverse group of human caliciviruses that are the most common cause of epidemic gastroenteritis and are detected typically in stool by reverse transcription (RT)-PCR or electron microscopy (EM). The application of a rapid nucleic acid sequence-based amplification (NASBA) assay for the detection of NLV RNA in stool is described using the NucliSens Basic Kit. Primers and probes for the NLV Basic Kit assay were based on the RNA polymerase region of the prototype NLV, Norwalk virus (NV) genome and could consistently detect 10(4) RT-PCR detectable units of NV RNA in a stool filtrate. When compared directly with RT-PCR on a dilution series of NV stool filtrate, the NucliSens Basic Kit assay was equally sensitive. Cross-reactivity studies with a representative panel of other enteric pathogens were negative. When applied to 15 stool specimens from NV-challenged volunteers, the NASBA Basic Kit application for NV detection yielded 100% sensitivity, 50% specificity, and 67% concordance, using RT-PCR as the 'gold standard'. Despite the specificity of the NASBA primer/probe sequences for NV, other representatives from both NLV genogroups I and II could be detected by the Basic Kit assay in outbreak stool specimens, although the results were inconsistent. Our results suggest that the NucliSens Basic Kit assay provides a rapid and sensitive alternative to RT-PCR for detecting NV RNA in stool specimens. However, improvements in test specificity and primer design will be needed before the assay can be used routinely in the clinical setting.
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Affiliation(s)
- Shermalyn R Greene
- Program in Infectious Diseases, Department of Epidemiology, School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7400, USA
| | - Christine L Moe
- Program in Infectious Diseases, Department of Epidemiology, School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7400, USA
- Corresponding author. Tel.: +1-404-727-9275; fax: +1-404-727-4590
| | - Lee-Ann Jaykus
- Department of Food Science, North Carolina State University, Raleigh, NC, USA
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Sair AI, D'Souza DH, Jaykus LA. Human Enteric Viruses as Causes of Foodborne Disease. Compr Rev Food Sci Food Saf 2002; 1:73-89. [DOI: 10.1111/j.1541-4337.2002.tb00008.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Koopmans M, von Bonsdorff CH, Vinjé J, de Medici D, Monroe S. Foodborne viruses. FEMS Microbiol Rev 2002; 26:187-205. [PMID: 12069883 PMCID: PMC7110323 DOI: 10.1111/j.1574-6976.2002.tb00610.x] [Citation(s) in RCA: 186] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2001] [Revised: 03/18/2002] [Accepted: 03/22/2002] [Indexed: 01/30/2023] Open
Abstract
Foodborne and waterborne viral infections are increasingly recognized as causes of illness in humans. This increase is partly explained by changes in food processing and consumption patterns that lead to the worldwide availability of high-risk food. As a result, vast outbreaks may occur due to contamination of food by a single foodhandler or at a single source. Although there are numerous fecal-orally transmitted viruses, most reports of foodborne transmission describe infections with Norwalk-like caliciviruses (NLV) and hepatitis A virus (HAV), suggesting that these viruses are associated with the greatest risk of foodborne transmission. NLV and HAV can be transmitted from person to person, or indirectly via food, water, or fomites contaminated with virus-containing feces or vomit. People can be infected without showing symptoms. The high frequency of secondary cases of NLV illness and - to a lesser extent - of hepatitis A following a foodborne outbreak results in amplification of the problem. The burden of illness is highest in the elderly, and therefore is likely to increase due to the aging population. For HAV, the burden of illness may increase following hygienic control measures, due to a decreasing population of naturally immune individuals and a concurrent increase in the population at risk. Recent advances in the research of NLV and HAV have led to the development of molecular methods which can be used for molecular tracing of virus strains. These methods can be and have been used for the detection of common source outbreaks. While traditionally certain foods have been implicated in virus outbreaks, it is clear that almost any food item can be involved, provided it has been handled by an infected person. There are no established methods for detection of viruses in foods other than shellfish. Little information is available on disinfection and preventive measures specifically for these viruses. Studies addressing this issue are hampered by the lack of culture systems. As currently available routine monitoring systems exclusively focus on bacterial pathogens, efforts should be made to combine epidemiological and virological information for a combined laboratory-based rapid detection system for foodborne viruses. With better surveillance, including typing information, outbreaks of foodborne infections could be reported faster to prevent further spread.
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Affiliation(s)
- Marion Koopmans
- National Institute of Public Health and the Environment, Research Laboratory for Infectious Diseases, Antonie van Leeuwenhoeklaan 9, Bilthoven, The Netherlands.
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