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Li X, Zhao Y, Gu W, Qian Y, Huang Q, Hu X, Xing H. A novel dual-mode aptasensor based colorimetry and electrochemical detection of norovirus in fecal sample. Anal Biochem 2024; 687:115444. [PMID: 38141797 DOI: 10.1016/j.ab.2023.115444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/04/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
Norovirus is a leading cause of acute gastroenteritis in humans. This paper presents the development of a novel dual-mode aptasensor for detecting norovirus using colorimetry and electrochemical methods. The initial colorimetric method utilizes gold nanoparticles (AuNPs) and sodium chloride to establish a positive correlation between the concentration of norovirus in a solution and the absorbance ratio A650/A520. The naked eye can detect concentrations as low as 0.1 μg/mL, corresponding to a Ct value of 33 (2.2 copies/μL, CT = 34.102-3.2185·lgX), allowing for qualitative and semi-quantitative analysis. For more accurate trace analysis, a gold electrode is modified with a thiol-modified aptamer and closed with 6-Mercapto-1-hexanol. After incubation with norovirus, the virus specifically binds to the aptamer, causing changes in its spatial structure and distance from the electrode surface. These changes can then be detected using electrochemical square wave voltammetry (SWV). Under optimal reaction conditions, the peak current from SWV exhibits a strong linear relationship with the logarithm of norovirus concentrations between 10-9 μg/mL and 10-2 μg/mL. The regression equation Y = 14.76789 + 1.03983·lgX, with an R2 value of 0.987, accurately represents this relationship. The limit of detection was determined to be 1.365 × 10-10 μg/mL. Furthermore, the aptasensor demonstrated high specificity for norovirus in fecal samples, making it a promising tool for detecting norovirus in various sample types.
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Affiliation(s)
- Xinyue Li
- School of Chemical and Environmental Engineering, Shanghai Institute of Technology, Shanghai, 201418, China
| | - Yongqiang Zhao
- School of Chemical and Environmental Engineering, Shanghai Institute of Technology, Shanghai, 201418, China
| | - Wenchao Gu
- Shanghai Putuo District Disease Control Center, Shanghai, 200336, China
| | - Yong Qian
- School of Chemical and Environmental Engineering, Shanghai Institute of Technology, Shanghai, 201418, China
| | - Qi Huang
- School of Chemical and Environmental Engineering, Shanghai Institute of Technology, Shanghai, 201418, China
| | - Xiaojun Hu
- School of Chemical and Environmental Engineering, Shanghai Institute of Technology, Shanghai, 201418, China.
| | - Haibo Xing
- School of Chemical and Environmental Engineering, Shanghai Institute of Technology, Shanghai, 201418, China.
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Widström J, Andersson ME, Westin J, Wahllöf M, Lindh M, Rydell GE. Complex norovirus transmission dynamics at hospital wards revealed by deep sequencing. J Clin Microbiol 2023; 61:e0060823. [PMID: 37889018 PMCID: PMC10662361 DOI: 10.1128/jcm.00608-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/05/2023] [Indexed: 10/28/2023] Open
Abstract
Detailed knowledge regarding norovirus transmission within hospitals is limited. We investigated a norovirus hospital outbreak affecting 65 patients at five different wards. PCR showed that 61 (94%) of the patients were infected with genotype II.4 strains. Successful Ion Torrent deep sequencing of GII.4 positive samples from 59 patients followed by phylogenetic analysis revealed that all sequences but two clustered into four distinct clades. Two of the clades belonged to GII.4 Sydney 2012, while the other two belonged to GII.4 New Orleans 2009. One of the clades was predominant at two wards, while two clades were predominant at one ward each. The fourth clade was found in sporadic cases at several wards. Thus, at four out of five wards, variants from one clade were predominant. At one ward, a single clade accounted for all cases, while at three wards the predominant clade accounted for 60%-71% of cases. Analysis of quasispecies variation identified positions that could further discriminate between variants from separate wards. The results illustrate a complex transmission of healthcare-associated norovirus infections and show that sequencing can be used to discriminate between related and unrelated cases.
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Affiliation(s)
- Julia Widström
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria E. Andersson
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Westin
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martina Wahllöf
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Lindh
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gustaf E. Rydell
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Ondrikova N, Harris JP, Douglas A, Hughes HE, Iturriza-Gomara M, Vivancos R, Elliot AJ, Cunliffe NA, Clough HE. Predicting Norovirus in England Using Existing and Emerging Syndromic Data: Infodemiology Study. J Med Internet Res 2023; 25:e37540. [PMID: 37155231 DOI: 10.2196/37540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 11/28/2022] [Accepted: 02/19/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Norovirus is associated with approximately 18% of the global burden of gastroenteritis and affects all age groups. There is currently no licensed vaccine or available antiviral treatment. However, well-designed early warning systems and forecasting can guide nonpharmaceutical approaches to norovirus infection prevention and control. OBJECTIVE This study evaluates the predictive power of existing syndromic surveillance data and emerging data sources, such as internet searches and Wikipedia page views, to predict norovirus activity across a range of age groups across England. METHODS We used existing syndromic surveillance and emerging syndromic data to predict laboratory data indicating norovirus activity. Two methods are used to evaluate the predictive potential of syndromic variables. First, the Granger causality framework was used to assess whether individual variables precede changes in norovirus laboratory reports in a given region or an age group. Then, we used random forest modeling to estimate the importance of each variable in the context of others with two methods: (1) change in the mean square error and (2) node purity. Finally, these results were combined into a visualization indicating the most influential predictors for norovirus laboratory reports in a specific age group and region. RESULTS Our results suggest that syndromic surveillance data include valuable predictors for norovirus laboratory reports in England. However, Wikipedia page views are less likely to provide prediction improvements on top of Google Trends and Existing Syndromic Data. Predictors displayed varying relevance across age groups and regions. For example, the random forest modeling based on selected existing and emerging syndromic variables explained 60% variance in the ≥65 years age group, 42% in the East of England, but only 13% in the South West region. Emerging data sets highlighted relative search volumes, including "flu symptoms," "norovirus in pregnancy," and norovirus activity in specific years, such as "norovirus 2016." Symptoms of vomiting and gastroenteritis in multiple age groups were identified as important predictors within existing data sources. CONCLUSIONS Existing and emerging data sources can help predict norovirus activity in England in some age groups and geographic regions, particularly, predictors concerning vomiting, gastroenteritis, and norovirus in the vulnerable populations and historical terms such as stomach flu. However, syndromic predictors were less relevant in some age groups and regions likely due to contrasting public health practices between regions and health information-seeking behavior between age groups. Additionally, predictors relevant to one norovirus season may not contribute to other seasons. Data biases, such as low spatial granularity in Google Trends and especially in Wikipedia data, also play a role in the results. Moreover, internet searches can provide insight into mental models, that is, an individual's conceptual understanding of norovirus infection and transmission, which could be used in public health communication strategies.
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Affiliation(s)
- Nikola Ondrikova
- Institute of Infection, Ecological and Veterinary Sciences, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- Institute for Risk and Uncertainty, University of Liverpool, Liverpool, United Kingdom
| | - John P Harris
- Field Service, Health Protection Operations, United Kingdom Health Security Agency, Liverpool, United Kingdom
| | - Amy Douglas
- Gastrointestinal Infections and Food Safety (One Health) Division, United Kingdom Health Security Agency, London, United Kingdom
| | - Helen E Hughes
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- Real-time Syndromic Surveillance Team, Health Protection Operations, United Kingdom Health Security Agency, Birmingham, United Kingdom
| | | | - Roberto Vivancos
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- Field Service, Health Protection Operations, United Kingdom Health Security Agency, Liverpool, United Kingdom
- National Institute for Health and Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
| | - Alex J Elliot
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- Real-time Syndromic Surveillance Team, Health Protection Operations, United Kingdom Health Security Agency, Birmingham, United Kingdom
| | - Nigel A Cunliffe
- Institute of Infection, Ecological and Veterinary Sciences, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
| | - Helen E Clough
- Institute of Infection, Ecological and Veterinary Sciences, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
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Chen Y, Lopman BA, Hall AJ, Kambhampati AK, Roberts L, Mason J, Vilen K, Salehi E, Fraser A, Adams C. Factors driving norovirus transmission in long-term care facilities: A case-level analysis of 107 outbreaks. Epidemics 2023; 42:100671. [PMID: 36682288 DOI: 10.1016/j.epidem.2023.100671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 11/12/2022] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Norovirus is the most common cause of gastroenteritis outbreaks in long-term care facilities (LTCFs) in the United States, causing a high burden of disease in both residents and staff. Understanding how case symptoms and characteristics contribute to norovirus transmission can lead to more informed outbreak control measures in LTCFs. We examined line lists for 107 norovirus outbreaks that took place in LTCFs in five U.S. states from 2015 to 2019. We estimated the individual effective reproduction number, Ri, to quantify individual case infectiousness and examined the contribution of vomiting, diarrhea, and being a resident (vs. staff) to case infectiousness. The associations between case characteristics and Ri were estimated using a multivariable, log-linear mixed model with inverse variance weighting. We found that cases with vomiting infected 1.28 (95 % CI: 1.11, 1.48) times the number of secondary cases compared to cases without vomiting, and LTCF residents infected 1.31 (95 % CI: 1.15, 1.50) times the number of secondary cases compared to staff. There was no difference in infectiousness between cases with and without diarrhea (1.07; 95 % CI: 0.90, 1.29). This suggests that vomiting, particularly by LTCF residents, was a primary driver of norovirus transmission. These results support control measures that limit exposure to vomitus during norovirus outbreaks in LTCFs.
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Affiliation(s)
- Yangping Chen
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA.
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
| | - Aron J Hall
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - Anita K Kambhampati
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - Lynn Roberts
- Division of Public Health, Wisconsin Department of Health Services, 1 W Wilson St, Madison, WI 53703, USA
| | - Jordan Mason
- Division of Public Health, Wisconsin Department of Health Services, 1 W Wilson St, Madison, WI 53703, USA
| | - Kelley Vilen
- Foodborne Disease Unit, Minnesota Department of Health, 625 Robert St N, St Paul, MN 55164, USA
| | - Ellen Salehi
- Bureau of Infectious Diseases, Ohio Department of Health, 246 N High St, Columbus, OH 43215, USA
| | - Angela Fraser
- Department of Food, Nutrition and Packaging Science, Clemson University, 105 Sikes Hall, Clemson, SC 29634, USA
| | - Carly Adams
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
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Adams C, Peterson SR, Hall AJ, Parashar U, Lopman BA. Associations of infection control measures and norovirus outbreak outcomes in healthcare settings: a systematic review and meta-analysis. Expert Rev Anti Infect Ther 2022; 20:279-290. [PMID: 34225537 PMCID: PMC8810727 DOI: 10.1080/14787210.2021.1949985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although most norovirus outbreaks in high-income countries occur in healthcare facilities, information on associations between control measures and outbreak outcomes in these settings is lacking. METHODS We conducted a systematic review/meta-analysis to assess associations between norovirus outbreak control measures and outcomes in hospitals and long-term care facilities (LTCFs), globally. Using regression analyses stratified by setting (hospital/LTCF), we compared durations, attack rates, and case counts for outbreaks in which control measures were reportedly implemented to those in which they were not. RESULTS We identified 102 papers describing 162 norovirus outbreaks. Control measures were reportedly implemented in 118 (73%) outbreaks and were associated with 0.6 (95% CI: 0.3-1.1) times smaller patient case counts and 0.7 (95% CI: 0.4, 1.0) times shorter durations in hospitals but 1.5 (95% CI: 1.1-2.2), 1.5 (95% CI: 1.0-2.1) and 1.6 (95% CI: 1.0-2.6) times larger overall, resident and staff case counts, respectively, and 1.4 (95% CI: 1.0-2.0) times longer durations in LTCFs. CONCLUSIONS Reported implementation of control measures was associated with smaller/shorter outbreaks in hospitals but larger/longer outbreaks in LTCFs. Control measures were likely implemented in response to larger/longer outbreaks in LTCFs, rather than causing them. Prospective observational or intervention studies are needed to determine effectiveness.
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Affiliation(s)
- Carly Adams
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA,Corresponding author
| | - Shenita R Peterson
- Woodruff Health Science Center Library, Emory University, 1462 Clifton Rd, Atlanta, GA 30322, USA
| | - Aron J Hall
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - Umesh Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
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6
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Overbey KN, Hamra GB, Nachman KE, Rock C, Schwab KJ. Quantitative microbial risk assessment of human norovirus infection in environmental service workers due to healthcare-associated fomites. J Hosp Infect 2021; 117:52-64. [PMID: 34403766 PMCID: PMC8978295 DOI: 10.1016/j.jhin.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Healthcare-associated norovirus outbreaks place a large burden on healthcare staff. Environmental service workers (ESWs), however, remain understudied despite high contact with potentially contaminated surfaces. Understanding the magnitude of the risk of norovirus infection in healthcare ESWs can protect workers and improve infection control. AIM This study simulated the risk of norovirus infection for unprotected ESWs after a single fomite contact, assuming no disinfection or protective equipment, in norovirus-positive patient rooms. In addition, the risk of secondary surface transmission from norovirus-exposed ESWs was simulated. METHODS A quantitative microbial risk assessment employing two-dimensional Monte Carlo simulation with parameters extracted from the literature was used to estimate norovirus infection from multiple fomite contact scenarios defined by: norovirus source (patient vomit/diarrhoea), location (bathroom/patient room) and target outcome (ESW/secondary illness). FINDINGS Unprotected ESWs have a maximum estimated risk of norovirus infection of 33% (1:3) for a single fomite contact in a room where a norovirus-positive patient had a diarrhoeal event. Patient vomit events lead to fomite contact risk estimates that are four orders of magnitude lower than those for diarrhoeal events. The estimated risk of secondary illness from touching a common surface is as high as 25% (1:4) after single fomite exposure following a diarrhoeal event. CONCLUSIONS A single fomite contact may lead to sizable risk of norovirus infection in ESWs if personal protective equipment and disinfection are not used appropriately. ESWs can also transfer virus to secondary surfaces, initiating further infections. Interventions are needed to reduce fomite transfer of norovirus, and protect patients and staff from nosocomial infections.
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Affiliation(s)
- K N Overbey
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - G B Hamra
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - K E Nachman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - C Rock
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, MD, USA
| | - K J Schwab
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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7
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Sood G, Perl TM. Outbreaks in Health Care Settings. Infect Dis Clin North Am 2021; 35:631-666. [PMID: 34362537 DOI: 10.1016/j.idc.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Outbreaks and pseudo-outbreaks in health care settings are complex and should be evaluated systematically using epidemiologic and molecular tools. Outbreaks result from failures of infection prevention practices, inadequate staffing, and undertrained or overcommitted health care personnel. Contaminated hands, equipment, supplies, water, ventilation systems, and environment may also contribute. Neonatal intensive care, endoscopy, oncology, and transplant units are areas at particular risk. Procedures, such as bronchoscopy and endoscopy, are sources of infection when cleaning and disinfection processes are inadequate. New types of equipment can be introduced and lead to contamination or equipment and medications can be contaminated at the manufacturing source.
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Affiliation(s)
- Geeta Sood
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Mason F. Lord Building, Center Tower, 3rd Floor, 5200 Eastern Avenue, Baltimore, MD 21224, USA.
| | - Trish M Perl
- Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Y7;302, Dallas, TX 75390, USA
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Liao L, Byeon JH, Park JH. Development of a size-selective sampler combined with an adenosine triphosphate bioluminescence assay for the rapid measurement of bioaerosols. ENVIRONMENTAL RESEARCH 2021; 194:110615. [PMID: 33309960 DOI: 10.1016/j.envres.2020.110615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/23/2020] [Accepted: 12/07/2020] [Indexed: 06/12/2023]
Abstract
In this study, a size-selective bioaerosol sampler was built and combined with adenosine triphosphate (ATP) bioluminescence assay for measuring the bioaerosol concentration more rapidly and easily. The ATP bioaerosol sampler consisted of a respirable cyclone, an impactor to collect bioaerosols onto the head of a swab used for ATP bioluminescence assay, a swab holder, and a sampling pump. The collection efficiency of the impactor was tested using aerosolized sodium chloride particles and then the particle diameter corresponding to the collection efficiency of 50% (cut-off diameter) was evaluated. The experimental cut-off diameter was 0.44 μm. The correlations between ATP bioluminescence (relative light unit; RLU) from commercially available swabs (UltraSnap and SuperSnap, Hygiena, LLC, U.S.A.) and colony forming unit (CFU) were examined using Escherichia coli (E. coli) suspension and then the conversion equations from RLU to CFU were obtained. From the correlation results, the R2 values of UltraSnap and SuperSnap were 0.53 and 0.81, respectively. The conversion equations were the linear function and the slopes of UltraSnap and SuperSnap were 633.6 and 277.78, respectively. In the lab and field tests, the ATP bioaerosol sampler and a conventional Andersen impactor were tested and the results were compared. In the lab tests, concentrations of aerosolized E. coli collected using the sampler were highly correlated to those from the Anderson impactor (R2 = 0.85). In the field tests, the concentrations measured using the ATP bioaerosol sampler were higher than those from the Andersen impactor due to the limitations of the colony counting method. These findings confirm the feasibility of developing a sampler for rapid measurement of bioaerosol concentrations, offering a compact device for measuring exposure to bioaerosols, and an easy-to-use methodological concept for efficient air quality management.
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Affiliation(s)
- Li Liao
- School of Health Sciences, Purdue University, West Lafayette, IN, 47906, USA
| | - Jeong Hoon Byeon
- School of Mechanical Engineering, Yeungnam University, Gyeongsan, 38541, Republic of Korea.
| | - Jae Hong Park
- School of Health Sciences, Purdue University, West Lafayette, IN, 47906, USA.
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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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10
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Acute gastroenteritis outbreaks in closed and semi-closed facilities during 2017 in Catalonia, Spain. Eur J Clin Microbiol Infect Dis 2020; 40:1085-1089. [PMID: 33211224 DOI: 10.1007/s10096-020-04101-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
Acute gastroenteritis (AGE) is a leading cause of disease worldwide. The aim of this prospective observational study is to describe the epidemiology of AGE in closed and semi-closed institutions in Catalonia. In 2017, 151 outbreaks were reported; 30.5% occurred in closed and semi-closed institutions; 71.7% caused by norovirus (NoV) (1532) cases. Person-to-person transmission accounted for 75.8% of NoV outbreaks vs 46.1% in non-NoV outbreaks (p < 0.001). Attack rate for NoV outbreaks was 33.1% vs 14.3% for non-NoV outbreaks (RR = 2.3; 95%CI: 2.0-2.7). The high number of affected underscores prompt and intense preventive measures to avoid the extension and perpetuation of outbreaks in these settings.
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11
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The burden of gastroenteritis outbreaks in long-term care settings in Philadelphia, 2009-2018. Infect Control Hosp Epidemiol 2020; 41:1310-1314. [PMID: 32799937 DOI: 10.1017/ice.2020.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Gastroenteritis causes significant morbidity and mortality in long-term care facility (LTCF) residents, a growing population within the United States. We set out to better understand gastroenteritis outbreaks in LTCF by identifying outbreak and facility characteristics associated with outbreak incidence as well as outbreak duration and size. DESIGN We conducted a retrospective cross-sectional study on LTCFs in Philadelphia County from 2009 to 2018. Outbreak characteristics and interventions were extracted from Philadelphia Department of Public Health (PDPH) database and quality data on all LTCFs was extracted from Centers for Medicare and Medicaid Services Nursing Home Compare database. RESULTS We identified 121 gastroenteritis outbreaks in 49 facilities. Numbers of affected patients ranged from 2 to 211 patients (median patient illness rate, 17%). Staff were reported ill in 94 outbreaks (median staff illness rate, 5%). Outbreak facilities were associated with higher occupancy rates (91% vs 88%; P = .033) and total bed numbers (176 vs 122; P = .071) compared to nonoutbreak facilities. Higher rates of staff illness were associated with prolonged outbreaks (13% vs 4%; P < .001) and higher patient illness rates (9% vs 4%; P = .012). Prolonged outbreaks were associated with lower frequency of cohorting for outbreak management (13% vs 41%; P = .046). CONCLUSION This study is the largest published analysis of gastroenteritis outbreaks in LTCFs. Facility characteristics and staff disease activity were associated with more severe outbreaks. Heightened surveillance for gastrointestinal symptoms among staff and increased use of cohorting might reduce the risk of prolonged gastroenteritis outbreaks in LTCF.
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12
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Domman D, Ruis C, Dorman MJ, Shakya M, Chain PSG. Novel Insights Into the Spread of Enteric Pathogens Using Genomics. J Infect Dis 2020; 221:S319-S330. [PMID: 31538189 DOI: 10.1093/infdis/jiz220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/19/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daryl Domman
- Bioscience Division, Los Alamos National Laboratory, New Mexico
| | - Christopher Ruis
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, United Kingdom.,Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Matthew J Dorman
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, United Kingdom
| | - Migun Shakya
- Bioscience Division, Los Alamos National Laboratory, New Mexico
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13
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Quantifying the roles of vomiting, diarrhea, and residents vs. staff in norovirus transmission in U.S. nursing home outbreaks. PLoS Comput Biol 2020; 16:e1007271. [PMID: 32210423 PMCID: PMC7135310 DOI: 10.1371/journal.pcbi.1007271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 04/06/2020] [Accepted: 02/21/2020] [Indexed: 12/16/2022] Open
Abstract
The role of individual case characteristics, such as symptoms or demographics, in norovirus transmissibility is poorly understood. Six nursing home norovirus outbreaks occurring in South Carolina, U.S. from 2014 to 2016 were examined. We aimed to quantify the contribution of symptoms and other case characteristics in norovirus transmission using the reproduction number (REi) as an estimate of individual case infectivity and to examine how transmission changes over the course of an outbreak. Individual estimates of REi were calculated using a maximum likelihood procedure to infer the average number of secondary cases generated by each case. The associations between case characteristics and REi were estimated using a weighted multivariate mixed linear model. Outbreaks began with one to three index case(s) with large estimated REi’s (range: 1.48 to 8.70) relative to subsequent cases. Of the 209 cases, 155 (75%) vomited, 164 (79%) had diarrhea, and 158 (76%) were nursing home residents (vs. staff). Cases who vomited infected 2.12 (95% CI: 1.68, 2.68) times the number of individuals as non-vomiters, cases with diarrhea infected 1.39 (95% CI: 1.03, 1.87) times the number of individuals as cases without diarrhea, and resident-cases infected 1.53 (95% CI: 1.15, 2.02) times the number of individuals as staff-cases. Index cases tended to be residents (vs. staff) who vomited and infected considerably more secondary cases compared to non-index cases. Results suggest that individuals, particularly residents, who vomit are more infectious and tend to drive norovirus transmission in U.S. nursing home norovirus outbreaks. While diarrhea also plays a role in norovirus transmission, it is to a lesser degree than vomiting in these settings. Results lend support for prevention and control measures that focus on cases who vomit, particularly if those cases are residents. The majority of all norovirus outbreaks reported to the CDC occur in long-term care facilities (LTCFs), including nursing homes, where older residents are at risk for more severe or prolonged infection. Because there is currently no publicly available norovirus vaccine, sound control measures are key to controlling norovirus outbreaks, but there is little evidence that standard control measures are effective in reducing the size and/or duration of LTCF norovirus outbreaks. Hence, studies leading to a better understanding of disease spread and prevention of additional cases, and thus more effective control measures, are needed. To this end, we aimed to quantify factors associated with norovirus transmission and to examine how transmission changes over the course of an outbreak. We show that vomiting and, to a lesser extent, diarrhea are critical in initiating and sustaining norovirus transmission in U.S. nursing home norovirus outbreaks. We also show that nursing home residents, rather than staff, are the primary drivers of transmission. Results suggest that control measures focusing on cases who vomit, particularly if those cases are residents, would be most effective at curtailing norovirus transmission in these settings.
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Volpini LP, Barreira DM, Almeida PLDS, Spano LC. An outbreak due to a norovirus GII.Pe-GII.4 Sydney_2012 recombinant in neonatal and pediatric intensive care units. J Infect Public Health 2020; 13:89-93. [DOI: 10.1016/j.jiph.2019.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/28/2019] [Accepted: 06/18/2019] [Indexed: 01/05/2023] Open
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Li B, Xiao D, Li Y, Wu X, Qi L, Tang W, Li Q. Epidemiological analysis of norovirus infectious diarrhea outbreaks in Chongqing, China, from 2011 to 2016. J Infect Public Health 2019; 13:46-50. [PMID: 31548166 DOI: 10.1016/j.jiph.2019.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 06/01/2019] [Accepted: 06/13/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We investigated the epidemiological characteristics of norovirus infection from 2011 to 2016 in Chongqing, China, in order to provide evidence for strategies on epidemic prevention and control. METHODS We collected data on norovirus infectious diarrhea epidemics in 38 districts and counties, and analyzed the information using descriptive epidemiological methods. RESULTS In 2011, the first case of norovirus infectious diarrhea in Chongqing was reported. From 2011 to 2015, 38 districts and counties in Chongqing reported a total of 4 epidemics. In 2016, however, the city reported 117 outbreaks. From 2011 to 2016, there were 1637 cases of norovirus infection but no deaths. In 2016, most outbreaks occurred over a 5-month period with a clear peak in December and higher incidence in major urban areas than smaller communities (83.61% vs. 16.39%). Of these 1637 cases, 99.18% occurred in urban schools and nurseries, and 80% were transmitted person-to-person. Infection by genogroup II genotype 2 (GII.2) viruses accounted for 98.71% of cases. Leukocytes were increased in 67.81% of patients, neutrophils in 65%, and lymphocytes in 50%. Medical treatment was sought by 70% of patients or guardians but only 3.66% of cases were hospitalized. The most frequent misdiagnosis was "suspected food poisoning". CONCLUSION The frequency of norovirus infectious diarrhea epidemics increased over 20-fold from 2011 to 2016 in Chongqing, China. These epidemics occurred predominantly in urban schools and nurseries. However, epidemics showed little spread to outlying districts and counties, so prevention and control pressures were relatively high. SUGGESTIONS Healthcare professionals and institutions should strengthen health education for groups at high-risk of norovirus infection, such as school children, and increase norovirus testing capacity to further improve emergency investigation. Prevention and control knowledge should be disseminated to the general public to reduce transmission risk and total disease burden. Finally, governments and health administrative departments should invest special funds to prevent and control norovirus epidemics.
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Affiliation(s)
- Baisong Li
- Infectious Disease Control Office, The Chongqing Center for Disease Control and Prevention, Chongqing 400010, China
| | - Dayong Xiao
- Infectious Disease Control Office, The Chongqing Center for Disease Control and Prevention, Chongqing 400010, China
| | - Yanlin Li
- Hainan Medical University, Haikou 570100, China
| | - Xianlan Wu
- The Department of Clinical Laboratory Medicine, Southwest Hospital, Army Medical University, Chongqing 400000, China
| | - Li Qi
- Infectious Disease Control Office, The Chongqing Center for Disease Control and Prevention, Chongqing 400010, China
| | - Wenge Tang
- Infectious Disease Control Office, The Chongqing Center for Disease Control and Prevention, Chongqing 400010, China
| | - Qin Li
- Infectious Disease Control Office, The Chongqing Center for Disease Control and Prevention, Chongqing 400010, China.
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Abstract
PURPOSE OF REVIEW The purpose of the review is to provide an update on control measures for norovirus (NoV), which is the most commonly implicated pathogen in acute gastroenteritis and outbreaks, causing major disruption in nurseries, schools, hospitals and care homes. RECENT FINDINGS Important developments include the discovery that virus particles, previously considered to be the infectious unit, also occur in clusters, which appear to be more virulent than individual virus particles; a working culture system using human stem-cell derived enteroids; promising results from early phase clinical trials of candidate NoV vaccines, which appear to be safe and immunogenic; chronic NoV affects patients with primary and secondary immune deficiencies. Although several treatments have been used none are supported by well designed clinical trials; infection control procedures are effective if properly implemented. SUMMARY NoV remains an important cause of morbidity and mortality. Although there are exciting developments on the vaccine front, the mainstay of control remains good hand hygiene, adherence to infection control procedures and limiting contamination of food, water and the wider environment. Once vaccines are available there will be important decisions to be made about how best to implement them.
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Hirvonen JJ. Comparison of three multiplex real-time PCR assays for detection of enteric viruses in patients with diarrhea. Eur J Clin Microbiol Infect Dis 2018; 38:241-244. [DOI: 10.1007/s10096-018-3418-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/30/2018] [Indexed: 02/06/2023]
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Preparation and Evaluation of Combined Detection of Norovirus GI and GII: An Innovative Fluorescent Particles Test Strip. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7862467. [PMID: 29682555 PMCID: PMC5845527 DOI: 10.1155/2018/7862467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/15/2017] [Accepted: 01/29/2018] [Indexed: 12/04/2022]
Abstract
This study was designed to prepare and evaluate the sensitivity and specificity of a Norovirus GI and GII fluorescent particles combined detection test strip method. Using selected chromatographic materials and antibodies specific to Norovirus GI and GII, the Norovirus GI and GII fluorescent particles combined detection test strip (tested method) was prepared as a conventional double antibody sandwich. The samples assayed included cultured rotavirus and 465 specimens from patients with symptoms of gastrointestinal infection. Norovirus was detected using the tested method and a reference method (CerTest Norovirus GI-GII test card). The results indicated that the sensitivity of the tested method was 4 (for GI detection) or 8 times (for GII detection) greater than the reference method. Neither of the two methods cross-reacted with rotavirus and so on. For specimens, 29 were found to be negative by the reference method and positive by the tested method, and 8 were found to be negative by the tested method and positive by the reference method. Furthermore, a retesting of these samples by qPCR showed that 28 of the 29 were positive, and 3 of the 8 were positive. In summary, the Norovirus GI and GII fluorescent particles combined detection test strip was successfully prepared and had good detection performance.
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Sacco KA, Pongdee T, Binnicker MJ, Espy M, Pardi D, Khanna S, Joshi AY. Presence of immune deficiency increases the risk of hospitalization in patients with norovirus infection. Diagn Microbiol Infect Dis 2017; 90:300-306. [PMID: 29398461 DOI: 10.1016/j.diagmicrobio.2017.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/18/2017] [Accepted: 11/25/2017] [Indexed: 12/22/2022]
Abstract
Norovirus is an emerging pathogen causing gastroenteritis. We sought to identify factors associated with clinical outcomes in a cohort of patients with laboratory-confirmed norovirus infection. We performed a retrospective chart review of patients with positive norovirus polymerase chain reaction in stool between October 1, 2015, and May 31, 2016. 128 unique patients were identified during the study period, 64 of whom had immune deficiency, of which only 3 patients had a primary immune deficiency (common variable immune deficiency), while 61 patients had a secondary immune deficiency. 50% of patients with immune deficiency were hospitalized as compared to only 30% of the non-immune-deficient cohort (odds ratio: 2.1 (1.1-4.18, P=0.04). One-third (32.8%) of the patients had a polymicrobial stool infection, and 21.1% had concurrent Clostridium difficile infection. Initial mean total leukocyte count was higher in the hospitalized group at 8.40×109/L versus 6.31×109/L in the nonhospitalized group (P=0.049). All 13 patients presenting with fever had symptomatic resolution (P=0.002). The presence of C. difficile infection was correlated with persistent symptoms (OR 2.30 [0.95-5.58], P=0.067). The overall mortality rate among our cohort was 3.13% (4 patients). All deceased patients had secondary immune deficiency, and none had C. difficile coinfection. Presence of an immune deficiency increases the risk of hospitalization with norovirus infection. Absence of fever is associated with lower resolution and possibly may contribute to a persistent infectious state. Presence of concomitant C. difficile infection is correlated with a lower overall mortality rate.
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Affiliation(s)
- Keith A Sacco
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Thanai Pongdee
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN
| | | | - Mark Espy
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Darrell Pardi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Sahil Khanna
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Avni Y Joshi
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN; Mayo Clinic Children's Center, Division of Pediatric Allergy and Immunology, Mayo Clinic, Rochester, MN.
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Cardemil CV, Parashar UD, Hall AJ. Norovirus Infection in Older Adults: Epidemiology, Risk Factors, and Opportunities for Prevention and Control. Infect Dis Clin North Am 2017; 31:839-870. [PMID: 28911830 PMCID: PMC6546097 DOI: 10.1016/j.idc.2017.07.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Norovirus is the leading cause of acute gastroenteritis. In older adults, it is responsible for an estimated 3.7 million illnesses; 320,000 outpatient visits; 69,000 emergency department visits; 39,000 hospitalizations; and 960 deaths annually in the United States. Older adults are particularly at risk for severe outcomes, including prolonged symptoms and death. Long-term care facilities and hospitals are the most common settings for norovirus outbreaks in developed countries. Diagnostic platforms are expanding. Several norovirus vaccines in clinical trials have the potential to reap benefits. This review summarizes current knowledge on norovirus infection in older adults.
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Affiliation(s)
- Cristina V Cardemil
- Viral Gastroenteritis Branch (proposed), Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Umesh D Parashar
- Viral Gastroenteritis Branch (proposed), Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aron J Hall
- Viral Gastroenteritis Branch (proposed), Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Moudjahed H, Pinçon C, Alidjinou K, Dewilde A, Goffard A. Comparison of three molecular assays for detection of enteric viruses in stool samples. J Virol Methods 2017; 250:55-58. [DOI: 10.1016/j.jviromet.2017.09.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/15/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
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Cui C, Pan L, Wang Y, Xue C, Zhu W, Zhu L, Ye C, Lu X, Song H, Fu Y, Sun Q. An outbreak of acute GII.17 norovirus gastroenteritis in a long-term care facility in China: The role of nursing assistants. J Infect Public Health 2017; 10:725-729. [DOI: 10.1016/j.jiph.2016.10.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/26/2016] [Accepted: 10/01/2016] [Indexed: 11/30/2022] Open
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Abstract
Hospital-associated infection (HAI) in immunocompromised patients can result in high rates of morbidity and mortality. Infections caused by multidrug-resistant organisms (MDROs) are especially worrisome because of the limited choice of remaining antibiotics available when a patient becomes colonized or infected with an MDRO. It is therefore important that immunocompromised patients be cared for in an environment that limits the risk for acquiring infections. However, with healthcare being increasingly delivered in settings other than the traditional inpatient hospital wards, a bigger effort will need to be set forth to prevent or rapidly diagnose HAI. The last few years have seen a significant increase in the number of singleplex and multiplex molecular assays for the detection of many of the organisms responsible for HAI, but more is needed as infections caused by organisms like Legionella pneumophila and Aspergillus species are still diagnosed with methods that have relatively low yield and are slow to provide actionable results. Finally, the use of novel techniques for outbreak investigations will provide new information on transmission of infectious agents in healthcare settings and allow stronger, evidence-based recommendations to be developed for prevention of HAIs in the immunocompromised host.
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Infection of exposed patients during norovirus outbreaks: are there predictive parameters? J Hosp Infect 2017; 96:75-80. [DOI: 10.1016/j.jhin.2017.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 02/15/2017] [Indexed: 01/11/2023]
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Norovirus Disease in Older Adults Living in Long-Term Care Facilities: Strategies for Management. CURRENT GERIATRICS REPORTS 2017; 6:26-33. [PMID: 29204334 DOI: 10.1007/s13670-017-0195-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose of Review Noroviruses are the most common cause of gastroenteritis outbreaks in long-term care facility (LTCFs). This review summarizes the most up-to-date knowledge on norovirus infection in LTCFs with the aim of identifying potential strategies for management. Recent Findings LTCF residents are at greater risk of norovirus infection. Early identification of norovirus infection and prompt initiation of appropriate supportive therapy are required to reduce morbidity and mortality. Measures to prevent outbreaks and reduce the risk of norovirus infection in LTCFs include timely diagnosis and implementation of infection control interventions to limit virus transmission. Summary Current guidelines for prevention and control are based on generic principles of infection control. Real-time reverse transcription-quantitative polymerase chain reaction assays have been the gold standard for the rapid and sensitive detection of noroviruses. With the recent breakthroughs of human norovirus in vitro culture, doors are now opened to evaluate the efficacy of environmental disinfectants and hand hygiene options. Additionally, development of licensed vaccines against noroviruses may provide another important tool for infection prevention among high-risk individuals.
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Aho-Laukkanen E, Hirvonen JJ, Saha K. Comparison of Xpert Norovirus and RidaGene Norovirus assays for the detection of noroviruses in clinical fecal specimens. Eur J Clin Microbiol Infect Dis 2017; 36:1019-1022. [DOI: 10.1007/s10096-016-2884-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/19/2016] [Indexed: 02/01/2023]
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No! When the immunologist becomes a virologist: Norovirus – an emerging infection in immune deficiency diseases. Curr Opin Allergy Clin Immunol 2016; 16:557-564. [DOI: 10.1097/aci.0000000000000323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kampmeier S, Pettke A, Kossow A, Willems S, Mellmann A. Norovirus infections in a tertiary care centre - individual cases do not necessarily lead to an outbreak. J Clin Virol 2016; 84:39-41. [PMID: 27701033 DOI: 10.1016/j.jcv.2016.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 07/25/2016] [Accepted: 09/29/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Norovirus is responsible for the majority of gastroenteritis outbreaks within healthcare settings. Routes of spread include foodborne-, waterborne- and especially person-to-person transmissions. OBJECTIVE We investigated the overall attack rate of norovirus, within and outside outbreak situations, transmitted via patient-to-patient contact in a tertiary care centre from January 2012 to March 2015. STUDY DESIGN We monitored exposed asymptomatic patients next to infectious patients for the development of symptoms of acute gastroenteritis following exposure. RESULTS We detected 102 patients with contact to 94 infectious patients. Of these only 11 patients developed typical norovirus symptoms after exposure while 91 patients remained asymptomatic. Total secondary attack rate was only 10.8%. CONCLUSIONS Patient-to-patient transmission of norovirus is potentially overestimated within clinical settings. Future prevention strategies should consider personal risk factors of exposed patients.
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Affiliation(s)
| | - Aleksandra Pettke
- Institute of Medical Microbiology - Clinical Virology, University Hospital Muenster, Muenster, Germany
| | - Annelene Kossow
- Institute of Hygiene, University Hospital Muenster, Muenster, Germany
| | - Stefanie Willems
- Institute of Hygiene, University Hospital Muenster, Muenster, Germany
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Assab R, Temime L. The role of hand hygiene in controlling norovirus spread in nursing homes. BMC Infect Dis 2016; 16:395. [PMID: 27507065 PMCID: PMC4977681 DOI: 10.1186/s12879-016-1702-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/08/2016] [Indexed: 01/16/2023] Open
Abstract
Background Norovirus, the leading cause of gastroenteritis, causes higher morbidity and mortality in nursing homes (NHs) than in the community. Hence, implementing infection control measures is crucial. However, the evidence on the effectiveness of these measures in NH settings is lacking. Using an innovative data-driven modeling approach, we assess various interventions to control norovirus spread in NHs. Methods We collected data on resident and staff characteristics and inter-human contacts in a French NH. Based on this data, we developed a stochastic compartmental model of norovirus transmission among the residents and staff of a 100-bed NH. Using this model, we investigated how the size of a 100-day norovirus outbreak changed following three interventions: increasing hand hygiene (HH) among the staff or residents and isolating symptomatic residents. Results Assuming a baseline staff HH compliance rate of 15 %, the model predicted on average 19 gastroenteritis cases over 100 days among the residents, which is consistent with published incidence data in NHs. Isolating symptomatic residents was highly effective, leading to an 88 % reduction in the predicted number of cases. The number of expected cases could also be reduced significantly by increasing HH compliance among the staff; for instance, by 75 % when assuming a 60 % HH compliance rate. While there was a linear reduction in the predicted number of cases when HH practices among residents increased, the achieved impact was less important. Conclusions This study shows that simple interventions can help control the spread of norovirus in NHs. Modeling, which has seldom been used in these settings, may be a useful tool for decision makers to design optimal and cost-effective control strategies.
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Affiliation(s)
- Rania Assab
- Laboratoire MESuRS, Conservatoire National des Arts et Métiers, 292 Rue Saint-Martin, 75003, Paris, France.
| | - Laura Temime
- Laboratoire MESuRS, Conservatoire National des Arts et Métiers, 292 Rue Saint-Martin, 75003, Paris, France
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Currie K, Price L, Curran E, Bunyan D, Knussen C. Acceptability of temporary suspension of visiting during norovirus outbreaks: investigating patient, visitor and public opinion. J Hosp Infect 2016; 93:121-6. [PMID: 26874935 PMCID: PMC4898206 DOI: 10.1016/j.jhin.2015.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/01/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND Noroviruses are a leading cause of outbreaks globally and the most common cause of service disruption due to ward closures. Temporary suspension of visiting (TSV) is increasingly a recommended public health measure to reduce exposure, transmission and impact during norovirus outbreaks; however, preventing patient-visitor contact may contravene the ethos of person-centred care, and public acceptability of this measure is not known. AIM To investigate the acceptability of TSV during norovirus outbreaks from the perspectives of patients, visitors and the wider public. METHODS Cross-sectional survey of patients (N = 153), visitors (N = 175) and the public (N = 224) in three diverse areas in Scotland. Health Belief Model constructs were applied to understand ratings of acceptability of TSV during norovirus outbreaks, and to determine associations between these levels and various predictor variables. FINDINGS The majority (84.6%) of respondents indicated that the possible benefits of TSV are greater than the possible disadvantages. Conversely, the majority (70%) of respondents disagreed that TSV 'is wrong as it ignores people's rights to have contact with family and friends'. The majority (81.6%) of respondents agreed that TSV would be more acceptable if exceptions were made for seriously ill or dying patients. Correlational analysis demonstrated that overall acceptability was positively related to perceived severity (r = 0.65), identified benefits (r = 0.54) and implementing additional communication strategies (r = 0.60); acceptability was negatively related to potential barriers (r = -0.49). CONCLUSIONS There is greater service user and public support for the use of TSV than concerns around impinging upon patients' rights to have visitors. TSV should be considered as an acceptable infection control measure that could be implemented consistently during norovirus outbreaks.
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Affiliation(s)
- K Currie
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK.
| | - L Price
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - E Curran
- Health Protection Scotland, Glasgow, UK
| | - D Bunyan
- Health Protection Scotland, Glasgow, UK
| | - C Knussen
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
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O'Brien SJ, Donaldson AL, Iturriza-Gomara M, Tam CC. Age-Specific Incidence Rates for Norovirus in the Community and Presenting to Primary Healthcare Facilities in the United Kingdom. J Infect Dis 2016; 213 Suppl 1:S15-8. [PMID: 26744427 DOI: 10.1093/infdis/jiv411] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In a prospective, population-based cohort study and a study of primary-healthcare consultations, we had a rare opportunity to estimate age-specific rates of norovirus-associated infectious intestinal disease in the United Kingdom. Rates in children aged <5 years were significantly higher than those for other age groups in the community (142.6 cases per 1000 person-years [95% confidence interval {CI}, 99.8-203.9] vs 37.6 [95% CI, 31.5-44.7]) and those for individuals presenting to primary healthcare (14.4 cases per 1000 person-years [95% CI, 8.5-24.5] vs 1.4 [95% CI, .9-2.0]). Robust incidence estimates are crucial for vaccination policy makers. This study emphasises the impact of norovirus-associated infectious intestinal disease, especially in children aged <5 years.
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Affiliation(s)
- Sarah J O'Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool Epidemiology and Population Health The Farr Institute@HeRC, Liverpool, United Kingdom
| | - Anna L Donaldson
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool Epidemiology and Population Health
| | - Miren Iturriza-Gomara
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool Clinical Infection, Microbiology, and Immunology, University of Liverpool Institute of Infection and Global Health
| | - Clarence C Tam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Zboromyrska Y, Vila J. Advanced PCR-based molecular diagnosis of gastrointestinal infections: challenges and opportunities. Expert Rev Mol Diagn 2016; 16:631-40. [PMID: 26986537 DOI: 10.1586/14737159.2016.1167599] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Acute infections of the gastrointestinal tract are among the most common infectious diseases. The etiological agents of gastroenteritis may be bacteria, viruses or protozoa. Identification of the etiological agents of acute diarrhea is important for the treatment and management of diarrheal diseases. Conventional stool culture for bacteria shows a low sensitivity and requires more than 24 hours. In addition, other approaches to detect viruses and protozoa mainly involve antigen detection, but this is not available for all enteropathogens, and microscopic observation requires training and is of low sensitivity. In this review, the authors describe currently available molecular methods to detect different enteropathogens and analyze the main advantages and disadvantages of these methods for laboratory diagnosis of gastroenteritis.
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Affiliation(s)
- Yuliya Zboromyrska
- a Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, School of Medicine , University of Barcelona , Barcelona , Spain.,b ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, University of Barcelona , Barcelona , Spain
| | - Jordi Vila
- a Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, School of Medicine , University of Barcelona , Barcelona , Spain.,b ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, University of Barcelona , Barcelona , Spain
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Cummins M, Ready D. Role of the Hospital Environment in Norovirus Containment. J Infect Dis 2016; 213 Suppl 1:S12-4. [DOI: 10.1093/infdis/jiv529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Curran ET, Wilson J, Haig CE, McCowan C, Leanord A, Loveday H. The Where is Norovirus Control Lost (WINCL) Study: an enhanced surveillance project to identify norovirus index cases in care settings in the UK and Ireland. J Infect Prev 2016; 17:8-14. [PMID: 28989447 PMCID: PMC5074184 DOI: 10.1177/1757177415613133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/26/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Norovirus outbreaks have a significant impact on all care settings; little is known about the index cases from whom these outbreaks initiate. AIM To identify and categorise norovirus outbreak index cases in care settings. METHODS A mixed-methods, multi-centre, prospective, enhanced surveillance study identified and categorised index cases in acute and non-acute care settings. RESULTS From 54 participating centres, 537 outbreaks were reported (November 2013 to April 2014): 383 (71.3%) in acute care facilities (ACF); 115 (21.4%) in residential or care homes (RCH) and 39 (7.3%) in other care settings (OCS). Index cases were identified in 424 (79%) outbreaks. Of the 245 index cases who were asymptomatic on admission and not transferred within/into the care setting, 123 (50%) had been an inpatient/resident for 4 days. Four themes emerged: missing the diagnosis, care service under pressure, delay in outbreak control measures and patient/resident location and proximity. CONCLUSION The true index case is commonly not identified as the cause of a norovirus outbreak with at least 50% of index cases being misclassified. Unrecognised norovirus cross-transmission occurs frequently suggesting that either Standard Infection Control Precautions (SICPs) are being insufficiently well applied, and or SICPs are themselves are insufficient to prevent outbreaks.
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Affiliation(s)
| | - Jennie Wilson
- Richard Wells Research Centre, University of West London, UK
| | - Caroline E Haig
- Robertson Centre for Biostatistics, University of Glasgow, UK
| | - Colin McCowan
- Robertson Centre for Biostatistics, University of Glasgow, UK
| | - Alistair Leanord
- Department of Infection, Immunity and Inflammation, University of Glasgow, UK
| | - Heather Loveday
- Richard Wells Research Centre, University of West London, UK
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Zhao Z, Zhang J, Xu ML, Liu ZP, Wang H, Liu M, Yu YY, Sun L, Zhang H, Wu HY. A rapidly new-typed detection of norovirus based on F 0F 1-ATPase molecular motor biosensor. BIOTECHNOL BIOPROC E 2016; 21:128-133. [PMID: 32218681 PMCID: PMC7091097 DOI: 10.1007/s12257-015-0384-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 11/09/2015] [Accepted: 01/18/2016] [Indexed: 11/29/2022]
Abstract
In order to adapt port rapid detection of food borne norovirus, presently we developed a new typed detection method based on F0F1-ATPase molecular motor biosensor. A specific probe was encompassed the conservative region of norovirus and F0F1-ATPase within chromatophore was constructed as a molecular motor biosensor through the "ε-subunit antibody-streptomycin-biotin-probe" system. Norovirus was captured based on probe-RNA specific binding. Our results demonstrated that the Limit of Quantification (LOQ) is 0.005 ng/mL for NV RNA and also demonstrated that this method possesses specificity and none cross-reaction for food borne virus. What's more, the experiment used this method could be accomplished in 1 h. We detected 10 samples by using this method and the results were consistent with RT-PCR results. Overall, based on F0F1-ATPase molecular motors biosensor system we firstly established a new typed detection method for norovirus detection and demonstrated that this method is sensitive and specific and can be used in the rapid detection for food borne virus.
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Affiliation(s)
- Zhuo Zhao
- Technical Center for Safety of Industrial Products, Tianjin Entry-Exit Inspection Quarantine Bureau, Tianjin, 300-308 China
| | - Jie Zhang
- Beijing Entry-Exit Inspection Quarantine Bureau, Beijing, 100-026 China
| | - Mei-Ling Xu
- Linyi Entry-Exit Inspection Quarantine Bureau, Linyi, 276-034 China
| | - Zhi-Peng Liu
- Technical Center for Safety of Industrial Products, Tianjin Entry-Exit Inspection Quarantine Bureau, Tianjin, 300-308 China
| | - Hua Wang
- Technical Center for Safety of Industrial Products, Tianjin Entry-Exit Inspection Quarantine Bureau, Tianjin, 300-308 China
| | - Ming Liu
- Technical Center for Safety of Industrial Products, Tianjin Entry-Exit Inspection Quarantine Bureau, Tianjin, 300-308 China
| | - Yan-Yan Yu
- Technical Center for Safety of Industrial Products, Tianjin Entry-Exit Inspection Quarantine Bureau, Tianjin, 300-308 China
| | - Li Sun
- Technical Center for Safety of Industrial Products, Tianjin Entry-Exit Inspection Quarantine Bureau, Tianjin, 300-308 China
| | - Hui Zhang
- Technical Center for Safety of Industrial Products, Tianjin Entry-Exit Inspection Quarantine Bureau, Tianjin, 300-308 China
| | - Hai-Yan Wu
- Weifang people’s hospital of high-tech industrial development zone, Weifang, 261-205 China
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Surveillance of Food- and Smear-Transmitted Pathogens in European Soldiers with Diarrhea on Deployment in the Tropics: Experience from the European Union Training Mission (EUTM) Mali. BIOMED RESEARCH INTERNATIONAL 2015; 2015:573904. [PMID: 26525953 PMCID: PMC4619819 DOI: 10.1155/2015/573904] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 01/28/2023]
Abstract
Introduction. Since 2013, European soldiers have been deployed on the European Union Training Mission (EUTM) in Mali. From the beginning, diarrhea has been among the most “urgent” concerns. Diarrhea surveillance based on deployable real-time PCR equipment was conducted between December 2013 and August 2014. Material and Methods. In total, 53 stool samples were obtained from 51 soldiers with acute diarrhea. Multiplex PCR panels comprised enteroinvasive bacteria, diarrhea-associated Escherichia coli (EPEC, ETEC, EAEC, and EIEC), enteropathogenic viruses, and protozoa. Noroviruses were characterized by sequencing. Cultural screening for Enterobacteriaceae with extended-spectrum beta-lactamases (ESBL) with subsequent repetitive sequence-based PCR (rep-PCR) typing was performed. Clinical information was assessed. Results. Positive PCR results for diarrhea-associated pathogens were detected in 43/53 samples, comprising EPEC (n = 21), ETEC (n = 19), EAEC (n = 15), Norovirus (n = 10), Shigella spp./EIEC (n = 6), Cryptosporidium parvum (n = 3), Giardia duodenalis (n = 2), Salmonella spp. (n = 1), Astrovirus (n = 1), Rotavirus (n = 1), and Sapovirus (n = 1). ESBL-positive Enterobacteriaceae were grown from 13 out of 48 samples. Simultaneous infections with several enteropathogenic agents were observed in 23 instances. Symptoms were mild to moderate. There were hints of autochthonous transmission. Conclusions. Multiplex real-time PCR proved to be suitable for diarrhea surveillance on deployment. Etiological attribution is challenging in cases of detection of multiple pathogens.
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Boyd KJ, Bansal P, Feng J, May ER. Stability of Norwalk Virus Capsid Protein Interfaces Evaluated by in Silico Nanoindentation. Front Bioeng Biotechnol 2015; 3:103. [PMID: 26284238 PMCID: PMC4520240 DOI: 10.3389/fbioe.2015.00103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/10/2015] [Indexed: 01/17/2023] Open
Abstract
Norwalk virus causes severe gastroenteritis for which there is currently no specific anti-viral therapy. A stage of the infection process is uncoating of the protein capsid to expose the viral genome and allow for viral replication. A mechanical characterization of the Norwalk virus may provide important information relating to the mechanism of uncoating. The mechanical strength of the Norwalk virus has previously been investigated using atomic force microscopy (AFM) nanoindentation experiments. Those experiments cannot resolve specific molecular interactions, and therefore, we have employed a molecular modeling approach to gain insights into the potential uncoating mechanism of the Norwalk capsid. In this study, we perform simulated nanoindentation using a coarse-grained structure-based model, which provides an estimate of the spring constant in good agreement with the experimentally determined value. We further analyze the fracture mechanisms and determine weak interfaces in the capsid structure, which are potential sites to inhibit uncoating by stabilization of these weak interfaces. We conclude by identifying potential target sites at the junction of a weak protein–protein interface.
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Affiliation(s)
- Kevin J Boyd
- Department of Molecular and Cell Biology, University of Connecticut , Storrs, CT , USA
| | - Prakhar Bansal
- Department of Molecular and Cell Biology, University of Connecticut , Storrs, CT , USA
| | - Jun Feng
- Department of Chemistry, West Virginia University , Morgantown, WV , USA
| | - Eric R May
- Department of Molecular and Cell Biology, University of Connecticut , Storrs, CT , USA
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Ayukekbong JA, Mesumbe HN, Oyero OG, Lindh M, Bergström T. Role of noroviruses as aetiological agents of diarrhoea in developing countries. J Gen Virol 2015; 96:1983-1999. [PMID: 26002299 DOI: 10.1099/vir.0.000194] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Diarrhoea is considered to be the second leading cause of death due to infections among children < 5 years of age worldwide that may be caused by bacteria, parasites, viruses and non-infectious agents. The major causative agents of diarrhoea in developing countries may vary from those in developed countries. Noroviruses are considered to be the most common cause of acute diarrhoea in both children and adults in industrialized countries. On the other hand, there is a lack of comprehensive epidemiological evidence from developing countries that norovirus is a major cause of diarrhoea. In these regions, asymptomatic norovirus infections are very common, and similar detection rates have been observed in patients with diarrhoea and asymptomatic persons. This review summarizes the current knowledge of norovirus infection in developing countries and seeks to position infections with noroviruses among those of other enteropathogens in terms of disease burden in these regions.
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Affiliation(s)
- James Ayukepi Ayukekbong
- Section for Clinical Research, Redeem Biomedical System, Buea, Cameroon
- Department of Infectious Diseases/Section of Clinical Virology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Olufunmilayo G Oyero
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
| | - Magnus Lindh
- Department of Infectious Diseases/Section of Clinical Virology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Tomas Bergström
- Department of Infectious Diseases/Section of Clinical Virology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
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Bonifait L, Charlebois R, Vimont A, Turgeon N, Veillette M, Longtin Y, Jean J, Duchaine C. Detection and quantification of airborne norovirus during outbreaks in healthcare facilities. Clin Infect Dis 2015; 61:299-304. [PMID: 25900175 DOI: 10.1093/cid/civ321] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 03/24/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Noroviruses are responsible for at least 50% of all gastroenteritis outbreaks worldwide. Noroviruses GII can infect humans via multiple routes including direct contact with an infected person, fecal matter, or vomitus, and contact with contaminated surfaces. Although norovirus is an intestinal pathogen, aerosols could, if inhaled, settle in the pharynx and later be swallowed. The aims of this study were to investigate the presence of norovirus GII bioaerosols during gastroenteritis outbreaks in healthcare facilities and to study the in vitro effects of aerosolization and air sampling on the noroviruses using murine norovirus as a surrogate. METHODS A total of 48 air samples were collected during norovirus outbreaks in 8 healthcare facilities. Samples were taken 1 m away from each patient, in front of the patient's room and at the nurses' station. The resistance to aerosolization stress of murine norovirus type 1 (MNV-1) bioaerosols was also tested in vitro using an aerosol chamber. RESULTS Norovirus genomes were detected in 6 of 8 healthcare centers. The concentrations ranged from 1.35 × 10(1) to 2.35 × 10(3) genomes/m(3) in 47% of air samples. MNV-1 preserved its infectivity and integrity during in vitro aerosol studies. CONCLUSIONS Norovirus genomes are frequently detected in the air of healthcare facilities during outbreaks, even outside patients' rooms. In addition, in vitro models suggest that this virus may withstand aerosolization.
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Affiliation(s)
- Laetitia Bonifait
- Centre de recherche de l'institut universitaire de cardiologie et de pneumologie de Québec
| | - Rémi Charlebois
- Centre de recherche de l'institut universitaire de cardiologie et de pneumologie de Québec
| | - Allison Vimont
- Institut sur la nutrition et les aliments fonctionnels, Laval University, Quebec
| | - Nathalie Turgeon
- Centre de recherche de l'institut universitaire de cardiologie et de pneumologie de Québec
| | - Marc Veillette
- Centre de recherche de l'institut universitaire de cardiologie et de pneumologie de Québec
| | - Yves Longtin
- Lady Davis Institute of Medical Research at the Jewish General Hospital and McGill University Faculty of Medicine, Montreal
| | - Julie Jean
- Institut sur la nutrition et les aliments fonctionnels, Laval University, Quebec Département des sciences des aliments et de nutrition, Faculté des sciences de l'agriculture et de l'alimentation
| | - Caroline Duchaine
- Centre de recherche de l'institut universitaire de cardiologie et de pneumologie de Québec Département de biochimie, de microbiologie et de bio-informatique, Faculté des sciences et de génie, Laval University, Quebec, Canada
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Kankanamalage ACG, Kim Y, Weerawarna PM, Uy RAZ, Damalanka VC, Mandadapu SR, Alliston KR, Mehzabeen N, Battaile KP, Lovell S, Chang KO, Groutas WC. Structure-guided design and optimization of dipeptidyl inhibitors of norovirus 3CL protease. Structure-activity relationships and biochemical, X-ray crystallographic, cell-based, and in vivo studies. J Med Chem 2015; 58:3144-55. [PMID: 25761614 PMCID: PMC4484267 DOI: 10.1021/jm5019934] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Norovirus infection constitutes the primary cause of acute viral gastroenteritis. There are currently no vaccines or norovirus-specific antiviral therapeutics available for the management of norovirus infection. Norovirus 3C-like protease is essential for viral replication, consequently, inhibition of this enzyme is a fruitful avenue of investigation that may lead to the emergence of antinorovirus therapeutics. We describe herein the optimization of dipeptidyl inhibitors of norovirus 3C-like protease using iterative SAR, X-ray crystallographic, and enzyme and cell-based studies. We also demonstrate herein in vivo efficacy of an inhibitor using the murine model of norovirus infection.
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Affiliation(s)
| | - Yunjeong Kim
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506
| | | | | | | | | | - Kevin R. Alliston
- Department of Chemistry, Wichita State University, Wichita, Kansas 67260
| | - Nurjahan Mehzabeen
- Protein Structure Laboratory, The University of Kansas, Lawrence, Kansas 66047
| | - Kevin P. Battaile
- IMCA-CAT, Hauptman-Woodward Medical Research Institute, APS Argonne National Laboratory, Argonne, IL 60439
| | - Scott Lovell
- Protein Structure Laboratory, The University of Kansas, Lawrence, Kansas 66047
| | - Kyeong-Ok Chang
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506
| | - William C. Groutas
- Protein Structure Laboratory, The University of Kansas, Lawrence, Kansas 66047
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