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Lindesmith LC, Brewer-Jensen PD, Conrad H, O’Reilly KM, Mallory ML, Kelly D, Williams R, Edmunds WJ, Allen DJ, Breuer J, Baric RS. Emergent variant modeling of the serological repertoire to norovirus in young children. Cell Rep Med 2023; 4:100954. [PMID: 36854303 PMCID: PMC10040388 DOI: 10.1016/j.xcrm.2023.100954] [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: 09/14/2022] [Revised: 12/05/2022] [Accepted: 02/02/2023] [Indexed: 03/02/2023]
Abstract
Human norovirus is the leading cause of acute gastroenteritis. Young children and the elderly bear the greatest burden of disease, representing more than 200,000 deaths annually. Infection prevalence peaks at younger than 2 years and is driven by novel GII.4 variants that emerge and spread globally. Using a surrogate neutralization assay, we characterize the evolution of the serological neutralizing antibody (nAb) landscape in young children as they transition between sequential GII.4 pandemic variants. Following upsurge of the replacement variant, antigenic cartography illustrates remodeling of the nAb landscape to the new variant accompanied by improved nAb titer. However, nAb relative avidity remains focused on the preceding variant. These data support immune imprinting as a mechanism of immune evasion and GII.4 virus persistence across a population. Understanding the complexities of immunity to rapidly evolving and co-circulating viral variants, like those of norovirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), and dengue viruses, will fundamentally inform vaccine design for emerging pathogens.
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Affiliation(s)
- Lisa C. Lindesmith
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Paul D. Brewer-Jensen
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Helen Conrad
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kathleen M. O’Reilly
- Centre for Mathematical Modelling of Infectious Diseases and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1EW 7HT, UK
| | - Michael L. Mallory
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Daniel Kelly
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Rachel Williams
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
- Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - W. John Edmunds
- Centre for Mathematical Modelling of Infectious Diseases and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1EW 7HT, UK
| | - David J. Allen
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Judith Breuer
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
- Department of Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Ralph S. Baric
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Cornejo-Sánchez T, Soldevila N, Coronas L, Alsedà M, Godoy P, Razquín E, Sabaté S, Guix S, Rodríguez Garrido V, Bartolomé R, Domínguez A, Belver AI, Camps N, Minguell S, Carol M, Izquierdo C, Parrón I, Pérez C, Rovira A, Sabaté M, Sala MR, Vileu RM, Barrabeig I, Jané M, Martínez A, Torner N, de Benito J, Moreno-Martínez A, Rius C, de Andres A, Camprubí E, Cunillé M, Forns ML, de Simón M. Epidemiology of GII.4 and GII.2 norovirus outbreaks in closed and semi-closed institutions in 2017 and 2018. Sci Rep 2023; 13:1659. [PMID: 36717621 PMCID: PMC9886968 DOI: 10.1038/s41598-023-28448-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 01/18/2023] [Indexed: 01/31/2023] Open
Abstract
Norovirus infections are a leading cause of acute gastroenteritis outbreaks worldwide, with genotypes GII.2 and GII.4 being the most prevalent. The aim of this study was to compare the characteristics of GII.2 and GII.4 norovirus outbreaks reported in Catalonia in closed or semi-closed institutions in 2017 and 2018. The epidemiological and clinical characteristics of GII.2 and GII.4 outbreaks were compared using the chi-square test or Fisher's exact test for categorical variables and the Mann-Whitney U test for continuous variables. Odds ratios and their 95% confidence intervals were estimated. 61 outbreaks were reported: GII.4 was the causative agent in 12 outbreaks (30%) and GII.2 in 9 outbreaks (22.5%). GII.2 outbreaks were detected more frequently in schools or summer camps (66.7%) and GII.4 outbreaks in nursing homes (91.7%) (p = 0.01). Ninety-three people were affected in GII.2 outbreaks and 94 in GII.4 outbreaks. The median age was 15 years (range: 1-95 years) in GII.2 outbreaks and 86 years (range: 0-100 years) in GII.4 outbreaks (p < 0.001). Nausea, abdominal pain, and headache were observed more frequently in persons affected by GII.2 outbreaks (p < 0.05). Symptomatic cases presented a higher viral load suggestive of greater transmission capacity, although asymptomatic patients presented relevant loads indicative of transmission capacity.
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Affiliation(s)
| | - Núria Soldevila
- CIBER Epidemiología y Salut Pública (CIBERSP), Madrid, Spain. .,Departament de Medicina, Universitat de Barcelona, Barcelona, Spain.
| | - Lorena Coronas
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain.,Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Miquel Alsedà
- Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Pere Godoy
- CIBER Epidemiología y Salut Pública (CIBERSP), Madrid, Spain.,Agència de Salut Pública de Catalunya, Barcelona, Spain.,Institut de Recerca Biomédica de Lleida, IRB Lleida, Lleida, Spain
| | - Efrén Razquín
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Sara Sabaté
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Susana Guix
- Departament de Genètica Microbiologia i Estadística, Grup de Virus Entèrics, Universitat de Barcelona, Barcelona, Spain.,Nutrition and Food Safety Research Institute (INSA·UB), Universitat de Barcelona, 08921, Santa Coloma de Gramenet, Spain
| | | | - Rosa Bartolomé
- Laboratori de Microbiologia, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Angela Domínguez
- CIBER Epidemiología y Salut Pública (CIBERSP), Madrid, Spain.,Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
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Donaldson AL, Harris JP, Vivancos R, O'Brien SJ. Can cases and outbreaks of norovirus in children provide an early warning of seasonal norovirus infection: an analysis of nine seasons of surveillance data in England UK. BMC Public Health 2022; 22:1393. [PMID: 35858892 PMCID: PMC9301858 DOI: 10.1186/s12889-022-13771-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background Children are important transmitters of norovirus infection and there is evidence that laboratory reports in children increase earlier in the norovirus season than in adults. This raises the question as to whether cases and outbreaks in children could provide an early warning of seasonal norovirus before cases start increasing in older, more vulnerable age groups. Methods This study uses weekly national surveillance data on reported outbreaks within schools, care homes and hospitals, general practice (GP) consultations for infectious intestinal disease (IID), telehealth calls for diarrhoea and/or vomiting and laboratory norovirus reports from across England, UK for nine norovirus seasons (2010/11–2018/19). Lagged correlation analysis was undertaken to identify lead or lag times between cases in children and those in adults for each surveillance dataset. A partial correlation analysis explored whether school outbreaks provided a lead time ahead of other surveillance indicators, controlling for breaks in the data due to school holidays. A breakpoint analysis was used to identify which surveillance indicator and age group provided the earliest warning of the norovirus season each year. Results School outbreaks occurred 3-weeks before care home and hospital outbreaks, norovirus laboratory reports and NHS 111 calls for diarrhoea, and provided a 2-week lead time ahead of NHS 111 calls for vomiting. Children provided a lead time ahead of adults for norovirus laboratory reports (+ 1–2 weeks), NHS 111 calls for vomiting (+ 1 week) and NHS 111 calls for diarrhoea (+ 1 week) but occurred concurrently with adults for GP consultations. Breakpoint analysis revealed an earlier seasonal increase in cases among children compared to adults for laboratory, GP and NHS 111 data, with school outbreaks increasing earlier than other surveillance indicators in five out of nine surveillance years. Conclusion These findings suggest that monitoring cases and outbreaks of norovirus in children could provide an early warning of seasonal norovirus infection. However, both school outbreak data and syndromic surveillance data are not norovirus specific and will also capture other causes of IID. The use of school outbreak data as an early warning indicator may be improved by enhancing sampling in community outbreaks to confirm the causative organism.
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Affiliation(s)
- Anna L Donaldson
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK. .,Institute of Population Health, University of Liverpool, 2nd Floor, Block F, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool, L69 3GL, UK. .,Field Epidemiology Service, Public Health England, Liverpool, UK.
| | - John P Harris
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,Institute of Population Health, University of Liverpool, 2nd Floor, Block F, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool, L69 3GL, UK.,Cumbria and Lancashire Health Protection Team, Public Health England, Preston, UK
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,Field Epidemiology Service, Public Health England, Liverpool, UK
| | - Sarah J O'Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,Institute of Population Health, University of Liverpool, 2nd Floor, Block F, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
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Donaldson AL, Harris JP, Vivancos R, O’Brien SJ. Symptom profiling for infectious intestinal disease (IID): Do symptom profiles alter with age? PLoS One 2022; 17:e0269676. [PMID: 35771750 PMCID: PMC9246150 DOI: 10.1371/journal.pone.0269676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 05/25/2022] [Indexed: 11/19/2022] Open
Abstract
Symptom profiles have previously been identified for infectious intestinal disease (IID) which distinguish bacterial from viral organisms. However, there is evidence that the seasonality, severity, and duration of IID may differ between children, adults and elderly. A secondary data analysis was undertaken to explore whether symptom profiles for bacterial and viral IID vary across different age groups. Data from 844 cases of IID were divided into three age categories: <16 years, 16–65 years and >65 years. Multivariable logistic regression modelling was used to compare the significance of different symptoms across the three age groups. The odds of bacterial IID in children were increased by onset in the summer, diarrhoea in the absence of vomiting and fever. These symptoms were also associated with lower odds of a viral pathogen. In adults, diarrhoea but no vomiting, bloody diarrhoea and diarrhoea lasting more than 3 days were associated with increased odds of a bacterial organism, whilst onset in the winter or spring and a loss of appetite were associated with viral IID. In the elderly, diarrhoea in the absence of vomiting and diarrhoea lasting more than 3 days were associated with higher odds of bacterial IID and lower odds of a viral cause. Only diarrhoea in the absence of vomiting emerged as a key symptom across all three age groups. Variation in symptom profiles by age has implications for clinicians, public health specialists and epidemiologists who use symptoms to guide presumptive diagnoses in the absence of microbiological confirmation.
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Affiliation(s)
- Anna L. Donaldson
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
- National Infection Service: Field Epidemiology, Public Health England, Liverpool, United Kingdom
- * E-mail:
| | - John P. Harris
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- National Infection Service: Field Epidemiology, Public Health England, Liverpool, United Kingdom
| | - Sarah J. O’Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
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5
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Donaldson AL, Harris JP, Vivancos R, Hungerford D, Hall I, O'Brien SJ. School Attendance Registers for the Syndromic Surveillance of Infectious Intestinal Disease in UK Children: Protocol for a Retrospective Analysis. JMIR Res Protoc 2022; 11:e30078. [PMID: 35049509 PMCID: PMC8814921 DOI: 10.2196/30078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Infectious intestinal disease (IID) is common, and children are more likely than adults both to have IID and to transmit infection onto others. Before the introduction of the vaccine, rotavirus was the leading cause of severe childhood diarrhea, with norovirus and Campylobacter predominate pathogens. Public health surveillance of IID is primarily based on health care data, and as such, illness that is managed within the community will often go undetected. School attendance registers offer a novel data set that has the potential to identify community cases and outbreaks of IID that would otherwise be missed by current health surveillance systems. Although studies have explored the role of school attendance registers in the monitoring of influenza among children, no studies have been identified that consider this approach in the surveillance of IID. Objective The aim of this study is to explore the role and utility of school attendance registers in the detection and surveillance of IID in children. The secondary aims are to estimate the burden of IID on school absenteeism and to assess the impact of the rotavirus vaccine on illness absence among school-aged children. Methods This study is a retrospective analysis of school attendance registers to investigate whether school absences due to illness can be used to capture seasonal trends and outbreaks of infectious intestinal disease among school-aged children. School absences in Merseyside, United Kingdom will be compared and combined with routine health surveillance data from primary care, laboratories, and telehealth services. These data will be used to model spatial and temporal variations in the incidence of IID and to apportion likely causes to changes in school absenteeism trends. This will be used to assess the potential utility of school attendance data in the surveillance of IID and to estimate the burden of IID absenteeism in schools. It will also inform an analysis of the impact of the rotavirus vaccine on disease within this age group. Results This study has received ethical approval from the University of Liverpool Research Ethics Committee (reference number 1819). Use of general practice data has been approved for the evaluation of rotavirus vaccination in Merseyside by NHS Research Ethics Committee, South Central-Berkshire REC Reference 14/SC/1140. Conclusions This study is unique in considering whether school attendance registers could be used to enhance the surveillance of IID. Such data have multiple potential applications and could improve the identification of outbreaks within schools, allowing early intervention to reduce transmission both within and outside of school settings. These data have the potential to act as an early warning system, identifying infections circulating within the community before they enter health care settings. School attendance data could also inform the evaluation of vaccination programs, such as rotavirus and, in time, norovirus. International Registered Report Identifier (IRRID) DERR1-10.2196/30078
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Affiliation(s)
- Anna L Donaldson
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,Institute of Population Health, University of Liverpool, Liverpool, United Kingdom.,Field Epidemiology Service, Public Health England, Liverpool, United Kingdom
| | - John P Harris
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,Field Epidemiology Service, Public Health England, Liverpool, United Kingdom
| | - Daniel Hungerford
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,Field Epidemiology Service, Public Health England, Liverpool, United Kingdom.,Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Ian Hall
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,Department of Mathematics and School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Sarah J O'Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
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Polkowska A, Räsänen S, Nuorti P, Maunula L, Jalava K. Assessment of Food and Waterborne Viral Outbreaks by Using Field Epidemiologic, Modern Laboratory and Statistical Methods-Lessons Learnt from Seven Major Norovirus Outbreaks in Finland. Pathogens 2021; 10:pathogens10121624. [PMID: 34959579 PMCID: PMC8707936 DOI: 10.3390/pathogens10121624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/17/2022] Open
Abstract
Seven major food- and waterborne norovirus outbreaks in Western Finland during 2014–2018 were re-analysed. The aim was to assess the effectiveness of outbreak investigation tools and evaluate the Kaplan criteria. We summarised epidemiological and microbiological findings from seven outbreaks. To evaluate the Kaplan criteria, a one-stage meta-analysis of data from seven cohort studies was performed. The case was defined as a person attending an implicated function with diarrhoea, vomiting or two other symptoms. Altogether, 22% (386/1794) of persons met the case definition. Overall adjusted, 73% of norovirus patients were vomiting, the mean incubation period was 44 h (4 h to 4 days) and the median duration of illness was 46 h. As vomiting was a more common symptom in children (96%, 143/149) and diarrhoea among the elderly (92%, 24/26), symptom and age presentation should drive hypothesis formulation. The Kaplan criteria were useful in initial outbreak assessments prior to faecal results. Rapid food control inspections enabled evidence-based, public-health-driven risk assessments. This led to probability-based vehicle identification and aided in resolving the outbreak event mechanism rather than implementing potentially ineffective, large-scale public health actions such as the withdrawal of extensive food lots. Asymptomatic food handlers should be ideally withdrawn from high-risk work for five days instead of the current two days. Food and environmental samples often remain negative with norovirus, highlighting the importance of research collaborations. Electronic questionnaire and open-source novel statistical programmes provided time and resource savings. The public health approach proved useful within the environmental health area with shoe leather field epidemiology, combined with statistical analysis and mathematical reasoning.
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Affiliation(s)
- Aleksandra Polkowska
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, 33100 Tampere, Finland; (A.P.); (P.N.)
| | - Sirpa Räsänen
- Pirkanmaa Hospital District, 33520 Tampere, Finland;
| | - Pekka Nuorti
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, 33100 Tampere, Finland; (A.P.); (P.N.)
| | - Leena Maunula
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, 00100 Helsinki, Finland;
| | - Katri Jalava
- Department of Mathematics and Statistics, Faculty of Social Sciences, University of Helsinki, 00100 Helsinki, Finland
- Correspondence: ; Tel.: +44-73-4224-7186
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7
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Safadi MA, Riera-Montes M, Bravo L, Tangsathapornpong A, Lagos R, Thisyakorn U, Linhares AC, Capeding R, Prommalikit O, Verstraeten T, O'Ryan M. The burden of norovirus disease in children: a multi-country study in Chile, Brazil, Thailand and the Philippines. Int J Infect Dis 2021; 109:77-84. [PMID: 34166792 DOI: 10.1016/j.ijid.2021.06.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Noroviruses (NoVs) cause acute gastroenteritis (AGE) worldwide, affecting children in particular. We aimed to estimate the burden of disease due to NoV among children aged <6 years in Brazil, Chile, Philippines and Thailand. METHODS This was a prospective, hospital-based, observational study. Children were recruited over one year between 2014 and 2017. Four cohorts were analysed: community-acquired AGE outpatients and inpatients, nosocomial AGE inpatients, and asymptomatic outpatients. We collected demographic and clinical data, and a stool sample that was tested for NoV. Positive samples were tested for Rotavirus (RV) and NoV-genotyped. Disease severity was assessed by the Vesikari and modified Vesikari scores. Prevalence and incidence of NoV-AGE were estimated by cohort and country. RESULTS 1637 participants yielded valid laboratory results. The proportion of NoV-positive cases was 23.8% (95% CI 20.8-27.2) in the outpatient cohort, 17.9% (15.0-21.3) in the hospital cohort, 21.4% (12.7-33.8) in the nosocomial cohort and 9.6% (6.9-13.2) in the asymptomatic cohort. Genotype GII.4 was predominant (58%). Less than 4% samples had RV coinfection. In general, NoV-positive subjects had more severe presentations than NoV-negative subjects. CONCLUSIONS NoV caused AGE with substantial burden throughout the studied settings, with higher relative frequency in Brazil where RV vaccination coverage is high.
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Affiliation(s)
- Marco Aurelio Safadi
- Department of Pediatrics, Santa Casa de Sao Paulo School of Medical Sciences, Sao Paulo, Brazil
| | | | - Lulu Bravo
- University of the Philippines Manila, Manila, the Philippines
| | | | - Rosanna Lagos
- Centre for Vaccine Development, Hospital de Niños Roberto del Rio, Santiago, Chile
| | - Usa Thisyakorn
- Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand
| | | | - Rose Capeding
- Research Institute for Tropical Medicine, Muntinlupa City, Manila Metro, Philippines
| | | | | | - Miguel O'Ryan
- Microbiology and Mycology Program, Institute of Biomedical Sciences, and Millenium Institute on Immunology and Immunotherapy, Faculty of Medicine, University of Chile, Chile.
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8
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Derrick J, Hollinghurst P, O'Brien S, Elviss N, Allen DJ, Iturriza-Gómara M. Measuring transfer of human norovirus during sandwich production: Simulating the role of food, food handlers and the environment. Int J Food Microbiol 2021; 348:109151. [PMID: 33940535 DOI: 10.1016/j.ijfoodmicro.2021.109151] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
Foodborne outbreaks associated with transmission of norovirus are increasingly becoming a public health concern. Foods can be contaminated with faecal material at the point of production or during food preparation, in both the home and in commercial premises. Transmission of norovirus occurs through the faecal-oral route, either via person-to-person contact or through faecal-contamination of food, water, or environmental surfaces. Understanding the role and pathways of norovirus transmission - either via food handlers' hands, contaminated foods or the environment - remains a key public health priority to reduce the burden of norovirus-associated gastroenteritis. However the proportion of norovirus that is typically transferred remains unknown. Understanding this is necessary to estimate the risk of infection and the burden of gastroenteritis caused by norovirus. In this paper we present a novel method of capture, concentration and molecular detection of norovirus from a wider range of complex food matrices than those demonstrated in existing published methods. We demonstrate that this method can be used as a tool to detect and quantify norovirus from naturally contaminated food, and for monitoring norovirus transfer between food handlers' gloved hands, food or the environment. We measure the effect of introducing contamination at different food production process stages, to the final food product, to determine whether this could cause infection and disease. Between 5.9 and 6.3 Log10 cDNA copies/μl of norovirus GII were inoculated onto food handlers' gloved hands, food or the environment and 1.1-7.4% of norovirus contamination was recovered from all samples tested. When interpreted quantitatively, this percentage equates to levels predicted to be sufficient to cause infection and disease through consumption of the final food product, demonstrating a public health risk. Overall detection and quantification of norovirus from foods, food handlers' gloved hands and the environment, when suspected to be implicated in foodborne transmissions, is paramount for appropriate outbreak investigation.
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Affiliation(s)
- Jade Derrick
- Virus Reference Department, National Infections Service, Public Health England, London, UK.
| | - Philippa Hollinghurst
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah O'Brien
- School of Natural and Environmental Sciences, Newcastle University, Newcastle, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, UK
| | - Nicola Elviss
- Food, Water and Environmental Microbiology Services, National Infections Service, Public Health England, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, UK
| | - David J Allen
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, UK
| | - Miren Iturriza-Gómara
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, UK
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9
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Guarines KM, Mendes RPG, de Magalhães JJF, Pena L. Norovirus-associated gastroenteritis, Pernambuco, Northeast Brazil, 2014-2017. J Med Virol 2019; 92:1093-1101. [PMID: 31743458 DOI: 10.1002/jmv.25631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/15/2019] [Indexed: 12/18/2022]
Abstract
Norovirus (NoV) is currently the leading cause of nonbacterial gastroenteritis. In Brazil, few studies have characterized the molecular, epidemiological and clinical features of NoV-associated gastroenteritis. This study aimed to describe the molecular and clinicoepidemiological findings of NoV infections in patients of all ages throughout Pernambuco state, Northeast Brazil. Thus, 1135 stool samples were analyzed from patients with gastroenteritis from Pernambuco state. NoV was detected by enzyme immunoassay in 125 (11.01%) samples. Regarding gender distribution, 55 (44.00%) patients were female and 70 (56.00%) male. Their ages ranged from 5 days to 87 years, and the group most affected by NoV infection (88.00%) was children under 3 years. Complete clinical information was available for 88 out of 125 NoV-positive patients. Diarrhea was present in all patients and vomiting was reported in 60 patients (68.68%). Nine patients (10.22%) had bloody stools and 46 (52.27%) had a fever, with temperatures ranging from 37.90°C to 39.90°C (mean 38.20°C). NoV was detected mainly in the summer-autumn seasons. Genome sequencing and phylogenetic analyses identified four different NoV GII genotypes circulating in this area of the country. Therefore, our study provided valuable information about the clinics and epidemiology of NoV infection in tropical settings and will assist health authorities to develop better control strategies against this important pathogen.
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Affiliation(s)
- Klarissa M Guarines
- Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil
| | - Renata P G Mendes
- Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil
| | - Jurandy J F de Magalhães
- Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil.,Department of Virology, Pernambuco State Central Laboratory (LACEN/PE), Recife, Pernambuco, Brazil
| | - Lindomar Pena
- Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil
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Harris JP, Iturriza-Gomara M, O'Brien SJ. Estimating Disability-Adjusted Life Years (DALYs) in Community Cases of Norovirus in England. Viruses 2019; 11:v11020184. [PMID: 30795617 PMCID: PMC6410119 DOI: 10.3390/v11020184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 12/14/2022] Open
Abstract
Disability adjusted life years (DALYs) have been used since the 1990s. It is a composite measure of years of life lost with years lived with disability. Essentially, one DALY is the equivalent of a year of healthy life lost if a person had not experienced disease. Norovirus is the most common cause of gastrointestinal diseases worldwide. Norovirus activity varies from one season to the next for reasons not fully explained. Infection with norovirus is generally not severe, and is normally characterized as mild and self-limiting with no long-term sequelae. In this study, we model a range of estimates of DALYs for community cases of norovirus in England and Wales. We estimated a range of DALYs for norovirus to account for mixing of the severity of disease and the range of length of illness experienced by infected people. Our estimates were between 1159 and 4283 DALYs per year, or 0.3⁻1.2 years of healthy life lost per thousand cases of norovirus. These estimates provide evidence that norovirus leads to a considerable level of ill health in England and Wales. This information will be helpful should candidate norovirus vaccines become available in the future.
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Affiliation(s)
- John P Harris
- Institute of Population Health Sciences, University of Liverpool, Liverpool, L69 3GL, UK.
- National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Gastrointestinal Infections, Liverpool, L69 3GL, UK.
| | - Miren Iturriza-Gomara
- National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Gastrointestinal Infections, Liverpool, L69 3GL, UK.
- Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK.
| | - Sarah J O'Brien
- Institute of Population Health Sciences, University of Liverpool, Liverpool, L69 3GL, UK.
- National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Gastrointestinal Infections, Liverpool, L69 3GL, UK.
- Modelling, Evidence and Policy Research Group, School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK.
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