An outbreak of rotavirus infection among adults in a cardiology ward

An outbreak of rotavirus infection among adults in an institution for rehabilitation: long-term residence in a closed community as a risk factor for rotavirus illness

An outbreak of group A rotavirus infection resulted in gastroenteritis among disabled adults in an isolated rehabilitation institution in Kobe, Japan. Of the 95 residents, 16 were diagnosed with rotavirus illness. The causative agent was a single strain of typical human group A rotavirus belonging to VP7 serotype G2, VP4 genotype P[4], and NSP4 genotype A. Mean duration of stay was significantly longer for residents with rotavirus illness (22.1+/-11.8 years) than for residents without the disease (13.5+/-10.6 years; P=0.01). Age, sex, disability and location of resident rooms displayed no significant relationships with illness. These observations suggest that long-term residence in a closed community, which might be related to absence of immuno-stimulation, represents a risk factor for rotavirus illness.

Molecular epidemiologic analysis of group A rotaviruses in adults and children with diarrhea in Wuhan city, China, 2000-2006

To compare epidemiologic features and genetic characteristics of group A rotaviruses causing diarrhea in children and adults, a survey was conducted in Wuhan, China, during the period of Dec. 2000-May 2006. A total of 3839 stool specimens from diarrheal patients from eight hospitals were analyzed. Winter seasonality was observed for rotavirus diarrhea in both adults and children, showing overall rotavirus-positive rates of 9.0 and 23.9%, respectively. Throughout the study period, G3 was the most frequent G serotype in both adults and children (detection rates 86.2 and 87.8%, respectively), and was mostly associated with VP4 genotype P[8], VP 6 genotype II (subgroup II), and NSP4 genotype B. G3 rotaviruses were differentiated into eight electropherotypes, among which seven types were found in specimens from both adults and children. VP7 gene sequences of G3 rotaviruses from adults and children (6 and 4 strains, respectively), detected in different years and different hospitals, showed extremely high sequence identities (99-100%) to each other and to a few G3 rotavirus strains reported in Asia. However, lower sequence identities (82-96%) were observed to most of the human and animal G3 rotaviruses reported so far, including some Chinese strains. These findings indicate that in Wuhan, China, epidemic and genetic features of rotaviruses are similar in adults and children, and it has been suggested that G3 rotaviruses that might have originated from the same rotavirus were circulating among children and adults as prevailing viruses. In this study, two rotavirus strains, G9P[8] strain L169, derived from an adult, and G4P[6] strain R479, derived from a child, were isolated and genetically analyzed. The VP7 gene of L169 belongs to a major lineage of G9 rotaviruses that are globally widespread, but is distinct from G9 rotaviruses reported previously in China. The strain R479 had a VP7 gene which was divergent from most G4 human rotaviruses and showed an unusual dual subgroup specificity, I + II. The R479 VP6 gene does not belong to the main clusters of subgroup I and II rotaviruses phylogenetically, but is related to those of the porcine rotaviruses and some unusual human rotaviruses represented by the RMC321 strain isolated in eastern India.

Outbreak of acute gastroenteritis associated with group A rotavirus and genogroup I sapovirus among adults in a mental health care facility in Japan

An outbreak of acute gastroenteritis consisting of 57 cases occurred in a mental health care facility in Takasaki city, Japan during 6th February and 27th March 2002. A total of 18 fecal specimens collected from 17 residents and one member of the medical staff during this outbreak were tested for the presence of viral enteropathogens by RT-PCR and latex agglutination. Group A rotavirus and sapovirus were detected in 5 out of 18 fecal specimens (55.6%). To our knowledge, this is the first finding of an outbreak of gastroenteritis associated with co-circulation of different kinds of viruses such as group A rotavirus and sapovirus. All of group A rotaviruses were typed further as P[4]G2 strains. Both rotavirus and sapovirus were subjected to molecular analysis by sequencing. It was noteworthy that all rotaviruses and sapoviruses had high homologies, respectively, to each other and sapoviruses presented a potential novel sapovirus genogroup I (GI) genotype, which was obviously different from any GI genotypes (GI-a, b, c, and d). The outbreak associated with these viruses spread gradually from dormitory to dormitory, suggesting a spread by person-to-person contact, although investigation on the route of transmission of the outbreak is lacking. The findings confirm the presence of group A rotavirus and sapovirus are important in acute gastroenteritis among adults in Japan.

Age-dependent diarrhea induced by a rotaviral nonstructural glycoprotein

The rotavirus nonstructural glycoprotein NSP4 is an intracellular receptor that mediates the acquisition of a transient membrane envelope as subviral particles bud into the endoplasmic reticulum. NSP4 also causes an increase in intracellular calcium in insect cells. Purified NSP4 or a peptide corresponding to NSP4 residues 114 to 135 induced diarrhea in young (6 to 10 days old) CD1 mice. This disease response was age-dependent, dose-dependent, and specific. Electrophysiologic data from intestinal mucosa showed that the NSP4 114-135 peptide potentiates chloride secretion by a calcium-dependent signaling pathway. Diarrhea is induced when NSP4, acting as a viral enterotoxin, triggers a signal transduction pathway.

Investigation of an outbreak of rotavirus infection in geriatric patients by serotyping and polyacrylamide gel electrophoresis (PAGE)

An outbreak of rotavirus diarrhoea amongst patients on two wards in a geriatric unit was investigated using polyacrylamide gel electrophoresis (PAGE) and serotyping. There had been no contact between the patients on different wards but some interchange of staff had occurred so it was important to exclude the possibility that the rotavirus had been spread by staff. Two strains of rotavirus were shown to be present, one on each ward. Differences in the electropherotypes and serotypes were demonstrated, showing conclusively that transfer of virus between the wards had not occurred. Thus, serotyping and PAGE are of value in the investigation of rotavirus outbreaks in the hospital setting where cross-infection between wards is suspected.

Inactivation of human and simian rotaviruses by chlorine dioxide

The inactivation of single-particle stocks of human (type 2, Wa) and simian (SA-11) rotaviruses by chlorine dioxide was investigated. Experiments were conducted at 4 degrees C in a standard phosphate-carbonate buffer. Both virus types were rapidly inactivated, within 20 s under alkaline conditions, when chlorine dioxide concentrations ranging from 0.05 to 0.2 mg/liter were used. Similar reductions of 10(5)-fold in infectivity required additional exposure time of 120 s at 0.2 mg/liter for Wa and at 0.5 mg/liter for SA-11, respectively, at pH 6.0. The inactivation of both virus types was moderate at neutral pH, and the sensitivities to chlorine dioxide were similar. The observed enhancement of virucidal efficiency with increasing pH was contrary to earlier findings with chlorine- and ozone-treated rotavirus particles, where efficiencies decreased with increasing alkalinity. Comparison of 99.9% virus inactivation times revealed ozone to be the most effective virucidal agent among these three disinfectants.

Outbreaks of astrovirus type 1 and rotavirus gastroenteritis in a geriatric in-patient population

Two outbreaks of viral gastroenteritis occurred in seven psychogeriatric wards of a 469-bed psychiatric hospital. The outbreaks occurred over an eight-week period; the first affected 30 people and rotavirus was detected in 12 of 14 persons from whom faecal specimens were available. The second affected 32 people (15 of whom were affected in the previous outbreak) and astrovirus was detected in 5 of the 24 people from whom specimens were available. Specific IgM to astrovirus was demonstrated in 3 patients. The rotavirus outbreak was characterised by a longer duration of illness (mean 4 days), and more severe symptoms; two elderly female patients had severe symptoms over a 14-15 day period but recovered. In the astrovirus outbreak the duration of illness was shorter and symptoms were milder although the attack rate was higher than that observed for rotavirus.

Passive protection against rotavirus-induced diarrhea by monoclonal antibodies to the heterotypic neutralization domain of VP7 and the VP8 fragment of VP4

A murine model was used to determine whether neutralizing monoclonal antibodies (MAbs) with heterotypic specificity directed to VP7 (MAb 57-8) or to the VP8 fragment of VP4 (MAb M14) passively protect mice against challenge with various strains of rotavirus. (The gene 4 product, an outer capsid protein, has traditionally been called VP3. It has been proposed, however, that the rotavirus gene 4 product be named VP4. The gene 3 product, a core protein, has been identified recently and named VP3 [M. Liu, P. A. Offit, and M. K. Estes, Virology 163:28-32, 1988]). Suckling mice orally inoculated with MAb 57-8 did not develop diarrhea when challenged with virulent serotype 3, 4, or 6 rotaviruses, while those inoculated with MAb M14 were passively protected from challenge with serotype 3 or 6 rotaviruses, as predicted by in vitro neutralization tests. These MAbs, however, did not protect mice from infection when the mice were challenged with rotaviruses of other serotypes. We conclude that specific neutralization epitopes on each surface protein are capable of mediating protection against one or several rotavirus serotypes.

Chemical disinfection of human rotavirus-contaminated inanimate surfaces

Fomites may play a role in the transmission of rotavirus infections, and in view of this, 27 disinfectants were evaluated for their ability to inactivate human rotavirus (HRV) on contaminated non-porous inanimate surfaces. Disks of stainless steel, glass and two types of plastics were contaminated with about 10(7) plaque-forming units of HRV suspended in faecal matter. The inoculum was allowed to dry and an equal volume of the product under test was applied to the contaminated surface. After contact for 1 min, the action of the disinfectant was stopped by dilution. Surviving infectious virus on the disks was determined by plaque assay in MA-104 cells. A product was considered to be effective if it could reduce the virus titre by at least 3 log10. Only 33.3% (9/27) of the formulations tested proved to be effective. Further testing of the effective products, which included antiseptics, instrument soaks and hard-surface disinfectants, showed that all of them could, in fact, reduce the virus titre on contaminated surfaces by at least 6 log10. These findings show the relative resistance of HRV to a wide range of chemical disinfectants in common use, and also emphasize the need for a more thorough evaluation of the virucidal potential of formulations regularly employed in attempts to prevent and control outbreaks of rotaviral diarrhoea.

Institutional outbreaks of rotavirus diarrhoea: potential role of fomites and environmental surfaces as vehicles for virus transmission

To assess the potential of fomites and environmental surfaces as vehicles in the transmission of rotaviral diarrhoea, disks (1 cm diameter) of various porous and non-porous materials were contaminated with about 10(5) plaque-forming units of the Wa strain of human rotavirus (HRV) suspended in faecal matter. The contaminated disks were then held for 10 days at either room temperature (22 +/- 2 degrees C) or 4 degrees C with the relative humidity (RH) at the high (85 +/- 5%), medium (50 +/- 5%) or low (25 +/- 5%) level. Survival was longer on non-porous surfaces at the lower temperature and at lower humidity. In contrast, survival on porous surfaces was very variable; better on cotton-polyester than on poster card or paper currency on which HRV survived very poorly. These results suggest that under the right environmental conditions, HRV-contaminated objects could play a role in the transmission of rotavirus infections in hospitals, nursing homes and day-care centres.

Rotavirus as a cause of severe gastroenteritis in adults

Rotavirus was identified as the only etiological agent in 5% of adults (28 of 526) with diarrhea who were admitted to Bamrasnaradura Hospital in Nonthaburi, Thailand, during a 1-year period. Infection was determined by detection of rotavirus in diarrheal stools by enzyme-linked immunosorbent assay accompanied by a greater than fourfold rise in serum complement fixation and radioimmunoassay antibody titers to rotavirus. Adults with clinical rotavirus infections were as severely ill as patients with most bacterial enteric infections; only patients with cholera passed more watery stools and were more dehydrated than those with rotavirus infections. Only 2 of the 28 adults with rotavirus infections had known recent contact with young children with diarrhea. Rotavirus infections in these adults occurred most frequently in the cooler, drier months in Thailand than during the rest of the year. In some settings, rotavirus should be considered in the differential diagnosis of severe diarrhea in adults as well as in young children.

Improved immunofluorescence techniques with microplates for the detection of M and G immunoglobulins against rotavirus

A selection of microplates and an inverted microscope were used for the detection of immuno-fluorescence in large numbers of infected cell monolayers. The optical features of this instrument in combination with either Terasaki or Microlymp plates, simplify procedures and allow economical use of reagents, for determining fluorescent antibody levels. The techniques described were applied for estimating M and G immunoglobulins against rotavirus in elderly patients and the validity of the tests was established.

Virus diarrhoea associated with pale fatty faeces

Steatorrhoea was a significant feature in an outbreak of rotavirus gastroenteritis which affected adults and infants in hospital. Fat globules or fatty acid crystals were obvious by light microscopy (LM) in faeces from 14 of 25 patients examined. Ten of the fatty stools and two of the remainder were very pale. By electron microscopy (EM) a rotavirus was seen in 11 of the 14 fatty faeces and in only two of 11 specimens without visible fat. In a further study of pale or fatty faeces 20 such specimens sent for laboratory examination from patients not involved in the hospital outbreak were compared microbiologically with a similar number which were neither pale nor fatty. Viruses were found by EM in 11 (55%) of the pale or fatty stools; eight rotaviruses, two astroviruses and an uncultivable adenovirus were seen; one further patient had acute jaundice. In contrast, no viruses were seen by EM in the twenty specimens which were normally pigmented and without evident fat. Steatorrhoea was significantly associated with rotavirus infection of the alimentary tract which usually presented as a fatty enteritis. We conclude that rotaviruses certainly, and other viruses possibly, can impede both the digestion of fat and the pigmentation of the faeces. Inspection and LM of faeces are easy. In acute enteritis a fatty or pale stool is an indication for virological examination.