[Norovirus outbreaks in hospitals and nursing homes in Catalonia, Spain]

Role of noroviruses as aetiological agents of diarrhoea in developing countries

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.

Person-to-person transmission of norovirus resulting in an outbreak of acute gastroenteritis at a summer camp

BACKGROUND

A significant proportion of norovirus (NV) gastroenteritis outbreaks described in the Spanish literature have been because of contaminated food or water.

AIM

This study describes an outbreak of acute gastroenteritis because of NV in which there was person-to-person transmission.

MATERIALS AND METHODS

A retrospective cohort study was carried out; we established the case definition for primary and secondary cases. An epidemiological survey was designed, including possible food exposures, and clinical and laboratory data. Water and stool samples were taken from affected individuals and food handlers. The presence of NV was detected using a reverse transcription-PCR assay. We analyzed the risk of gastroenteritis using relative risk and its 95% confidence interval as the measure of association, and estimated the basic reproductive number (R0).

RESULTS

The primary attack rate was 45.0%, with no significant differences between sexes. The secondary attack rate during the camp stay was 22.7%. The basic reproductive number for 5 days was R0=2.62. The most frequent symptoms were abdominal pain (85.7%) and vomiting (81.9%). Epidemiological analysis showed no association with food or drinking water. A total of 66.6% (8/12) of stool samples tested positive for NV (genogroup II).

CONCLUSION

Control measures in general, and hand hygiene in particular, should be extended to the families once the children return home, to prevent secondary cases in NV outbreaks.

Evaluation of murine norovirus persistence in environments relevant to food production and processing

Human norovirus (NoV) causes outbreaks of acute gastroenteritis associated with many ready-to-eat foods, including fresh produce. Effective inactivation procedures must consider virus survival under conditions of produce production and processing. This study aimed to investigate the persistence of NoV in a variety of environments, using murine NoV (MNV) as a surrogate for NoV. MNV was incubated for up to 42 days at room temperature on stainless steel disks, on lettuce, on soil, and in potable water and titers determined by plaque assay. A 1-log reduction of MNV infectivity was observed after 29 days in water, 4 days on lettuce, 12 days on soil, and 15 days on stainless steel disks. MNV survived longer in water than in any of the other environments, indicating that drying may contribute to NoV inactivation. MNV genomes were not significantly reduced for up to 42 days, suggesting that genomic detection is not a reliable indicator of viability. Overall, our findings provide valuable information regarding the potential for NoV transmission in the food supply.

Using molecular epidemiology to trace transmission of nosocomial norovirus infection

Nosocomial norovirus (NoV) infection is common and may lead to complications in vulnerable hospitalized patients. Understanding sources and modes of transmission of noroviruses within health care settings will support the design of evidence-based strategies for reducing introduction and further spread. We sequenced a highly variable segment of the genome to identify possible clusters in patients with and without acute gastroenteritis who were hospitalized in the period 2002-2007. Admission and sampling dates were used to separate patients with nosocomial infection from those without nosocomial infection. Epidemiological clustering retrieved 22 clusters, defined as ≥ 2 patients with nosocomial infection on the same ward within 5 days. In total, 264 patients (of 2,458 tested) were diagnosed with NoV infection, and 61% of the patient strains could be genotyped. Of those, 51% (n = 82) belonged to GII.4, 34% (n = 54) belonged to GII.3, and 15% (n = 24) belonged to other genotypes (GI.6B, GII.17, GII.7, and GII.2). In children's wards, GII.3 strains were associated with nosocomial spread more often than other viruses were, whereas in adults this was the case for GII.4 strains. Sequence alignment recognized 11 new clusters based on identical P2 domains (4 GII.3 and 7 GII.4 clusters), involving patients in different wards. This increased the total number of recognized clusters by 50%. Five of these clusters involved at least one outpatient, providing a possible target for improvement of infection control. We concluded that the use of sequence-based typing should be considered for identifying hidden nosocomial clusters of NoV infections within health care settings.