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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Markt R, Stillebacher F, Nägele F, Kammerer A, Peer N, Payr M, Scheffknecht C, Dria S, Draxl-Weiskopf S, Mayr M, Rauch W, Kreuzinger N, Rainer L, Bachner F, Zuba M, Ostermann H, Lackner N, Insam H, Wagner AO. Expanding the Pathogen Panel in Wastewater Epidemiology to Influenza and Norovirus. Viruses 2023; 15:263. [PMID: 36851479 PMCID: PMC9966704 DOI: 10.3390/v15020263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/01/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Since the start of the 2019 pandemic, wastewater-based epidemiology (WBE) has proven to be a valuable tool for monitoring the prevalence of SARS-CoV-2. With methods and infrastructure being settled, it is time to expand the potential of this tool to a wider range of pathogens. We used over 500 archived RNA extracts from a WBE program for SARS-CoV-2 surveillance to monitor wastewater from 11 treatment plants for the presence of influenza and norovirus twice a week during the winter season of 2021/2022. Extracts were analyzed via digital PCR for influenza A, influenza B, norovirus GI, and norovirus GII. Resulting viral loads were normalized on the basis of NH4-N. Our results show a good applicability of ammonia-normalization to compare different wastewater treatment plants. Extracts originally prepared for SARS-CoV-2 surveillance contained sufficient genomic material to monitor influenza A, norovirus GI, and GII. Viral loads of influenza A and norovirus GII in wastewater correlated with numbers from infected inpatients. Further, SARS-CoV-2 related non-pharmaceutical interventions affected subsequent changes in viral loads of both pathogens. In conclusion, the expansion of existing WBE surveillance programs to include additional pathogens besides SARS-CoV-2 offers a valuable and cost-efficient possibility to gain public health information.
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Affiliation(s)
- Rudolf Markt
- Department of Microbiology, Universität Innsbruck, 6020 Innsbruck, Austria
- Department of Health Sciences and Social Work, Carinthia University of Applied Sciences, 9020 Klagenfurt, Austria
| | | | - Fabiana Nägele
- Department of Microbiology, Universität Innsbruck, 6020 Innsbruck, Austria
| | - Anna Kammerer
- Department of Microbiology, Universität Innsbruck, 6020 Innsbruck, Austria
| | - Nico Peer
- Department of Microbiology, Universität Innsbruck, 6020 Innsbruck, Austria
| | - Maria Payr
- Department of Microbiology, Universität Innsbruck, 6020 Innsbruck, Austria
| | - Christoph Scheffknecht
- Institut für Umwelt und Lebensmittelsicherheit des Landes Vorarlberg, 6900 Bregenz, Austria
| | - Silvina Dria
- Institut für Umwelt und Lebensmittelsicherheit des Landes Vorarlberg, 6900 Bregenz, Austria
| | | | - Markus Mayr
- Department of Microbiology, Universität Innsbruck, 6020 Innsbruck, Austria
| | - Wolfgang Rauch
- Department of Infrastructure, Universität Innsbruck, 6020 Innsbruck, Austria
| | - Norbert Kreuzinger
- Institute for Water Quality and Resource Management, Technische Universität Wien, 1040 Vienna, Austria
| | - Lukas Rainer
- Austrian National Public Health Institute, 1010 Vienna, Austria
| | - Florian Bachner
- Austrian National Public Health Institute, 1010 Vienna, Austria
| | - Martin Zuba
- Austrian National Public Health Institute, 1010 Vienna, Austria
| | | | - Nina Lackner
- Department of Health Sciences and Social Work, Carinthia University of Applied Sciences, 9020 Klagenfurt, Austria
| | - Heribert Insam
- Department of Microbiology, Universität Innsbruck, 6020 Innsbruck, Austria
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3
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Gerrity D, Papp K, Pecson BM. Pathogen Peak "Averaging" in Potable Reuse Systems: Lessons Learned from Wastewater Surveillance of SARS-CoV-2. ACS ES T Water 2022; 2:1863-1870. [PMID: 37566355 PMCID: PMC8791031 DOI: 10.1021/acsestwater.1c00378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/19/2021] [Accepted: 11/29/2021] [Indexed: 05/10/2023]
Abstract
This study describes wastewater concentrations of SARS-CoV-2 at seven different sampling locations in Southern Nevada (ranging from 4.2 to 8.7 log10 gc/L) and highlights several key variables affecting those concentrations, including COVID-19 incidence, sample type, and service area population. This information is important for implementing wastewater-based epidemiology, but it also provides insight relevant to the design and regulation of potable reuse systems. Specifically, smaller systems may be more prone to influent concentration spikes that can drive enteric pathogen risk during disease outbreaks. It may be possible to leverage reactor hydraulics to achieve peak "averaging" in these scenarios, although it then becomes important to consider how elevated risks at the lower percentiles potentially offset benefits at the upper percentiles. Informed by SARS-CoV-2 concentration dynamics, the current study simulated relative risk for a hypothetical enteric pathogen. Simulated reactor hydraulics (i.e., dispersion) increased pathogen concentrations by up to 2.6 logs at lower percentiles but also decreased concentrations by up to 1.1 logs at the upper percentiles that sometimes drive public health risk. Collectively, these data highlight the importance of considering outbreak conditions, pathogen spikes, and peak "averaging" in the design and operation of treatment systems and in the development of regulatory frameworks.
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Affiliation(s)
- Daniel Gerrity
- Applied Research and Development Center,
Southern Nevada Water Authority, Las Vegas, Nevada 89193,
United States
| | - Katerina Papp
- Applied Research and Development Center,
Southern Nevada Water Authority, Las Vegas, Nevada 89193,
United States
| | - Brian M. Pecson
- Trussell Technologies,
Inc., Oakland, California 94612, United States
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4
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He T, Chen X, Deng Y, Li B, Wang H, Wang Q, Zhai A, Shi L, Chen Y, Wu C. Development and validation of an efficient nomogram for risk assessment of norovirus infection in pediatric patients. Eur J Clin Microbiol Infect Dis 2022; 41:1433-1443. [PMID: 36282340 PMCID: PMC9592877 DOI: 10.1007/s10096-022-04510-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/14/2022] [Indexed: 11/27/2022]
Abstract
This study aimed to establish a predictive model and nomogram based on routine laboratory blood indicators and clinical symptoms, subsequently providing a rapid risk assessment of norovirus (NoV) infection in children. This retrospective study enrolled 307 pediatric patients with symptoms of acute gastroenteritis and detected NoV using real-time quantitative polymerase chain reaction. Significant indicators selected by multivariate logistic regression, including routine blood tests and consultation symptoms, were used to develop the nomogram. We divided the sample into training and internal validation sets and performed external validation of the final model. Furthermore, we evaluated the clinical performance using the Akaike information criterion (AIC), area under the curve (AUC), calibration curve, decision curve analysis (DCA), sensitivity, specificity, concordance rate, positive predictive value, and negative predictive value. Overall, 153 cases were NoV-PCR-positive, and 154 were negative. The multivariate logistic regression included five predictors of NoV infection, including symptoms of vomiting, upper respiratory tract infection, and indicators of white blood cells, lymphocyte absolute counts, and platelet counts. The nomogram showed a significant predictive value with overall internal set diagnosis, with an AUC of 0.827 (95% confidence interval (CI): 0.785–0.868), and 0.812 (95% CI: 0.755–0.869) with 0.799 (95% CI: 0.705–0.894) in the training and internal validation sets, respectively. Nevertheless, the AUC in the external validation set was higher (0.915; 95% CI: 0.862–0.968). This nomogram is a useful tool for risk assessment for NoV infection. Moreover, the evaluated indicators are accessible, substantially reducing the time for laboratory testing.
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Affiliation(s)
- Taojun He
- Department of Laboratory Medicine, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, 518033 Guangdong Province China
| | - Xiaohua Chen
- Department of Digestive Endoscopy Center, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, 518033 Guangdong Province China
| | - Yilin Deng
- Department of Laboratory Medicine, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, 518033 Guangdong Province China
| | - Bin Li
- Department of Laboratory Medicine, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, 518033 Guangdong Province China
| | - Hongmei Wang
- Department of Infectious Diseases, Shenzhen Children’s Hospital, Shenzhen, 518000 Guangdong Province China
| | - Qinjin Wang
- Department of Laboratory Medicine, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, 518033 Guangdong Province China
| | - Aixia Zhai
- Department of Laboratory Medicine, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, 518033 Guangdong Province China
| | - Liang Shi
- Department of Laboratory Medicine, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, 518033 Guangdong Province China
| | - Ying Chen
- Department of Laboratory Medicine, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, 518033 Guangdong Province China
| | - Chao Wu
- Department of Laboratory Medicine, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, 518033 Guangdong Province China
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Fanaselle W, Pouillot R, Papafragkou E, Liggins G, Williams L, Doren JMVAN. Evaluation of the Impact of Compliance with Mitigation Strategies and Frequency of Restaurant Surface Cleaning and Sanitizing on Control of Norovirus Transmission from Ill Food Employees Using an Existing Quantitative Risk Assessment Model. J Food Prot 2022; 85:1177-1191. [PMID: 35358310 DOI: 10.4315/jfp-21-423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/29/2022] [Indexed: 11/11/2022]
Abstract
ABSTRACT Reduction of foodborne illness caused by norovirus (NoV) continues to be a focus for the food safety community. Using a previously published quantitative risk assessment model, we evaluated more than 60 scenarios examining the impact of implementation of and compliance with risk management strategies identified in the U.S. Food and Drug Administration Food Code for (a) surface cleaning and sanitizing, (b) hand hygiene, (c) exclusion, or (d) restriction of ill employees. Implementation of and compliance with hand hygiene and ill food employee exclusion strategies had the largest impact on the predicted number of highly contaminated food servings and associated consumer illnesses. In scenarios in which gloves were always worn and hand washing compliance was 90%, the model estimated reductions in the number of highly contaminated food servings and ill consumers to 39 and 43% of baseline estimates (i.e., typical practice), respectively. Reductions were smaller when gloves were never worn. Hand washing compliance after using the restroom strongly impacted predicted numbers of highly contaminated servings and consumer illnesses. Ten percent compliance with removing or excluding ill food employees was predicted to increase the number of highly contaminated food servings and ill consumers to 221 and 213% of baseline estimates, respectively. Ninety-four percent compliance with exclusion of ill food employees was predicted to decrease these numbers to 69 and 71% of baseline estimates, respectively. Surface cleaning in food establishments had a relatively small impact on these measures. Restriction of food employees (removed from contact with food and food contact equipment and utensils) was not effective for reducing NoV illness unless this restriction included additional provisions. The results from this study can help risk managers prioritize mitigation strategies and their implementation for controlling the transmission of NoV and subsequent consumer foodborne illness. HIGHLIGHTS
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Affiliation(s)
- Wendy Fanaselle
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 5001 Campus Drive, College Park, Maryland 20740, USA
| | - Régis Pouillot
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 5001 Campus Drive, College Park, Maryland 20740, USA
| | - Efstathia Papafragkou
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 5001 Campus Drive, College Park, Maryland 20740, USA
| | - Girvin Liggins
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 5001 Campus Drive, College Park, Maryland 20740, USA
| | - Laurie Williams
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 5001 Campus Drive, College Park, Maryland 20740, USA
| | - Jane M VAN Doren
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 5001 Campus Drive, College Park, Maryland 20740, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Sun W, Pang Z, He Y, Chen Y, Pan J, Gao J, Miao Z. Improper handling of vomitus as a risk factor in the human norovirus outbreak in a kindergarten in Wuyi County, Zhejiang Province, China. Epidemiol Infect 2022;:1-19. [PMID: 35578778 DOI: 10.1017/S0950268822000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Anfruns-estrada E, Sabaté S, Razquin E, Cornejo Sánchez T, Bartolomé R, Torner N, Izquierdo C, Soldevila N, Coronas L, Domínguez À, Fuentes C, Pintó R, Bosch A, Guix S, (PI/) T. Epidemiological and Genetic Characterization of Norovirus Outbreaks That Occurred in Catalonia, Spain, 2017–2019. Viruses 2022; 14:488. [PMID: 35336893 PMCID: PMC8955687 DOI: 10.3390/v14030488] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 01/27/2023] Open
Abstract
Molecular characterization of human norovirus (HuNoV) genotypes enhances the understanding of viral features and illustrates distinctive evolutionary patterns. The aim of our study was to describe the prevalence of the genetic diversity and the epidemiology of the genotypes involved in HuNoV outbreaks in Catalonia (Spain) between 2017 and 2019. A total of 100 HuNoV outbreaks were notified with the predominance of GII (70%), followed by GI (27%) and mixed GI/GII (3%). Seasonality was observed for GII outbreaks only. The most prevalent genotypes identified were GII.4[P31] Sydney 2012, GII.4[P16] Sydney 2012 and GII.2[P16]. As compared to person-to-person (P/P) transmitted outbreaks, foodborne outbreaks showed significantly higher attack rates and lower duration. The average attack rate was higher in youth hostel/campgrounds compared to nursing homes. Only genotypes GI.4[P4], GII.2[P16], GII.4[P16], GII.4[P31] and GII.17[P17] were consistently detected every year, and only abundance of GII.2[P16] showed a negative trend over time. GII.4 Sydney 2012 outbreaks were significantly associated to nursing homes, while GII.2[P16] and GI.3[P3] were most frequently identified in youth hostel/campgrounds. The average attack rate was significantly higher when comparing GII.2[P16] vs. GI.4[P4], GII.2[P16] vs. GII.4[P31] Sydney 2012, and GII.6[P7] vs. GII.4[P31] Sydney 2012. No correlations were found between genotype and outbreak duration or age of affected individuals.
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Liu P, Rahman M, Leon J, Moe C. Less severe clinical symptoms of Norwalk virus 8fIIb inoculum compared to its precursor 8fIIa from human challenge studies. J Med Virol 2021; 93:3557-3563. [PMID: 33017074 DOI: 10.1002/jmv.26578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 09/07/2020] [Accepted: 09/28/2020] [Indexed: 11/10/2022]
Abstract
Noroviruses (NoV) are a leading cause of epidemic gastroenteritis. Human challenge studies have been used to examine the infectivity, pathogenicity, and host immune response to NoV as well as vaccine efficacy. The goal of this study was to conduct a meta-analysis of data from five previously completed human challenge trials and compare the response to the secondary NV inoculum (8fIIb) to its precursor (8fIIa). We investigated a total of 158 subjects: 76 subjects were experimentally challenged with NV inoculum 8fIIa, and 82 subjects were challenged with 8fIIb. We compared demographic characteristics, infection, illness, mean severity score, blood types, and duration of viral shedding between the two groups of subjects. There were no statistically significant differences in overall infection and illness rates between subjects inoculated with 8fIIa and 8fIIb. However, individuals challenged with 8fIIa had significantly higher severity scores (5.05 vs. 3.22, p = .008) compared with those challenged with 8fIIb. We also observed that infection with 8fIIb was associated with significantly longer duration of viral shedding compared with 8fIIa (11.0 days vs. 5.0 days, p = .0005). These results have serious implications for the development of new NoV inocula for human challenge studies to test candidate vaccine efficacy-where illness severity and duration of viral shedding are important outcomes.
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Affiliation(s)
- Pengbo Liu
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mumu Rahman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Juan Leon
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Christine Moe
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Farkas K, Green E, Rigby D, Cross P, Tyrrel S, Malham SK, Jones DL. Investigating awareness, fear and control associated with norovirus and other pathogens and pollutants using best-worst scaling. Sci Rep 2021; 11:11194. [PMID: 34045602 PMCID: PMC8160009 DOI: 10.1038/s41598-021-90704-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/10/2021] [Indexed: 02/04/2023] Open
Abstract
Pollutants found in the water and air environment represent an ever-growing threat to human health. Contact with some air-, water- and foodborne pathogens (e.g. norovirus) results in gastrointestinal diseases and outbreaks. For future risk mitigation, we aimed to measure people's awareness of waterborne and foodborne norovirus relative to other environment-associated pollutants (e.g. pesticides, bioaerosols, antibiotic resistant bacteria) and well-known risks (e.g. diabetes, dementia, terrorist attack). We used an online survey, which included a best-worst scaling component to elicit personal levels of control and fear prompted by norovirus relative to 15 other risks. There was a negative correlation between levels of fear vs. control for all 16 measured risks. Perceived infection control levels were higher amongst women compared to men and correlated with age and the level of qualification in both groups. Participants who had sought advice regarding the symptoms caused by norovirus appeared to have more control over the risks. Norovirus is associated with high levels of fear, however, the levels of control over it is low compared to other foodborne illnesses, e.g. Salmonella. Addressing this deficit in the public's understanding of how to control exposure to the pathogen in an important health need.
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Affiliation(s)
- Kata Farkas
- grid.7362.00000000118820937School of Natural Sciences, Bangor University, Deiniol Road, Bangor, Gwynedd, LL57 2UW UK ,grid.7362.00000000118820937School of Ocean Sciences, Bangor University, Menai Bridge, Anglesey, LL53 5AB UK ,Marine Centre Wales, Menai Bridge, Anglesey, LL59 5AB UK
| | - Emma Green
- grid.7362.00000000118820937School of Natural Sciences, Bangor University, Deiniol Road, Bangor, Gwynedd, LL57 2UW UK
| | - Dan Rigby
- grid.5379.80000000121662407Department of Economics, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Paul Cross
- grid.7362.00000000118820937School of Natural Sciences, Bangor University, Deiniol Road, Bangor, Gwynedd, LL57 2UW UK
| | - Sean Tyrrel
- grid.12026.370000 0001 0679 2190School of Water, Energy and Environment, Cranfield University, Cranfield, MK43 0AL UK
| | - Shelagh K. Malham
- grid.7362.00000000118820937School of Ocean Sciences, Bangor University, Menai Bridge, Anglesey, LL53 5AB UK
| | - David L. Jones
- grid.7362.00000000118820937School of Natural Sciences, Bangor University, Deiniol Road, Bangor, Gwynedd, LL57 2UW UK ,grid.1012.20000 0004 1936 7910UWA Oceans Institute, The University of Western Australia, Perth, WA 6009 Australia
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11
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Burke RM, Mattison CP, Marsh Z, Shioda K, Donald J, Salas SB, Naleway AL, Biggs C, Schmidt MA, Hall AJ. Norovirus and Other Viral Causes of Medically Attended Acute Gastroenteritis Across the Age Spectrum: Results from the Medically Attended Acute Gastroenteritis Study in the United States. Clin Infect Dis 2021; 73:e913-e920. [PMID: 34398953 DOI: 10.1093/cid/ciab033] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Acute gastroenteritis (AGE) causes a substantial burden in the United States, but its etiology frequently remains undetermined. Active surveillance within an integrated healthcare delivery system was used to estimate the prevalence and incidence of medically attended norovirus, rotavirus, sapovirus, and astrovirus. METHODS Active surveillance was conducted among all enrolled members of Kaiser Permanente Northwest during July 2014-June 2016. An age-stratified, representative sample of AGE-associated medical encounters were recruited to provide a stool specimen to be tested for norovirus, rotavirus, sapovirus, and astrovirus. Medically attended AGE (MAAGE) encounters for a patient occurring within 30 days were grouped into 1 episode, and all-cause MAAGE incidence was calculated. Pathogen- and healthcare setting-specific incidence estimates were calculated using age-stratified bootstrapping. RESULTS The overall incidence of MAAGE was 40.6 episodes per 1000 person-years (PY), with most episodes requiring no more than outpatient care. Norovirus was the most frequently detected pathogen, with an incidence of 5.5 medically attended episodes per 1000 PY. Incidence of norovirus MAAGE was highest among children aged < 5 years (20.4 episodes per 1000 PY), followed by adults aged ≥ 65 years (4.5 episodes per 1000 PY). Other study pathogens showed similar patterns by age, but lower overall incidence (sapovirus: 2.4 per 1000 PY; astrovirus: 1.3 per 1000 PY; rotavirus: 0.5 per 1000 PY). CONCLUSIONS Viral enteropathogens, particularly norovirus, are important contributors to MAAGE, especially among children < 5 years of age. The present findings underline the importance of judicious antibiotics use for pediatric AGE and suggest that an effective norovirus vaccine could substantially reduce MAAGE.
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Affiliation(s)
- Rachel M Burke
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, Georgia,USA
| | - Claire P Mattison
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, Georgia,USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee,USA
| | - Zachary Marsh
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, Georgia,USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee,USA
| | - Kayoko Shioda
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, Georgia,USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee,USA
| | - Judy Donald
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon,USA
| | - S Bianca Salas
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon,USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon,USA
| | - Christianne Biggs
- Public Health Division of the Oregon Health Authority, Portland, Oregon,USA
| | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon,USA
| | - Aron J Hall
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, Georgia,USA
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12
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Li Y, Fan X, Yu G, Wei P, Wang Y, Guo H. An acute gastroenteritis outbreak associated with breakfast contaminated with norovirus by asymptotic food handler at a kindergarten in Shenzhen, China. BMC Infect Dis 2021; 21:54. [PMID: 33435906 PMCID: PMC7802125 DOI: 10.1186/s12879-021-05762-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background An outbreak of acute gastroenteritis occurred in a kindergarten located Shenzhen City on March 4, 2018. We were invited to investigate to the risk factors associated with this outbreak. Methods We conducted retrospective cohort-studies on three different groups of subjects in order to figure out the difference of incidence of acute gastroenteritis among subjects of different activities on March 2: group one consisted of people who attended the Lantern festival activities; group two consisted of children and employees who ate breakfast and bread provided by the kindergarten; and groups three consisted of children and employees who did not eat breakfast or bread provided by the kindergarten. Fecal, anal swabs, dishware swabs and hand swabs specimens were collected in the study. Bacteria known to cause acute gastroenteritis were cultured. Viruses associated with acute gastroenteritis were tested using real-time PCR. Capsid gene fragment of 557 bp of norovirus was amplified and sequenced. The phylogenetic tree was constructed with MEGA 7.0 using neighbor-joining method based on capsid gene fragment of norovirus. Results A total of 143 suspected cases were identified in this outbreak. Diarrhea happened more often in adults than in children while emesis and bellyache were more frequently found in children than in adults. Higher AGE incidence was observed in group 2, children and employees who had breakfast in the kindergarten on March 2, as well as in group 3, and among employees who eating bread involved in breakfast provided on March 2. Five anal swab specimens were positive for norovirus. All noroviruses belongs to group II.3 and have an identity more than 99%. Conclusion A chef, as an asymptomatic carrier with norovirus, was the infectious resource in this outbreak. He contaminated breakfast food provided on March 2. Although morning check is implemented in kindergartens of China, employees are often excluded in morning check. Our finding highlights the importance of morning check covering employees and periodical training for cooks. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05762-z.
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Affiliation(s)
- Yuan Li
- Shenzhen Bao'an Center for Disease Control and Prevention, Shenzhen, China
| | - Xiangbo Fan
- Hezhou Center for Disease Control and Prevention, Hezhou, China
| | - Guangqing Yu
- Shenzhen Bao'an Center for Disease Control and Prevention, Shenzhen, China
| | - Peinan Wei
- Wuqing Center for Disease Control and Prevention, Tianjin, China
| | - Yong Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hongxiong Guo
- Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiangsu Road, Nanjing, China.
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Ebenezer O, Jordaan MA, Damoyi N, Shapi M. Discovery of Potential Inhibitors for RNA-Dependent RNA Polymerase of Norovirus: Virtual Screening, and Molecular Dynamics. Int J Mol Sci 2020; 22:E171. [PMID: 33375298 DOI: 10.3390/ijms22010171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/26/2020] [Accepted: 11/26/2020] [Indexed: 01/16/2023] Open
Abstract
Noroviruses are non-enveloped viruses with a positive-sense single-stranded RNA (ssRNA) genome belonging to the genus Norovirus, from the family Caliciviridae, which are accountable for acute gastroenteritis in humans. The Norovirus genus is subdivided into seven genogroups, i.e., (GI-GVII); among these, the genogroup II and genotype 4 (GII.4) strains caused global outbreaks of human norovirus (HuNov) disease. The viral genome comprises three open reading frames (ORFs). ORF1 encodes the nonstructural polyprotein that is cleaved into six nonstructural proteins, which include 3C-like cysteine protease (3CLpro) and a viral RNA-dependent RNA polymerase. ORF2 and ORF3 encode the proteins VP1 and VP2. The RNA-dependent RNA polymerase (RdRp) from noroviruses is one of the multipurpose enzymes of RNA viruses vital for replicating and transcribing the viral genome, making the virally encoded enzyme one of the critical targets for the development of novel anti-norovirus agents. In the quest for a new antiviral agent that could combat HuNov, high throughput virtual screening (HTVS), combined with e-pharmacophore screening, was applied to screen compounds from the PubChem database. CMX521 molecule was selected as a prototype for a similarity search in the PubChem online database. Molecular dynamics simulations were employed to identify different compounds that may inhibit HuNov. The results predicted that compound CID-57930781 and CID-44396095 formed stable complexes with MNV-RdRp within 50 ns; hence, they may signify as promising human norovirus inhibitors.
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Phattanawiboon B, Nonthabenjawan N, Boonyos P, Jetsukontorn C, Towayunanta W, Chuntrakool K, Ngaopravet K, Ruchusatsawat K, Uppapong B, Sangkitporn S, Mekada E, Matsuura Y, Tatsumi M, Mizushima H. Norovirus transmission mediated by asymptomatic family members in households. PLoS One 2020; 15:e0236502. [PMID: 32702014 PMCID: PMC7377487 DOI: 10.1371/journal.pone.0236502] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
The transmission of human norovirus excreted from infected persons occasionally causes sporadic infections and outbreaks. Both symptomatic patients and asymptomatic carriers have been reported to contribute to norovirus transmission, but little is known about the magnitude of the contribution of asymptomatic carriers. We carried out a 1-year survey of residents of a district of Bangkok, Thailand to determine the percentage of norovirus transmissions originating from asymptomatic individuals. We screened 38 individuals recruited from 16 families from May 2018 to April 2019 for GI and GII genotypes. Norovirus was detected every month, and 101 of 716 stool samples (14.1%) from individuals with no symptoms of acute gastroenteritis were norovirus-positive. The average infection frequency was 2.4 times per person per year. Fourteen genotypes were identified from the positive samples, with GII.4 being detected most frequently. Notably, 89.1% of the norovirus-positive samples were provided by individuals with no diarrhea episode. Similar to cases of symptomatic infections in Thailand, asymptomatic infections were observed most frequently in December. We detected 4 cases of NV infection caused by household transmission, and 3 of the 4 transmissions originated from asymptomatic individuals. We also identified a case in which norovirus derived from an asymptomatic individual caused diarrhea in a family member. These results suggest that asymptomatic individuals play a substantial role in both the maintenance and spreading of norovirus in a community through household transmission.
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Affiliation(s)
- Benjarat Phattanawiboon
- Thailand-Japan Research Collaboration Center on Emerging and Re-emerging Infections, Nonthaburi, Thailand
| | - Nutthawan Nonthabenjawan
- Thailand-Japan Research Collaboration Center on Emerging and Re-emerging Infections, Nonthaburi, Thailand
| | - Patcharaporn Boonyos
- Thailand-Japan Research Collaboration Center on Emerging and Re-emerging Infections, Nonthaburi, Thailand
| | - Chanya Jetsukontorn
- Thailand-Japan Research Collaboration Center on Emerging and Re-emerging Infections, Nonthaburi, Thailand
| | | | | | | | - Kriangsak Ruchusatsawat
- Department of Medical Sciences, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Ballang Uppapong
- Department of Medical Sciences, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Somchai Sangkitporn
- Department of Medical Sciences, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Eisuke Mekada
- Research and Education Promotion Foundation, Bangkok, Thailand
| | - Yoshiharu Matsuura
- Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Masashi Tatsumi
- Thailand-Japan Research Collaboration Center on Emerging and Re-emerging Infections, Nonthaburi, Thailand
| | - Hiroto Mizushima
- Thailand-Japan Research Collaboration Center on Emerging and Re-emerging Infections, Nonthaburi, Thailand
- * E-mail:
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15
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Mizuta K, Tanaka W, Komabayashi K, Tanaka S, Seto J, Aoki Y, Ikeda T. Longitudinal Epidemiology of Viral Infectious Diseases Combining Virus Isolation, Antigenic Analysis, and Phylogenetic Analysis as Well as Seroepidemiology in Yamagata, Japan, between 1999 and 2018. Jpn J Infect Dis 2019; 72:211-223. [PMID: 30814463 DOI: 10.7883/yoken.jjid.2018.500] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We introduced a microplate method for virus isolation in the Department of Microbiology, Yamagata Prefectural Institute of Public Health (YPIPH) in 1999 in Yamagata, Japan. We have since carried out longitudinal epidemiological studies on viral infectious diseases, particularly respiratory viruses, combining traditional technologies such as virus isolation and serological techniques and newly developed molecular methods. Here, we provide an overview of our activities at YPIPH between 1999 and 2018. During the study period, we observed emerging and re-merging diseases such as those caused by echovirus type 13, enterovirus D68, parechovirus-A3 (PeV-A3), and Saffold virus. With regard to PeV-A3, we proposed a new disease concept, "PeV-A3-associated myalgia/myositis." We also revealed the longitudinal epidemiologies of several viruses such as enterovirus A71 and coxsackievirus A16. To perform longitudinal epidemiological studies at any time in Yamagata, we established a system for stocking clinical specimens, viral isolates, complementary DNAs, and serum specimens. We have also pursued collaboration works with virology laboratories across Japan. We hope our experiences, findings, and research materials will further contribute to the development of countermeasures against viral infectious diseases and improvement in public health strategies in Yamagata, Japan, Asia, and around the world.
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Affiliation(s)
- Katsumi Mizuta
- Department of Microbiology, Yamagata Prefectural Institute of Public Health
| | - Waka Tanaka
- Department of Microbiology, Yamagata Prefectural Institute of Public Health
| | | | - Shizuka Tanaka
- Department of Microbiology, Yamagata Prefectural Institute of Public Health
| | - Junji Seto
- Department of Microbiology, Yamagata Prefectural Institute of Public Health
| | - Yoko Aoki
- Department of Microbiology, Yamagata Prefectural Institute of Public Health
| | - Tatsuya Ikeda
- Department of Microbiology, Yamagata Prefectural Institute of Public Health
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16
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Andersen BM. Norovirus and Other Viral Gastroenteritis. Prevention and Control of Infections in Hospitals 2019. [DOI: 10.1007/978-3-319-99921-0_54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
New and old entero-pathogenic viruses are increasing in the society and in the healthcare, like the Calicivirus family (Norovirus, Sapovirus, Astrovirus), Reovirus family (Rotavirus) (especially infant, toddler and elderly) and rarely other viral types such as adenovirus (especially serotype 40, 41), bocavirus, parechovirus, enterovirus and a variety of other types. In all types of gastroenteritis, infection prevention measures are performed as with norovirus, described below. The following chapter is focused on practical measures to detect and prevent transmission of entero-pathogenic viruses in healthcare institutions.
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Van Dycke J, Neyts J, Rocha-Pereira J. Assessing the Efficacy of Small Molecule Inhibitors in aMouse Model of Persistent Norovirus Infection. Bio Protoc 2018; 8:e2831. [PMID: 34286040 DOI: 10.21769/bioprotoc.2831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 11/02/2022] Open
Abstract
Human norovirus is the most common cause of acute gastroenteritis worldwide, resulting in estimated mortality of ~210,000 each year, of whom most are children under the age of five. However, norovirus can infect people of all age groups. There is a risk of prolonged infection in children, the elderly and patients who are immunocompromised. To study the inhibition of persistent norovirus replication by small molecule antivirals in vivo, we used a murine norovirus CR6 strain (MNV.CR6). We demonstrated earlier that efficient small molecules can reduce viral shedding in the stool of infected mice. Here we present how to generate the MNV.CR6 virus stock, infect type I and II interferon receptor knockout AG129 mice via oral gavage, administer antivirals to mice, and quantify viral genome copies in the stool of these mice.
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Affiliation(s)
- Jana Van Dycke
- Department of Microbiology and Immunology, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Johan Neyts
- Department of Microbiology and Immunology, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Joana Rocha-Pereira
- Department of Microbiology and Immunology, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, KU Leuven - University of Leuven, Leuven, Belgium
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18
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Su YM, Phan L, Edomwande O, Weber R, Bleasdale SC, Brosseau LM, Fritzen-Pedicini C, Sikka M, Jones RM. Contact patterns during cleaning of vomitus: A simulation study. Am J Infect Control 2017; 45:1312-1317. [PMID: 28844383 DOI: 10.1016/j.ajic.2017.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Environmental service workers cleaning bodily fluids may transfer pathogens through the environment and to themselves through contacts. METHODS Participants with experience in cleaning of hospital environments were asked to clean simulated vomitus using normal practices in a simulated patient room while being videorecorded. Contacts with environmental surfaces and self were later observed. RESULTS In 21 experimental trials with 7 participants, environmental surfaces were contacted 26.8 times per trial, at a frequency of 266 contacts per hour, on average. Self-contact occurred in 9 of 21 trials, and involved 1-18 contacts, mostly to the upper body. The recommended protocol of cleaning bodily fluids was followed by a minority of participants (2 of 7), and was associated with fewer surface contacts, improved cleaning quality, and different tool use. Participants used different cleaning practices, but each employed similar practices each time they performed an experimental trial. CONCLUSIONS Training in the use of the recommended protocol may standardize cleaning practices and reduce the number of surface contacts.
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Affiliation(s)
- Yu-Min Su
- School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Linh Phan
- School of Public Health, University of Illinois at Chicago, Chicago, IL
| | | | - Rachel Weber
- School of Public Health, University of Illinois at Chicago, Chicago, IL
| | | | - Lisa M Brosseau
- School of Public Health, University of Illinois at Chicago, Chicago, IL
| | | | - Monica Sikka
- College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Rachael M Jones
- School of Public Health, University of Illinois at Chicago, Chicago, IL.
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19
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Wong RSL, Yeo F, Chia WT, Lee CK, Leong MH, Ng CWS, Poon KS, Yan GZ, Chiu LL, Yan BJ, Jureen R, Koay ESC, Lee HK. Performance evaluation of Cepheid Xpert Norovirus kit with a user-modified protocol. J Med Virol 2017; 90:485-489. [PMID: 29073731 DOI: 10.1002/jmv.24981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/24/2017] [Indexed: 01/21/2023]
Abstract
The Cepheid Xpert® Norovirus kit automates sample processing, nucleic acid extraction, and real-time reverse transcription polymerase chain reactions (RT-PCRs) to detect norovirus genogroups I (GI) and II (GII). Eighty-five stool samples collected between February 2015 and May 2017 were used to compare the performance of a user-modified Xpert assay against a clinically validated laboratory-developed test (LDT). Of the 85 samples, 54 were previously archived in -80°C freezer. The remaining 31 were fresh samples tested concurrently with the LDT. The results of all samples tested using the Xpert kit and LDT were found to be concordant, including 12 GI- and 42 GII-positive samples, 1 GI and GII coinfection, and 30 negative samples. Comparison of the assays showed perfect concordance with a kappa coefficient score of 1.00 (95%CI from 1.00 to 1.00). Of the 30 negative stool samples tested, three samples were positive for rotavirus detected using an immunochromatographic assay, with no cross-reactivity shown in both LDT and Xpert assays. In-run sample processing control of the Xpert assay for all negative samples tested showed no/minor inhibition. Compared to the LDT, the Xpert assay produced similar or better Ct values for detection. It also showed better mitigation of PCR inhibition in stool sample testing.
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Affiliation(s)
- Rachel Shi-Lei Wong
- School of Life Sciences and Chemical Technology, Ngee Ann Polytechnic, Singapore
| | - Fion Yeo
- School of Life Sciences and Chemical Technology, Ngee Ann Polytechnic, Singapore
| | - Wai Theng Chia
- School of Life Sciences and Chemical Technology, Ngee Ann Polytechnic, Singapore
| | - Chun Kiat Lee
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Mun Han Leong
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Christopher Wai-Siong Ng
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Kok Siong Poon
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Gabriel Zherong Yan
- Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Lily-Lily Chiu
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Benedict Junrong Yan
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore.,Translational Centre for Development and Research, National University Health System, Singapore
| | - Roland Jureen
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Evelyn Siew-Chuan Koay
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hong Kai Lee
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
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20
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Inns T, Pulawska-Czub A, Harris JP, Vivancos R, Read JM, Beeching NJ, Allen DJ, Iturriza-Gomara M, O'Brien SJ. Prospective cohort study to investigate the burden and transmission of acute gastroenteritis in care homes: a study protocol. BMJ Open 2017; 7:e018867. [PMID: 29102999 PMCID: PMC5722098 DOI: 10.1136/bmjopen-2017-018867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Noroviruses are the leading cause of acute gastroenteritis in all age groups, but illness is more severe and causes excess mortality in the elderly, particularly those in long-term care. The total burden of norovirus disease in the elderly in the UK is poorly defined; no current surveillance programmes systematically or accurately quantify norovirus infection in those living in care homes. The aim of this study is to evaluate an enhanced surveillance system for acute gastroenteritis among the elderly in care homes. METHODS AND ANALYSIS We will conduct this prospective cohort study in care homes in North West England; residents and staff at study care homes will be asked to participate. We will prospectively enrol a cohort of participants in an enhanced surveillance system to capture the incidence of acute gastroenteritis and use multiplex PCR to detect pathogens. We will sample symptomatic and non-symptomatic participants to understand characteristics of norovirus disease and susceptibility to infection. We will generate novel data on transmission dynamics by collecting data on the pattern of interactions within care homes using electronic proximity sensors. Comparisons of outbreak and non-outbreak periods will be used to quantify the impact of norovirus outbreaks on care homes. ETHICS AND DISSEMINATION The study has been approved by the North West-Greater Manchester South NHS Research Ethics Committee (REC Reference: 16/NW/0541). Study outputs will be disseminated through scientific conferences and peer-reviewed publications. This study will provide detailed insight on the burden and aetiology of acute gastroenteritis in care homes, in addition to generating novel data on transmission dynamics and risks. The study will identify areas for improving infection control practice and allow more accurate modelling of the introduction of interventions such as vaccination.
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Affiliation(s)
- Thomas Inns
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Field Epidemiology Services, Health Protection, Public Health England, Liverpool, UK
| | - Anna Pulawska-Czub
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - John P Harris
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Field Epidemiology Services, Health Protection, Public Health England, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging Infections and Zoonoses, University of Liverpool, Liverpool, UK
| | - Jonathan M Read
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging Infections and Zoonoses, University of Liverpool, Liverpool, UK
- Centre for Health Informatics Computing and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Nicholas J Beeching
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging Infections and Zoonoses, University of Liverpool, Liverpool, UK
- Tropical and Infectious Disease Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
- Clinical Sciences Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - David J Allen
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Miren Iturriza-Gomara
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Sarah J O'Brien
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging Infections and Zoonoses, University of Liverpool, Liverpool, UK
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Moyo SJ, Kommedal Ø, Blomberg B, Hanevik K, Tellevik MG, Maselle SY, Langeland N. Comprehensive Analysis of Prevalence, Epidemiologic Characteristics, and Clinical Characteristics of Monoinfection and Coinfection in Diarrheal Diseases in Children in Tanzania. Am J Epidemiol 2017; 186:1074-1083. [PMID: 28541454 PMCID: PMC5860328 DOI: 10.1093/aje/kwx173] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 12/15/2022] Open
Abstract
The role of interactions between intestinal pathogens in diarrheal disease is uncertain. From August 2010 to July 2011, we collected stool samples from 723 children admitted with diarrhea (cases) to 3 major hospitals in Dar es Salaam, Tanzania, and from 564 nondiarrheic children (controls). We analyzed the samples for 17 pathogens and assessed interactions between coinfections in additive and multiplicative models. At least one pathogen was detected in 86.9% of the cases and 62.8%, of the controls. Prevalence of coinfections was 58.1% in cases and 40.4% in controls. Rotavirus, norovirus genogroup II, Cryptosporidium, and Shigella species/enteroinvasive Escherichia coli were significantly associated with diarrhea both as monoinfections and as coinfections. In the multiplicative interaction model, we found 2 significant positive interactions: rotavirus + Giardia (odds ratio (OR) = 23.91, 95% confidence interval (CI): 1.21, 470.14) and norovirus GII + enteroaggregative E. coli (OR = 3.06, 95% CI: 1.17, 7.98). One significant negative interaction was found between norovirus GII + typical enteropathogenic E. coli (OR = 0.09, 95% CI: 0.01, 0.95). In multivariate analysis, risk factors for death were presence of blood in stool and severe dehydration. In conclusion, coinfections are frequent, and the pathogenicity of each organism appears to be enhanced by some coinfections and weakened by others. Severity of diarrhea was not affected by coinfections.
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Affiliation(s)
- Sabrina J Moyo
- Correspondence to Dr. Sabrina J. Moyo, Department of Clinical Science, Laboratoriebygget, 8th floor, Jonas Lies vei 87, N-5021 Bergen, Norway (e-mail: )
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Farfán-García AE, Zhang C, Imdad A, Arias-Guerrero MY, Sánchez-Alvarez NT, Shah R, Iqbal J, Tamborski ME, Gómez-Duarte OG. Case-Control Pilot Study on Acute Diarrheal Disease in a Geographically Defined Pediatric Population in a Middle Income Country. Int J Pediatr 2017; 2017:6357597. [PMID: 28855919 DOI: 10.1155/2017/6357597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/04/2017] [Indexed: 12/23/2022] Open
Abstract
Introduction Acute diarrheal disease (ADD) is a common cause of morbidity and mortality in children under 5 years of age. Understanding of the etiology of ADD is lacking in most low and middle income countries because reference laboratories detect limited number of pathogens. The objective of this study was to determine the feasibility to conduct a comprehensive case-control study to survey diarrheal pathogens among children with and without moderate-to-severe ADD. Materials and Methods Microbiology and molecular-based techniques were used to detect viral, bacterial, and parasitic enteropathogens. The study was conducted in Bucaramanga, Colombia, after Institutional Review Board approval was obtained. Results Ninety children less than 5 years of age were recruited after a written informed consent was obtained from parents or guardians. Forty-five subjects served as cases with ADD and 45 as controls. Thirty-six subjects out of 90 (40.0%) were positive for at least one enteropathogen, that is, 20 (44.4%) cases and 16 (35.5%) controls. Conclusions The three most common enteric pathogens were enteroaggregative E. coli (10.0%), Norovirus (6.7%), and Salmonella spp. (5.6%). The E. coli pathogens were 18.8% of all infections making them the most frequent pathogens. Half of ADD cases were negative for any pathogens.
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Eden JS, Chisholm RH, Bull RA, White PA, Holmes EC, Tanaka MM. Persistent infections in immunocompromised hosts are rarely sources of new pathogen variants. Virus Evol 2017; 3:vex018. [PMID: 28775894 PMCID: PMC5534129 DOI: 10.1093/ve/vex018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Many viruses, including human norovirus and influenza, cause self-limiting diseases of short duration. However, infection by the same viruses in an immunocompromised host can result in prolonged illness in the absence of effective treatment. Such persistent infections are often characterized by increased genetic diversity with potentially elevated rates of evolution compared to acute infections, leading to suggestions that immunocompromised hosts represent an important reservoir for the emergence of novel viral variants. Here, we develop a mathematical model that combines epidemiological dynamics with within-host evolution to quantify the relative contribution of immunocompromised hosts to the overall rate of pathogen evolution. Using human norovirus as a case study we show that the majority of evolutionary substitutions are expected to occur in acute infections of immunocompetent hosts. Hence, despite their potential to generate a high level of diversity, infections of immunocompromised hosts likely contribute less to the evolution and emergence of new genetic variants at the epidemiological scale because such hosts are rare and tend to be isolated. This result is robust to variation in key parameters, including the proportion of the population immunocompromised, and provides a means to understand the adaptive significance of mutations that arise during chronic infections in immunocompromised hosts.
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Affiliation(s)
- John-Sebastian Eden
- Marie Bashir Institute for Infectious Diseases and Biosecurity, Charles Perkins Centre, School of Life and Environmental Sciences, and Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia.,Centre for Virus Research, The Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Rebecca H Chisholm
- School of Biotechnology and Biomolecular Sciences, and Evolution & Ecology Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
| | - Rowena A Bull
- Systems Medicine, Inflammation and Infection Research Centre, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Peter A White
- School of Biotechnology and Biomolecular Sciences, and Evolution & Ecology Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
| | - Edward C Holmes
- Marie Bashir Institute for Infectious Diseases and Biosecurity, Charles Perkins Centre, School of Life and Environmental Sciences, and Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
| | - Mark M Tanaka
- School of Biotechnology and Biomolecular Sciences, and Evolution & Ecology Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
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Kazama S, Miura T, Masago Y, Konta Y, Tohma K, Manaka T, Liu X, Nakayama D, Tanno T, Saito M, Oshitani H, Omura T. Environmental Surveillance of Norovirus Genogroups I and II for Sensitive Detection of Epidemic Variants. Appl Environ Microbiol 2017; 83:e03406-16. [PMID: 28213546 DOI: 10.1128/AEM.03406-16] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/13/2017] [Indexed: 12/14/2022] Open
Abstract
Sewage samples have been investigated to study the norovirus concentrations in sewage or the genotypes of noroviruses circulating in human populations. However, the statistical relationship between the concentration of the virus and the number of infected individuals and the clinical importance of genotypes or strains detected in sewage are unclear. In this study, we carried out both environmental and clinical surveillance of noroviruses for 3 years, 2013 to 2016. We performed cross-correlation analysis of the concentrations of norovirus GI or GII in sewage samples collected weekly and the reported number of gastroenteritis cases. Norovirus genotypes in sewage were also analyzed by pyrosequencing and compared with those identified in stool samples. The cross-correlation analysis found the peak coefficient (R = 0.51) at a lag of zero, indicating that the variation in the GII concentration, expressed as the log10 number of copies per milliliter, was coincident with that in the gastroenteritis cases. A total of 15 norovirus genotypes and up to 8 genotypes per sample were detected in sewage, which included all of the 13 genotypes identified in the stool samples except 2. GII.4 was most frequently detected in both sample types, followed by GII.17. Phylogenetic analysis revealed that a strain belonging to the GII.17 Kawasaki 2014 lineage had been introduced into the study area in the 2012-2013 season. An increase in GI.3 cases was observed in the 2015-2016 season, and sewage monitoring identified the presence of GI.3 in the previous season (2014-2015). Our results demonstrated that monitoring of noroviruses in sewage is useful for sensitive detection of epidemic variants in human populations.IMPORTANCE We obtained statistical evidence of the relationship between the variation in the norovirus GII concentration in sewage and that of gastroenteritis cases during the 3-year study period. Sewage sample analysis by a pyrosequencing approach enabled us to understand the temporal variation in the norovirus genotypes circulating in human populations. We found that a strain closely related to the GII.17 Kawasaki 2014 lineage had been introduced into the study area at least 1 year before its appearance and identification in clinical cases. A similar pattern was observed for GI.3; cases were reported in the 2015-2016 season, and closely related strains were found in sewage in the previous season. Our observation indicates that monitoring of noroviruses in sewage is useful for the rapid detection of an epidemic and is also sensitive enough to study the molecular epidemiology of noroviruses. Applying this approach to other enteric pathogens in sewage will enhance our understanding of their ecology.
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Gustavsson L, Nordén R, Westin J, Lindh M, Andersson LM. Slow Clearance of Norovirus following Infection with Emerging Variants of Genotype GII.4 Strains. J Clin Microbiol 2017; 55:1533-9. [PMID: 28275078 DOI: 10.1128/JCM.00061-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/02/2017] [Indexed: 11/20/2022] Open
Abstract
The emergence of new norovirus genotype GII.4 strains is associated with widespread norovirus epidemics. Extended periods of viral shedding can contribute to the epidemic potential of norovirus. To describe the duration of viral shedding in infections with novel emerging GII.4 strains versus infections with previously circulating strains, we performed a prospective cohort study of patients hospitalized with norovirus gastroenteritis during separate winter seasons. Rectal swab samples were obtained at the time of inclusion and weekly during follow-ups. The subgenotype strain was determined from capsid sequences. The outcome was defined by the detection of virus for >14 days (slow clearance) or by the detection of negative samples within 14 days (rapid clearance). Two major epidemic GII.4 strains emerged during the study period, GII.4 New Orleans 2009, in 2010, and GII.4 Sydney 2012, in 2012. From these two seasons, sequences were available from 24 cases where the duration of shedding could be determined. The median age of the patients was 83 years and 50% were women. The majority of patients were infected with virus that clustered with the respective season's epidemic strain (n = 19), whereas 5 patients had previously circulating strains (3 were Den Haag 2006b, in 2010, and 2 were New Orleans 2009, in 2012). Among the patients infected with an epidemic strain, the proportion who shed virus for >14 days was significantly higher (16/19 [84%] versus 1/5 [20%], P = 0.01). In summary, a slow clearance of norovirus from stool was more common in infections with novel epidemic GII.4 strains. This suggests that the average duration of shedding may be longer during seasons when new GII.4 strains have emerged.
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Nasheri N, Petronella N, Ronholm J, Bidawid S, Corneau N. Characterization of the Genomic Diversity of Norovirus in Linked Patients Using a Metagenomic Deep Sequencing Approach. Front Microbiol 2017; 8:73. [PMID: 28197136 PMCID: PMC5282449 DOI: 10.3389/fmicb.2017.00073] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/11/2017] [Indexed: 01/14/2023] Open
Abstract
Norovirus (NoV) is the leading cause of gastroenteritis worldwide. A robust cell culture system does not exist for NoV and therefore detailed characterization of outbreak and sporadic strains relies on molecular techniques. In this study, we employed a metagenomic approach that uses non-specific amplification followed by next-generation sequencing to whole genome sequence NoV genomes directly from clinical samples obtained from 8 linked patients. Enough sequencing depth was obtained for each sample to use a de novo assembly of near-complete genome sequences. The resultant consensus sequences were then used to identify inter-host nucleotide variations that occur after direct transmission, analyze amino acid variations in the major capsid protein, and provide evidence of recombination events. The analysis of intra-host quasispecies diversity was possible due to high coverage-depth. We also observed a linear relationship between NoV viral load in the clinical sample and the number of sequence reads that could be attributed to NoV. The method demonstrated here has the potential for future use in whole genome sequence analyses of other RNA viruses isolated from clinical, environmental, and food specimens.
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Affiliation(s)
- Neda Nasheri
- National Food Virology Reference Centre, Bureau of Microbial Hazards, Food Directorate, Health Canada Ottawa, ON, Canada
| | - Nicholas Petronella
- Biostatistics and Modeling Division, Bureau of Food Surveillance and Science Integration, Food Directorate, Health Canada Ottawa, ON, Canada
| | - Jennifer Ronholm
- Department of Food Science and Agricultural Chemistry, Faculty of Agricultural and Environmental Sciences, Macdonald Campus, McGill UniversityMontreal, QC, Canada; Department of Animal Science, Faculty of Agricultural and Environmental Sciences, Macdonald Campus, McGill UniversityMontreal, QC, Canada
| | - Sabah Bidawid
- National Food Virology Reference Centre, Bureau of Microbial Hazards, Food Directorate, Health Canada Ottawa, ON, Canada
| | - Nathalie Corneau
- National Food Virology Reference Centre, Bureau of Microbial Hazards, Food Directorate, Health Canada Ottawa, ON, Canada
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Oyinloye SO, Aminu M, Ella EE, Jatau ED. The prevalence and predisposing factors of norovirus and astrovirus infection among diarrheic children in north east, Nigeria. ACTA ACUST UNITED AC 2016. [DOI: 10.5897/jphe2016.0840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kazama S, Masago Y, Tohma K, Souma N, Imagawa T, Suzuki A, Liu X, Saito M, Oshitani H, Omura T. Temporal dynamics of norovirus determined through monitoring of municipal wastewater by pyrosequencing and virological surveillance of gastroenteritis cases. Water Res 2016; 92:244-53. [PMID: 26874777 DOI: 10.1016/j.watres.2015.10.024] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 10/14/2015] [Accepted: 10/17/2015] [Indexed: 05/21/2023]
Abstract
Norovirus is a leading etiological agent of viral gastroenteritis. Because of relatively mild disease symptoms and frequent asymptomatic infections, information on the ecology of this virus is limited. Our objective was to examine the genetic diversity of norovirus circulating in the human population by means of genotyping the virus in municipal wastewater. We investigated norovirus genogroups I and II (GI and GII) in municipal wastewater in Japan by pyrosequencing and quantitative PCR (qPCR) from November 2012 to March 2013. Virological surveillance for gastroenteritis cases was concurrently conducted in the same area. A total of fourteen distinct genotypes in total (GI.1, 3, 4, 6, 7, GII.2, 4, 5, 6, 7, 12, 13, 14, and 17), with up to eight genotypes detected per sample, were observed in wastewater using pyrosequencing; only four genotypes (GI.6, GII.4, 5, and 14) were obtained from clinical samples. Seventy-eight percent of norovirus-positive stool samples contained GII.4, but this genotype was not dominant in wastewater. The norovirus GII.4 Sydney 2012 variant, which appeared and spread during our study period, was detected in both the wastewater and clinical samples. These results suggest that an environmental approach using pyrosequencing yields a more detailed distribution of norovirus genotypes/variants. Thus, wastewater monitoring by pyrosequencing is expected to provide an effective analysis of the distribution of norovirus genotypes causing symptomatic and asymptomatic infections in human populations.
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Affiliation(s)
- Shinobu Kazama
- New Industry Creation Hatchery Center, Tohoku University, Sendai, Miyagi, 980-8479, Japan
| | - Yoshifumi Masago
- New Industry Creation Hatchery Center, Tohoku University, Sendai, Miyagi, 980-8479, Japan; Institute for the Advanced Study of Sustainability, United Nations University, Shibuya-ku, Tokyo 150-8925, Japan.
| | - Kentaro Tohma
- Department of Virology, Tohoku Graduate School of Medicine, Tohoku University, Sendai, Miyagi, 980-8575, Japan
| | - Nao Souma
- Department of Virology, Tohoku Graduate School of Medicine, Tohoku University, Sendai, Miyagi, 980-8575, Japan
| | - Toshifumi Imagawa
- Department of Virology, Tohoku Graduate School of Medicine, Tohoku University, Sendai, Miyagi, 980-8575, Japan
| | - Akira Suzuki
- Virus Research Center, Clinical Research Division, Sendai Medical Center, Sendai, Miyagi, 983-8520, Japan
| | - Xiaofang Liu
- Department of Virology, Tohoku Graduate School of Medicine, Tohoku University, Sendai, Miyagi, 980-8575, Japan
| | - Mayuko Saito
- Department of Virology, Tohoku Graduate School of Medicine, Tohoku University, Sendai, Miyagi, 980-8575, Japan
| | - Hitoshi Oshitani
- Department of Virology, Tohoku Graduate School of Medicine, Tohoku University, Sendai, Miyagi, 980-8575, Japan
| | - Tatsuo Omura
- New Industry Creation Hatchery Center, Tohoku University, Sendai, Miyagi, 980-8479, Japan
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Abstract
OBJECTIVE The concept of aerosol transmission is developed to resolve limitations in conventional definitions of airborne and droplet transmission. METHODS The method was literature review. RESULTS An infectious aerosol is a collection of pathogen-laden particles in air. Aerosol particles may deposit onto or be inhaled by a susceptible person. Aerosol transmission is biologically plausible when infectious aerosols are generated by or from an infectious person, the pathogen remains viable in the environment for some period of time, and the target tissues in which the pathogen initiates infection are accessible to the aerosol. Biological plausibility of aerosol transmission is evaluated for Severe Acute Respiratory Syndrome coronavirus and norovirus and discussed for Mycobacterium tuberculosis, influenza, and Ebola virus. CONCLUSIONS Aerosol transmission reflects a modern understanding of aerosol science and allows physically appropriate explanation and intervention selection for infectious diseases.
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Rocha-Pereira J, Van Dycke J, Neyts J. Treatment with a Nucleoside Polymerase Inhibitor Reduces Shedding of Murine Norovirus in Stool to Undetectable Levels without Emergence of Drug-Resistant Variants. Antimicrob Agents Chemother 2015; 60:1907-11. [PMID: 26711754 DOI: 10.1128/AAC.02198-15] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/17/2015] [Indexed: 11/20/2022] Open
Abstract
Prolonged norovirus shedding may occur in certain patients, such as organ transplant recipients. We established a mouse model for persistent norovirus infection (using the mouse norovirus MNV.CR6 strain). The nucleoside viral polymerase inhibitor 2'-C-methylcytidine (2CMC), but not favipiravir (T-705), reduced viral shedding to undetectable levels. Viral rebound was observed after stopping treatment, which was again effectively controlled by treatment with 2CMC. No drug-resistant variants emerged.
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Costantini VP, Cooper EM, Hardaker HL, Lee LE, Bierhoff M, Biggs C, Cieslak PR, Hall AJ, Vinjé J. Epidemiologic, Virologic, and Host Genetic Factors of Norovirus Outbreaks in Long-term Care Facilities. Clin Infect Dis 2015; 62:1-10. [PMID: 26508509 DOI: 10.1093/cid/civ747] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/04/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In the Unites States, long-term care facilities (LTCFs) are the most common setting for norovirus outbreaks. These outbreaks provide a unique opportunity to better characterize the viral and host characteristics of norovirus disease. METHODS We enrolled 43 LTCFs prospectively to study the epidemiology, virology, and genetic host factors of naturally occurring norovirus outbreaks. Acute and convalescent stool, serum, and saliva samples from cases, exposed and nonexposed controls were collected. Norovirus infection was confirmed using quantitative polymerase chain reaction testing of stool samples or 4-fold increase in serum antibody titers. The presence of histo-blood group antigens (secretor, ABO, and Lewis type) was determined in saliva. RESULTS Sixty-two cases, 34 exposed controls, and 18 nonexposed controls from 10 norovirus outbreaks were enrolled. Forty-six percent of acute, 27% of convalescent case, and 11% of control stool samples tested norovirus positive. Outbreak genotypes were GII.4 (Den Haag, n = 3; New Orleans, n = 4; and Sydney, n = 2) and GI.1 (n = 1). Viral load in GII.4 Sydney outbreaks was significantly higher than in outbreaks caused by other genotypes; cases and controls shed similar amounts of virus. Forty-seven percent of cases shed virus for ≥ 21 days. Symptomatic infections with GII.4 Den Haag and GII.4 New Orleans were detected among nonsecretor individuals. CONCLUSIONS Almost half of all symptomatic individuals shed virus for at least 21 days. Viral load was highest in GII.4 viruses that most recently emerged; these viruses also infect the nonsecretor population. These findings will help to guide development of targeted prevention and control measures in the elderly.
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Affiliation(s)
- Veronica P Costantini
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emilie M Cooper
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hope L Hardaker
- Public Health Division of the Oregon Health Authority, Portland
| | - Lore E Lee
- Public Health Division of the Oregon Health Authority, Portland
| | - Marieke Bierhoff
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Paul R Cieslak
- Public Health Division of the Oregon Health Authority, Portland
| | - Aron J Hall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jan Vinjé
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Belliot G, Lopman BA, Ambert-Balay K, Pothier P. The burden of norovirus gastroenteritis: an important foodborne and healthcare-related infection. Clin Microbiol Infect 2015; 20:724-30. [PMID: 24943671 DOI: 10.1111/1469-0691.12722] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Human norovirus (NoV) is now recognized as one of the most important causative agents of gastroenteritis in all age groups worldwide. During the course of NoV infection, symptoms are usually mild and disappear within 48 h after onset. The incidence of NoV infection is high, with hundreds of cases per 10 000 of the population, although the number of infections is still underestimated. Epidemiological surveys conducted in Europe and North America have shown that NoV infections constitute a major disease burden, especially for young children and the elderly, in whom NoV infection leads to high rates of hospitalization and mortality. NoV infections are also of concern in hospitals, where viral infections can be persistent in immunocompromised patients. Although the cost of NoV infection in the hospital community has not yet been clearly established, it appears that NoV infections could cost hundreds of thousands of euros in terms of unit closure, and NoV-related sickness in patients and health workers. Besides their clinical burden, NoVs, as foodborne pathogens, also cause to millions of dollars of losses for the healthcare system and the food industry. Recent estimates in the USA showed that, annually, NoV illness cost $2 billion and led to a loss of approximately 5000 quality-adjusted life-years, making NoV one of the top five pathogens causing enteric illnesses. The highest cost among 14 foodborne pathogens is also attributed to human NoV in The Netherlands. This accumulation of evidence underlines the enormous impact of NoV on populations.
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Affiliation(s)
- G Belliot
- Laboratory of Virology, National Reference Centre for Enteric Viruses, Public Hospital of Dijon, Dijon, France
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Hovi T, Ollgren J, Haapakoski J, Amiryousefi A, Savolainen-Kopra C. Exposure to persons with symptoms of respiratory or gastrointestinal infection and relative risk of disease: self-reported observations by controls in a randomized intervention trial. Trials 2015; 16:168. [PMID: 25879224 PMCID: PMC4412200 DOI: 10.1186/s13063-015-0691-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/30/2015] [Indexed: 11/29/2022] Open
Abstract
Background Little is known about the quantitative relationships between a self-recognized exposure to people with symptoms of respiratory (RTI) or gastrointestinal tract infection (GTI) and subsequent occurrence of homologous symptoms in the exposed person. Methods Adult office employees, controls in an intervention trial, reported weekly own symptoms of RTI or GTI and exposures to other persons with similar symptoms. To ascertain the reliability of the self-reported data, the participants received both in-advance training and repeated instructions in the weekly Email requests for reports. The relationship of self-reported exposures to self-reported homologous symptoms during the same or the following week was analyzed including, in the statistical models, cluster effects and longitudinal aspects in the data, seasonality, and cluster-specific baseline values. Results Altogether 11,644 weekly reports were received from 230 participants during the 16-month duration of the study. The mean age of the reporters was 42.9 years (standard deviation 11.1 years), and the female/male ratio 157/68 (for 5 participants this information was not available). A reported exposure to RTI was associated with an almost 5-fold higher relative risk for a reported homologous infection during the same week (4.9; 95% confidence interval (CI) 4.0 to 5.9), and with a 3-fold risk during the following week (3.3; CI 2.8 to 3.8). For GTI the corresponding figures were 15.1 (CI 10.4 to 21.8) and 4.3 (CI 3.1 to 5.8), respectively. On the other hand, for 24% of the designated RTI episodes, a homologous exposure had been reported during neither the same nor the preceding week. For GTI this figure was even greater (40%). For both RTI and GTI, weeks with a reported exposure were more frequent outside the workplace than only at the workplace (434 versus 262, and 109 versus 41, respectively). Conclusion A reported exposure to persons with obvious symptoms of RTI or GTI significantly increased the relative risk of reported homologous infection in the exposed adult persons. Yet, a substantial part of reported designated RTI and, especially, GTI episodes occurred without a reported exposure during the same or the previous week. Trial registration ClinicalTrials.gov with an identifier of NCT00821509 (12 March 2009).
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Affiliation(s)
- Tapani Hovi
- National Institute for Health and Welfare (THL), Department of Infectious Diseases, Viral Infections Unit, PO Box 30, FIN-00271, Helsinki, Finland.
| | - Jukka Ollgren
- National Institute for Health and Welfare (THL), Department of Infectious Diseases, Viral Infections Unit, PO Box 30, FIN-00271, Helsinki, Finland.
| | - Jaason Haapakoski
- National Institute for Health and Welfare (THL), Department of Infectious Diseases, Viral Infections Unit, PO Box 30, FIN-00271, Helsinki, Finland.
| | - Ali Amiryousefi
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland.
| | - Carita Savolainen-Kopra
- National Institute for Health and Welfare (THL), Department of Infectious Diseases, Viral Infections Unit, PO Box 30, FIN-00271, Helsinki, Finland.
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Magill-Collins A, Gaither M, Gerba CP, Kitajima M, Iker BC, Stoehr JD. Norovirus Outbreaks Among Colorado River Rafters in the Grand Canyon, Summer 2012. Wilderness Environ Med 2015; 26:312-8. [PMID: 25890859 DOI: 10.1016/j.wem.2015.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 02/12/2015] [Accepted: 02/16/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the incidence and causative agent of the recurrent outbreaks of acute gastrointestinal illness (AGI) among different rafting groups on the Colorado River in the Grand Canyon National Park during the 2012 summer season. METHODS Confidential illness reports were completed by all individuals with symptoms of AGI, and samples of fecal matter and vomitus, surface swabs of rafting equipment, and environmental swabs at stops along the hiking corridor were collected and tested for the presence of norovirus using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). RESULTS During the active outbreak period between May 9 and July 9, 2012, 97 rafters (1.4%) from 10 trips (2.9% of all trips) declared AGI symptoms. AGI incidence within the 10 infected trips varied from 6% to 88%. Outbreaks occurred in 3 distinct temporal clusters that involved 2 different genogroups of norovirus. All available toilet fecal samples (5 samples) were positive for norovirus RNA: 1 with genogroup I (GI) and 4 with GII. The vomitus sample tested positive for GI. None of the fomite samples from rafting equipment or from the hiking corridors were confirmed for norovirus. CONCLUSIONS The results suggest that norovirus may have been introduced by ill or asymptomatic individuals actively shedding the virus in their vomitus or feces, and spread within, or between, river trips by different modes of transmission. This study reinforces the importance of appropriate guidance and practice regarding norovirus prevention and the necessity of postoutbreak containment in relatively isolated groups of individuals.
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Grove SF, Suriyanarayanan A, Puli B, Zhao H, Li M, Li D, Schaffner DW, Lee A. Norovirus cross-contamination during preparation of fresh produce. Int J Food Microbiol 2015; 198:43-9. [PMID: 25590260 DOI: 10.1016/j.ijfoodmicro.2014.12.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 12/04/2014] [Accepted: 12/21/2014] [Indexed: 12/19/2022]
Abstract
Infection with human norovirus (HuNoV) is considered a common cause of foodborne illness worldwide. Foodborne HuNoV outbreaks may result from consumption of food contaminated by an infected food handler in the foodservice environment, in which bare-hand contact, lack of hand washing, and inadequate cleaning and disinfection are common contributing factors. The goal of this study was to examine cross-contamination of a HuNoV surrogate, murine norovirus (MNV-1), during common procedures used in preparing fresh produce in a food service setting, including turning water spigots, handling and chopping Romaine lettuce, and washing hands. MNV-1 transfer % was log-transformed to achieve a normal distribution of the data and enable appropriate statistical analyses to be performed. MNV-1 transfer coefficients varied by surface type, and a greater affinity for human hands and chopped lettuce was observed. For example, greater transfer was observed from a contaminated stainless steel spigot to a clean hand (24% or 1.4-log transfer %) compared to transfer from hand to spigot (0.6% or -0.2-log transfer %). During the chopping of Romaine lettuce, MNV-1 was transferred from either a contaminated cutting board (25% or 1.4-log transfer %) or knife (~100% or 2.0-log transfer %) to lettuce at a significantly greater rate (p>0.05) than from contaminated lettuce to the board (2.1% or 0.3-log transfer %) and knife (1.2% or 0.06-log transfer %). No significant difference (p>0.05) in MNV-1 transfer coefficients was observed between bare hands and Romaine lettuce during handling. For handwashing trials, only one hand was inoculated with MNV-1 prior to washing. The handwashing methods included rubbing hands under tap water for at least 5s (average 2.8-log reduction) or washing hands for at least 20s with liquid soap (average 2.9-log reduction) or foaming soap (average 3.0-log reduction), but no statistical difference between these reductions was achieved (p>0.05). Despite the reductions of MNV-1 observed, residual virions were detected on both hands after washing in every replicate trial. This observation reveals that virions are transferred from one hand to the other during washing with and without soap. Each transfer scenario was repeated at least 9 times, and the data gathered indicate that MNV-1 transfers readily between common surfaces during food preparation. These data are important for the development of quantitative risk analyses, and will assist in the development of appropriate intervention strategies for enteric viruses in food preparation.
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Affiliation(s)
- Stephen F Grove
- Institute for Food Safety and Health, Illinois Institute of Technology, 6502 S. Archer Road, Bedford Park, IL 60501-1957, USA.
| | - Annamalai Suriyanarayanan
- Institute for Food Safety and Health, Illinois Institute of Technology, 6502 S. Archer Road, Bedford Park, IL 60501-1957, USA
| | - Balasubramanyam Puli
- Institute for Food Safety and Health, Illinois Institute of Technology, 6502 S. Archer Road, Bedford Park, IL 60501-1957, USA
| | - Heng Zhao
- Institute for Food Safety and Health, Illinois Institute of Technology, 6502 S. Archer Road, Bedford Park, IL 60501-1957, USA
| | - Mingming Li
- Institute for Food Safety and Health, Illinois Institute of Technology, 6502 S. Archer Road, Bedford Park, IL 60501-1957, USA
| | - Di Li
- Department of Food Science, 65 Dudley Road, Rutgers University, New Brunswick, NJ 08901-8520, USA
| | - Donald W Schaffner
- Department of Food Science, 65 Dudley Road, Rutgers University, New Brunswick, NJ 08901-8520, USA
| | - Alvin Lee
- Institute for Food Safety and Health, Illinois Institute of Technology, 6502 S. Archer Road, Bedford Park, IL 60501-1957, USA
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Teunis PF, Sukhrie FH, Vennema H, Bogerman J, Beersma MF, Koopmans MP. Shedding of norovirus in symptomatic and asymptomatic infections. Epidemiol Infect 2015; 143:1710-7. [PMID: 25336060 DOI: 10.1017/S095026881400274X] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Norovirus is the most frequent cause of acute infectious gastroenteritis and it is difficult to control in crowded environments like hospitals and nursing homes. Transmission depends on oral intake of virus deposited in the environment by infectious subjects. Data from volunteer studies indicate that virus concentrations in stool are highly variable, but systematic studies of the time-course of shedding and its individual variation are lacking. This paper quantifies norovirus shedding in a large population of 102 subjects, including asymptomatic shedders, and uses a longitudinal model to generalize shedding patterns. Enhanced surveillance for studies of transmission of norovirus in hospital outbreaks has yielded a considerable number of faecal samples from symptomatic and asymptomatic shedders, both from patients and staff. Norovirus concentrations were determined by real-time PCR. A quantitative dynamic model was fitted to the shedding data, in a multilevel Bayesian framework, to study the time-course of shedding and its variation. The results indicate that shedding in asymptomatic subjects is similar to that in symptomatic infections, both showing considerable variation in peak levels (average 105-109 /g faeces) as well as duration of virus shedding (average 8-60 days). Patients appear to shed higher numbers of virus than staff, for slightly longer durations, but the differences are too small to be significant. Given equal shedding, the greater contribution of symptomatic cases to transmission must be caused by their higher efficiency in spreading these viruses. The results of this study will be helpful for risk studies that need to quantify the deposition of virus in the environment.
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Loutreul J, Cazeaux C, Levert D, Nicolas A, Vautier S, Le Sauvage AL, Perelle S, Morin T. Prevalence of human noroviruses in frozen marketed shellfish, red fruits and fresh vegetables. Food Environ Virol 2014; 6:157-68. [PMID: 24923255 DOI: 10.1007/s12560-014-9150-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/20/2014] [Indexed: 06/03/2023]
Abstract
Noroviruses (NoVs), currently recognised as the most common human food-borne pathogens, are ubiquitous in the environment and can be transmitted to humans through multiple foodstuffs. In this study, we evaluated the prevalence of human NoV genogroups I (GI) and II (GII) in 493 food samples including soft red fruits (n = 200), salad vegetables (n = 210) and bivalve mollusc shellfish (n = 83), using the Bovine Enterovirus type 1 as process extraction control for the first time. Viral extractions were performed by elution concentration and genome detection by TaqMan Real-Time RT-PCR (RT-qPCR). Experimental contamination using hepatitis A virus (HAV) was used to determine the limit of detection (LOD) of the extraction methods. Positive detections were obtained from 2 g of digestive tissues of oysters or mussels kept for 16 h in seawater containing 2.0-2.7 log10 plaque-forming units (PFU)/L of HAV. For lettuces and raspberries, the LOD was, respectively, estimated at 2.2 and 2.9 log10 PFU per 25 g. Of the molluscs tested, 8.4 and 14.4% were, respectively, positive for the presence of GI NoV and GII NoV RNA. Prevalence in GI NoVs varied from 11.9% for the salad vegetables samples to 15.5% for the red soft fruits. Only 0.5% of the salad and red soft fruits samples were positive for GII NoVs. These results highlight the high occurrence of human NoVs in foodstuffs that can be eaten raw or after a moderate technological processing or treatment. The determination of the risk of infection associated with an RT-qPCR positive sample remains an important challenge for the future.
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Affiliation(s)
- Julie Loutreul
- ACTALIA, Groupe Sécurité des Aliments et Innovation Procédés, 23 Boulevard du 13 Juin 1944 BP2, 14310, Villers-Bocage, France
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38
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Bartsch SM, Huang SS, Wong KF, Avery TR, Lee BY. The spread and control of norovirus outbreaks among hospitals in a region: a simulation model. Open Forum Infect Dis 2014; 1:ofu030. [PMID: 25734110 PMCID: PMC4281820 DOI: 10.1093/ofid/ofu030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/11/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Because hospitals in a region are connected via patient sharing, a norovirus outbreak in one hospital may spread to others. METHODS We utilized our Regional Healthcare Ecosystem Analyst software to generate an agent-based model of all the acute care facilities in Orange County (OC), California and simulated various norovirus outbreaks in different locations, both with and without contact precautions. RESULTS At the lower end of norovirus reproductive rate (R0) estimates (1.64), an outbreak tended to remain confined to the originating hospital (≤6.1% probability of spread). However, at the higher end of R0 (3.74), an outbreak spread 4.1%-17.5% of the time to almost all other OC hospitals within 30 days, regardless of the originating hospital. Implementing contact precautions for all symptomatic cases reduced the probability of spread to other hospitals within 30 days and the total number of cases countywide, but not the number of other hospitals seeing norovirus cases. CONCLUSIONS A single norovirus outbreak can continue to percolate throughout a system of different hospitals for several months and appear as a series of unrelated outbreaks, highlighting the need for hospitals within a region to more aggressively and cooperatively track and control an initial outbreak.
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Affiliation(s)
- Sarah M. Bartsch
- Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Industrial Engineering
| | - Susan S. Huang
- University of California School of Medicine, Irvine, California
| | - Kim F. Wong
- Center for Simulation and Modeling, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Taliser R. Avery
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Bruce Y. Lee
- Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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39
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Davis C, Vally H, Bell R, Sheehan F, Beard F. Viral gastrointestinal outbreaks in residential care facilities: an examination of the value of public health unit involvement. Aust N Z J Public Health 2014; 38:177-83. [DOI: 10.1111/1753-6405.12171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/01/2013] [Accepted: 10/01/2013] [Indexed: 01/29/2023] Open
Affiliation(s)
- Craig Davis
- Communicable Diseases Unit; Department of Health; Queensland
- National Centre for Epidemiology and Population Health, The Australian National University, Australian Capital Territory
- School of Population Health, The University of Queensland
| | - Hassan Vally
- National Centre for Epidemiology and Population Health, The Australian National University, Australian Capital Territory
- School of Public Health and Human Biosciences; La Trobe University; Victoria
| | - Robert Bell
- OzFoodNet (Queensland), Communicable Diseases Unit, Department of Health; Queensland
| | - Frances Sheehan
- Communicable Diseases Unit; Department of Health; Queensland
| | - Frank Beard
- Communicable Diseases Unit; Department of Health; Queensland
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40
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Kirby A, Shi J, Montes J, Lichtenstein M, Moe C. Disease course and viral shedding in experimental Norwalk virus and Snow Mountain virus infection. J Med Virol 2014; 86:2055-64. [DOI: 10.1002/jmv.23905] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 01/24/2014] [Indexed: 12/16/2022]
Affiliation(s)
- A.E. Kirby
- Hubert Department of Global Health; Rollins School of Public Health; Emory University; Atlanta Georgia
| | - J. Shi
- Hubert Department of Global Health; Rollins School of Public Health; Emory University; Atlanta Georgia
| | - J. Montes
- Hubert Department of Global Health; Rollins School of Public Health; Emory University; Atlanta Georgia
| | - M. Lichtenstein
- Hubert Department of Global Health; Rollins School of Public Health; Emory University; Atlanta Georgia
| | - C.L. Moe
- Hubert Department of Global Health; Rollins School of Public Health; Emory University; Atlanta Georgia
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41
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Huynen P, Mauroy A, Martin C, Savadogo LGB, Boreux R, Thiry E, Melin P, De Mol P. Molecular epidemiology of norovirus infections in symptomatic and asymptomatic children from Bobo Dioulasso, Burkina Faso. J Clin Virol 2013; 58:515-21. [DOI: 10.1016/j.jcv.2013.08.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 08/07/2013] [Accepted: 08/16/2013] [Indexed: 10/26/2022]
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Richardson C, Bargatze RF, Goodwin R, Mendelman PM. Norovirus virus-like particle vaccines for the prevention of acute gastroenteritis. Expert Rev Vaccines 2013; 12:155-67. [PMID: 23414407 DOI: 10.1586/erv.12.145] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Noroviruses (NoVs) are the most common cause of nonbacterial acute gastroenteritis in humans worldwide. These highly infectious viruses were, until recently, commonly thought to cause a mild, self-limiting disease in healthy individuals, but increasing epidemiology shows that the incidence and severity of illness due to NoV infection is substantial and similar to diseases where immunization is widely recommended. Human NoV challenge studies have identified carbohydrate histo-blood group antigen expression as an important human susceptibility factor for many strains and correspondingly, that antibodies which block carbohydrate virus binding represent a potential correlate of protection against NoV infection and illness. Since human NoVs do not replicate in cell culture, there are numerous challenges to the development of a vaccine to prevent illness or infection. However, the development of NoV virus-like particles (VLPs) has enabled significant progress toward effective vaccine candidates designed to protect against multiple circulating NoV strains. Vaccination with NoV VLP vaccines has been shown to both induce antibodies that block virus-derived VLP carbohydrate binding and protect against homologous viral challenge in a human clinical study.
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Affiliation(s)
- Charles Richardson
- LigoCyte Pharmaceuticals Inc., 2155 Analysis Drive, Bozeman, MT 59718, USA.
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43
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Affiliation(s)
- Erin Dicaprio
- Department of Food Science and Technology, College of Food, Agricultural, and Environmental Sciences, The Ohio State University, 110 Parker Food Science and Technology Building, 2015 Fyffe Road, Columbus, OH 43210, USA
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Abstract
Excretion of enteropathogens by subjects without diarrhea influences our appreciation of the role of these pathogens as etiologic agents. Characteristics of the pathogens and host and environmental factors help explain asymptomatic excretion of diarrheal pathogens by persons without diarrhea. After causing acute diarrhea followed by clinical recovery, some enteropathogens are excreted asymptomatically for many weeks. Thus, in a prevalence survey of persons without diarrhea, some may be excreting pathogens from diarrheal episodes experienced many weeks earlier. Volunteer challenges with Vibrio cholerae O1, enterotoxigenic Escherichia coli (ETEC), enteropathogenic E. coli, Campylobacter jejuni, and Giardia lamblia document heterogeneity among enteropathogen strains, with some inexplicably not eliciting diarrhea. The immune host may not manifest diarrhea following ingestion of a pathogen but may nevertheless asymptomatically excrete. Some human genotypes render them less susceptible to symptomatic or severe diarrheal infection with certain pathogens such as Vibrio cholerae O1 and norovirus. Pathogens in stools of individuals without diarrhea may reflect recent ingestion of inocula too small to cause disease in otherwise susceptible hosts or of animal pathogens (eg, bovine or porcine ETEC) that do not cause human illness.
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Affiliation(s)
- Myron M Levine
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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45
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Milbrath MO, Spicknall IH, Zelner JL, Moe CL, Eisenberg JN. Heterogeneity in norovirus shedding duration affects community risk. Epidemiol Infect 2013; 141:1572-84. [PMID: 23507473 DOI: 10.1017/S0950268813000496] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Norovirus is a common cause of gastroenteritis in all ages. Typical infections cause viral shedding periods of days to weeks, but some individuals can shed for months or years. Most norovirus risk models do not include these long-shedding individuals, and may therefore underestimate risk. We reviewed the literature for norovirus-shedding duration data and stratified these data into two distributions: regular shedding (mean 14-16 days) and long shedding (mean 105-136 days). These distributions were used to inform a norovirus transmission model that predicts the impact of long shedders. Our transmission model predicts that this subpopulation increases the outbreak potential (measured by the reproductive number) by 50-80%, the probability of an outbreak by 33%, the severity of transmission (measured by the attack rate) by 20%, and transmission duration by 100%. Characterizing and understanding shedding duration heterogeneity can provide insights into community transmission that can be useful in mitigating norovirus risk.
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Abstract
In the United States, the leading cause of foodborne illness is norovirus; an average of 1 foodborne norovirus outbreak is reported every day. The more we know about how this virus is spread and in which foods, the better we can ward off future outbreaks. A recent study identified the most common sources of foodborne norovirus outbreaks as ready-to-eat foods that contain fresh produce and mollusks that are eaten raw, such as oysters. Most implicated foods had been prepared in restaurants, delicatessens, and other commercial settings and were most often contaminated by an infected food worker. Although possible contamination during production, harvesting, or processing cannot be overlooked, food safety during meal preparation should be emphasized. Food handlers should wash their hands, avoid bare-handed contact with ready-to-eat foods, and not work when they are sick. Keywords: norovirus, foodborne disease, outbreaks, attribution, United States, viruses
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Affiliation(s)
- Aron J Hall
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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47
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Thornley CN, Hewitt J, Perumal L, Van Gessel SM, Wong J, David SA, Rapana JP, Li S, Marshall JC, Greening GE. Multiple outbreaks of a novel norovirus GII.4 linked to an infected post-symptomatic food handler. Epidemiol Infect 2013; 141:1585-97. [DOI: 10.1017/s0950268813000095] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
SUMMARYMultiple norovirus outbreaks following catered events in Auckland, New Zealand, in September 2010 were linked to the same catering company and investigated. Retrospective cohort studies were undertaken with attendees of two events: 38 (24·1%) of 158 surveyed attendees developed norovirus-compatible illness. Attendees were at increased risk of illness if they had consumed food that had received manual preparation following cooking or that had been prepared within 45 h following end of symptoms in a food handler with prior gastroenteritis. All food handlers were tested for norovirus. A recombinant norovirus GII.e/GII.4 was detected in specimens from event attendees and the convalescent food handler. All catering company staff were tested; no asymptomatic norovirus carriers were detected. This investigation improved the characterization of norovirus risk from post-symptomatic food handlers by narrowing the potential source of transmission to one individual. Food handlers with gastroenteritis should be excluded from the workplace for 45 h following resolution of symptoms.
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48
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Lai CC, Wang YH, Wu CY, Hung CH, Jiang DDS, Wu FT. A norovirus outbreak in a nursing home: Norovirus shedding time associated with age. J Clin Virol 2013; 56:96-101. [DOI: 10.1016/j.jcv.2012.10.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 09/25/2012] [Accepted: 10/18/2012] [Indexed: 10/27/2022]
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49
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Ohe M. A "blind spot" regarding the norovirus infection pathway. TOHOKU J EXP MED 2013; 229:125-8. [PMID: 23327929 DOI: 10.1620/tjem.229.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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50
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Mathijs E, Stals A, Baert L, Botteldoorn N, Denayer S, Mauroy A, Scipioni A, Daube G, Dierick K, Herman L, Van Coillie E, Uyttendaele M, Thiry E. A review of known and hypothetical transmission routes for noroviruses. Food Environ Virol 2012; 4:131-52. [PMID: 23412887 DOI: 10.1007/s12560-012-9091-z] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 10/06/2012] [Indexed: 05/04/2023]
Abstract
Human noroviruses (NoVs) are considered a worldwide leading cause of acute non-bacterial gastroenteritis. Due to a combination of prolonged shedding of high virus levels in feces, virus particle shedding during asymptomatic infections, and a high environmental persistence, NoVs are easily transmitted pathogens. Norovirus (NoV) outbreaks have often been reported and tend to affect a lot of people. NoV is spread via feces and vomit, but this NoV spread can occur through several transmission routes. While person-to-person transmission is without a doubt the dominant transmission route, human infective NoV outbreaks are often initiated by contaminated food or water. Zoonotic transmission of NoV has been investigated, but has thus far not been demonstrated. The presented review aims to give an overview of these NoV transmission routes. Regarding NoV person-to-person transmission, the NoV GII.4 genotype is discussed in the current review as it has been very successful for several decades but reasons for its success have only recently been suggested. Both pre-harvest and post-harvest contamination of food products can lead to NoV food borne illness. Pre-harvest contamination of food products mainly occurs via contact with polluted irrigation water in case of fresh produce or with contaminated harvesting water in case of bivalve molluscan shellfish. On the other hand, an infected food handler is considered as a major cause of post-harvest contamination of food products. Both transmission routes are reviewed by a summary of described NoV food borne outbreaks between 2000 and 2010. A third NoV transmission route occurs via water and the spread of NoV via river water, ground water, and surface water is reviewed. Finally, although zoonotic transmission remains hypothetical, a summary on the bovine and porcine NoV presence observed in animals is given and the presence of human infective NoV in animals is discussed.
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Affiliation(s)
- Elisabeth Mathijs
- Department of Infectious and Parasitic diseases, Virology and Viral diseases, Faculty of Veterinary Medicine, University of Liège, Boulevard du Colonster 20, 4000, Liège, Belgium
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