Environmental transmission of norovirus gastroenteritis

Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Current opinion in virology 02/2012; 2(1):96-102. DOI: 10.1016/j.coviro.2011.11.005
Source: PubMed


The advent of molecular techniques and their increasingly widespread use in public health laboratories and research studies has transformed the understanding of the burden of norovirus. Norovirus is the most common cause of community-acquired diarrheal disease across all ages, the most common cause of outbreaks of gastroenteritis, and the most common cause of foodborne disease in the United States. They are a diverse group of single-stranded RNA viruses that are highly infectious and stable in the environment; both symptomatic and asymptomatic infections are common. Through shedding in feces and vomit, norovirus can be transmitted directly through an array of routes: person-to-person, food or the environment. The relative importance of environmental transmission of virus is yet to be fully quantified but is likely to be substantial and is an important feature that complicates control.

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    • "The development of PCR techniques has improved our ability to detect norovirus in clinical and environmental samples, however the test identifies viral RNA and cannot distinguish viable viral particles and may also detect norovirus RNA in the stool of healthy people . Transmission of norovirus in care settings occurs primarily through person-to-person spread via a faecal–oral route, in the community, exposure to contaminated food leads to significant point source outbreaks (Lopman et al., 2011). Contact with vomit either directly, by aerosolisation, or via contaminated surfaces may be a contributory factor in outbreaks in healthcare and other confined settings such as residential homes and cruise ships (Patel et al., 2009). "

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    • "Enteric viruses are considered as the most common pathogens associated with human gastroenteritis. Human Noroviruses (NoVs) are found in all age groups (Atmar 2010; Tian et al. 2014) and are a major cause of foodborne and waterborne outbreaks (Lopman et al. 2012; Gould et al. 2013; Kim et al. 2014; Wilkes et al. 2014). Waterborne NoVs caused by contaminated surface water, drinking waters, mineral waters, recreational waters, and groundwater pose a grave danger to public health (Rutjes et al. 2006; Iwai et al. 2009; Wyn-Jones et al. 2011; Lee et al. 2012). "

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    • "Worldwide, rotavirus A (RVA) and noroviruses (NoV) are the major causes of AGE, responsible for over 400,000 deaths each year mainly in low-income countries (Glass et al., 2009; Patel et al., 2009; Desai et al., 2011; Lopman et al., 2012; Tate et al., 2012; Walker et al., 2013). In 2009, WHO recommended the introduction of RVA vaccines into the routine immunization programs, and despite evidence that these vaccines provide good protection against hospitalizations, the AGE morbidity associated to RVA infections remains significant worldwide. "
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    ABSTRACT: Rotavirus A (RVA) and noroviruses (NoV) are the major viral agents of acute gastroenteritis (AGE) worldwide. In the present study, we aimed to evaluate the performance of a one-step duplex quantitative RT-PCR (dRT-qPCR) assay, established for detection and quantification of RVA and NoV genogroup II (GII) using a single DNA standard curve (SC), as well as to investigate the association between fecal viral load and optical density (OD) values, and viruses' genotyping. The results obtained by dRT-qPCR in 530 fecal samples from AGE cases were compared with methods employed for the diagnosis of those viruses as follows: enzyme immunoassay (EIA) and polyacrylamide gel electrophoresis (PAGE) for RVA; and qualitative PCR for NoV. By using dRT-qPCR, we detected RVA and NoV in 353 (66%), increasing the positivity rate by 22.5% for RVA and 11.5% NoV, comparing the number of positive samples. RVA and NoV GII were detected in a range of 5.17 x 10(3) to 6.56 x 10(9) and 3.76 x 10(3) to 9.13 x 10(10) genome copies per gram of feces, respectively. We observed a significant direct correlation between genome copies values and optical density, using dRT-qPCR and EIA assays, respectively (Spearman ρ=0.41; p<0.0001). Viruses characterization demonstrated a predominance of NoV GII.4 Sidney 2012 variant during October 2013 to February 2014, followed by the emergence of RVA genotype G12P[8] in 2014. The established assay using a single SC provides an early feedback concerning detection and quantification, with the advantage of detecting simultaneously RVA and NoV GII, reducing time and reagent costs.
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