NoV Vaccines Research Articles

Blockade Antibody Responses in Human Subjects Challenged with a New Snow Mountain Virus Inoculum.

Noroviruses (NoVs) are a leading cause of non-bacterial gastroenteritis in young children and adults worldwide. Snow Mountain Virus (SMV) is the prototype of NoV GII genotype 2 (GII.2) that has been developed as a viral model for human challenge studies, an important tool for studying pathogenesis and immune response of NoV infections and for evaluating NoV vaccine candidates. Previous studies have identified blockade antibodies that block the binding of NoV virus-like particles (VLPs) to histo-blood group antigens (HBGAs) as a surrogate for neutralization in human Norwalk virus and GII.4 infections but little is known about SMV blockade antibodies. In this secondary data analysis study, blockade antibodies were characterized in pre-challenge and post-challenge serum samples from human subjects challenged with a new SMV inoculum. The correlation between blockade antibody geometric mean antibody titers (GMTs) and SMV-specific serum IgG/IgA GMTs were examined after stratifying the subjects by infection status. A linear mixed model was applied to test the association between HBGA blockade antibody concentrations and post-challenge days accounting for covariates and random effects. Laboratory results from 33 SMV inoculated individuals were analyzed and 75.7% (25/33) participants became infected. Serum SMV-specific blockade antibodies, IgA, and IgG were all significantly different between infected and uninfected individuals beginning day 15 post-challenge. Within infected individuals, a significant correlation was observed between both IgG and IgA and blockade antibody concentration as early as day 6 post-challenge. Analysis of blockade antibody using the linear mixed model showed that infected individuals, when compared to uninfected individuals, had a statistically significant increase in blockade antibody concentrations across the post-challenge days. Among the post-challenge days, blockade antibody concentrations on days 15, 30, and 45 were significantly higher than those observed pre-challenge. The intraclass correlation coefficient (ICC) analysis indicated that the variability of blockade antibody titers is more observed between individuals rather than within subjects. These results indicate that HBGA-blockade antibody GMTs are generated after SMV challenge and the blockade antibodies were still detectable at day 45 post-challenge. These data indicate that the second-generation of SMV inoculum is highly effective.

Genotypes and transmission routes of noroviruses causing sporadic acute gastroenteritis among adults and children, Japan, 2015-2019.

Noroviruses (NoVs) are major causes of acute viral gastroenteritis at all ages worldwide. The molecular epidemiology of sporadic cases remains poorly understood, especially in adults. Additionally, no studies have analyzed the transmission route in sporadic acute gastroenteritis. In this study, we investigated cases of very mild sporadic NoV acute gastroenteritis in adults (medical staff) who do not visit the outpatient clinic and child outpatients. We also evaluated genotype differences between adults and children and possible transmission routes in adults during 5years. The number of NoV positives were 58 in adults and 124 in children. In adults, the NoV positivity rate in this study was higher (64.4%) than that in previous reports of outpatients (10%) and inpatients (5%) in the United State. This finding suggested that the NoV positivity rate might be high in adults with very mild acute gastroenteritis. In adults, human-to-human transmission rates from children and food-borne transmission (raw oysters) were 21.6% (11/51) and 19.6% (10/51), respectively. Among adults, GII.2, GII.4, and GII.17 were the predominant genotypes, with rates of 32.7%, 30.9%, and 21.8%, respectively. Among children, GII.4 and GII.2 were the predominant genotypes, with rates of 45.5% and 40.6%, respectively. GII.17 was only detected in 0.8% (1/123) of children. Trends in NoV genotypes are expected to differ depending on the patient's age. Investigating sporadic cases including the patient's background (age and transmission route) may be helpful to monitor the trend of NoV strains, forecast prevalent NoV GII genotypes, and develop NoV vaccines.

Human Norovirus Molecular Analysis and Development of Norovirus Vaccine

The most common organism of acute viral gastroenteritis is norovirus, which accounts for roughly 20% of all occurrences of acute gastroenteritis globally. The virus kills over 200,000 children each year and is the leading cause of childhood diarrhea in the rotavirus-vaccinated population. This study aims to review available studies regarding the information on the genogroup norovirus in humans, development of norovirus vaccines, and effectiveness of norovirus vaccines. A systematic review using Science Direct, PubMed, and Scopus databases to identify eligible case studies. The search was conducted in September-October 2021. The quality of the included literature used checklists from the Critical Appraisal Skills Program (CASP). All of the six selected studies with populations given RT-PCR intervention showed positive for norovirus infection. The most predominant genogroups in humans are GI and GII. As for the research results of the two selected studies on norovirus vaccine, namely the human phase 2 trial containing two Virus-Like Particles (VLP) genotypes, one study showed efficacy at 18-49 one study at ≥ 60 years of age. This study analysis uses Takeda bivalent vaccine. The vaccine includes norovirus antigens of the GI and GII genogroups, intending to expand its protective immune potential. GI, GII, and GIV genogroups are prevalent in humans. VLP that contains GI.I and consensus GII.4c have been created as the NoV vaccine, providing signifi cant efficacy. Very likely because they contain GI dan GII antigens, which are the genogroups that infect humans the most. Patients given a placebo developed acute gastroenteritis due to norovirus GII.2, indicating a genotype cross-reactivity.

A split NanoLuc complementation-based human norovirus-like particle entry assay facilitates evaluation of anti-norovirus antibodies in live cells

Human noroviruses (NoVs) are the most common cause of acute gastroenteritis worldwide. One major obstacle in developing NoV vaccines is the lack of robust cell culture for efficacy evaluation. In this study, we successfully developed a NoV virus-like particle (VLP) entry assay based on split NanoLuc luciferase (LgBiT and HiBiT) complementation. HiBiT-tagged NoV GII.4 VLP (VLP-HiBiT) can be efficiently produced in Pichia pastoris and retain binding activity towards NoV receptor histo-blood group antigens (HBGAs). A 293T-FUT2-LgBiT cell line was established and was shown to stably express cell surface HBGAs and intracellular LgBiT. GII.4 VLP-HiBiT can bind and enter into the 293-FUT2-LgBiT cells, producing strong luminescence signals in live cells. Anti-GII.4 sera can inhibit VLP-HiBiT entry into the 293-FUT2-LgBiT cells in a dose-dependent manner, and neutralizing titers well correlate with their blocking titers measured by HBGAs-binding blockade assay. Moreover, such a surrogate infection/neutralization assay can be applied to other NoV genotypes such as GI.1 and GII.17. Together, the VLP-HiBiT entry assay can mimic both NoV attachment and internalization in live cells and thus facilitate reliable and comprehensive evaluation of NoV vaccine and antibodies.

Prevalence and Evolution of Noroviruses between 1966 and 2019, Implications for Vaccine Design.

Noroviruses (NoVs), a group of single-stranded RNA viruses causing epidemic acute gastroenteritis in humans, are highly diverse, consisting of multiple genogroups with >30 genotypes. Their continual evolutions make NoV vaccine design and development difficult. Here, we report a study of NoV sequences obtained from a population-based diarrhea surveillance in Zhengding County of Hebei Province spanning from 2001 to 2019 and those available in the GenBank database from 1966 to 2019. NoV genotypes and/or variants that may evade immunity were screened and identified based on primary and conformational structures for vaccine design. We selected 366, 301, 139, 74 and 495 complete VP1-coding nucleotide sequences representing the predominant genotypes of GII.4, GII.2, GII.3, GII.6 and GII.17, respectively. A total of 16 distinct GII.4 variants were identified, showing a typical linear evolutionary pattern of variant replacement, while only 1–4 variants of the other genotypes were found to co-circulate over the 40–50-year period without typical variant replacement. The vaccine strain GII.4c is close to variant Sydney_2012 (0.053) in their primary structure, but they are distinct at epitopes A and E in conformations. Our data suggested GII.4 variant Sydney_2012, GII.2 variant A, a GII.3 strain, GII.6 variants B and C and GII.17 variant D are primary candidate strains for NoV vaccine development.

Crossing the T’s on Norovirus

Human noroviruses (NoVs) are highly contagious viral pathogens and the leading cause of virally induced gastroenteritis across all age groups.1 Currently, there are no approved therapeutics or vaccines available against NoVs. Adaptive immune control of NoVs in humans, especially humoral antibody responses, has been intensively analyzed in clinical settings, but T cell responses against NoVs have generally been understudied. NoV vaccine design has predominantly focused on antibody-mediated protection, targeting the structural portions of NoVs, but their success thus far has been limited.

Phylogenetic and biological characterizations of a GI.3 norovirus.

Noroviruses (NoVs) are a major cause of acute non-bacterial gastroenteritis worldwide. In this study, we report the isolation, near-complete genome sequencing, and expression and biological characterization of the major capsid protein (VP1) of a GI.3 NoV isolated from a child presenting acute gastroenteritis. The genome of the GI.3 NoV is 7746bp in length, not including the poly-adenylation tail. Phylogenetic analysis based on the complete VP1 nucleotide sequences indicates that GI.3 NoVs could be divided into four clusters, with 4.6%, 5.3%, 6.6%, 1.9% intracluster variations in nucleotide and 4.8%, 3.8%, 6.1%, 1.7% intracluster variations in amino acid sequences, respectively. A Bayesian evolutionary analysis showed that GI.3 NoVs evolved at 2.44×10-3, 2.78×10-3, and 3.04×10-3 nucleotide substitutions/site/year using a strict clock model, an uncorrelated log-normal model (UCLN), and an uncorrelated exponential derivation model (UCED), respectively. VP1 protein expression using a recombinant baculovirus expression system leads to the successful assembly of virus-like particles (VLPs). In vitro VLP-Histo-blood group antigen (HBGA) binding assay indicates that GI.3 NoV VLPs strongly bind to blood type A salivary HBGAs, moderately bind to blood type O salivary HBGAs, and weakly bind or do not bind to blood type B and AB salivary HBGAs. In vitro VLP-HBGA binding blockade assay indicated that the binding of GI.3 NoV VLPs to blood type A salivary HBGAs could only be blocked by anti-GI.3 NoV VLPs serum but not non-GI.3 NoV genotype-specific hyperimmune sera (GI.2, GI.7, GII.4, GII.6, GII.7, and GII.17). The detailed characterization of GI.3 NoV in this study provides evidence that GI.3 NoV undergoes rapid evolution and exhibits no cross-blocking effects, suggesting that GI.3 NoV may potentially be utilized in the development of multivalent NoV vaccines.

78. Oral Norovirus Vaccination in Humans Induces Plasmablast B-Cell Expansion and Follicular T-Cell Activation Comparable to Natural Infection

BackgroundNorovirus (NoV) is a common cause of acute gastroenteritis, but no vaccines are currently licensed. Vaxart is developing an oral tableted NoV vaccine that induces both systemic and mucosal immune responses.MethodsTwo separate clinical studies were conducted to evaluate the safety and immunogenicity of an oral NoV vaccine and NoV infection. The first study investigated an oral tablet vaccine based on a recombinant adenovirus vector expressing NoV VP1 (rAd-VP1). In the second study, a controlled NoV infection (Norwalk virus) was performed using a strain isolated and purified from an infected subject. Serum and PBMCs were collected pre- and post-immunization/infection. Serum immune responses were assessed using IgG/IgA ELISAs and blocking titer (BT50) assays. Cellular immune responses were evaluated using antibody-secreting cell (ASC) assays to quantitate norovirus-specific B cells. Flow cytometry was used to analyze the phenotype of circulating B and T cells.ResultsThe rAd-VP1 vaccine was well tolerated whereas most subjects (56%) in the controlled infection study had significant gastroenteritis 2–4 days post-inoculation. Subjects in cohorts vaccinated 28 days apart with 1 × 1010 or 1 × 1011 IUs showed the highest rises in serum IgG and IgA titers compared with those immunized 2 or 7 days apart with a 1 × 1010 IU vaccine dose. Subjects in the 1 × 1011 IU vaccine dose cohort had a 6-fold rise in serum IgA and 4-fold rise in BT50 titers, with mean IgA and IgG ASC values of 698 and 389 counts, respectively. In comparison, NoV-challenged subjects showed an average of 2,072 IgA and 886 IgG ASC counts. Remarkably, flow cytometry analysis revealed that activated B- and T-cell responses were similar post-vaccination and post-infection, with significant expansion of T follicular cells, plasmablasts, mucosal homing B cells, and preferential activation of IgA B cells.ConclusionThe phenotype of activated B and T cells induced post-immunization was similar to that induced post-infection, suggesting that an oral vaccine can induce comparable adaptive immune responses without the substantial adverse clinical events that occur from natural infection. Future work in dose ranging will aide in the development of a safe and efficacious oral NoV vaccine.Disclosures All Authors: No reported Disclosures.

Norovirus and Rotavirus Disease Severity in Children: Systematic Review and Meta-analysis.

Rotaviruses (RVs) and noroviruses (NoVs) are the most common causes of severe acute gastroenteritis in children. It is generally accepted that RVs cause severe acute gastroenteritis in a higher proportion of cases compared with NoVs. To our knowledge, there are no systematic reviews and meta-analyses comparing the severity of NoV and RV disease. We searched MEDLINE for studies reporting data for NoV and RV medically attended disease severity in children. We included studies where all children had been tested for both NoV (reverse transcription polymerase chain reaction) and RV (enzyme-linked immunosorbent assay or reverse transcription polymerase chain reaction) and that reported disease severity using the Vesikari or modified Vesikari score, or provided clinical information on severity. We generated pooled estimates of the mean with 95% confidence intervals using random effects meta-analysis. We identified 266 publications, of which 31 were retained for qualitative analysis and 26 for quantitative analysis. Fourteen studies provided data on severity score for the meta-analysis. The pooled mean severity scores (95% confidence interval) among outpatients were 10 (8-12) and 11 (8-14) for NoV and RV, respectively. Among inpatients, they were 11 (9-13) for NoV and 12 (10-14) for RV. The difference was statistically significant among inpatients, but relatively small (1 point in a 20-point scale). About 20% more children with RV required rehydration when compared with children with NoV. NoV causes moderate to severe disease similar to RV in young children. This information should be useful for future evaluations of an eventual introduction of NoV vaccines in national immunization programs.

Development of a Surrogate Neutralization Assay for Norovirus Vaccine Evaluation at the Cellular Level.

Noroviruses (NoVs) are the main pathogens responsible for sporadic and epidemic nonbacterial gastroenteritis, causing an estimated 219,000 deaths annually worldwide. There is no commercially available vaccine for NoVs, due partly to the difficulty in establishing NoV cell culture models. The histo-blood group antigen (HBGA) blocking assay is used extensively to assess the protective potential of candidate vaccine-elicited antibodies, but there is still no widely used cellular evaluation model. In this study, we have established a cell line-based NoV vaccine evaluation model through the construction of human α1,2-fucosyltransferase 2-overexpressing 293T (293T-FUT2) cell lines. The 293T-FUT2 cells stably expressed H type 2 and Lewis y antigens. Virus-like particles (VLPs) of the NoV prototype strain genogroup I.1 (GI.1) and the predominant strains GII.4 and GII.17 could attach to the cell line efficiently in a dose-dependent manner. Importantly, antisera against these NoV VLPs could inhibit the attachment of the VLPs, where the inhibitory effects measured by the attachment inhibition assay correlated significantly with the antibody levels determined by the HBGA blocking assay. Collectively, our attachment inhibition assay could serve as a surrogate neutralization assay for the evaluation of NoV vaccines at the cellular level.

Enzymatic cleavage promotes disassembly of GII.3 norovirus virus like particles and its binding to salivary histo-blood group antigens

In this study, we found that addition of fecal extract significantly promoted the binding of GII.3 NoV VLPs to salivary HBGAs. SDS-PAGE analysis indicated that major capsid proteins (VP1) were cleaved into two major bands with molecular weights of 26 and 31kD, respectively. Pretreatment of fecal extract by boiling or addition of protease inhibitor cocktail or type specific protease inhibitor (leupeptin and aprotinin) during incubation all decreased VP1 cleavage and its binding to salivary HBGAs. Trypsin digestion led to cleavage of VP1 and promoted its binding to HBGAs, suggesting that the active enzyme(s) might be trypsin or trypsin-like enzymes. Trypsin and fecal extract pretreatment all led to loss of morphological intact VLPs, indicating enhanced signal was possible due to increased binding of fragmented subunits. N-terminal sequencing was performed to characterize the cleavage sites with indecisive results. In vitro VLP-salivary HBGAs binding blockade assay using VLPs derived from VP1 of different GII.3 strains and rabbit anti-genotype specific hyperimmune serum indicated that GII.3 NoVs might have conservative HBGA binding sites. In summary, our results provide evidence about the widespread presence of active enzyme in fecal samples that can cleave GII.3 NoV VLPs and demonstrate that GII.3 NoVs have conservative HBGA binding sites which might have implications in the design of multivalent NoV vaccines.

Norovirus vaccines under development

Noroviruses (NoVs) are one of the leading causes of acute gastroenteritis, including both outbreaks and endemic infections. The development of preventive strategies, including vaccines, for the most susceptible groups (children <5years of age, the elderly and individuals suffering crowding, such as military personnel and travelers) is desirable. However, NoV vaccine development has faced many difficulties, including genetic/antigenic diversity, limited knowledge on NoV immunology and viral cycle, lack of a permissive cell line for cultivation and lack of a widely available and successful animal model. Vaccine candidates rely on inoculation of virus-like particles (VLPs) formed by the main capsid protein VP1, subviral particles made from the protruding domain of VP1 (P-particles) or viral vectors with a NoV capsid gene insert produced by bioengineering technologies. Polivalent vaccines including multiple NoV genotypes and/or other viruses acquired by the enteric route have been developed. A VLP vaccine candidate has reached phase II clinical trials and several others are in pre-clinical stages of development. In this article we discuss the main challenges facing the development of a NoV vaccine and the current status of prevailing candidates.

Characterization of virus-like particles derived from a GII.3 norovirus strain distantly related with current dominating strains.

Genogroup II, genotype 3 noroviruses (GII.3 NoVs) are secondary to GII.4 NoVs in causing acute non-bacterial gastroenteritis worldwide. In our previous study, we found that virus-like particles (VLPs) derived from a GII.3 NoV strain exhibited no binding activity to any salivary and synthetic histo-blood group antigens (HBGAs) tested. In this study, the nucleotide sequence encoding the major capsid protein of another documented GII.3 NoV strain was codon-optimized and synthesized, and the major capsid protein was expressed using recombinant baculovirus virus expression system. The assembly of VLPs was verified by electron microscopy, and the binding profiles of the assembled VLPs to salivary HBGAs were determined, and in vitro VLP-salivary HBGAs binding blockade assay was used to test the cross-blocking effects of hyperimmune sera produced against different genotypes (GI.2, GII.3, and GII.4). The expression of the major capsid proteins led to the successful assembly of VLPs, and in vitro VLP-salivary HBGAs binding assay indicated that the assembled VLPs bound to salivary HBGAs from blood type A, B, AB, and O individuals, with the highest binding capacity to type A salivary HBGAs. In vitro VLP-salivary HBGAs binding blockade assay demonstrated the absence of blocking activities for hyperimmune sera produced against GI.2and GII.4 VLPs and the presence of blocking activity for that against GII.3 VLPs. Our results suggest the absence of cross-blocking activities among different genotypes and the presence of blocking activities between GII.3 NoVs from different clusters, which might have implications for the design of multivalent NoV vaccines.

Vaccines against norovirus: state of the art trials in children and adults

Noroviruses (NoVs), a group of nonenveloped, single-stranded RNA viruses belonging to the Caliciviridae family, are the leading cause worldwide of acute infectious gastroenteritis. Serious and eventual fatal outcomes may be observed in at-risk populations such as the very young or older adults, especially in those with underlying diseases. NoVs are highly infectious, with a low number of virus particles causing infection, and they are highly resistant to environmental conditions. NoVs have multiple routes of transmission including faecal–oral, aerosolized vomitus, person to person and via contaminated surfaces or food and water. NoVs can cause frequent and dramatic outbreaks where people congregate in close quarters such as hospitals, long-term care facilities, cruise liners and military barracks and ships. Of the seven NoV genogroups, human disease is most frequently caused by genogroups I and II, although genogroup IV has also been associated with illness. The absence of reliable, high-yield cell culture systems or animal models has steered the development of vaccines towards nonreplicating recombinant capsid proteins including viruslike particles and the sub-virus-sized P particles. Takeda Vaccines is developing a candidate NoV vaccine formulation based on adjuvanted viruslike particles from the GI.1 genotype and a consensus GII.4 sequence derived from three natural GII.4 variants. Early clinical trial results show good tolerability and robust immune responses to both components. This approach is designed to induce broad protective immune responses in adults and children.

Norovirus Infection: Replication, Manipulation of Host, and Interaction with the Host Immune Response.

Noroviruses (NoVs) belong to the Caliciviridae family of viruses and are responsible for causing the majority of gastroenteritis outbreaks worldwide. In the past decade, research on NoV biology has intensified because of the discovery of murine NoV and subsequently the first cell culture system and small animal model for NoV replication and pathogenesis. In this review, we discuss the current literature on NoV biology, focusing particularly on NoV replication and the interaction between NoV and the host immune response. Understanding the NoV replication cycle and its interaction with cellular processes and innate immune immunity will help develop molecular targets to control human NoV infection and prevent outbreaks. In addition to the innate immune response, we have documented the current efforts to develop NoV vaccines to control outbreaks.

Genotype considerations for virus-like particle-based bivalent norovirus vaccine composition.

Norovirus (NoV) genogroup I (GI) and GII are responsible for most human infections with NoV. Because of the high genetic variability of NoV, natural infection does not induce sufficient protective immunity to different genotypes or to variants of the same genotype and there is little or no cross-protection against different genogroups. NoV-derived virus-like particles (VLPs) are promising vaccine candidates that induce high levels of NoV-specific humoral and cellular immune responses. It is believed that a bivalent NoV vaccine consisting of a representative VLP from GI and GII is a minimum requirement for an effective vaccine. Here, we compared the abilities of monovalent immunizations with NoV GI.1-2001, GI.3-2002, GII.4-1999, and GII.4-2010 New Orleans VLPs to induce NoV type-specific and cross-reactive immune responses and protective blocking antibody responses in BALB/c mice. All of the VLPs induced comparable levels of type-specific serum IgG antibodies, as well as blocking antibodies to the VLPs used for immunization. However, the abilities of different VLP genotypes to induce cross-reactive IgG and cross-blocking antibodies varied remarkably. Our results confirm previous findings of a lack of cross-protective immune responses between GI and GII NoVs. These data support the rationale for including NoV GI.3 and GII.4-1999 VLPs in the bivalent vaccine formulation, which could be sufficient to induce protective immune responses across NoV genotypes in the two common genogroups in humans.

Experimental human infection with Norwalk virus elicits a surrogate neutralizing antibody response with cross-genogroup activity.

The human noroviruses (NoVs) are genetically diverse, rapidly evolving RNA viruses and are the major cause of epidemic gastroenteritis of humans. Serum antibodies that block the interaction of NoVs and NoV viruslike particles (VLPs) with host attachment factors are considered surrogate neutralizing antibodies in the absence of cell culture and small-animal replication models for the human NoVs. A serological assay for NoV-blocking antibodies was used to assess the breadth of the heterotypic antibody response in the context of an experimental challenge study with a human NoV. Heterotypic histo-blood group antigen (HBGA)-blocking activity against GI.4, GI.7, and GII.4 NoVs increased significantly in the serum of individuals (n = 18) infected with Norwalk virus (GI.1). Although the fold increases and peak titers of heterotypic antibody were more modest than titers of antibody reactive with the challenge antigen, Norwalk virus infection elicited a serological rise even against the novel Sydney variant of GII.4 NoVs. These observations indicate that the development of a broadly cross-protective NoV vaccine containing a limited number of genotypes may be possible.

Genetic analyses of norovirus GII.4 variants in Finnish children from 1998 to 2013

Noroviruses (NoVs) are the major causative agents of acute gastroenteritis (AGE) in outbreaks and in sporadic AGE in young children. Since the mid-1990s, NoV genotype GII.4 has been predominant worldwide. New GII.4 variants appear every two to three years, and antigenic variation is focused on the highly variable protruding domain (P2) of the NoV capsid protein which contains the receptor-binding regions.We studied NoV GII.4 variants in cases of endemic AGE in Finnish children from 1998 to 2013. Fecal specimens were collected from cases of AGE followed prospectively in rotavirus vaccine trials from 1998 to 2007, and from children seen at Tampere University Hospital because of AGE from 2006 to 2013. Partial capsid sequences were identified with RT-PCR and sequenced allowing P2 domain alignment and phylogenetic comparison of different GII.4 strains, with virus-like particles (VLPs) developed as candidate vaccines.Of 1495 NoV positive specimens 829 (55%) were of the GII.4 genotype, and altogether twelve GII.4 variants were identified. Identical GII.4 variants were detected in outbreaks of NoVs worldwide. A phylogenetic tree of the amino acid changes in the P2 region showed nine variants that arose over time.Our data indicates that GII.4 continues to be the predominant NoV genotype circulating in the Finnish community, and the changes in the P2 domain over time result in the development of new variants that cause AGE in children. Future NoV vaccines should either induce type specific immunity for each variant or, alternatively, induce broadly reactive protective immunity covering multiple variants.

Median infectious dose of human norovirus GII.4 in gnotobiotic pigs is decreased by simvastatin treatment and increased by age

Human noroviruses (NoVs), a major cause of viral gastroenteritis, are difficult to study due to the lack of a cell-culture and a small-animal model. Pigs share with humans the types A and H histo-blood group antigens on the intestinal epithelium and have been suggested as a potential model for studies of NoV pathogenesis, immunity and vaccines. In this study, the effects of age and a cholesterol-lowering drug, simvastatin, on the susceptibility of pigs to NoV infection were evaluated. The median infectious dose (ID50) of a genogroup II, genotype 4 (GII.4) 2006b variant was determined. The ID50 in neonatal (4-5 days of age) pigs was ≤2.74×10(3) viral RNA copies. In older pigs (33-34 days of age), the ID50 was 6.43×10(4) but decreased to <2.74×10(3) in simvastatin-fed older pigs. Evidence of NoV infection was obtained by increased virus load in the intestinal contents, cytopathological changes in the small intestine, including irregular microvilli, necrosis and apoptosis, and detection of viral antigen in the tip of villi in duodenum. This GII.4 variant was isolated in 2008 from a patient from whom a large volume of stool was collected. GII.4 NoVs are continuously subjected to selective pressure by human immunity, and antigenically different GII.4 NoV variants emerge every 1-2 years. The determination of the ID50 of this challenge virus is valuable for evaluation of protection against different GII.4 variants conferred by NoV vaccines in concurrence with other GII.4 variants in the gnotobiotic pig model.

Intranasal norovirus vaccination shows efficacy in preventing acute gastroenteritis following a live GI.1 NoV challenge (106.5)

Abstract NoVs are a common cause of both epidemic and endemic AGE. Currently, no vaccine is available to prevent illness. Vaccination with an IN GI.1 NoV virus-like particle (VLP) vaccine (adjuvanted with chitosan and monophosphoryl lipid A) was followed by a homologous viral challenge. The trial employed a randomized, double-blind, placebo-controlled design for assessing safety, immunogenicity and efficacy against AGE and infection. Two-doses of vaccine or placebo IN 3 weeks apart were administered to healthy adults 18-49 years of age. At least 3 weeks later ~10 HID50 of a GI.1 challenge virus was administered to subjects who were then monitored for illness and infection. Two doses of the NoV VLP vaccine were administered to 90 subjects with the vaccine being well tolerated. The per protocol (PP) population was 77 of the 84 persons who completed the challenge. Of the 84, 64% of vaccinees had a &amp;gt;4-fold serum IgA response, none receiving placebo. In the PP analysis the incidence of AGE decreased from 69% to 37% by vaccination and infection was reduced from 82% to 61%. Efficacy against illness was 47% (95% CI, 15-67%) and against infection was 26% (95% CI, 1-36%) relative to placebo and severity of illness was also reduced. Of note, protection from NoV illness and infection correlated with the level of 50% HBGA blocking activity prior to challenge. We report that a NoV vaccine candidate can prevent AGE and that an IN-delivered vaccine can prevent illness due to an enteric pathogen.