Viral Gastroenteritis Outbreaks Research Articles

Viral Gastroenteritis Outbreaks in Deployed British Troops During 2002-7

ObjectivesThe aim of this study was to see what lessons could be learnt from the suspected viral gastroenteritis outbreaks that have occurred in deployed British troops during 2002-7.MethodEpidemiological and laboratory...

Seasonal tracking of histo-blood group antigen expression and norovirus binding in oyster gastrointestinal cells.

Noroviruses (NORs) are the most common cause of viral gastroenteritis outbreaks. Outbreaks are often associated with the consumption of contaminated oysters and generally occur between the months of November and March, when oysters produce the highest levels of glycogen. Oyster glycogen has been proposed as playing a role in NOR accumulation. Recent research indicates that histo-blood group antigens (HBGAs) function as viral receptors on human gastrointestinal cells. In this study, oyster glycogen was tested to determine whether it contains HBGA-like molecules and whether it plays a role in NOR binding. The correlation between the amount of HBGA expression and NOR binding also was measured. We also tested whether seasonal changes affected HBGA expression and binding of recombinant NORs. The results indicate that recombinant NOR binding is highly correlated with HBGA expression in Virginica (Crassostrea virginica), Pacific (Crassostrea gigas), and Kumamato (Crassostrea sikamea) oysters, but the association does not have a seasonal pattern. No obvious trend in either HBGA expression or recombinant NOR binding by month was noted. A significant increase in recombinant NOR binding was observed in Virginica and Pacific oysters in a season not generally associated with NOR gastroenteritis outbreaks. A significant increase in HBGA expression also was observed for Pacific and Virginica oysters in the same season. Paradoxically, HBGA expression and NOR binding both were higher in oysters produced in the non-NOR gastroenteritis season (April through October) than in those produced in the NOR gastroenteritis season (November through March), suggesting that seasonal NOR gastroenteritis outbreaks are not associated with high levels of HBGA expression or NOR binding.

Multiple exposures during a norovirus outbreak on a river-cruise sailing through Europe, 2006

In the summer of 2006, several cruise-related viral gastroenteritis outbreaks were reported in Europe. One report came from a river-cruise, belonging to a ship-owner who had two other ships with outbreaks. This situation warranted onsite investigation in order to identify a potential common source of infection. A retrospective cohort study was performed among 137 people on board. Epidemiological questionnaire data were analysed using logistic regression. Stool, food, water and surface samples were collected for norovirus detection. Norovirus GGII.4-2006b was responsible for 48 gastroenteritis cases on this ship as confirmed in six patients. Identical norovirus sequences were detected in stool samples, on surfaces and in tap water. Epidemiological and microbiological data indicated multiple exposures contributing to the outbreak. Microbiological results demonstrated person-to-person transmission to be clearly present. Epidemiological results indicated that consuming tap water was a risk factor; however, this could not be concluded definitively on the basis of the available data. A common source for all cruise-related outbreaks was unlikely. The ongoing outbreaks on this ship demonstrated that evidence based guidelines on effective disinfection strategies are needed.

Aetiology and epidemiology of viral gastroenteritis outbreaks in Catalonia (Spain) in 2004–2005

Background Acute infectious gastroenteritis causes substantial morbidity and economic loss. Objective The aetiology, epidemiology, and clinical features of acute viral gastroenteritis outbreaks reported during 1 year in Catalonia were investigated. Study Design This was a population-based study in which enzyme immunoassay and reverse transcriptase-polymerase chain reaction (RT-PCR) techniques were used to determine the presence of virus in stool specimens from outbreaks clinically and epidemiologically compatible with a viral aetiology and negative for bacteria, parasites and toxins. Results Sixty outbreaks affecting 1791 people were evaluated. Fifty-five outbreaks were positive for norovirus, four were positive for norovirus and other microorganisms (adenovirus, astrovirus, S. Typhimurium and V. parahaemolyticus in one each). Thirty-seven percentage of the outbreaks occurred in collective catering; 18.3% in nursing homes; 10% in hospitals and long-term-care facilities. Foodborne transmission accounted for 50% of outbreaks. Norovirus genotype GGII.4 accounted for 42% of all the outbreaks, being more prevalent in nursing homes, hospital and long-term-care facilities. Conclusions The large number of norovirus outbreaks and resulting health service demand and absenteeism indicate that acute gastroenteritis caused by norovirus is an important health problem in Catalonia. Preventive measures should target education and control of food handlers, and immediate specific control measures should be adopted in institutions.

Typing database for noroviruses

The FBVE (Food-borne Viruses in Europe) network was initiated during a research project funded by the European Commission (contract QLK1-1999-00594). The aim of the network is to establish a framework for rapid, (pre-publication) exchange of epidemiological, virological and molecular diagnostic data on outbreaks of viral gastroenteritis and acute hepatitis due to hepatitis A and E viruses for both surveillance and research purposes.

Norovirus strains belonging to the GII.4 genotype dominate as a cause of nosocomial outbreaks of viral gastroenteritis in Sweden 1997–2005: Arrival of new variants is associated with large nation-wide epidemics

Background In recent years an increase of the incidence of nosocomial outbreaks caused by noroviruses has been observed throughout Sweden, with high peaks noted in the winter seasons 2002/2003 and 2004/2005, respectively. Objectives To phylogenetically characterize norovirus strains causing nosocomial outbreaks from 1997 to 2005 and estimate the impact of norovirus-like disease on the Swedish health care system during the peak season 2002/2003 when a new variant of norovirus occurred. Study design Stool samples from 115 randomly selected nosocomial outbreaks occurring during 1997–2005 throughout Sweden were studied by RT-PCR and sequencing. In addition, to investigate the impact on the health-care system, a questionnaire was distributed to infection control units ( n = 90) serving all Swedish hospitals, nursing homes and other health-care institutions during the largest epidemic of nosocomial outbreaks. Results Sequencing of 279 nucleotides of the norovirus RNA polymerase gene in stools containing norovirus RNA showed that strains belonging to the GII.4 genotype dominated. Each of the two large epidemics was due to a new variant within this cluster. The questionnaire revealed that 30,000–35,000 episodes of nosocomial norovirus-like infections occurred in 80 of 82 major Swedish hospitals affected in 2002/2003. Conclusion New norovirus variants within the cluster GGII.4 may have a major impact on the health-care system.

Epochal Evolution of GGII.4 Norovirus Capsid Proteins from 1995 to 2006

Noroviruses are the causative agents of the majority of viral gastroenteritis outbreaks in humans. During the past 15 years, noroviruses of genotype GGII.4 have caused four epidemic seasons of viral gastroenteritis, during which four novel variants (termed epidemic variants) emerged and displaced the resident viruses. In order to understand the mechanisms and biological advantages of these epidemic variants, we studied the genetic changes in the capsid proteins of GGII.4 strains over this period. A representative sample was drawn from 574 GGII.4 outbreak strains collected over 15 years of systematic surveillance in The Netherlands, and capsid genes were sequenced for a total of 26 strains. The three-dimensional structure was predicted by homology modeling, using the Norwalk virus (Hu/NoV/GGI.1/Norwalk/1968/US) capsid as a reference. The highly significant preferential accumulation and fixation of mutations (nucleotide and amino acid) in the protruding part of the capsid protein provided strong evidence for the occurrence of genetic drift and selection. Although subsequent new epidemic variants differed by up to 25 amino acid mutations, consistent changes were observed in only five positions. Phylogenetic analyses showed that each variant descended from its chronologic predecessor, with the exception of the 2006b variant, which is more closely related to the 2002 variant than to the 2004 variant. The consistent association between the observed genetic findings and changes in epidemiology leads to the conclusion that population immunity plays a role in the epochal evolution of GGII.4 norovirus strains.

Implementation of Universal Precautions during Norovirus Outbreak at One County Long Term Care Facility

ISSUE: Noroviruses are very common: they account for 93% of nonbacterial gastroenteritis reported to the Centers for Disease Control and Prevention (CDC) for which a cause is identified. Outbreaks in long-term care facilities are not uncommon. In one recent two-year period, 80% of norovirus outbreaks were in skilled nursing facilities. Taking specific steps to prevent the virus from being transmitted from person to person can control outbreaks. CONTROL OF AN OUTBREAK OF VIRAL GASTROENTERITIS 1. Interrupt person-to-person transmission; 2.

Large outbreak of viral gastroenteritis caused by contaminated drinking water in Apulia, Italy, May - October 2006

At the end of July 2006, an unusually high number of patients with acute diarrhoea were reported by the accident and emergency departments in Taranto, Apulia. Subsequently, a field investigation was conducted jointly by the Apulia Regional Epidemiological Observatory and the Regional Reference Laboratory in Bari, and the Epidemiological Department of Taranto Local Health Unit.

Etiological Role of Viruses in Outbreaks of Acute Gastroenteritis in The Netherlands from 1994 through 2005

Acute gastroenteritis is one of the most common diseases worldwide. In developed countries, viruses, particularly noroviruses, are recognized as the leading cause. In The Netherlands, the surveillance of gastroenteritis outbreaks with suspected viral etiologies (as determined by Kaplan criteria) was established by the National Institute for Public Health and the Environment in 1994. This paper presents an overview of viral gastroenteritis outbreaks reported from 1994 through 2005. A minimum epidemiological data set consisting of the associated setting(s), the probable transmission mode, the date of the first illness and the date of sampling, the number of persons affected, and the number of hospitalizations was requested for each reported outbreak. Stool samples were tested for the presence of norovirus, sapovirus, rotavirus, astrovirus, adenovirus, and Aichi virus by electron microscopy, enzyme-linked immunosorbent assay, and/or reverse transcription-PCR. A total of 6,707 stool samples from 941 gastroenteritis outbreaks were investigated. Noroviruses were detected as the causative agent in 735 (78.1%) of the outbreaks, and rotaviruses, adenoviruses, and astroviruses were found to be responsible for 46 (4.9%), 9 (1.0%), and 5 (0.5%) outbreaks, respectively. Among the gastroenteritis outbreaks in which a mode of transmission was identified, most outbreaks (38.1%) were associated with person-to-person transmission, and the majority (54.9%) of the outbreaks investigated were reported by residential institutions. Since 2002, the total number of outbreaks reported and the number of unexplained outbreaks have increased. Furthermore, the number of rotavirus-associated outbreaks has increased, especially in nursing homes. Despite thorough testing, 115 (12.2%) outbreaks suspected of having viral etiologies remain unexplained. Increases in numbers of reported outbreaks may indicate undefined changes in the criteria for reporting or the emergence of new pathogens.

Trapping Norovirus by Glycosylated Hydrogels: a Potential Oral Antiviral Drug

Trapped! Hydrogels have potential for use as prophylactic drugs against norovirus infection, as they absorb virus particles with high affinity. Virus entrapped in the hydrogel would be rendered harmless as it is cleared from the body. This approach could be useful in the worldwide fight against viral gastroenteritis outbreaks.

Molecular epidemiology of norovirus gastroenteritis outbreaks in North Carolina, United States: 1995–2000

Noroviruses (NoVs) are the most common cause of acute non-bacterial gastroenteritis outbreaks in the US. We investigated 16 gastroenteritis outbreaks in North Carolina (NC), from 1995 to 2000, to further characterize the epidemiology of NoV using RT-PCR on stool and ELISA on sera. NoV were identified in 14 outbreaks by RT-PCR. Sequence analyses of the amplicons indicated the outbreak strains belonged to the following clusters: five GII/4, three GI/3, one GI/4, one GII/2, one GII/5, one GII/7, and one GII/13 (prototype strain). We detected NoV in stool samples from one outbreak but could not determine its specific cluster within the GII genogroup based on polymerase sequence analysis. The five GII/4 strains were classified as the "95/96 US common strain" and occurred throughout the 5-year period. In contrast to national trends, the majority (86%) of NoV outbreaks identified in North Carolina were foodborne. Of the 12 food-related NoV outbreaks, we were able to document transmission by food handlers in two outbreaks. Person-to-person transmission from primary cases was suggested in three outbreaks. Our results indicate that NoVs are important agents of viral gastroenteritis outbreaks in NC.

Gastrointestinal Virus Outbreaks Strike European Cruise Ships

European scientists studying food-borne viruses have recorded 45 outbreaks of norovirus on cruise ships in European waters. A report in the August 11, 2006 issue of Science notes that this is “a sharp increase from previous years,” adding that a similar spike in case numbers occurred on US ships a few years ago. In some cases, >40% of all passengers on a cruise ship have become ill. Moreover, several ships have experienced outbreaks on ≥3 subsequent trips, despite sterilization attempts between cruises. Although thorough disinfection after a cruise can eliminate the virus, crewmembers can carry it to the next cruise, as can new passengers. According to an epidemiologist with the European Centre for Disease Prevention and Control, the outbreaks are most likely the result of an increased level of norovirus activity in the general population following the emergence of new strains (Figure 1). Some virologists at the National Institute of Public Health and the Environment (RIVM) in Bilthoven, the Netherlands, support this likelihood. They note the recent appearance of 2 new strains of norovirus within the same genogroup in the past year. In 2002, hospitals across Europe reported an increased frequency of cases attributable to noroviruses. Many researchers placed the blame for these cases on a new strain of the virus within genogroup 114, the group of noroviruses that assumed predominance in 2002. According to the Science report, RIVM virologist Dr Harry Venemma said he suspects that noroviruses may evade host immune systems through frequent genetic changes, thereby triggering “fresh outbreaks along the way.” But the absence of an animal model and the inability of culturing noroviruses in the laboratory would make that difficult to investigate. In that regard, Centers for Disease Control and Prevention officials point out that recent advances in finding a cell culture system for noroviruses may allow for assessing the efficacy of various disinfectants. However, only by full epidemiologic investigation of viral gastroenteritis outbreaks and by application of molecular tests will transmission routes be determined, differences in epidemiology between strains be detected, and targeted control measures implemented. “Norovirus infections are common and likely to become more so. Effective prevention strategies must now be designed and implemented.” For further details, see Science 2006;313:747.

Real-Time Detection of Noroviruses in Surface Water by Use of a Broadly Reactive Nucleic Acid Sequence-Based Amplification Assay

Noroviruses are the most common agents causing outbreaks of viral gastroenteritis. Outbreaks originating from contaminated drinking water and from recreational waters have been described. Due to a lack of cell culture systems, noroviruses are detected mostly by molecular methods. Molecular detection assays for viruses in water are often repressed by inhibitory factors present in the environment, like humic acids and heavy metals. To study the effect of environmental inhibitors on the performance of nucleic acid sequence-based amplification (NASBA), we developed a real-time norovirus NASBA targeting part of the RNA-dependent RNA polymerase (RdRp) gene. Specificity of the assay was studied with 33 divergent clones that contained part of the targeted RdRp gene of noroviruses from 15 different genogroups. Viral RNA originated from commercial oysters, surface waters, and sewage treatment plants in The Netherlands. Ninety-seven percent of the clones derived from human noroviruses were detected by real-time NASBA. Two clones containing animal noroviruses were not detected by NASBA. We compared the norovirus detection by real-time NASBA with that by conventional reverse transcriptase PCR (RT-PCR) with large-volume river water samples and found that inhibitory factors of RT-PCR had little or no effect on the performance of the norovirus NASBA. This consequently resulted in a higher sensitivity of the NASBA assay than of the RT-PCR. We show that by combining an efficient RNA extraction method with real-time NASBA the sensitivity of norovirus detection in water samples increased at least 100 times, which consequently has implications for the outcome of the infectious risk assessment.

Correlation of norovirus variants with epidemics of acute viral gastroenteritis in Hong Kong

Norovirus (NV) (formerly called Norwalk-like virus) is the most common etiological agent of acute viral gastroenteritis outbreaks worldwide. Recent reports have shown that two new GII.4 variants caused epidemics in Europe. To investigate if it is also the case in Hong Kong, a molecular epidemiological study was undertaken between January 2002 and June 2005. During this period, there was a substantial increase in acute cases of gastroenteritis caused by NV. Phylogenetic analysis showed that GII.2 and GII.4 are the major circulating genotypes. Two new GII.4 variants (variants C and D) were identified in 2002 and 2004, which quickly became the predominant strains. They were almost identical to the variants causing epidemics in Europe recently. Since geographically distinct areas were involved within a short period of time, it is possible that GII.4 has a particular propensity for causing pandemics.

Outbreaks of viral gastroenteritis: what??s new in 2004?

Purpose of reviewDescriptions of outbreaks of viral gastroenteritis have become a prominent feature in scientific journals and other media such as the electronic reporting service ‘promed’. A review of outbreak reports was done to further our understanding of the burden of disease, common and rare m

Outbreaks of viral gastroenteritis: whatʼs new in 2004?

Descriptions of outbreaks of viral gastroenteritis have become a prominent feature in scientific journals and other media such as the electronic reporting service 'promed'. A review of outbreak reports was done to further our understanding of the burden of disease, common and rare modes of transmission, complications, and possibilities for control and prevention. Viral gastroenteritis outbreaks occur worldwide. In 2004, besides outbreak reports and surveys, there was considerable attention paid to food and waterborne outbreaks and the difficulties in proving these modes of transmission. Costs of viral gastroenteritis outbreaks are high. Complications and unusual manifestations of viral gastroenteritis, such as convulsions, transplant rejection, and chronic infection, may have been underreported. Viral gastroenteritis is a very common illness in health care settings that can cause significant disruption. Clinicians working in these settings should be familiar with the epidemiology and the possible modes of transmission of enteric viruses to be able to translate them into strategies for prevention or intervention. Research is needed to support these strategies.

Norovirus genotypes causing gastroenteritis outbreaks in Finland 1998–2002

Background: Outbreak investigation methods for enteric viruses were improved in 1990s when gene amplification techniques were established in viral laboratories. Objectives: The objective of the study was to determine the causative agents for Finnish viral gastroenteritis outbreaks. Our aim was also to further characterise the norovirus strains, reveal the temporal occurrence of norovirus (NV) genotypes and to study some epidemiological aspects concerning the outbreaks. Study design: A total of 416 Finnish viral gastroenteritis outbreaks that occurred during 5 years (1998–2002), excluding those among hospitalised children, were investigated for enteric viruses. Stool samples were screened by electron microscopy as well as analyzed by specific noro- and astrovirus RT-PCR tests. Amplicon sequence analysis was used to find out norovirus genotypes. Results: Noroviruses caused 252 (60.6%) of the outbreaks; other viruses, astro- or rotavirus, caused four epidemics. Norovirus epidemics occurred in all kinds of settings, most often in hospitals (30.6%) and in restaurants and canteens (14.3%). Both NV genogroups were found every year, but NV GGII outbreaks always outnumbered those of GGI. All but one outbreak at hospitals and nursing homes were of genotype GII. Polymerase sequence analysis revealed a variety of NV genotypes; six GI and at least eight GII genotypes. The GI.3 Birmingham-like and GII.4 Bristol-like genotype appeared every year, whereas the other types were circulating for shorter periods or sporadically. During the study period the genotypes GII.4 (Bristol), GII.1 (Hawaii), an emerging genotype GIIb, and a new variant of GII.4 predominated in that order. Indication for rapid genetic changes in the genotype GII.4 was also noticed. Conclusions: Noroviruses were the most prevalent causative agents in the outbreaks. Many NV genotypes were circulating, and a shift in the predominant genotypes was evident between epidemic seasons.

Are Noroviruses Emerging?

Are Noroviruses Emerging?

Existence of multiple outbreaks of viral gastroenteritis among infants in a day care center in Japan

A total of 921 fecal specimens collected from 44 infants in a day care center (DCC) in Tokyo, Japan during June 1999 to July 2000 were tested for the presence of rotavirus, norovirus, sapovirus, astrovirus and adenovirus by reverse-transcription-multiplex polymerase chain reaction (RT-multiplex PCR) and sequence analysis. Of 88 fecal specimens from infants with acute gastroenteritis, 51.1% (45) were found to be positive for diarrheal viruses. Astrovirus was the most prevalent (15.9%, 14 of 88), followed by norovirus GII (14.8%, 13 of 88), adenovirus (12.5%, 11 of 88), and sapovirus (2.3%, 2 of 88). Viral mixed infection accounted for 5.7% (5 of 88). Interestingly, 230 of 833 (27.6%) fecal specimens collected from asymptomatic infants were also infected with diarrheal viruses. Of these, astrovirus, norovirus GII, adenovirus and sapovirus were identified in 53, 46, 96 and 22 fecal specimens (23%, 20%, 41.7%, and 9.6%, respectively). Moreover, 13 of 833 (1.6%) normal specimens showed mixed viral infections. Surprisingly, no rotavirus (known as the most common causative agent of acute gastroenteritis in DCCs) was detected in those subjects. Another interesting feature was the demonstration of five separate outbreaks of acute gastroenteritis identified in a single DCC. Outbreak A was associated with both astrovirus serotype 1 and norovirus GII/3 (known as Toronto virus cluster); Outbreak B with adenovirus 12; Outbreak C with norovirus GII/4 (Lordsdale virus cluster); Outbreak D with sapovirus GIV and Outbreak E with astrovirus serotype 1. To our knowledge, this is the first proof of multiple outbreaks of viral gastroenteritis in Japanese infants in a single DCC. Our results confirm the presence as well as the importance of these viruses and warn of the threat they pose.