Severe Outcomes Are Associated With Genogroup 2 Genotype 4 Norovirus Outbreaks: A Systematic Literature Review

Desai, Rishi; Hembree, C.; Handel, Andreas; Matthews, Jonathan; Dickey, B. W.; McDonald, Sharla; Hall, Aron J.; Parashar, Umesh D.; León, Juan S.; Lopman, Benjamin A.

doi:10.1093/cid/cis372

Cited by 151 publications

(124 citation statements)

References 20 publications

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“…Our results are comparable to the 0·03% in longterm care facilities in Australia [22] and the 0·07% described in a review of published outbreaks [20], considering that our dataset includes sporadic cases that are younger and less likely to develop complications. Our mortality rate of 0·5/100 000 cases per season in the elderly (575 years) is lower than modelling estimates from the USA, UK and The Netherlands of 2/100 000, 0·6/100 000 and 3/100 000, respectively 8 11 2 5 8 11 2 5 8 11 2 5 8 11 2 5 8 11 2 5 ll.4 all ll.2 ll.7 Gll other Gl all GII recomb [3,23,24], but comparable when considering that the surveillance system captures only half of norovirusassociated deaths compared to the German causeof-death statistics [25].…”

Section: Discussionsupporting

confidence: 86%

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Epidemiology of norovirus gastroenteritis in Germany 2001–2009: eight seasons of routine surveillance

et al. 2013

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SUMMARYWe analysed data on laboratory or epidemiologically confirmed cases (n = 856 539) and on outbreaks (n = 31 644) notified during week 31 (2001) to week 30 (2009), and performed molecular typing of specimens from 665 outbreaks. We aimed at identifying demographic and molecular characteristics to inform on potential additional approaches to prevent disease spread in the population. The mean incidence by norovirus season (week 31 in one year to week 30 in the following year) was 130 (range 19-300) cases/100 000 population and was highest in persons aged <5 years (430/100 000) and 575 years (593/100 000). The proportion hospitalized in community-acquired cases was 8-19% per season. The mean norovirus-associated mortality was 0·05/100 000 per season and 0·5/100 000 in the 575 years age group. Most outbreaks with known setting (75%) occurred in hospitals (32%), nursing homes (28%), households (24%) and childcare facilities (10%). GII strains dominated in the outbreak specimens. GII.4 strains were found in 82% of nursing home outbreaks, 85% of hospital outbreaks, and 33% of childcare facility and school outbreaks. Cases in younger individuals were notified earlier during the season than adult cases, and outbreaks in childcare facilities and schools preceded those in nursing/residential homes, hospitals and private households. We suggest future studies to investigate more closely potential transmission patterns between children and adults.

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Section: Discussionsupporting

confidence: 86%

“…GII.4 strains have been reported to cause more severe illness [20,27] and a higher viral load in infected persons than other strains [28], which may lead to more frequent disease transmission. A higher environmental stability has also been discussed [26].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of norovirus gastroenteritis in Germany 2001–2009: eight seasons of routine surveillance

et al. 2013

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“…Although it often causes a brief and self-limited illness, among vulnerable populations, such as elderly people or individuals who are immunosuppressed, NoV illness can be more protracted and have severe outcomes [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Norovirus in symptomatic and asymptomatic individuals: cytokines and viral shedding

Newman

Moe

Kirby

et al. 2016

Clinical and Experimental Immunology

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Summary Noroviruses (NoV) are the most common cause of epidemic gastroenteritis world-wide. NoV infections are often asymptomatic, although individuals still shed large amounts of NoV in their stool. Understanding the differences between asymptomatic and symptomatic individuals would help in elucidating mechanisms of NoV pathogenesis. Our goal was to compare the serum cytokine responses and faecal viral RNA titres of asymptomatic and symptomatic NoV-infected individuals. We tested serum samples from infected subjects (n = 26; 19 symptomatic, seven asymptomatic) from two human challenge studies of GI.1 NoV for 16 cytokines. Samples from prechallenge and days 1-4 post-challenge were tested for these cytokines. Cytokine levels were compared to stool NoV RNA titres quantified previously by reverse transcription–polymerase chain reaction (RT–qPCR). While both symptomatic and asymptomatic groups had similar patterns of cytokine responses, the symptomatic group generally exhibited a greater elevation of T helper type 1 (Th1) and Th2 cytokines and IL-8 post-challenge compared to the asymptomatic group (all P < 0·01). Daily viral RNA titre was associated positively with daily IL-6 concentration and negatively with daily IL-12p40 concentration (all P < 0·05). Symptoms were not associated significantly with daily viral RNA titre, duration of viral shedding or cumulative shedding. Symptomatic individuals, compared to asymptomatic, have greater immune system activation, as measured by serum cytokines, but they do not have greater viral burden, as measured by titre and shedding, suggesting that symptoms may be immune-mediated in NoV infection.

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“…Within the genotypes, GII.4 is the most prevalent worldwide (Zakikhany et al 2012;Kim et al 2013;Maritschnik et al 2013). The GII.4 strains evolve through serial changes in the VP1 sequence, which allows evasion of immunity in the human population (Siebenga et al 2009) and the observed increase in the number of outbreaks has coincided with the emergence of novel variants (Desai et al 2012; Centers for Disease Control and Prevention (CDC) 2013).…”

Section: Introductionmentioning

confidence: 99%

Norovirus GII.17 Predominates in Selected Surface Water Sources in Kenya

et al. 2014

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In this study the prevalence and genotypes of NoVs in selected water sources from rural, urban and refugee settings in Kenya was investigated. Ten liters each of river, household and borehole water were collected in rural (Mboone river), urban (Nairobi and Mutoine river), and refugee (Dadaab refugee camp) settings. Noroviruses were recovered from the water samples by a glass wool adsorption-elution technique and/or PEG/NaCl precipitation.Nucleic acid was extracted using the automated MagNA Pure platform. Noroviruses were detected with singleplex real-time reverse transcription-polymerase chain reaction assays and characterised by nucleotide sequence analysis. Noroviruses were detected in 63% (25/40) of the selected water samples comprising GII (42.5%), GI (2.5%) and mixed GI/GII (17.5%) positive samples. The prevalence of NoVs in the Mutoine river (urban area) was higher than in the Mboone river (rural area) (P=0.0013). Norovirus GI.1, GI.3, GI.9, GII.4, GII.6, GII.12, GII.16 and GII.17 were identified, with GII.17 accounting for 76% (16/21) of the typed strains. The NoV GII.17 predominance differs to other studies in Africa and further surveillance of NoVs in clinical and environmental settings is required to clarify/elucidate this observation. As information regarding NoVs in Kenyan water sources is limited this report provides valuable new data on NoV genotypes circulating in environmental water sources and the surrounding communities in Kenya.

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Severe Outcomes Are Associated With Genogroup 2 Genotype 4 Norovirus Outbreaks: A Systematic Literature Review

Abstract: Our review suggests that hospitalizations and deaths were more likely in outbreaks associated with GII.4 viruses, independent of other factors, and underscores the importance of developing vaccines against GII.4 viruses to prevent severe disease outcomes.

Cited by 151 publications

References 20 publications

Epidemiology of norovirus gastroenteritis in Germany 2001–2009: eight seasons of routine surveillance

Epidemiology of norovirus gastroenteritis in Germany 2001–2009: eight seasons of routine surveillance

Norovirus in symptomatic and asymptomatic individuals: cytokines and viral shedding

Norovirus GII.17 Predominates in Selected Surface Water Sources in Kenya

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