Nosocomial Transmission of Norovirus Is Mainly Caused by Symptomatic Cases

Sukhrie, Faizel H. A.; Teunis, Peter; Vennema, Harry; Copra, Cedrick; Beersma, Matthias F. C.; Bogerman, Jolanda; Koopmans, Marion

doi:10.1093/cid/cir971

Cited by 122 publications

(106 citation statements)

References 33 publications

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“…Although symptomatic infection is of great concern, both for individual and public health reasons [7,8], the causes of symptomatic NoV infection are poorly understood. In part, the lack of understanding is the result of a paucity of available animal models of NoV infection, none of which fully recapitulates symptoms observed in humans (reviewed in [9]).…”

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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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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“…However, IC might have adequate sensitivity comparable to those of other methods for detecting a high viral load in the early phase of the disease, since there was no apparent NV outbreak during our study period [23]. Moreover, it is still unclear whether NA patients who are positive by RT-PCR but negative by IC have infectious potential and are clinically significant [13,31,32]. The significance of false-negative cases according to the IC kit should be evaluated in a future study.…”

Section: Discussionmentioning

confidence: 92%

Characteristics and outcomes of patients diagnosed with norovirus gastroenteritis after allogeneic hematopoietic stem cell transplantation based on immunochromatography

Ueda¹,

Fuji²,

Mori

et al. 2015

Int J Hematol

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Norovirus gastroenteritis (NV-GE) is a highly transmittable disease that can lead to fatal outcomes in vulnerable populations including patients after hematopoietic stem cell transplantation (HSCT). Prompt detection of NV is therefore important for HSCT recipients. Immunochromatography (IC) can be used to easily and rapidly diagnose NV-GE by detecting NV antigens. In this study, we examined 642 stool specimens in patients who developed diarrhea after allogeneic HSCT between January 2007 and June 2011. NV was detected in 10 of 350 (2.9 %) HSCT recipients. The median onset of symptoms was 36 days (range 3-93) after HSCT. The median duration of symptoms was 42 days (3-135). A second or subsequent allogeneic HSCT was associated with a higher incidence of NV-GE (P = 0.034). Of four patients who underwent colonoscopy, two showed intestinal graft-versus-host disease (GVHD) histopathology, whereas the other two showed no evidence of GVHD, and thus no need for intensified immunosuppression. None of the patients died of NV-GE. In conclusion, IC may be useful in the differential diagnosis of diarrhea after allogeneic HSCT, and could enable the appropriate adjustment of immunosuppressive drugs and prompt preventive measures.

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“…The nosocomial transmission of NoV has prompted shedding studies among health care workers to assess the potential transmission of virus (NoV GII.4) in the hospital setting following recovery. 70 The results of the study concluded the ability of symptomatic health care workers to shed and transmit the virus. Further cohort studies are clearly needed to determine the impact of viral shedding and prevalence of antibodies on transmission and susceptibility to NoV, respectively.…”

Section: Viral Shedding Natural Infection With Nov and Seroprotectionmentioning

confidence: 94%

Norovirus vaccines: Correlates of protection, challenges and limitations

Melhem

2016

Human Vaccines & Immunotherapeutics

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Norovirus (NoV) is responsible for at least 50% of all gastroenteritis outbreaks worldwide. NoVs are classified into 6 different genogroups (GGI-GGVI) based on the viral capsid protein with NoV genogroup II genotype 4 (GII.4) being the predominant strain causing human diseases. Supportive therapy involving reversal of dehydration and electrolyte deficiency is the main treatment of NoV gastroenteritis. However, the worldwide increased recognition of NoV as an important agent of diarrheal gastroenteritis prompted researchers to focus on establishing preventive strategies conferring long-lasting immunity. This review describes the current status of animal and human vaccine models/studies targeting NoV and addresses the factors hampering the development of a broadly effective vaccine.

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Nosocomial Transmission of Norovirus Is Mainly Caused by Symptomatic Cases

Abstract: We found that symptomatic patients and HCWs were more often involved in transmission events than asymptomatic shedders. Asymptomatic HCWs rarely contributed to transmission, despite high levels of fecal virus shedding.

Cited by 122 publications

References 33 publications

Norovirus in symptomatic and asymptomatic individuals: cytokines and viral shedding

Norovirus in symptomatic and asymptomatic individuals: cytokines and viral shedding

Characteristics and outcomes of patients diagnosed with norovirus gastroenteritis after allogeneic hematopoietic stem cell transplantation based on immunochromatography

Norovirus vaccines: Correlates of protection, challenges and limitations

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