Last data update: Jun 03, 2024. (Total: 46935 publications since 2009)
Records 1-30 (of 31 Records) |
Query Trace: Gregoricus N [original query] |
---|
Evaluation of viral co-infections among patients with community-associated Clostridioides difficile infection
Korhonen L , Cohen J , Gregoricus N , Farley MM , Perlmutter R , Holzbauer SM , Dumyati G , Beldavs Z , Paulick A , Vinjé J , Limbago BM , Lessa FC , Guh AY . PLoS One 2020 15 (10) e0240549 We assessed viral co-infections in 155 patients with community-associated Clostridioides difficile infection in five U.S. sites during December 2012-February 2013. Eighteen patients (12%) tested positive for norovirus (n = 10), adenovirus (n = 4), rotavirus (n = 3), or sapovirus (n = 1). Co-infected patients were more likely than non-co-infected patients to have nausea or vomiting (56% vs 31%; p = 0.04), suggesting that viral co-pathogens contributed to symptoms in some patients. There were no significant differences in prior healthcare or medication exposures or in CDI complications. |
Incidence and etiology of infectious diarrhea from a facility-based surveillance system in Guatemala, 2008-2012
Arvelo W , Hall AJ , Henao O , Lopez B , Bernart C , Moir JC , Reyes L , Montgomery SP , Morgan O , Estevez A , Parsons MB , Lopez MR , Gomez G , Vinje J , Gregoricus N , Parashar U , Mintz ED , McCracken J , Bryan JP , Lindblade KA . BMC Public Health 2019 19 (1) 1340 BACKGROUND: Diarrhea is a major cause of morbidity and mortality, yet incidence and etiology data are limited. We conducted laboratory-based diarrhea surveillance in Guatemala. METHODS: A diarrhea case was defined as >/=3 loose stools in a 24-h period in a person presenting to the surveillance facilities. Epidemiologic data and stool specimens were collected. Specimens were tested for bacterial, parasitic, and viral pathogens. Yearly incidence was adjusted for healthcare seeking behaviors determined from a household survey conducted in the surveillance catchment area. RESULTS: From November 2008 to December 2012, the surveillance system captured 5331 diarrhea cases; among these 1381 (26%) had specimens tested for all enteric pathogens of interest. The adjusted incidence averaged 659 diarrhea cases per 10,000 persons per year, and was highest among children aged < 5 years, averaging 1584 cases per 10,000 children per year. Among 1381 (26%) specimens tested for all the pathogens of interest, 235 (17%) had a viral etiology, 275 (20%) had a bacterial, 50 (4%) had parasites, and 86 (6%) had co-infections. Among 827 (60%) specimens from children aged < 5 years, a virus was identified in 196 (23%) patients; 165 (20%) had norovirus and 99 (12%) rotavirus, including co-infections. Among 554 patients aged >/=5 years, 103 (19%) had a bacterial etiology, including diarrheagenic Escherichia coli in 94 (17%) cases, Shigella spp. in 31 (6%), Campylobacter spp. in 5 (1%), and Salmonella spp. in 4 (1%) cases. Detection of Giardia and Cryptosporidium was infrequent (73 cases; 5%). CONCLUSIONS: There was a substantial burden of viral and bacterial diarrheal diseases in Guatemala, highlighting the importance of strengthening laboratory capacity for rapid detection and control and for evaluation of public health interventions. |
Water quality, availability, and acute gastroenteritis on the Navajo Nation - a pilot case-control study
Grytdal SP , Weatherholtz R , Esposito DH , Campbell J , Reid R , Gregoricus N , Schneeberger C , Lusk TS , Xiao L , Garrett N , Bopp C , Hammitt LL , Vinje J , Hill VR , O'Brien KL , Hall AJ . J Water Health 2018 16 (6) 1018-1028 The Navajo Nation includes approximately 250,000 American Indians living in a remote high desert environment with limited access to public water systems. We conducted a pilot case-control study to assess associations between acute gastroenteritis (AGE) and water availability, use patterns, and quality. Case patients with AGE and non-AGE controls who presented for care to two Indian Health Service hospitals were recruited. Data on demographics and water use practices were collected using a standard questionnaire. Household drinking water was tested for presence of pathogens, coliforms, and residual chlorine. Sixty-one subjects (32 cases and 29 controls) participated in the study. Cases and controls were not significantly different with respect to water sources, quality, or patterns of use. Twenty-one percent (n = 12) of study participants resided in dwellings not connected to a community water system. Eleven percent (n = 7) of subjects reported drinking hauled water from unregulated sources. Coliform bacteria were present in 44% (n = 27) of household water samples, and 68% (n = 40) of samples contained residual chlorine concentrations of <0.2 mg/L. This study highlights issues with water availability, quality, and use patterns within the Navajo Nation, including sub-optimal access to community water systems, and use of water hauled from unregulated sources. |
High hand contamination rates during norovirus outbreaks in long-term care facilities
Park GW , Williamson KJ , DeBess E , Cieslak PR , Gregoricus N , De Nardo E , Fricker C , Costantini V , Vinje J . Infect Control Hosp Epidemiol 2018 39 (2) 1-3 We examined norovirus contamination on hands of ill patients during 12 norovirus outbreaks in 12 long-term care facilities (LTCFs). The higher frequency and norovirus titers on hands of residents compared to hands of heathcare workers highlights the importance of adhering to appropriate hand hygiene practices during norovirus outbreaks in LTCFs. Infect Control Hosp Epidemiol 2018;1-3. |
Comparison of three multiplex gastrointestinal platforms for the detection of gastroenteritis viruses.
Chhabra P , Gregoricus N , Weinberg GA , Halasa N , Chappell J , Hassan F , Selvarangan R , Mijatovic-Rustempasic S , Ward ML , Bowen M , Payne DC , Vinje J . J Clin Virol 2017 95 66-71 BACKGROUND: Viruses are major etiological agents of childhood gastroenteritis. In recent years, several molecular platforms for the detection of viral enteric pathogens have become available. OBJECTIVE/STUDY DESIGN: We evaluated the performance of three multiplex platforms including Biofire's Gastrointestinal Panel (FilmArray), Luminex xTAG(R) Gastrointestinal Pathogen Panel (GPP), and the TaqMan Array Card (TAC) for the detection of five gastroenteritis viruses using a coded panel of 300 archived stool samples. RESULTS: The FilmArray detected a virus in 199 (96.1%) and the TAC in 172 (83.1%) of the 207 samples (187 samples positive for a single virus and 20 samples positive for more than one virus) whereas the GPP detected a virus in 100 (78.7%) of the 127 (97 positive for one virus and three positive for more than one virus) samples. Overall the clinical accuracy was highest for the FilmArray (98%) followed by TAC (97.2%) and GPP (96.9%). The sensitivity of the FilmArray, GPP and TAC platforms was highest for rotavirus (100%, 95.8%, and 89.6%, respectively) and lowest for adenovirus type 40/41 (97.4%, 57.9% and 68.4%). The specificity of the three platforms ranged from 95.6% (rotavirus) to 99.6% (norovirus/sapovirus) for the FilmArray, 99.6% (norovirus) to 100% (rotavirus/adenovirus) for GPP, and 98.9% (astrovirus) to 100% (rotavirus/sapovirus) for TAC. CONCLUSION: The FilmArray demonstrated the best analytical performance followed by TAC. In recent years, the availability of multi-enteric molecular testing platforms has increased significantly and our data highlight the strengths and weaknesses of these platforms. |
Genetic and Epidemiologic Trends of Norovirus Outbreaks in the US Demonstrated Emergence of Novel GII.4 Recombinant Viruses, 2013-2016.
Cannon JL , Barclay L , Collins NR , Wikswo ME , Castro CJ , Magana LC , Gregoricus N , Marine RL , Chhabra P , Vinje J . J Clin Microbiol 2017 55 (7) 2208-2221 Noroviruses are the most frequent cause of epidemic acute gastroenteritis in the United States (US). Between September 2013 and August 2016, 2,715 genotyped norovirus outbreaks were submitted to CaliciNet. GII.4 Sydney viruses caused 58% of outbreaks during these years. A GII.4 Sydney variant with a novel GII.P16 polymerase emerged in November 2015, causing 60% of all GII.4 outbreaks in the 2015-2016 season. Multiple polymerase types were found associated with GII.2 (3), GII.3 (3), GII.4 Sydney (3), GII.13 (2) and GII.17 (2) genotypes, 4 of which included GII.P16 variants. GII.P16 polymerase sequences associated with GII.2 and GII.4 Sydney strains were nearly identical, suggesting common ancestry. Other common genotypes, each causing 5-17% of outbreaks in a season, included GI.3, GI.5, GII.2, GII.3, GII.6, GII.13 and GII.17 Kawasaki. Acquisition of alternative RNA polymerases by recombination is an important mechanism for norovirus evolution and a phenomenon that was shown to occur more frequently than previously recognized in the US. Continued molecular surveillance of norovirus strains, including typing of both polymerase and capsid genes, is important for monitoring emerging strains in our continued efforts to reduce the overall burden of norovirus disease. |
Acute flaccid myelitis in the United States-August - December 2014: Results of nation-wide surveillance
Sejvar JJ , Lopez AS , Cortese MM , Leshem E , Pastula DM , Miller L , Glaser C , Kambhampati A , Shioda K , Aliabadi N , Fischer M , Gregoricus N , Lanciotti R , Nix WA , Sakthivel SK , Schmid DS , Seward JF , Tong S , Oberste MS , Pallansch M , Feikin D . Clin Infect Dis 2016 63 (6) 737-745 BACKGROUND: During late summer/fall 2014, pediatric cases of acute flaccid myelitis (AFM) occurred in the U.S., coincident with a national outbreak of enterovirus-D68 (EV-D68)-associated severe respiratory illness. METHODS: Clinicians and health departments reported to Centers for Disease Control and Prevention (CDC) standardized clinical, epidemiologic, and radiologic information on AFM cases, and submitted biological samples for testing. Cases were≤21 years old, with acute onset of limb weakness 01 August-31 December 2014 and spinal MRI showing lesions predominantly restricted to gray matter. RESULTS: From August-December 2014, 120 AFM cases were reported from 34 states. Median age was 7.1 years (interquartile range, 4.8-12.1 years); 59% were male. Most experienced respiratory (81%) or febrile (64%) illness before limb weakness onset. MRI abnormalities were predominantly in the cervical spinal cord (103/118). All but one case was hospitalized; none died. CSF pleocytosis (>5 white blood cells/mm3) was common (81%). At CDC, one CSF specimen was positive for EV-D68 and Epstein-Barr virus by real-time PCR, although the specimen had >3,000 red blood cells/mm3 The most common virus detected in upper respiratory tract specimens was EV-D68 (from 20%, and 47% with specimen collected ≤7 days from respiratory illness/fever onset). Continued surveillance in 2015 identified 14 AFM cases reported from 11 states. CONCLUSIONS: Epidemiologic data suggest this AFM cluster was likely associated with the large outbreak of EV-D68-associated respiratory illness, although direct laboratory evidence linking AFM with EV-D68 remains inconclusive. Continued surveillance will help define the incidence, epidemiology and etiology of AFM. |
Norovirus in a United States Virgin Islands resort: outbreak investigation, response, and costs
Leshem E , Gastanaduy PA , Trivedi T , Laufer Halpin A , Pringle J , Lang F , Gregoricus N , Vinje J , Behravesh CB , Parashar U , Hall AJ . J Travel Med 2016 23 (5) BACKGROUND: During 8-20 April 2012, an outbreak of gastrointestinal illness occurred among guests and employees of a resort hotel in St. Thomas, US Virgin Islands. We describe outbreak characteristics, and estimate indirect (non-medical) costs to travellers. METHODS: Employees who met the case definition were interviewed and provided stool samples. Samples were tested for norovirus by real-time reverse-transcription polymerase chain reaction. Guests were asked to complete a survey aimed to identify and characterize cases, and to estimate quality adjusted vacation days (QAVD) lost. RESULTS: Overall, 66 persons (20 employees and 46 guests) met the probable case definition. The first reported illness onset occurred in a hotel employee on 8 April, while the first reported onset in a guest occurred on 13 April. An employee suffered a public diarrhoea incident on 13 April in the central kitchen, followed by illness onset in the next day among employees that assisted with the clean-up. On 15 April, after 10 guests reported ill, the hotel implemented an outbreak response protocol instructing ill employees to take a 3-day leave, and obtain medical clearance prior to resuming work. Ill guests were advised to self-isolate, and rapid cleaning of public areas and guest rooms where suspected contamination occurred was implemented. We estimated that 65 QAVDs were lost by 43 guests (1.5 days/guest). Using an approximate cost of $450 per vacation day, we estimated indirect illness cost at $675 per guest case. Seven (64%) of 11 cases' stool specimens were positive for norovirus genotype GII.4 Den Haag. CONCLUSIONS: A norovirus outbreak in a resort hotel resulted in substantial indirect costs and loss of vacation days to ill travellers. We recommend outbreak control measures including exclusion of ill employees, until ≥48-72 h after resolution of symptoms, self-isolation of ill guests and appropriate cleaning in hotel-associated norovirus outbreaks. |
Population-Based Incidence Rates of Diarrheal Disease Associated with Norovirus, Sapovirus, and Astrovirus in Kenya
Shioda K , Cosmas L , Audi A , Gregoricus N , Vinje J , Parashar UD , Montgomery JM , Feikin DR , Breiman RF , Hall AJ . PLoS One 2016 11 (4) e0145943 BACKGROUND: Diarrheal diseases remain a major cause of mortality in Africa and worldwide. While the burden of rotavirus is well described, population-based rates of disease caused by norovirus, sapovirus, and astrovirus are lacking, particularly in developing countries. METHODS: Data on diarrhea cases were collected through a population-based surveillance platform including healthcare encounters and household visits in Kenya. We analyzed data from June 2007 to October 2008 in Lwak, a rural site in western Kenya, and from October 2006 to February 2009 in Kibera, an urban slum. Stool specimens from diarrhea cases of all ages who visited study clinics were tested for norovirus, sapovirus, and astrovirus by RT-PCR. RESULTS: Of 334 stool specimens from Lwak and 524 from Kibera, 85 (25%) and 159 (30%) were positive for norovirus, 13 (4%) and 31 (6%) for sapovirus, and 28 (8%) and 18 (3%) for astrovirus, respectively. Among norovirus-positive specimens, genogroup II predominated in both sites, detected in 74 (87%) in Lwak and 140 (88%) in Kibera. The adjusted community incidence per 100,000 person-years was the highest for norovirus (Lwak: 9,635; Kibera: 4,116), followed by astrovirus (Lwak: 3,051; Kibera: 440) and sapovirus (Lwak: 1,445; Kibera: 879). For all viruses, the adjusted incidence was higher among children aged <5 years (norovirus: 22,225 in Lwak and 17,511 in Kibera; sapovirus: 5,556 in Lwak and 4,378 in Kibera; astrovirus: 11,113 in Lwak and 2,814 in Kibera) compared to cases aged ≥5 years. CONCLUSION: Although limited by a lack of controls, this is the first study to estimate the outpatient and community incidence rates of norovirus, sapovirus, and astrovirus across the age spectrum in Kenya, suggesting a substantial disease burden imposed by these viruses. By applying adjusted rates, we estimate approximately 2.8-3.3 million, 0.45-0.54 million, and 0.77-0.95 million people become ill with norovirus, sapovirus, and astrovirus, respectively, every year in Kenya. |
Characterization of a Salivirus (Picornaviridae) from a Diarrheal Child in Guatemala.
Ng TF , Magana L , Montmayeur A , Lopez MR , Gregoricus N , Oberste MS , Vinje J , Nix WA . Genome Announc 2016 4 (1) The complete genome sequence of a salivirus was identified in a stool sample from a Guatemalan child with acute gastroenteritis during a 2009 norovirus outbreak. This genome (genotype A1 strain GUT/2009/A-1746) shares 82% to 94% genome-wide nucleotide identity with saliviruses from the United States, China, Germany, and Nigeria, representing the first salivirus sequence from Central America. |
Transmission of norovirus within households in Quininde, Ecuador
Gastanaduy PA , Vicuna Y , Salazar F , Broncano N , Gregoricus N , Vinje J , Chico M , Parashar UD , Cooper PJ , Lopman B . Pediatr Infect Dis J 2015 34 (9) 1031-3 We studied the transmission of norovirus infection in households in Quininde, Ecuador. Among household contacts of norovirus positive children with diarrhea, norovirus negative children with diarrhea, and asymptomatic controls, infection attack rates (iARs) were 33%, 8%, and 18%, respectively (N= 45, 36, 83). iARs were higher when index children had a higher viral load. |
Differences in norovirus-associated hospital visits between Jewish and Bedouin children in southern Israel
Leshem E , Givon-Lavi N , Vinje J , Gregoricus N , Parashar U , Dagan R . Pediatr Infect Dis J 2015 34 (9) 1036-8 Population-based surveillance during 2006-2013 showed norovirushospitalization rates among Bedouin (low-middle income settings) children<5 years old,were 13.9/10,000 person-years compared with7.1/10,000 among Jewish (high-income settings) childrenwho were < 5 years (rate ratio [RR]2.0, 95% confidence interval [CI] 1.6-2.3). Differenceswere most prominent among infants (59.7 versus 19.7/10,000, respectively;RR3.0, 95%CI 2.5-3.8). GII.3 and GII.4 strains dominated (67%) in both populations. |
Serological correlates of protection against a GII.4 norovirus
Atmar RL , Bernstein DI , Lyon GM , Treanor JJ , Al-Ibrahim MS , Graham DY , Vinje J , Jiang X , Gregoricus N , Frenck RW , Moe CL , Chen WH , Ferreira J , Barrett J , Opekun AR , Estes MK , Borkowski A , Baehner F , Goodwin R , Edmonds A , Mendelman PM . Clin Vaccine Immunol 2015 22 (8) 923-9 Noroviruses are the leading cause of acute gastroenteritis worldwide, and norovirus vaccine prevention strategies are under evaluation. The immunogenicity of two doses of bivalent GI.1/GII.4 (50mug VLP of each strain adjuvanted with aluminum hydroxide and MPL) norovirus vaccine administered to healthy adults in a phase 1-2 double-blind, placebo-controlled trial was determined using virus-specific, serum total antibody ELISA, IgG, IgA and histoblood group antigen (HBGA) blocking assays. Trial participants subsequently received an oral live virus challenge with a GII.4 strain and vaccine efficacy results have been reported previously (D.I. Bernstein et al. J Infect Dis 211:870-878, 2015, doi:10.1093/infdis/jiu497). This report assesses the impact of pre-challenge serum antibody levels on infection and illness outcomes. Serum antibody responses were observed in vaccine recipients by all antibody assays, with first dose seroresponse frequencies ranging from 88-100% for the GI.1 antigen and from 69-84% for the GII.4 antigen. There was little increase in antibody level after the second vaccine dose. Among placebo subjects, higher pre-challenge serum anti-GII.4 HBGA-blocking and IgA antibody levels, but not IgG or total antibody levels, were associated with a lower frequency of virus infection and associated illness. Notably, some placebo subjects without measurable serum antibody pre-challenge did not become infected after norovirus challenge. In vaccinees, anti-GII.4 HBGA-blocking antibody levels >1:500 were associated with a lower frequency of moderate-to-severe vomiting or diarrheal illness. In this study, pre-challenge serum HBGA antibody titers correlated with protection in placebo subjects; however, other factors may impact the likelihood of infection and illness after virus exposure. |
Norovirus Infection and Disease in an Ecuadorian Birth Cohort: Association of Certain Norovirus Genotypes With Host FUT2 Secretor Status.
Lopman B , Trivedi T , Vicuna Y , Costantini V , Collins N , Gregoricus N , Parashar U , Sandoval C , Broncano N , Vaca M , Chico ME , Vinje J , Cooper PJ . J Infect Dis 2014 211 (11) 1813-21 BACKGROUND: Although norovirus is the most common cause of gastroenteritis, there are few data on the community incidence of infection/disease or the patterns of acquired immunity or innate resistance to norovirus. METHODS: We followed a community-based birth cohort of 194 children in Ecuador with the aim to estimate (1) incidence of norovirus gastroenteritis from birth to three years (2) the protective effect of norovirus infection on subsequent infection/disease and (3) the association of infection/disease with secretor status. RESULTS: Over the 3-year period, we detected a mean of 2.26 (Range 0 - 12) diarrheal episodes per child. Norovirus was detected in 260 (18%) samples, but not more frequently in diarrhea samples (79/438; 18%) than diarrhea-free samples (181/1016; 18%, p=0.919). 66% of children had at least one norovirus infection during the first 3 years of life and 40% of children had two infections. Previous norovirus infections were not associated with subsequent risk of infection. All GII.4 infections were amongst secretor positive children (p<0.001), but higher rates of non-GII.4 infections were found in secretor-negative children (RR=0.56; p=0.029). CONCLUSIONS: GII.4 infections were uniquely detected in secretor positive children while non-GII.4 infections were more often found in secretor negatives. |
Norovirus vaccine against experimental human GII.4 virus illness: a challenge study in healthy adults
Bernstein DI , Atmar RL , Lyon GM , Treanor JJ , Chen WH , Jiang X , Vinje J , Gregoricus N , Frenck RW Jr , Moe CL , Al-Ibrahim MS , Barrett J , Ferreira J , Estes MK , Graham DY , Goodwin R , Borkowski A , Clemens R , Mendelman PM . J Infect Dis 2014 211 (6) 870-8 BACKGROUND: Vaccines against norovirus, the leading cause of acute gastroenteritis, should protect against medically significant illness and reduce transmission. METHODS: In this randomised, double-blind, placebo-controlled trial, 18-50 year-olds received two injections of placebo or norovirus GI.1/GII.4 bivalent VLP vaccine with MPL and alum. Participants were challenged as inpatients with GII.4 virus (4400 RT-PCR units), and monitored for illness and infection. RESULTS: Per-protocol, 27/50 (54.0%) vaccinees and 30/48 (62.5%) controls were infected. Using predefined illness and infection definitions, vaccination did not meet the primary endpoint, but self-reported cases of severe (0 vaccinees vs 8.3% controls, p=0.054), moderate or greater (6.0% vs 18.8%, p=0.068), and mild or greater severity of vomiting and/or diarrhea (20.0% vs 37.5%, p=0.074) were less frequent. Vaccination also reduced the modified Vesikari score from from 7.3 to 4.5 (p=0.002). Difficulties encountered were low norovirus disease rate, and inability to define illness by RT-qPCR or further antibody rise in vaccinees due to high vaccine-induced titers. By day 10, 11/49 (22.4%) vaccinees were shedding virus compared with 17/47 (36.2%) placebo recipients (p=0.179). CONCLUSIONS: Bivalent norovirus VLP vaccine reduced norovirus related vomiting and/or diarrhea; field efficacy studies are planned. |
Divergent picobirnaviruses in human feces.
Ng TF , Vega E , Kondov NO , Markey C , Deng X , Gregoricus N , Vinje J , Delwart E . Genome Announc 2014 2 (3) The near-complete genomes of two picobirnaviruses (PBVs) in diarrheal stool samples, human picobirnaviruses D and E (HuPBV-D and -E), were genetically characterized. Their RNA-dependent RNA polymerase (RdRp) protein sequences had <66% identities to known PBVs. Due to a single nucleotide insertion, the open reading frame 2 (ORF2) in segment 1 of HuPBV-D was interrupted by a stop codon. A small stem-loop structure overlying the stop codon may result in translational readthrough into the rest of ORF2. |
Diagnostic performance of rectal swab versus bulk stool specimens for the detection of rotavirus and norovirus: Implications for outbreak investigations
Arvelo W , Hall AJ , Estevez A , Lopez B , Gregoricus N , Vinje J , Gentsch JR , Parashar U , Lindblade KA . J Clin Virol 2013 58 (4) 678-82 BACKGROUND: In January of 2008, during the peak of the rotavirus season in Guatemala, a gastroenteritis outbreak with high mortality among infants was reported in Guatemala. Despite extensive efforts, the investigation was limited by the lack of bulk stool specimens collected, particularly from the more severely dehydrated or deceased children. OBJECTIVES: We evaluated the diagnostic performance of rectal swab specimens compared with bulk stool for the detection of rotavirus and norovirus. STUDY DESIGN: Patients with diarrhea (≥3 loose stools in 24h) were enrolled through an ongoing surveillance system in Guatemala. From January through March 2009, we attempted to enroll 100 patients <5 years old captured by the diarrhea surveillance, and collected paired bulk stool and rectal swabs specimens from them. Specimens were tested for norovirus using real-time reverse transcription-polymerase chain reaction and for rotavirus via enzyme immunoassay. RESULTS: We enrolled 102 patients with paired specimens; 91% of 100 paired specimens tested for rotavirus yielded concordant results positive for rotavirus with a negativity rate of 83%. Among 100 paired specimens tested for norovirus, 86% were concordant norovirus detection and the negativity rate was 85%. The diagnostic performance for rotavirus and norovirus detection did not differ significantly between the two specimen types. CONCLUSIONS: Testing of properly collected fecal specimens using rectal swabs may be a viable alternative to bulk stool for detection of rotavirus and norovirus, particularly during outbreaks where collection of bulk stool may be difficult. |
Genotypic and epidemiologic trends of norovirus outbreaks in the United States, 2009 to 2013.
Vega E , Barclay L , Gregoricus N , Shirley SH , Lee D , Vinje J . J Clin Microbiol 2013 52 (1) 147-55 Noroviruses are the leading cause of epidemic acute gastroenteritis in the United States. From September 2009 through August 2013, 3,960 norovirus outbreaks were reported to CaliciNet. Of the 2,895 outbreaks with a known transmission route, person-to-person and foodborne transmission were reported for 2,425 (83.7%) and 465 (16.1%) of the outbreaks, respectively. A total of 2,475 (62.5%) of outbreaks occurred in long term care facilities (LTCF) followed by 389 (9.8%) in restaurants and 227 (5.7%) in schools. A total of 435 (11%) outbreaks were typed as GI and 3,525 (89%) as GII norovirus. GII.4 viruses caused 2,853 (72%) of all outbreaks, of which 94% typed as either GII.4 New Orleans or GII.4 Sydney. In addition, three non-GII.4 viruses, GII.12, GII.1, and GI.6, caused 528 (13%) of all outbreaks. Several non-GII.4 genotypes (GI.3, GI.6, GI.7, GII.3, GII.6, and GII.12) were significantly more associated with foodborne transmission (P < 0.05; OR: 1.9 - 7.1). Patients in LTCF and people ≥ 65 years of age were at a higher risk for GII.4 infections compared to other settings and genotypes (P < 0.05). Phylogeographic analysis identified three major dispersions from two geographic locations responsible for the GI.6 outbreaks from 2011 -- 2013. In conclusion, our data demonstrate the cyclic emergence of new (non-GII.4) norovirus strains, and several genotypes are more often associated with foodborne outbreaks. These surveillance data can be used to improve viral foodborne surveillance and help guide studies to develop and evaluate targeted prevention methods such as norovirus vaccines, antivirals and environmental decontamination methods. |
Household transmission of rotavirus in a community with rotavirus vaccination in Quininde, Ecuador
Lopman B , Vicuna Y , Salazar F , Broncano N , Esona MD , Sandoval C , Gregoricus N , Bowen MD , Payne D , Vaca M , Chico M , Parashar U , Cooper PJ . PLoS One 2013 8 (7) e67763 BACKGROUND: We studied the transmission of rotavirus infection in households in peri-urban Ecuador in the vaccination era. METHODS: Stool samples were collected from household contacts of child rotavirus cases, diarrhea controls and healthy controls following presentation of the index child to health facilities. Rotavirus infection status of contacts was determined by RT-qPCR. We examined factors associated with transmissibility (index-case characteristics) and susceptibility (household-contact characteristics). RESULTS: Amongst cases, diarrhea controls and healthy control household contacts, infection attack rates (iAR) were 55%, 8% and 2%, (n = 137, 130, 137) respectively. iARs were higher from index cases with vomiting, and amongst siblings. Disease ARs were higher when the index child was <18 months and had vomiting, with household contact <10 years and those sharing a room with the index case being more susceptible. We found no evidence of asymptomatic infections leading to disease transmission. CONCLUSION: Transmission rates of rotavirus are high in households with an infected child, while background infections are rare. We have identified factors associated with transmission (vomiting/young age of index case) and susceptibility (young age/sharing a room/being a sibling of the index case). Vaccination may lead to indirect benefits by averting episodes or reducing symptoms in vaccinees. |
Genotype GI.6 norovirus, United States, 2010-2012.
Leshem E , Barclay L , Wikswo M , Vega E , Gregoricus N , Parashar UD , Vinje J , Hall AJ . Emerg Infect Dis 2013 19 (8) 1317-20 We report an increase in the proportion of genotype GI.6 norovirus outbreaks in the United States from 1.4% in 2010 to 7.7% in 2012 (p<0.001). Compared with non-GI.6 outbreaks, GI.6 outbreaks were characterized by summer seasonality, foodborne transmission, and non-health care settings. |
Prevalence and genetic diversity of norovirus among patients with acute diarrhea in Guatemala.
Estevez A , Arvelo W , Hall AJ , Lopez MR , Lopez B , Reyes L , Moir JC , Gregoricus N , Vinje J , Parashar UD , Lindblade KA . J Med Virol 2013 85 (7) 1293-8 Noroviruses (NoVs) are a leading cause of acute gastroenteritis outbreaks and sporadic cases of diarrhea in industrialized countries. To study the prevalence and genetic diversity of NoVs in Guatemala, stool specimens were collected from hospitalized and ambulatory patients presenting with diarrhea (≥3 loose or liquid stools in a 24-hr period) who were enrolled in a prospective surveillance system in the Departments of Santa Rosa (October 2007 to August 2010) and Quetzaltenango (August 2009 to August 2010), Guatemala. Specimens were tested for rotavirus, enteric bacteria, and parasites by routine methods and for genogroups I and II NoV by real-time reverse transcription-PCR. A total of 2,403 stool specimens were collected from hospitalized (n = 528) and ambulatory patients (n = 1,875). Overall, 341 (14%) samples tested positive for NoVs including 114 (22%) hospitalized and 227 (12%) ambulatory patients. NoVs disease peaked during the winter (November-January) months. Among the 341 NoVs-positive patients, 32 (9%) were also positive for rotavirus, 32 (9%) for bacteria, and 9 (3%) for protozoa. Nucleotide sequences were obtained from 84 samples collected from hospitalized children aged <5 years of age, which could be grouped into nine GII and three GI genotypes with GII.4 (74%) and GI.8 (10%) being the most common. This is the first study on the prevalence of NoVs among hospitalized and ambulatory patients with diarrhea in Guatemala. The findings highlight the need to implement laboratory diagnostics for NoVs to improve appropriate clinical management of diarrheal diseases and guide vaccine development. (J. Med. Virol. (c) 2013 Wiley Periodicals, Inc.) |
Sapovirus gastroenteritis in preschool center, Puerto Rico, 2011
Hassan-Rios E , Torres P , Munoz E , Matos C , Hall AJ , Gregoricus N , Vinje J . Emerg Infect Dis 2013 19 (1) 174-5 TO THE EDITOR: Human sapoviruses belong to a group of viruses within the family Caliciviridae, which also includes noroviruses, that cause acute gastroenteritis (1). Evidence of worldwide distribution of sapovirus has been documented on the basis of detection of virus and antibody prevalence against sapovirus in different populations (2). However, no evidence of sapovirus infection or outbreaks in Latin America and the Caribbean Islands has been reported. |
Norovirus outbreak of probable waterborne transmission with high attack rate in a Guatemalan resort
Arvelo W , Sosa SM , Juliao P , Lopez MR , Estevez A , Lopez B , Morales-Betoulle ME , Gonzalez M , Gregoricus NA , Hall AJ , Vinje J , Parashar U , Lindblade KA . J Clin Virol 2012 55 (1) 8-11 BACKGROUND: In February 2009, a group of Guatemalan school children developed acute gastroenteritis (AGE) after participating in a school excursion. OBJECTIVES: We conducted a retrospective cohort investigation to characterize the outbreak and guide control measures. STUDY DESIGN: A case was defined as an illness with onset of diarrhea or vomiting during February 25-March 5, 2009. Participants were interviewed using a standardized questionnaire, and stool specimens were collected. We inspected the excursion site and tested water samples for total coliforms and Escherichia coli. RESULTS: We identified 119 excursion participants, of which 92 (77%) had been ill. Fifty-six (62%) patients sought care for their illness, and three (3%) were hospitalized. Eighteen (90%) of the 20 specimens from ill children tested positive for norovirus. Among these, 16 (89%) were of the genogroup I (GI.7) and two (11%) were genogroup II (GII.12 and GII.17). One (8%) of the 12 food handlers had norovirus (GI.7). Drinking water samples had 146 most probable numbers (MPN)/100ml of total coliforms and five MPN/100ml of E. coli. CONCLUSION: We describe the first laboratory-confirmed norovirus outbreak in Guatemala. The high illness attack rate, detection of multiple norovirus strains in sick persons, and presence of fecal contamination of drinking water indicate likely waterborne transmission. |
Experimental inoculation of juvenile rhesus macaques with primate enteric caliciviruses
Sestak K , Feely S , Fey B , Dufour J , Hargitt E , Alvarez X , Pahar B , Gregoricus N , Vinje J , Farkas T . PLoS One 2012 7 (5) e37973 BACKGROUND: Tissue culture-adapted Tulane virus (TV), a GI.1 rhesus enteric calicivirus (ReCV), and a mixture of GII.2 and GII.4 human norovirus (NoV)-containing stool sample were used to intrastomacheally inoculate juvenile rhesus macaques (Macaca mulatta) in order to evaluate infection caused by these viruses. METHODOLOGY & FINDINGS: Two of the three TV-inoculated macaques developed diarrhea, fever, virus-shedding in stools, inflammation of duodenum and 16-fold increase of TV-neutralizing (VN) serum antibodies but no vomiting or viremia. No VN-antibody responses could be detected against a GI.2 ReCV strain FT285, suggesting that TV and FT285 represent different ReCV serotypes. Both NoV-inoculated macaques remained asymptomatic but with demonstrable virus shedding in one animal. Examination of duodenum biopsies of the TV-inoculated macaques showed lymphocytic infiltration of the lamina propria and villous blunting. TV antigen-positive (TV+) cells were detected in the lamina propria. In most of the TV+ cells TV co-localized perinuclearly with calnexin - an endoplasmic reticulum protein. A few CD20+TV+ double-positive B cells were also identified in duodenum. To corroborate the authenticity of CD20+TV+ B cells, in vitro cultures of peripheral blood mononuclear cells (PBMCs) from healthy macaques were inoculated with TV. Multicolor flow cytometry confirmed the presence of TV antigen-containing B cells of predominantly CD20+HLA-DR+ phenotype. A 2-log increase of viral RNA by 6 days post inoculation (p<0.05) suggested active TV replication in cultured lymphocytes. CONCLUSIONS/SIGNIFICANCE: Taken together, our results show that ReCVs represent an alternative cell culture and animal model to study enteric calicivirus replication, pathogenesis and immunity. |
Updated norovirus outbreak management and disease prevention guidelines
Hall AJ , Vinjé J , Lopman B , Park GW , Yen C , Gregoricus N , Parashar U . MMWR Recomm Rep 2011 60 1-18 Noroviruses are the most common cause of epidemic gastroenteritis, responsible for at least 50% of all gastroenteritis outbreaks worldwide, and a major cause of foodborne illness. In the United States, approximately 21 million illnesses attributable to norovirus are estimated to occur annually. Since 2001, when the most recent norovirus recommendations were published (CDC. "Norwalk-like viruses." Public health consequences and outbreak management. MMWR 2001;50[No. RR-9]), substantial advances have been made in norovirus epidemiology, immunology, diagnostic methods, and infection control. As molecular diagnostic techniques have improved in performance and become more widely available, detection and reporting of norovirus outbreaks have increased. Although the inability to culture human noroviruses in vitro has hampered progress, assessment of the performance of disinfectants has been facilitated by the discovery of new, cultivable surrogates for human noroviruses. In addition, the periodic emergence of epidemic strains (from genogroup II type 4, GII.4) and outbreaks in specific populations (e.g., the elderly in nursing homes) have been characterized. This report reviews these recent advances and provides guidelines for outbreak management and disease prevention. These recommendations are intended for use by public health professionals investigating outbreaks of acute gastroenteritis, including state and local health authorities, as well as academic and research institutions. |
Transmission of Norovirus among NBA players and staff, Winter 2010-2011
Desai R , Yen C , Wikswo M , Gregoricus NA , Provo JE , Parashar UD , Hall AJ . Clin Infect Dis 2011 53 (11) 1115-7 In December 2010, 24 players and staff members from 13 National Basketball Association teams were affected with gastroenteritis symptoms. Four of 5 stool specimens from ill players and staff tested positive for norovirus genogroup II. We document evidence of transmission both within teams and, potentially, between teams in 2 instances. |
Incidence of acute gastroenteritis and role of norovirus, Georgia, USA, 2004-2005
Hall AJ , Rosenthal M , Gregoricus N , Greene SA , Ferguson J , Henao OL , Vinje J , Lopman BA , Parashar UD , Widdowson MA . Emerg Infect Dis 2011 17 (8) 1381-8 Approximately 179 million cases of acute gastroenteritis (AGE) occur annually in the United States. However, lack of routine clinical testing for viruses limits understanding of their role among persons seeking medical care. Fecal specimens submitted for routine bacterial culture through a health maintenance organization in Georgia, USA, were tested with molecular diagnostic assays for norovirus, rotavirus, astrovirus, sapovirus, and adenovirus. Incidence was estimated by using national health care utilization rates. Routine clinical diagnostics identified a pathogen in 42 (7.3%) of 572 specimens; inclusion of molecular viral testing increased pathogen detection to 15.7%. Community AGE incidence was 41,000 cases/100,000 person-years and outpatient incidence was 5,400/100,000 person-years. Norovirus was the most common pathogen, accounting for 6,500 (16%) and 640 (12%) per 100,000 person-years of community and outpatient AGE episodes, respectively. This study demonstrates that noroviruses are leading causes of AGE among persons seeking medical care. |
Novel surveillance network for norovirus gastroenteritis outbreaks, United States.
Vega E , Barclay L , Gregoricus N , Williams K , Lee D , Vinje J . Emerg Infect Dis 2011 17 (8) 1389-95 CaliciNet, the outbreak surveillance network for noroviruses in the United States, was launched in March 2009. As of January 2011, twenty state and local health laboratories had been certified to submit norovirus sequences and epidemiologic outbreak data to CaliciNet. During the network's first year, 552 outbreaks were submitted to CaliciNet, of which 78 (14%) were associated with foodborne transmission. A total of 395 (72%) outbreaks were typed as GII.4, of which 298 (75%) belonged to a new variant, GII.4 New Orleans, which first emerged in October 2009. Analysis of the complete capsid and P2 region sequences confirmed that GII.4 New Orleans is distinct from previous GII.4 variants, including GII.4 Minerva (2006b). |
Disease transmission and passenger behaviors during a high morbidity norovirus outbreak on a cruise ship, January 2009
Wikswo ME , Cortes J , Hall AJ , Vaughan G , Howard C , Gregoricus N , Cramer EH . Clin Infect Dis 2011 52 (9) 1116-22 BACGROUND: Norovirus continues to pose a significant burden on cruise ships, causing an average of 27 confirmed outbreaks annually over the past 5 years. In January 2009, the report of a suspected norovirus outbreak among passengers on a cruise ship prompted an investigation. METHODS: A retrospective cohort study among passengers was conducted on board the ship. Questionnaires about health care-seeking behaviors, hygiene practices, and possible norovirus exposures were placed in every cabin. Stool samples from several ill passengers were tested for norovirus by quantitative reverse-transcriptase polymerase chain reaction (RT-qPCR) and confirmed by sequence analysis. RESULTS: Of 1842 passengers, 1532 (83.2%) returned questionnaires, and 236 (15.4% of participants) met the case definition. Of these, 95 (40%) did not report to the infirmary. Case passengers were significantly more likely to have an ill cabin mate (relative risk [RR] = 3.0; P < .01) and to have witnessed vomiting during boarding (RR = 2.8; P = .01). Over 90% of all passengers reported increased hand hygiene practices following the outbreak; 38% of ill passengers and 11% of well passengers decreased participation in public activities. Of 14 samples tested, 12 were positive for norovirus by RT-qPCR; 5 of these were confirmed by sequence analysis and typed as GII.4 Minerva. CONCLUSIONS: Person-to-person transmission, including an incident of public vomiting during boarding, likely contributed to this high morbidity outbreak. Infirmary surveillance detected only 60% of acute gastroenteritis (AGE) cases involved in this outbreak. Adjustments to outbreak reporting thresholds may be needed to account for incomplete voluntary AGE reporting and to more rapidly implement control measures. |
A multi-center comparison of two norovirus ORF2-based genotyping protocols
Mattison K , Grudeski E , Auk B , Charest H , Drews SJ , Fritzinger A , Gregoricus N , Hayward S , Houde A , Lee BE , Pang XL , Wong J , Booth TF , Vinje J . J Clin Microbiol 2009 47 (12) 3927-32 Norovirus outbreaks can be difficult to track due to the high frequency of environmental norovirus detection and the limited strain variation in some genotyping regions. However, rapid and accurate source identification can limit the spread of a foodborne outbreak and reduce the number of cases. Harmonization of genotyping assays is critical for enabling the rapid exchange of sequence data nationally and internationally. Several regions of the genome have been proposed for this purpose, but no consensus has been reached. In the present study, two standardized genotyping protocols (region C and region D) were evaluated by 9 laboratories in Canada and the United States using a coded panel of 96 fecal specimens representing 22 different norovirus genotypes. Overall, region C typing had a success rate of 78% compared to 52% for region D, however region D provides greater nucleotide sequence diversity for identifying new GII.4 variant strains. Significant differences in successful genotyping were observed between the 9 participating laboratories (10% to 100%) and between the different genotypes (6% to 100%). For several genogroup II strains, the reduced region D amplification correlated directly with mismatches between primer sequences and template. Based on overall performance, we recommended the region C protocol for routine genotyping of noroviruses while the region D protocol may be useful for identifying new GII.4 variants. Standardized genotyping will enable the rapid exchange of outbreak and sequence data through electronic norovirus surveillance networks. |
- Page last reviewed:Feb 1, 2024
- Page last updated:Jun 03, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure