No association between histo-blood group antigens and susceptibility to clinical infections with genogroup II norovirus

Noroviruses (NoVs) are a leading cause of viral gastroenteritis in humans. In the present study, the association between NoV susceptibility and the ABO histo-blood group was studied during 2 outbreaks of acute gastroenteritis in military units in Israel caused by genogroup II (GII) NoVs. The findings demonstrate that, unlike for genogroup I of NoV, there is no association between the ABO histo-blood group and clinical infection with GII NoVs. This is the largest study to test the association between NoVs, proven clinical infection with GII, and the ABO histo-blood group.     

医院内诺如病毒性急性胃肠炎暴发的流行病学与临床特点分析

目的通过对我院急性胃肠炎聚集病例的调查,了解诺如病毒性急性胃肠炎流行及临床特点。方法调查与分析我院2006年冬季(2006年11月28日—2006年12月24日)聚集发生的急性胃肠炎的临床表现和流行特点,采用PCR法检测患者便标本诺如病毒核酸和免疫印迹法查血清抗体。结果本次流行的急性胃肠炎患者共87例,中老年人发病占大多数,主要临床特点为腹泻、呕吐、腹痛等,大便细菌培养阴性。用PCR法检测20例患者大便标本,其中12例诺如病毒呈阳性。检测24例患者血标本,19例诺如病毒抗体阳性。结论证实2006年我院发生的急性胃肠炎是诺如病毒性急性胃肠炎医院感染的暴发流行,潜伏期24~48h,多表现为腹泻、呕吐等非细菌性胃肠炎,在医院中该病传染性极强,冬季好发,中老年人易感,饮食、接触污染物表面及人与人密切接触等是主要的传播方式。提高对该病的认识、及时识别对治疗与控制具有重要意义。     

Association of histo-blood group antigens and susceptibility to norovirus infections

BACKGROUND: Noroviruses (NoVs) are the leading cause of viral gastroenteritis in humans of all ages. Challenge studies that used the NoV prototype strain Norwalk virus (NV) have shown that some individuals are not susceptible to infection, suggesting the absence of a receptor. Recent studies have identified histo-blood group antigens (HBGAs) as possible receptors. Being a nonsecretor and presence of HBGA type B were associated with protection against infection with NV, a genogroup (GG) I NoV. METHODS: In the present retrospective study, we investigated the association between presence of HBGAs and the risk of infection with another NoV belonging to GGI (Hu/NV/I/Birmingham/93/UK). The study was done as part of an investigation of a waterborne outbreak in a group of schoolchildren and of a cohort of healthy adults. The ABH histo-blood group phenotype was determined by use of saliva or serum samples from these individuals. RESULTS: Presence of HBGA type B was significantly correlated with a lack of susceptibility to infection with GGI NoV and with an absence of antibodies. No correlation was found with GGII NoV. Although the infection rate in nonsecretors was lower, this difference was not statistically significant, and several children lacking HBGAs in saliva were found to be infected. CONCLUSIONS: Individuals with the HBGA type B may be protected against infection with GGI (but not GGII) NoVs. The association between susceptibility to NoV infection and being a secretor may be restricted to GGI NoV.     

Norovirus outbreaks in a teaching hospital: the role of infection control

In January 2004, 20 patients and 19 staff in one ward became ill in an outbreak of norovirus-related gastroenteritis over a 12-day period. The epidemic curve indicated person-to-person transmission. Infection control measures were instituted in consultation with the government health authorities. A prompt rigorous response may have prevented spread to other wards. In March 2004, 54 staff and 1 member of a patient's family became ill in an outbreak of gastroenteritis. The source of norovirus contamination was associated with food served at the hospital restaurant. Secondary infection was prevented because the outbreak was recognized early and staff members with gastroenteritis symptoms were asked to stay home. Immediate control measures, such as identification and announcement of the outbreak, isolation of symptomatic individuals from others, personal protection, helped control the infection.     

Infecciones por norovirus

Noroviruses infect persons of all ages, often causing epidemic outbreaks of acute gastroenteritis as well as sporadic cases. The application of novel molecular methods to the diagnosis of norovirus infections is now revealing their real impact. Molecular epidemiology studies have identified the most common viral genotypes responsible for human infections. Norovirus gastroenteritis is usually mild and of short duration, although the disease can also be severe, especially in the elderly, or may become chronic, as occurred in the immunocompromised patients. Several factors have been identified regarding the differential susceptibility to norovirus infection among individuals, consisting of several histo-blood antigens (ABO, Lewis and secretor) that are involved in the binding process of noroviruses to the enterocytes. The expression of these antigens in humans is genetically encoded, and shows a high polymorphism, which combined with the genetic diversity of noroviruses, makes the virus-host relationship rather complex. The diagnosis of norovirus infections is not performed routinely in many laboratories, but those involved in epidemiological surveillance have identified norovirus strains that evolve sequentially over time, similarly to Influenza viruses.     

Norwalk virus infection and disease is associated with ABO histo-blood group type

Some people are resistant to Norwalk virus (NV) infection; however, the factor(s) responsible for resistance or susceptibility to NV infection has not been identified. This study investigated the relationship between a person's ABO histo-blood group type and the risk of NV infection and symptomatic disease after clinical challenge. ABO phenotypes were identified by using serum samples from volunteers who participated in an NV challenge study (n=51). Individuals with an O phenotype were more likely to be infected with NV (odds ratio [OR], 11.8; 95% confidence interval [CI], 1.3-103), whereas persons with a B histo-blood group antigen had decreased risk of infection (OR, 0.096; 95% CI, 0.16-0.56) and symptomatic disease (OR, 0; 95% CI, 0-0.999). This is the first report demonstrating an association between a genetic factor and the risk of NV infection and symptomatic disease.     

The norovirus-epidemic in Berlin - clinic, epidemiology, and prevention

INTRODUCTION: During the winter 2002/2003, an increased number of outbreaks of acute gastroenteritis caused by norovirus was reported from Germany, some other European countries and the USA. In this study, the epidemiological and clinical features of the Berlin norovirus outbreak were investigated in order to identify the reasons for the spread of norovirus gastroenteritis and possible control measures. METHODS: Cases and spread of norovirus infection in eleven long-term care facilities and a university hospital in Berlin were monitored from October 2002 to February 2003. To investigate the symptomatology and routes of transmission, a retrospective and interview-based study of infected staff members was performed. RESULTS: Norovirus outbreaks in eleven long-term care facilities affected 314 patients (attack rate: 28.3 %, rate of hospitalisation: 20.7 %). 219 persons were affected in the hospital, during a period of four months. Sequence analysis revealed the circulation of Norovirus genogroup II (Grimsby-like viruses). The mean duration of symptoms was 69 hours. The duration of outbreaks on specific wards was negatively correlated with the time of returning to work (mean: 1.8 days) of the staff members after the disease. DISCUSSION: This report demonstrates the potential of norovirus to cause large outbreaks by person to person transmission. Spread by aerosols generated by vomiting and environmental contamination seem to be particular important in institutional settings. The duration of symptoms was longer than reported previously, reflecting a possible increased virulence. Besides this, the outbreak was facilitated by insufficient preventive measures.     

The effect of ABO blood group on the diagnosis of von Willebrand disease

In order to firmly establish a normal range for von Willebrand factor antigen (vWF:Ag), we determined plasma vWF:Ag concentrations in 1,117 volunteer blood donors by quantitative immunoelectrophoresis. The presence of the ABO blood group has a significant influence on vWF:Ag values; individuals with blood group O had the lowest mean vWF:Ag level (74.8 U/dL), followed by group A (105.9 U/dL), then group B (116.9 U/dL), and finally group AB (123.3 U/dL). Multiple regression analysis revealed that age significantly correlated with vWF:Ag levels in each blood group. We then performed reverse ABO typing on stored plasma from 142 patients with the diagnosis of von Willebrand disease (vWd). Of 114 patients with type I vWd, blood group O was found in 88 (77%), group A in 21 (18%), group B in 5 (4%), and group AB in none (0%), whereas the frequency of these blood groups in the normal population is significantly different (45%, 45%, 7% and 3%, respectively) (P less than .001). Patients with type II or III vWd had ABO blood group frequencies that were not different from the expected distribution. There may be a subset of symptomatic vWd patients with decreased concentrations of structurally normal vWf (vWd, type I) on the basis of blood group O. Some individuals of blood group AB with a genetic defect of vWF may have the diagnosis overlooked because vWF levels are elevated due to blood type.     

Distribution of ABO/Rh blood groups and their association with hepatitis B virus infection in 3.8 million Chinese adults: A population‐based cross‐sectional study

ABO and Rh blood groups play a vital role in blood transfusion safety and clinical practice and are thought to be linked with disease susceptibility. The results from previous studies that focused on the association between blood groups and HBV infection remain controversial. China has the world's largest burden of HBV infection. We assessed the distribution of ABO/Rh blood groups in Chinese adults and examined the association between these groups and HBV infection. We did a nationwide cross‐sectional study using data from a physical check‐up programme from 31 provinces examined between 2010 and 2012. ELISA was used to test for HBsAg in serologic samples. Multivariable logistic regression was used to estimate aOR of the association between ABO and Rh blood groups and HBV infection. Among 3 827 125 participants, the proportion of participants with blood group A was highest (30.54%), followed by O (30.37%), B (29.42%) and AB (9.66%). A total of 38 907 (1.02%) were Rh‐D negative. The prevalence of HBsAg in blood groups O, A, B and AB were 6.34%, 5.55%, 5.18% and 5.06%, respectively. HBsAg prevalence was 5.65% in Rh‐D‐positive and 3.96% in Rh‐D‐negative participants. After controlling for other potential risk factors, multivariate models showed that participants with blood group O (adjusted OR = 1.22, 95% CI: 1.20‐1.25) were at higher risk of HBV infection compared with group AB. Rh‐D‐positive participants (adjusted OR = 1.44, 95% CI: 1.37‐1.52) were at higher risk of HBV infection than Rh‐D‐negative participants. The associations between ABO/Rh blood groups and HBV infection were similar in subgroup analysis. The proportions of O, A, B and AB blood groups were approximately 3:3:3:1, and nearly 1 in 100 people was Rh‐D negative among Chinese adults. Blood group O and Rh‐D positivity were both associated with increased HBV infection. The risk of HBV infection and blood safety should be taken into consideration in clinical practice, especially when transfusing those with blood group O. Awareness and prevention of HBV infection is of particular importance for individuals with blood group O.     

Identification of a novel cellular target and a co-factor for norovirus infection – B cells & commensal bacteria

Human noroviruses are a leading cause of gastroenteritis worldwide but research on these important enteric pathogens has long been restricted by their uncultivability. Extensive efforts to infect intestinal epithelial cells with murine and human noroviruses in vitro have been thus far unsuccessful while murine noroviruses efficiently and lytically infect innate immune cells including macrophages and dendritic cells. We have recently discovered that murine and human noroviruses infect B cells in vitro. The nature of B cell infection was distinct from innate immune cell infection in that mature B cells were infected noncytopathically in contrast to the lytic infection of macrophages and dendritic cells. Human norovirus infection of B cells was facilitated by commensal bacteria expressing an appropriate histo-blood group antigen. Importantly, we used the mouse model of norovirus infection to confirm that Peyer''s patch B cells are infected, and that commensal bacteria stimulate infection, in vivo.     

Norovirus outbreak among primary schoolchildren who had played in a recreational water fountain

BACKGROUND: A gastroenteritis outbreak was associated with playing in a norovirus-contaminated recreational fountain. OBJECTIVE AND STUDY DESIGN: A retrospective cohort study was performed to estimate the magnitude of the outbreak and identify its source. Epidemiological investigation included standardized questionnaires about sex, age, school, class, risk exposures, and illness characteristics. Stool samples and environmental water samples were analyzed for the presence of bacteria, viruses, and parasites. RESULTS: Questionnaires were returned for 191 schoolchildren (response rate, 83%) with a mean age of 9.2 years, of whom 47% were ill (diarrhea and/or vomiting). Children were more likely to have been ill if they had played in the recreational fountain (relative risk, 10.4). Norovirus (Birmingham) was detected in 22 (88%) stool specimens from ill children and in 6 (38%) specimens from healthy children. The water sample from the fountain contained a norovirus strain that was identical to the RNA sequence found in stools. CONCLUSIONS: Recreational water may be the source of gastroenteritis outbreaks. Adequate water treatment can prevent these types of outbreak.     

Identification of Norovirus as the Top Enteric Viruses Detected in Adult Cases with Acute Gastroenteritis

To elucidate the importance of the norovirus and other enteric viruses, and the difference of the genetic relatedness on norovirus between the outbreak and sporadic cases, a total of 557 stool samples, consisting of 503 sporadic cases and 54 samples of 4 outbreaks were collected and tested for norovirus and other enteric viruses in Beijing, China, July 2007–June 2008. The data showed norovirus, rotavirus, astrovirus, and sapovirus, were detected in 26.6%, 6.1%, 1.8%, and 0.5%, respectively. Norovirus was detected almost throughout the surveillance period, norovirus co-infecting with rotavirus, astrovirus, and sapovirus, respectively, were identified both in outbreak and the sporadic cases. GII.4/2006 was identified as the predominant strain circulating both in outbreak and sporadic cases. The results showed that norovirus was rather the important agent than other enteric viruses affected adults with acute gastroenteritis; no significant genetic relatedness of the dominant strains was found between the outbreak and sporadic cases.     

Acute gastroenteritis outbreak caused by a GII.6 norovirus

AIM:To report an acute gastroenteritis outbreak caused by a genogroup 2 genotype 6(GII.6) strain norovirus in Shanghai,China.METHODS:Noroviruses are responsible for approximately half of all reported gastroenteritis outbreaks in many countries.Genogroup 2 genotype 4 strains are the most prevalent.Rare outbreaks caused by GII.6 strains have been reported.An acute gastroenteritis outbreak occurred in an elementary school in Shanghai in December of 2013.Field and molecular epidemiologic investigations were conducted.RESULTS:The outbreak was limited to one class in an elementary school located in southwest Shanghai.The age of the students ranged from 9 to 10 years.The first case emerged on December 10,2013,and the last case emerged on December 14,2013.The cases peaked on December 11,2013,with 21 new cases.Of 45 students in the class,32 were affected.The main symptom was gastroenteritis,and 15.6%(5/32) of the cases exhibited a fever.A field epidemiologic investigation showed the pathogen may have been transmitted to the elementary school from employees in a delicatessen via the first case student,who had eaten food from the delicatessen one day before the gastroenteritis episodes began.A molecular epidemiologic investigation identified the cause of the gastroenteritis as norovirus strain GII.6;the viral sequence of the student cases showed 100% homology with that of the shop employees.Genetic relatedness analyses showed that the new viral strain is closely related to previously reported GII.6 sequences,especially to a strain reported in Japan.CONCLUSION:This is the first report to show that norovirus strain GII.6 can cause a gastroenteritis outbreak.Thus,the prevalence of GII.6 noroviruses requires attention.     

Identification of a novel cellular target and a co-factor for norovirus infection – B cells & commensal bacteria

Human noroviruses are a leading cause of gastroenteritis worldwide but research on these important enteric pathogens has long been restricted by their uncultivability. Extensive efforts to infect intestinal epithelial cells with murine and human noroviruses in vitro have been thus far unsuccessful while murine noroviruses efficiently and lytically infect innate immune cells including macrophages and dendritic cells. We have recently discovered that murine and human noroviruses infect B cells in vitro. The nature of B cell infection was distinct from innate immune cell infection in that mature B cells were infected noncytopathically in contrast to the lytic infection of macrophages and dendritic cells. Human norovirus infection of B cells was facilitated by commensal bacteria expressing an appropriate histo-blood group antigen. Importantly, we used the mouse model of norovirus infection to confirm that Peyer's patch B cells are infected, and that commensal bacteria stimulate infection, in vivo.     

Multiple outbreaks of gastroenteritis due to a single strain of genotype GII/4 norovirus in Kobe, Japan, 2006: risk factors for norovirus spread in health care settings

A large number of gastroenteritis outbreaks due to a norovirus GII/4 strain and its variants occurred during November and December 2006 in Kobe, Japan. Of the 118 outbreaks, 6 were foodborne and 112 were caused by person-to-person transmission in healthcare settings such as nursing homes and hospitals. The distribution of norovirus outbreaks in healthcare settings was skewed, particularly in the south coastal area. Moreover, several outbreaks occurred within 1 km(2) in various areas. Outbreaks in neighboring settings, especially within 1 km, and travel from the sources of outbreaks were risk factors for the spread of the norovirus. The use of ineffective disinfectants such as alcohol and benzalkonium chloride might also have helped to spread the infection.     

Efficient management of a norovirus outbreak causing gastroenteritis in two hotels in Spain, 2014

ObjectivesTo determine the aetiological agent causing a gastroenteritis outbreak in two hotels in Majorca (Spain) on August and September 2014.MethodsAn epidemiological study was carried out. Environmental and stool samples were analyzed for different pathogens, including norovirus.ResultsEpidemiological analysis detected 79 cases among the tourists hosted in the affected hotels over the period 18th August to 3rd September. They included 52 (attack rate: 6.4%) and 27 (attack rate: 3.0%) cases in hotel A and B, respectively. Seven of the staff members were also affected. Microbiological analyses detected genotype 2 norovirus in patient's stool samples, in rooms and in common areas’ surfaces. The specific control plan rapidly implemented at the beginning of the outbreak, and further adapted for norovirus elimination, allowed to control the outbreak.ConclusionsOur study demonstrates that the outbreak was caused by genotype 2 norovirus, and reflects the importance of a rapid analysis and response for its control.     

A nosocomial sapovirus-associated outbreak of gastroenteritis in adults

The human caliciviruses norovirus and sapovirus are leading causes of acute, non-bacterial gastroenteritis. In contrast to norovirus, sapovirus is known to give infections mainly in infants and young children. We describe a nosocomial outbreak of gastroenteritis associated with sapovirus involving 23 adult patients and medical staff. The mean age of the patients and medical staff was 52 y and the major signs and symptoms were nausea, diarrhoea, vomiting, abdominal cramp, headache, myalgia and fever. More patients had diarrhoea (72%) than vomiting (56%) and the mean duration of symptoms was 6 d. A secondary attack rate of 45% was seen affecting in all 10 persons with a mean age of 29 y. Sequences of the capsid gene revealed a 97% nucleotide homology to the sapovirus genogroup IV reference strain Chiba/000671T/1999. This is one of the first reported nosocomial outbreaks of sapovirus infection among adults and shows that a diagnostic test for sapovirus should be included in investigation of gastroenteritis among adults.     

An outbreak of gastroenteritis associated with acute rotaviral infection in schoolchildren

In April 1988 a large outbreak of group C rotavirus infection associated with acute gastroenteritis occurred among schoolchildren and their teachers simultaneously at seven elementary schools in Fukui city, Japan. Of 3,102, 675 (21.8%) became ill. Clinical symptoms were mild, predominantly abdominal pain and vomiting, with diarrhea reported in only 27.6%. The outbreak subsided within 2 d. No pathogenic bacteria were found in fecal specimens; the virus particles detected by electron microscopy were morphologically indistinguishable from conventional infantile rotavirus. Immune electron microscopy showed that these virions formed large aggregates with convalescent serum and with the reference serum specific to group C rotavirus. Polyacrylamide gel electrophoresis showed similar RNA patterns for virus from this outbreak and typical group C rotavirus.     

ABO blood groups in malaria and schistosomiasis haematobium

We sought to determine if there was any relationship between ABO blood groups and susceptibility to malaria and urinary schistosomiasis. In Epe and outlying villages in south-western Nigeria, we examined 681 people for their blood groups, malaria parasitemia and for the presence of Schistosoma haematobium eggs in their urine specimens. Two hundred and sixty-nine individuals were parasitemic for falciparum malaria, 97 subjects had urinary schistosomiasis and 56 people carried concurrent infections of both parasites. Frequencies of the blood groups were 56.68% for group 0, 22.32% for group B, 18.5% for group A and 2.50% for the AB group. The rates of infection with malaria and/or schistosomiasis showed no significant association with the frequencies of the ABO blood groups.