Should we pay attention to recombinant norovirus strain GII.P7/GII.6?

BACKGROUND: Recombinant norovirus strain GII.P7/GII.6 has been circulating in Asia and around the world for at least 20 years, but has been responsible for relatively few outbreaks. METHODS: We used statistical analyses, real-time reverse transcription - PCR, and genome sequence analyses to investigate an outbreak of gastroenteritis, identifying the pathogen, the risk factors associated with the outbreak, and the molecular features of GII.P7/GII.6 strains. RESULTS: An outbreak of gastroenteritis was reported at a school involving 12 students and lasting 6 days, from September 13 to September 18, 2017. Epidemiological studies suggested that norovirus was transmitted from person to person and not via contaminated food or drinking water in this outbreak. Using a sequence analysis of the junction region between open reading frames 1 and 2, the pathogen was identified as a recombinant norovirus (strain GII.P7/GII.6). The full-length genome of the outbreak strain shared 86%-97% identity with those of other GII.P7/GII.6 strains. Phylogenetic trees were constructed from partial open reading frame 1 (ORF1) and ORF2 sequences from the outbreak strain and GII.P7/GII.6 norovirus sequences available in GenBank. On the ORF1 tree, the partial sequences of ORF1 were grouped into cluster A (with GII.6), cluster B (with GII.7), and a separate cluster (C), based on the GII.6 and GII.7 reference strains. The ORF2 tree showed all GII.P7/GII.6 strains formed a cluster together with GII.6 strains. Amino-acid substitutions and insertions/deletions were common in the capsid protein, especially in it's P2 and P1 domains. The outbreak was controlled within several days using appropriate measures. CONCLUSIONS: Because it may play a prominent role in future outbreaks, recombinant norovirus strain GII.P7/GII.6 should be monitored with routine surveillance.

Norovirus outbreaks in Fengtai District, Beijing, China, 2014.

Norovirus (NoV) is the most common cause of non-bacterial acute gastroenteritis (AGE) outbreaks worldwide. Eight NoV outbreaks in the Fengtai District of Beijing City, China, were identified in 2014. Samples were collected from the eight outbreaks, and 73 out of 119 samples from cases and 10 out of 59 samples from the close contacts were positive for NoVs. The genotypes were determined by sequencing analysis. Six different GII genotypes, including GII.2, 4, 6, 7, 8, 14, and 17 were found, and GII.4 was not the local major epidemic genotype in the present study. Enhanced strain surveillance is necessary for future NoV epidemics.

A Waterborne Gastroenteritis Outbreak Caused by Norovirus GII.17 in a Hotel, Hebei, China, December 2014.

Norovirus (NoV) is responsible for an estimated 90 % of all epidemic nonbacterial outbreaks of gastroenteritis worldwide. Waterborne outbreaks of NoV are commonly reported. A novel GII.17 NoV strain emerged as a major cause of gastroenteritis outbreaks in China during the winter of 2014/2015. During this time, an outbreak of gastroenteritis occurred at a hotel in a ski park in Hebei Province, China. Epidemiological investigations indicated that one water well, which had only recently been in use, was the probable source. GII.17 NoV was detected by real-time reverse-transcription polymerase chain reaction from samples taken from cases, from concentrated water samples from water well, and from the nearby sewage settling tank. Nucleotide sequences of NoV extracted from clinical and water specimens were genetically identical and had 99 % homology with Beijing/CHN/2015. All epidemiological data indicated that GII.17 NoV was responsible for this outbreak. This is the first reported laboratory-confirmed waterborne outbreak caused by GII.17 NoV genotype in China. Strengthening management of well drinking water and systematica monitoring of NoV is essential for preventing future outbreaks.