Human bocaviruses are not significantly associated with gastroenteritis: results of retesting archive DNA from a case control study in the UK.

Gastroenteritis is a common illness causing considerable morbidity and mortality worldwide. Despite improvements in detection methods, a significant diagnostic gap still remains. Human bocavirus (HBoV)s, which are associated with respiratory infections, have also frequently been detected in stool samples in cases of gastroenteritis, and a tentative association between HBoVs, and in particular type-2 HBoVs, and gastroenteritis has previously been made. The aim of this study was to determine the role of HBoVs in gastroenteritis, using archived DNA samples from the case-control Infectious Intestinal Disease Study (IID). DNA extracted from stool samples from 2,256 cases and 2,124 controls were tested for the presence of HBoV DNA. All samples were screened in a real time PCR pan-HBoV assay, and positive samples were then tested in genotype 1 to 3-specific assays. HBoV was detected in 7.4% but no significantly different prevalence was observed between cases and controls. In the genotype-specific assays 106 of the 324 HBoV-positive samples were genotyped, with HBoV-1 predominantly found in controls whilst HBoV-2 was more frequently associated with cases of gastroenteritis (p<0.01). A significant proportion of HBoV positives could not be typed using the type specific assays, 67% of the total positives, and this was most likely due to low viral loads being present in the samples. However, the distribution of the untyped HBoV strains was no different between cases and controls. In conclusion, HBoVs, including HBoV-2 do not appear to be a significant cause of gastroenteritis in the UK population.

Norovirus outbreak in a cruise ship sailing around the British Isles: investigation and multi-agency management of an international outbreak.

OBJECTIVE: Managing an outbreak of gastroenteritis (GI) on board a cruise ship while minimising disruption to passengers' on board and shore visit activities is difficult. For this reason it is important to understand the complex patterns of transmission in a closed community. We describe the epidemiological investigation of an outbreak of norovirus during an international cruise. METHODS: A retrospective cohort study was conducted using information from lists routinely maintained by the travel company, including the passenger manifest, and organised coach tour lists. Information on air-conditioning (AC) systems was used to assess the possible sources of exposures. FINDINGS: Of the 1194 passengers 191 (16%) and 5 crew (<1%) became ill with GI symptoms. The attack rate was higher amongst passengers whose cabin was on the main deck (RR 3.41, 95% CI 1.47-7.94) that houses both passengers' cabins and leisure facilities including shops. Passengers who went on one of the organised coach tours where there were symptomatic passengers were at an increased risk of infection (RR 2.14, CI 1.51-3.03). Analysis of the 56 AC sections on the ship and did not detect an association with infection. CONCLUSIONS: Patterns of transmission of norovirus on a cruise ship are complex. Our study suggests infections are more likely among those passengers staying in areas of the ship that are highly transited or used for communal activities and more difficult to clean. Emphasis on the importance of early reporting of symptoms can help minimise transmission. Internationally agreed guidelines on the management of outbreaks on cruise ships are needed.

Human caliciviruses in symptomatic and asymptomatic infections in children in Vellore, South India.

Pediatric gastroenteritis is a major cause of childhood morbidity and mortality worldwide, especially in developing countries. It has been increasingly recognised that human caliciviruses (HuCV), comprising noroviruses (NoV), and sapoviruses (SaV), are important in both outbreak and non-outbreak settings. This study aimed to characterise caliciviruses detected in the faeces of hospitalized children and children in the community in India. This study examined 350 faecal samples from children presenting to the hospital with acute gastroenteritis and 673 samples collected from children in the community, 500 from children with diarrhea, and 173 samples from children without diarrhea. Strain characterisation was performed by reverse transcription-polymerase chain reaction (RT-PCR) and partial sequencing of the gene encoding the RNA-dependent RNA polymerase (RdRp) and/or a region spanning the open reading frames (ORFs) 1 and 2 (ORF1/ORF2) junction. A total of 68 of 350 specimens (19.4%) from hospitalized children were positive, and SaV and NoV accounted for 5.1 and 15.1% of the infections, respectively. Mixed infections of HuCVs with other enteric pathogens were seen in 9.4% of the total children tested. Sixty-eight out of 673 (10.1%) samples collected from children in the community were positive for caliciviruses, and SaV and NoV accounted for 3.4 and 6.6% of the infections. In the community cohort 55/500 (11%) and 13/173 (7.5%) were from symptomatic and asymptomatic children, respectively, and SaVs accounted for 17/500 (3.4%) and NoVs for 38/500 (7.6%) of the symptomatic infections. This is the first report of genotyping of circulating caliciviruses in both hospital and community in India and has increased the evidence for the role of these viruses in pediatric gastroenteritis in India.

Molecular epidemiology of rotaviral infection in South Indian children with acute diarrhea from 1995-1996 to 1998-1999.

The distribution of VP7 (G-) and VP4 (P-) genotypes among 126 rotavirus strains from South Indian children, < 5 years of age and with acute diarrhoea, presenting to a single hospital during the months to November and December, from 1995 to 1998, was studied. Multiplex hemi-nested G- and P-typing polymerase chain reactions determined 101 (80%) G types and 78 (61%) P types, respectively. In order of frequency, the commonest G types were G1, G4, G2, G9, G3, and G8, and P types were P1B[4], P1A[8], and P2A[6] and the most common G:P combinations were G1:P1A[8], G1:P1B[4], G2P1B[4] and G4:P1A[8]. G1, G2, and G4 types were seen in all years. The single G3 isolate was seen in 1998. The single G8 isolate and the 5 G9 isolates were seen in 1997, after a period of heavy rain. Sequence analysis showed that the G8 isolate was related most closely to the bovine strain A5, and the G9 strains were distinct from the nonpathogenic Indian isolate 116E and similar to G9s isolated in Mysore and the United Kingdom described previously.