Rotavirus surveillance in europe, 2005-2008: web-enabled reporting and real-time analysis of genotyping and epidemiological data.

BACKGROUND: The first European rotavirus surveillance network, EuroRotaNet, comprising 16 laboratories in 15 European countries, has been established. METHODS: Fecal samples from gastroenteritis cases positive for group A rotavirus antigen were collected from multiple European countries from 2005 to mid-2008 and were subjected to G and P genotyping. Epidemiological data collected included age, sex, geographical location, setting, dates of onset and sample collection, and clinical symptoms. RESULTS: A total of 8879 rotavirus-positive samples were characterized: 2129 cases were from the 2005-2006 season, 4030 from the 2006-2007 season, and 2720 from the ongoing 2007-2008 season. A total of 30 different G and P type combinations of strains circulated in the region from 2005 through 2008. Of these strains, 90% had genotypes commonly associated with human infections-G1P[8], G2P[4], G3P[8], G4P[8], and G9P[8]-and 1.37% represented potential zoonotic introductions. G1P[8] remained the most prevalent genotype in Europe as a whole, but the incidence of infection with G1P[8] rotavirus strains was <50% overall, and all 3 seasons were characterized by a significant diversity of cocirculating strains. The peak incidence of rotavirus infection occurred from January through May, and 81% of case patients were aged <2.5 years. Conclusions. Data gathered through EuroRotaNet will provide valuable background information on the rotavirus strain diversity in Europe before the introduction of rotavirus vaccines, and the network will provide a robust method for surveillance during vaccine implementation.

Structural and functional changes of the duodenum in human norovirus infection.

BACKGROUND: Norovirus infection is the most frequent cause of infectious diarrhoea in the western world. This study aimed to characterise functionally and histomorphologically the diseased duodenum in human biopsies. METHODS: Norovirus infection was diagnosed by the Kaplan criteria and confirmed by PCR of stool samples. Duodenal biopsies were obtained endoscopically. In miniaturised Ussing chambers, short circuit current, flux measurements and impedance spectroscopy were performed. Histological analysis including apoptosis staining and characterisation of intraepithelial lymphocytes was performed. Tight junction proteins were quantified by immunoblotting. RESULTS: In norovirus infection, epithelial resistance decreased from (mean (SEM)) 24 (2) Omega cm(2) in controls to 10 (1) Omega cm(2). Mannitol flux increased from 113 (24) nmol h(-1) cm(-2) in controls to 242 (29) nmol h(-1) cm(-2). Microdissection revealed a villus surface area reduced by 47% (6.6%). Intraepithelial lymphocytes were increased to 63 (7) per 100 enterocytes, with an increased rate of perforin-positive cytotoxic T cells. Expression of tight junctional proteins occludin, claudin-4 and claudin-5 was reduced. The epithelial apoptotic ratio was doubled in norovirus infection. Furthermore, the basal short circuit current was increased in norovirus infection and could be reduced by bumetanide and 5-nitro-2-(3-phenylpropylamino)benzoic acid (NPPB). CONCLUSIONS: Norovirus infection leads to epithelial barrier dysfunction paralleled by a reduction of sealing tight junctional proteins and an increase in epithelial apoptosis, which may partly be mediated by increased cytotoxic intraepithelial lymphocytes. Furthermore, active anion secretion is markedly stimulated. Thus, the diarrhoea in norovirus infection is driven by both a leak flux and a secretory component.

Analysis of integrated virological and epidemiological reports of norovirus outbreaks collected within the Foodborne Viruses in Europe network from 1 July 2001 to 30 June 2006.

The Foodborne Viruses in Europe network has developed integrated epidemiological and virological outbreak reporting with aggregation and sharing of data through a joint database. We analyzed data from reported outbreaks of norovirus (NoV)-caused gastroenteritis from 13 European countries (July 2001 to July 2006) for trends in time and indications of different epidemiology of genotypes and variants. Of the 13 countries participating in this surveillance network, 11 were capable of collecting integrated epidemiological and virological surveillance data and 10 countries reported outbreaks throughout the entire period. Large differences in the numbers and rates of reported outbreaks per country were observed, reflecting the differences in the focus and coverage of national surveillance systems. GII.4 strains predominated throughout the 5-year surveillance period, but the proportion of outbreaks associated with GII.4 rose remarkably during years in which NoV activity was particularly high. Spring and summer peaks indicated the emergence of genetically distinct variants within GII.4 across Europe and were followed by increased NoV activity during the 2002-2003 and 2004-2005 winter seasons. GII.4 viruses predominated in health care settings and in person-to-person transmission. The consecutive emergence of new GII.4 variants is highly indicative of immune-driven selection. Their predominance in health care settings suggests properties that facilitate transmission in settings with a high concentration of people such as higher virus loads in excreta or a higher incidence of vomiting. Understanding the mechanisms driving the changes in epidemiology and clinical impact of these rapidly evolving RNA viruses is essential to design effective intervention and prevention measures.

Data quality of 5 years of central norovirus outbreak reporting in the European Network for food-borne viruses.

BACKGROUND: The food-borne viruses in Europe (FBVE) network database was established in 1999 to monitor trends in outbreaks of gastroenteritis due to noroviruses (NoVs), to identify major transmission routes of NoV infections within and between participating countries and to detect diffuse international food-borne outbreaks. METHODS: We reviewed the total of 9430 NoV outbreak reports from 13 countries with date of onset between 1 January 2002 and 1 January 2007 for representativeness, completeness and timeliness against these objectives. RESULTS: Rates of reporting ranged from a yearly average of 1.8 in 2003 to 11.6 in 2006. Completeness of reporting of an agreed minimum dataset improved over the years, both for epidemiological and virological data. For the 10 countries that provided integrated (epidemiological AND virological) reporting over the 5-year period, the completeness of the minimum dataset rose from 15% in 2003 to 48% in 2006. Two countries have not been able to combine both data types due to the structure of the national surveillance system (England and Wales and Germany). Timeliness of reporting (median days between the onset of an outbreak and the date of reporting to the FBVE database) differed greatly between countries, but gradually improved to 47 days in 2006. CONCLUSION: The outbreaks reported to the FBVE reflect the lack of standardization of surveillance systems across Europe, making direct comparison of data between countries difficult. However, trends in reported outbreaks per country, distribution of NoV genotypes, and detection of diffuse international outbreaks were used as background data in acute questions about NoV illness and the changing genotype distribution during the 5-year period, shown to be of added value. Integrated reporting is essential for these objectives, but could be limited to sentinel countries with surveillance systems that allow this integration. For successful intervention in case of diffuse international outbreaks, completeness and timeliness of reporting would need to be improved and expanded to countries that presently do not participate.

Characterization of nucleotide sequences from European hepatitis C virus isolates.

We characterized the 5' end and parts of the structural genes of European isolates of hepatitis C virus (HCV) and compared them with recently published RNA sequences of American and Japanese HCV isolates. The cDNA, obtained by reverse transcription of viral RNA extracted from different sera, was amplified by nested PCR, cloned and sequenced. Within 239 nucleotides (nt) of the 5' end, we found only three single-nt exchanges compared to two sequences of Japanese origin and one exchange to the prototype HCV sequence (ptHCV) (homology greater than 99%). The sequence of the core region (534 nt) in two European isolates showed a homology of about 97-98% on the nt level, as compared to ptHCV and one Japanese isolate, and 90% to other Japanese isolates. The amino acid (aa) homology was between 98-99% among all published sequences. A greater discrepancy was found in the European isolates within the 434 nt sequenced from the N-terminus of the putative envelope region, where the nt homology to ptHCV and one Japanese isolate was 90-93% (aa homology 93-95%), and to other Japanese isolates was 72-73% (aa homology 77-78%), indicating that the European isolates may be more closely related to the ptHCV and one Japanese isolate than to the other Japanese isolates. Amplified genes encoding structural proteins (core, envelope) were expressed in Escherichia coli. Sera from chronically infected patients reacted strongly with the recombinant core protein, but no specific immunoreactivity occurred with the putative envelope protein.

GB virus C infection in patients with chronic hepatitis B and C before and after liver transplantation.

Recently, a novel virus, tentatively designated GB virus (GBV-C) was identified in patients with hepatitis. The frequency of this novel virus infection was therefore investigated in 58 patients with chronic hepatitis B virus (HBV) infection and in 74 patients with chronic hepatitis C virus (HCV) infection who had received orthotopic liver transplantation (OLT) because of decompensated liver cirrhosis. Before OLT, GBV-C sequences were found by reverse transcription nested polymerase chain reaction with primers derived from the helicase-like region in six (10%) of the HBV- and in six (8%) of the HCV-infected patients. Specificity of the polymerase chain reaction products was confirmed in eight of them by direct sequencing. Pretransplant GBV-6 viremia was associated with posttransplant viremia in 75% of patients. The comparison of GBV-C nucleotide and amino acid sequences within the helicase-like region revealed that pre- and posttransplant sequences differed only in 0-7 nucleotide exchanges, and with the exception of one, all of them were silent mutations. After OLT, 29% of the HBV- infected and 12% of the HCV-infected patients became GBV-C positive,indicating a high rate of "de novo" GBV-C infection. By correlating the GBV-C status with the frequency of the occurrence of graft hepatitis in both groups of patients, it became evident that posttransplant GBV-C viremia did not increase the risk for this clinical condition. However, we found a significantly higher percentage of hepatocellular carcinoma in patients with pre-OLT GBV-C/HCV coinfection compared with patients with HCV infection alone (5/6 vs. 16/68;P<0.01).

Molecular typing of echovirus serotype 4 isolates.

We report on clinical samples Stuttgart/97, Berlin/99 and Jasi/99 associated with aseptic meningitis. All three samples contained echovirus 4 (E4) but Stuttgart/97 was simultaneous infected with echovirus 30 (E30). The genetic relationship of the E4 strains was assessed using RT-PCR and direct sequencing of amplicons derived from the genomic region encoding the capsid protein VP1. The sequences have been compared with each other and with sequences of further E4 strains obtained from GenBank. The analysis confirms that sequences of recent isolates have drifted away from elderly strains over a longer period of time. Several amino acid changes in assumed antigenic sites of the VP1 gene may be sufficient to cause changes in antigenic specificity and therefore they may be a reason for failure of serological typing of some new antigenic E4 variants.

Community-wide outbreak of enteroviral illness caused by echovirus 30: a cross-sectional survey and a case-control study.

BACKGROUND: In June, 1997, 21 children from a single community in Germany were hospitalized with aseptic meningitis. An epidemiologic investigation was conducted to determine the extent of the outbreak and risk factors for illness. METHOD: The extent of the outbreak was assessed with a cross-sectional survey of every 10th child listed in the town register among the 2240 town children < 16 years old. A case-control study determined risk factors for illness. Sixty-two cases were identified through the cross-sectional survey from hospitalized persons and from persons seen by local physicians. Controls were 114 asymptomatic persons identified from the cross-sectional survey. RESULTS: The overall attack rate was 16%, with the highest attack rates (24%) among the 6- to 8-year olds. Onsets occurred during a 37-day period. Among the 2240 town children <16 years of age, an estimated 353 met the case definition for enteroviral illness, 168 visited a doctor and 21 were hospitalized. Data from the case-control study indicated that contact with an ill household member [odds ratio (OR) = 6.3; 95% confidence interval (CI) 2.6 to 15.5], day-care attendance (OR = 2.6; 95% CI 1.1 to 6.2) and playground use, either two to three times per week (OR = 3.7; 95% CI 1.3 to 10.2) or daily (OR = 4.3; 95% CI 1.6 to 11.3), were risk factors for illness. CONCLUSION: Echovirus 30 caused substantial morbidity during this community outbreak caused by person-to-person spread. Household contacts, day-care centers and playgrounds were prominent risk factors for transmission.

Genotypes of hepatitis C virus isolates from different parts of the world.

Hepatitis C virus (HCV) causes most cases of posttransfusion non-A, non-B hepatitis. HCV isolates were classified by their genetic relatedness into at least six genotypes and a series of subtypes. Methods for typing included amplification of certain genomic regions using universal or type/subtype specific primers, restriction fragment length polymorphism analysis, differential hybridization, nucleotide sequencing, and serologic genotyping. HCV genotypes and their subtypes coexist in various geographic locations but show different prevalences. The identification of genotypes/subtypes is useful for studies on the molecular epidemiology and pathogenesis of HCV infection.

Variability of the envelope regions of HCV in European isolates and its significance for diagnostic tools.

Following the original description of HCV in 1989 a tremendous amount of sequence data is now available. Based on the 8 complete nucleotide sequences published so far at least 4 genotypes can be distinguished. Partial sequences of additional HCV isolates indicate the existence of further genotypes. A serological typing is not yet possible. For detection of virus, reverse transcription and amplification of the 5' non coding region is most commonly performed. This region of the genome is highly conserved among all isolates. In this study we used regions of the E1 and E2 gene in order to classify HCV isolates. The nucleotide sequences of regions in E1 and E2 gene of different European isolates from Germany, Croatia, Hungary, and Rumania were determined and compared to recently published RNA sequences of American and Japanese HCV isolates. The cDNA, obtained by reverse transcription of viral RNA extracted from sera was amplified by nested PCR, cloned and sequenced. Within 564 nucleotides (nt) of E1 we found 87-90% homology (and 89-92% homology at aa level) compared to sequences of Japanese origin and 73-74% homology (77-81% at aa level) compared to the prototype HCV sequence (ptHCV-I). In all characterized isolates the sequence of E2 (643 nucleotides) showed a homology of about 83% at the nucleotide level as compared to genotype II sequences, and a homology of about 70% to genotype I. Our results confirm the existence of two hypervariable regions in the E2 gene of genotype II sequences. Our results also indicate together with other reports from European HCV isolates that genotype II is predominant in Europe.

Detection and characterization of hepatitis C virus sequence in the serum of a patient with chronic HCV infection.

A cDNA fragment corresponding to the nonstructural gene region of Hepatitis C virus was cloned and sequenced. cDNA was obtained by reverse transcription of viral RNA extracted from serum of a German patient with chronic post transfusion hepatitis. "Nested" PCR resulted in a cDNA fragment of 345 nt. The sequence showed a homology of 96% to the American prototype HCV.

Detection of tick-borne encephalitis virus RNA in ticks (Ixodes ricinus) by the polymerase chain reaction.

A polymerase chain reaction for the detection of tick-borne encephalitis virus (TBEV) RNA in ticks was developed. Two pairs of primers for nested PCR were selected from the 5'-NCR and the 5'-terminus of the C protein coding region, which are highly conserved among the TBEV isolates sequenced so far. The sensitivity of the nested PCR was tested by dilution experiments of a TBEV positive brain suspension. The specificity of the PCR products was confirmed by Southern blotting. In a pilot study, 60 homogenates of 7200 ticks (I. ricinus) were examined by PCR. Two homogenates were found positive. The PCR for TBEV RNA appears to be a valuable method to define endemic areas of TBE.

Typing of hepatitis C virus isolates by DNA enzyme immunoassay.

Recently, at least six types of hepatitis C viruses (HCV) have been identified. Different types of HCV appear to possess different pathogenic properties and a different sensitivity to interferon treatment. Typing of HCV isolates may therefore be an important diagnostic procedure. We report on a new method for identification of HCV types 1a, 1b, 2a, 2b and 3a which are most prevalent in Europe, North America and Japan. The assay is based on a combination of two well established techniques, the polymerase chain reaction (PCR) and DNA enzyme immunoassay (DEIA). In the first step of the method a cDNA of about 250 bp corresponding to the HCV core-region is amplified by nested PCR. The target cDNA is then hybridized to type-specific oligonucleotides fixed to a solid phase through an avidin-biotin bridge. The formed hybrids are detected by a standard ELISA using monoclonal antibodies reacting with double-stranded DNA. Typically, signal-to-noise (S/N) ratios between 18.2 and 48.6 could be observed when different HCV types/subtypes were analyzed by this method. The test was evaluated using cloned HCV cDNAs of known types and by sequence determination of some of the typed cDNAs. Typing of 115 isolates from Germany, Russia and Turkey revealed that subtype 1b (59-100%) and 1a (24-32%) are most prevalent in these countries.

Aseptic meningitis in Germany associated with echovirus type 13.

BACKGROUND: Echoviruses are the commonest cause of aseptic meningitis. Echovirus type 13 which has not been isolated in Germany over a long period of time was the predominant enterovirus serotype associated with different local outbreaks of aseptic meningitis in Germany in 2000. METHODS: Virus isolation was performed from cerebrospinal fluid and stools. In order to study the genetic relationship of echovirus type 13 isolates, sequence analysis of a part of VP1 (~300 nt) was carried out. Isolates from different geographic regions were compared to each other as well as to elder viruses (prototype strain from 1953, four isolates from 1965-1986). RESULTS: Overall, 55 isolates of echovirus type 13 were obtained from different parts of Germany. It was shown that the new isolated strains have a very high degree of homology on the nucleotide level (> 98%)) but differ significantly from the old strains (76-85%). CONCLUSIONS: a) Rare enterovirus serotypes can cause serious illness.b) The molecular drift has also been shown for other enterovirus serotypes.

Prevalence and risk factors for HBV, HCV and HDV infections among injecting drug users from Rio de Janeiro, Brazil.

Viral hepatitis constitutes a major health issue, with high prevalence among injecting drug users (IDUs). The present study assessed the prevalence and risk determinants for hepatitis B, C and D viruses (HBV, HCV and HDV) infections among 102 IDUs from Rio de Janeiro, Brazil. Serological markers and HCV-RNA were detected by enzyme immunoassay and nested PCR, respectively. HCV genotyping was determined by restriction fragment length polymorphism analysis (RFLP). HBsAg, anti-HBc and anti-HBs were found in 7.8, 55.8 and 24. 7% of IDUs, respectively. In the final logistic regression, HBV infection was independently associated with male homosexual intercourse within the last 5 years (odds ratio (OR) 3.1; 95% confidence interval (CI) 1.1-8.8). No subject presented anti-delta (anti-HD). Anti-HCV was detected in 69.6% of subjects, and was found to be independently associated with needle sharing in the last 6 months (OR 3.4; 95% CI 1.3-9.2) and with longer duration of iv drug use (OR 3.1; 95% CI 1.1-8.7). These data demonstrate that this population is at high risk for both HBV and HCV infection. Among IDUs from Rio de Janeiro, unprotected sexual intercourse seems to be more closely associated with HBV infection, whereas HCV is positively correlated with high risk injecting behavior. Comprehensive public health interventions targeting this population and their sexual partners must be encouraged.

Distribution of HCV genotypes among different exposure categories in Brazil.

Hepatitis C virus (HCV) infection is widespread and responsible for more than 60% of chronic hepatitis cases. HCV presents a genetic variability which has led to viral classification into at least 6 genotypes and a series of subtypes. These variants present characteristic geographical distribution, but their association with different responses to treatment with interferon and severity of disease still remains controversial. The aim of this study was to investigate the patterns of distribution of HCV genotypes among different exposure categories in Brazil. Two hundred and fifty anti-HCV positive samples were submitted to HCV-RNA detection by RT-PCR and their genotype was determined by restriction fragment length polymorphism (RFLP) analysis. In addition, the genotype/subtype of 60 samples was also determined by a reverse hybridization assay. HCV 1 was the most prevalent (72.0%), followed by type 3 (25.3%), HCV 2 (2.0%) and HCV 4 (0.7%). The HCV genotype distribution varied among the different exposure categories, with HCV 1 being more frequent among blood donors, hemophiliacs and hemodialysis patients. A high frequency of HCV 3 was observed in cirrhotic patients, blood donors from the South of Brazil and injecting drug users (IDUs). The general distribution of the HCV genotype in Brazil is similar to that in other regions of the world.

An outbreak of viral gastroenteritis in a mother-and-child health clinic.

An outbreak of diarrhoeal disease in a modern mother-and-child health clinic prompted the health authorities to initiate a retrospective cohort study in order to assess the scope of the outbreak and to identify possible risk factors. The management of the clinic had been rather concerned because four similar outbreaks had occurred during the last two years. A total of 151 guests, i.e. mothers with their children, who had arrived some days before the peak of the outbreak for a three-week-stay and another 15 guests who had arrived earlier and had extended their stay were enrolled in the study which mainly focused on the possible role of treatment measures as risk factors. In addition, a total of 49 staff members were requested to provide information about symptoms, working area and attendance at work. Relevant data were available from 164 of 166 guests and 47 of 49 staff members (response rates 98.8% and 96.0%, respectively). The attack rate among guests was 44.0% (adults 27.0%, children 54.0%) and among staff 23.4%. The mean age of affected children (3.5 years) was significantly lower than that of those not affected (6.3 years). The main symptoms were diarrhoea and vomiting. The sudden start of the outbreak suggested a single source of infection which, however, remained unknown. Person-to-person transmission was supposed to be the cause of the following spread. No association between distinct treatment measures and the disease was proven by the cohort study. Norwalk-like viruses as well as astroviruses were detected by polymerase chain reaction in specimens taken from seven patients. No other enteropathogenic agents were found. Regarding the special conditions in a mother-and-child health clinic where social contacts among guests are much more frequent and intensive than among patients in a "normal" hospital, measures to prevent the spread of gastrointestinal infections should concentrate on early recognition and isolation of symptomatic individuals. Guests and staff members should be instructed to keep to the rules of personal hygiene, especially handwashing. If disinfection is required, it should be virucidal.

[Worldwide eradication of poliomyelitis]. / Die weltweite Eradikation der Poliomyelitis.

Poliomyelitis, an infectious disease with acute and persistent flaccid paralysis is caused by poliovirus (types 1, 2 or 3), an enterovirus. The infection is asymptomatic in 95% of infected subjects. Most of the paralytic cases occur in adolescents or adults in the course of polio type 1 infection. In the prevaccination era, in countries with poor hygienic conditions, infection in early childhood was common, mostly asymptomatic, and immunity in the population prevailed. In developed countries polio often struck adolescents and adults taking its toll in paralytic disease. The introduction of vaccination with the Salk vaccine (IPV Inactivated Polio Vaccine) in the USA and in Europe in 1956 and with the Oral Polio Vaccine (OPV) developed by Sabin worldwide in the early sixties made it possible to control the epidemic in large geographic areas, but it could not eliminate the disease worldwide. Poliomyelitis is still endemic in Central Africa and in the Indian sub-continent. Acts of war led to the reduction in the vaccination rate in different geographic areas, and smaller epidemics with wild virus but also with reverted vaccine strains occurred. In some parts of the world the rate of vaccination also declined due to elimination of poliomyelitis, and it came to small epidemics of paralytic polio mainly caused by reverted vaccine strains circulating in the population. Reverted vaccine strains also remain a central problem in the eradication of poliomyelitis projected for 2005 by the World Health Organisation. A high vaccination rate, preferably with 3 doses of OPV in infancy or early childhood, and exact worldwide monitoring of cases is indispensable for the eradication. For the complete eradication of poliovirus the live vaccine OPV would have to be changed to an inactivated vaccine IPV worldwide. However, this is presently unachieveable, because of logistic problems and high costs.

Antibodies to polymerase proteins of influenza virus A/PR/8/34 (H1N1): comparison on the immunoreactivity with polymerase proteins of other influenza A and B virus strains.

The polymerase proteins (PB1, PB2, PA) of the influenza virus strain A/PR/8/34 (H1N1) were isolated from whole virion or ribonucleoprotein (RNP) fractions by electrophoresis on polyacrylamide gel and electroelution or Sepharose CL-6B chromatography in the presence of SDS. Antisera to polymerase proteins (P proteins) were raised in rabbits; the immunoglobulins (Ig) were purified by affinity chromatography. Characterization of the antibody fraction by Western blot analysis showed a highly monospecific reaction with the three polymerase proteins. Spot immunobinding assay was used to compare the immunoreactivity of the monospecific polymerase antibodies with the P proteins of other influenza A subtypes and influenza B strains, revealing high immunoreactivity with the components of all influenza A strains and only insignificant reactivity with the components of the influenza B strains tested.

Interaction between anti-influenza viral polymerase antibodies and RNP particles using the in vitro transcription process and an immunogold labelling technique.

Immunogold labelling and in vitro transcription of influenza virus vRNA have been used to analyse the interaction of anti-influenza polymerase antibodies with influenza-ribonucleoprotein (RNP) complexes. The polymerase proteins (P proteins) were localized exclusively at one end of the RNP segments. In the course of transcription the amount of P protein decreased significantly. The in vitro transcriptase activity y of influenza A virus RNP complexes in the presence of anti-polymerase antibodies to the strain A/PR/8/34 was inhibited by 60%. In contrast, RNP transcriptase activity of influenza B virus was not inhibited by these antibodies.