Detection of multiple sapovirus genotypes and genogroups in oyster-associated outbreaks.

This report describes multiple viruses in stool specimens from oyster-associated gastroenteritis. Eleven outbreaks of oyster-associated gastroenteritis were examined for enteric viruses between January 2002 and March 2006 in Japan. Multiple norovirus genotypes were detected in all outbreaks; moreover, kobuvirus, sapovirus, and astrovirus were also detected in 6, 3, and 1 of the 11 outbreaks, respectively. Notably, multiple sapovirus genogroups were detected in the stool specimens from subjects in two oyster-associated gastroenteritis outbreaks.

Immunochromatography test for rapid detection of norovirus in fecal specimens.

An immunochromatography (IC) assay for rapid detection of norovirus (NoV) was evaluated with fecal samples collected from children who suffered from acute gastroenteritis during the winter season of 2007-2008 in Japan. A total of 75 fecal specimens were tested for NoV by the newly developed IC kit and by a gold standard RT-PCR method. The sensitivity, specificity, and agreement of this IC kit were 75.4%, 100%, and 80%, respectively. In addition, phylogenetic analysis revealed that the majority of NoV circulating in Japan during 2007-2008 belonged to the new variant GII/4 2006b genetic cluster. It was demonstrated that the IC kit evaluated in this study could detect these new variant NoV strains, which emerged recently in Japan. Therefore, it is suggested that this NoV IC kit could be used as an alternative method for the screening of NoV in fecal specimens, especially during the season of acute gastroenteritis outbreak.

Detection and quantification of enterovirus 71 genome from cerebrospinal fluid of an encephalitis patient by PCR applications.

Enterovirus 71 (EV71) is one of the causative agents of hand, foot, and mouth disease (HFMD) and is known to cause encephalitis, but several reports have identified EV71 in cerebrospinal fluid (CSF). We detected EV71 in CSF from a 20-month-old infant. The patient was diagnosed with brainstem encephalitis associated with HFMD. The clinical features of the patient were high fever (39.1C) and myoclonic jerks, and magnetic resonance imaging of the brain showed a bright signal area around the 4th ventricle. From a nasopharyngeal swab and rectal swab, EV71 was detected using reverse transcription (RT)-nested polymerase chain reaction (PCR). From CSF, the EV71 genome was identified using pan-enterovirus RT-nested PCR and sequencing. By real-time PCR, the nasopharyngeal swab, rectal swab, and CSF contained 1.8 x 10(4), 9.8 x 10(4), and 1.8 x 10 copies of the EV71 genome/microL, respectively. The enterovirus could only be isolated by cell culture from the rectal swab, and it was identified by a neutralization test using EV71-specific antiserum. RT-nested PCR and real-time PCR are considered to be sensitive tools for EV71 diagnosis in CSF.

Detection of human enteric viruses in Japanese clams.

A total of 57 clam packages that were collected from supermarkets and fish markets from 11 different sites in western Japan between 8 December 2005 and 6 September 2006 were examined for human enteric viruses (i.e., norovirus, Aichi virus, rotavirus, adenovirus, hepatitis A virus, and astrovirus), using PCR and reverse transcription PCR. Sixty-one percent of the packages were contaminated with one type of virus, 9% had two different types of viruses, 28% had three different types of viruses, and 9% had at least four different types of viruses. Thirty-one (54%) of 57 packages were contaminated with noroviruses. Norovirus genogroup I and genogroup II sequences were detected in 24 and 23 packages, respectively, and these sequences belonged to nine genogroup I and eight genogroup II genotypes. Aichi viruses were found in 19 (33%) of 57 packages, and these belonged to genogroup A. Rotaviruses (group A) were detected in 14 (42%) of 33 of packages and 9 of 14 rotavirus-positive packages contained two or more rotavirus genogroup types. Adenoviruses (Ad40 and Ad41) were detected in 17 (52%) of 33 packages. One of the 57 (2%) packages was positive with hepatitis A virus (subtype IA). Astrovirus was not detected in any of the packages. This is the first study to detect such a high level of contamination in Japanese clams. These results represent an important finding because the Japanese clams were considered suitable for human consumption. Further studies are needed to determine the health risks associated with eating these highly contaminated clams.

Monitoring of adenovirus from conjunctival scrapings in Japan during 2005--2006.

A total of 189 conjunctival scrapings were collected from patients in Tokyo, Japan by monitoring adenovirus infection in community-based clinics during 2005 and 2006. Of the 189 samples, 155 (82%) had adenoviruses detected by polymerase chain reaction (PCR). The serotypes were determined by PCR-restriction fragment length polymorphism (PCR-RFLP) analysis, using a combination of endonucleases, such as HhaI, AluI, and HaeIII, and neutralization tests (NTs). PCR-RFLP identified five serotypes: serotype 3: 16.8%, serotype 4: 9.7%, serotype 8: 34.8%, serotype 11: 23.2%, and serotype 37: 15.5%. Adenovirus 8 was the most common serotype identified. A subset consisting of 25 isolates identified as adenovirus 8 from this study plus 25 isolates from Kawasaki were analyzed using PCR sequencing of the hexon gene. Compared with prototype adenovirus serotype 8 and serotype 9 derived in Tokyo and Kawasaki, these isolates shared 61.7-62.8% and 80.5-82.7% amino acid homology, respectively, suggesting that a variant adenovirus serotype 8 was involved in this outbreak, and is different from the prototype adenovirus 8 virus. This variant had not been detected in Japan prior to 1996 and appears to be the most common adenovirus type 8 involved in cases of epidemic keratoconjunctivitis in Japan at present.

Statistical analysis of attack rate in norovirus foodborne outbreaks.

Norovirus (NoV), which causes foodborne gastroenteritis outbreaks, is one of the important viruses in public health. We statistically analyzed the attack rate in foodborne outbreaks caused by NoV. The attack rate in 95 oyster-associated outbreaks was significantly higher than that in 195 food handler-associated outbreaks (P=0.007). The difference in the number of NoV genotypes implicated is considered to be an important factor for this difference. The attack rate in 20 outbreaks associated only with GII/3 was higher than that in 143 other outbreaks (P=0.247), while the attack rate in 27 outbreaks associated only with GII/4 was lower than that in 136 other outbreaks (P=0.004), suggesting that GII/4 NoVs cause asymptomatic infection more frequently than do other NoV genotypes. Our results suggest that differences in implicated foods, susceptibility of the host to NoV infection, and pathogenicity of NoVs may influence the attack rate in NoV foodborne outbreaks.

Evaluation of immunochromatography and commercial enzyme-linked immunosorbent assay for rapid detection of norovirus antigen in stool samples.

The efficiency of immunochromatography and commercial enzyme-linked immunosorbent assay (ELISA) kit (Denka Seiken Co. Ltd., Tokyo, Japan) were evaluated for rapid detection of norovirus (NoV) from stool specimens. A total of 503 stool specimens collected from infants and young children who suffered from acute gastroenteritis were tested for NoV by the NoV-immunochromatography kit, Denka ELISA kit, and by a monoplex RT-PCR method. The NoV-immunochromatography revealed 78.9% sensitivity, 96.4% specificity, and 92.4% efficiency with the monoplex RT-PCR method. The Denka ELISA kit had a sensitivity of 90.4%, specificity of 96.4%, and an efficiency level of 95%. The findings indicate that the newly developed NoV-immunochromatography kit provides the specificity equal to that of the Denka ELISA kit, even through the sensitivity of detection was lower. However, the advantage of the NoV-immunochromatography kit is less time consuming and simpler. The data show that both the Denka ELISA and the NoV-immunochromatography kits may be used as an alternative method for screening of NoV in stool samples.

Molecular epidemiology of noroviruses detected in food handler-associated outbreaks of gastroenteritis in Japan.

Twelve outbreaks of food handler-associated gastroenteritis between November 2002 and March 2006 in Japan were examined for norovirus (NoV) using RT-PCR and sequence analysis. NoV was detected in 77 of 81 customers and 45 of 104 food handlers. Identical NoV sequences were detected in patients and food handlers in each outbreak.

A case of meningoencephalitis associated with G1P[8] rotavirus infection in a Japanese child.

We report the case of a 2-y, 11-month-old boy with G1P[8] rotavirus infection accompanied by acute meningoencephalitis. Substitutions in both the VP4 and VP7 genes were found in the identified strain. A commonly circulating G1P[8] rotavirus with such mutations might be associated with the pathogenesis of CNS complications, including meningoencephalitis.

Molecular and epidemiological trend of norovirus associated gastroenteritis in Dhaka City, Bangladesh.

BACKGROUND: Diarrhea, over the years, has killed millions of people and continues to be a major threat in Bangladesh. OBJECTIVES: To determine the incidence of norovirus infection in infants and young children with acute gastroenteritis in Dhaka City, Bangladesh and to determine the genogroup and genotype in norovirus-positive stool specimens. STUDY DESIGN: Fecal specimens were collected from infants and children with acute gastroenteritis in Dhaka City, Bangladesh from October 2004 to September 2005, and examined for norovirus by reverse transcription-polymerase chain reaction. RESULTS: Noroviruses were detected in 41 of 917 fecal specimens. Molecular analysis of norovirus was carried out by sequencing methods. Only norovirus GII/4 strains were detected during this study. The dominant genotype throughout the study period was GII/4. Norovirus infections were most commonly observed in winter and rainy seasons in Dhaka City. The common clinical symptoms in norovirus-infected patients were diarrhea (90%), vomiting (75%) and abdominal pain (46%). CONCLUSIONS: This is the first epidemiological research of norovirus in Bangladesh. Norovirus is an important enteropathogen responsible for viral gastroenteritis among infants and children in Bangladesh.

Detection and phylogenetic analysis of norovirus in Corbicula fluminea in a freshwater river in Japan.

To study the molecular epidemiology of noroviruses (NoVs) in bivalves residing in freshwater rivers, we detected, quantified and phylogenetically analyzed the NoV genome in purified concentrates obtained from the gills and digestive diverticula of Corbicula fluminea in a freshwater river in Gunma Prefecture, Japan. We detected the NoV genome in 35 of the 58 C. fluminea samples. Based on our phylogenetic analysis, the NoV genome detected in the samples was classified into 4 genotypes (GI/1, GI/2, GI/3 and GI/4) in genogroup I and 5 genotypes (GII/3, GII/4, GII/5, GII/8 and GII/12) in genogroup II. The phylogenetic tree showed wide genetic diversity among the genogroups. In addition, more than 10(4) copies of the NoV genome were detected in 2 of 35 samples. These results suggest that the freshwater bivalve C. fluminea is a reservoir for NoVs, similar to seawater bivalves such as oysters.

Detection and genetic characterization of norovirus in oysters from China and Japan.

A total of 225 oysters from China and Japan were collected during October 2005 to September 2006 and were then tested for the presence of norovirus by RT-nested PCR. The detection rate of norovirus was different between China and Japan, accounting for 14.6% (19 of 130) and 25.3% (24 of 95), respectively. In China, norovirus in oyster was detected continuously from July to February with the highest prevalence in August, October and November (each of 21%, 4 of 19). On the other hand, norovirus in Japan was found year-round with highest prevalence in March and October (each of 20.8%, 5 of 24). Norovirus strains detected were subjected to further characterization by sequence analysis. It was found that the norovirus strains belonged to only two distinct genotypes, the GII/3 (known as the Mexico virus cluster) and the GII/4 (known as the Lordsdale virus cluster). In China, the norovirus GII/4 was the most predominant, accounting for 78.9% (15 of 19). In contrast, it was interesting that both the norovirus GII/4 and the norovirus GII/3 were co-predominant with a prevalence of 50% (12 of 24) in Japan. Another interesting feature of the study was that the norovirus GII/4 strains in oysters from both countries were grouped into two distinct variant clusters known as the Farmington Hills variant and the Hunter variant. More than 102 copies of norovirus were detected in 41 of 43 oysters. This study provided additional evidence of the presence of norovirus in oysters and is also the first report to demonstrate the existence of norovirus variants in oysters.

Human sapovirus in clams, Japan.

Human sapovirus was detected in 4 of 57 clam packages by reverse transcription-PCR and sequence analysis. This represents the first finding of sapovirus contamination in food. Closely matching sequences have been detected in stool specimens from patients with gastroenteritis in Japan, which indicates a possible food-to-human transmission link.

Prevalence of sapovirus infection among infants and children with acute gastroenteritis in Dhaka City, Bangladesh during 2004-2005.

Sapovirus, a member of the family Caliciviridae is one of the major causative agents of viral gastroenteritis affecting all age group. Sapovirus was detected in 25 of 917 stool specimens from infants and children with acute gastroenteritis in a Children Hospital in Dhaka City, Bangladesh during 2004-2005. All fecal specimens were examined for sapovirus by reverse transcription-polymerase chain reaction. Molecular analysis of sapovirus was carried out by sequencing methods. Sapovirus detected in this study was clustered into only one distinct genogroup I. Sapovirus GI/1 was predominant, followed by GI/2 and accounted for 92% (23 of 25) and 8% (2 of 25), respectively. The results clearly indicated that sapovirus infections were observed most commonly in the autumn to winter seasons (September to January) in Dhaka City. The common clinical symptoms of sapovirus infected patients were dehydration (88%), vomiting (76%), and abdominal pain (60%). This is the first report of sapovirus in Bangladesh.

Genotyping and quantitation of noroviruses in oysters from two distinct sea areas in Japan.

Norovirus (NV) is a causative agent of acute gastroenteritis in humans, and shellfishes including oysters act as major vehicles of the virus. To investigate the genetic characteristics of NVs, we collected 1,512 oysters for raw consumption between October 2002 and March 2005 from two distinct areas (area A: the Sanriku Sea area; area B: the Setouchi Sea area). We detected the capsid gene and subjected it to phylogenetic analysis. By further quantification of the copy number of the genome by using real-time PCR, the NV capcid gene was detected in approximately 5% of the oysters, and they showed wide diversity. Two percent of the oysters from area B showed relatively large number of NVs, i.e., over 100 copies of capsid gene/oyster, whereas this was not observed in area A. Most of the detected NVs from oysters and humans were genetically related when the capsid region was compared. These results suggested that NVs obtained from humans and those obtained from oysters showed a potential relationship to each other and that some populations of Japanese oysters accumulated a relatively large number of NVs.

Detection of dual-infected cases of adenoviruses and coxsackieviruses type B by real-time PCR but not by the conventional viral culture technique.

The aim of this study was to evaluate the applicability of diagnostic methods for dual-infected cases of human adenoviruses (AdVs) and coxsackieviruses type B (CBs). For this purpose, 100 nasopharyngeal samples from patients with acute exudative tonsillitis and clinically suspected AdV infection were analyzed. Using PCR and real-time PCR techniques for AdVs and CBs, we found 86 AdVs-only positive samples; we also found five dual-infected samples containing 5.4 x 10(5) to 7.1 x 10(8) copies/mL of AdV genomes and 1.4x104 to 1.3 x 10(9) copies/mL of CB genomes. By viral culture using A549 cells, two co-infected samples, which contained over 10(8) copies/mL of AdV genomes and <10(5) copies/mL of CB genomes, became AdV dominant, while three samples with less than 2.0 x 10(6) copies/mL of AdV genomes became CB dominant. An immunochromatography kit for diagnosing AdVs at the bedside was positive for 3/5 dual-infected patients, and PCR techniques for AdVs and CBs were both positive for 5/5. Viral culture is usually considered to be the gold standard for AdV diagnosis, but our results demonstrate the importance of PCR applications for the detection of AdV and CB genomes, particularly in clinical cases of suspected AdV infection. Even though the sample size of dual infection (n=5) is small, our results show the existence of dual infection cases which were difficult to diagnose by viral culture alone.

Genetic characterization of group A rotavirus strains circulating among children with acute gastroenteritis in Japan in 2004-2005.

A total of 752 fecal specimens collected from July 2004 to June 2005 from children with acute gastroenteritis in four localities in Japan (Maizuru, Tokyo, Sapporo, and Osaka) were screened for group A rotavirus by RT-PCR. It was found that 82 (10.9%) specimens were positive for group A rotavirus. The G-(VP7 genotypes) and P-(VP4 genotypes) types were further investigated. The P-types of 18 rotavirus strains, which could not be typed by RT-PCR, were determined by sequencing analysis. Of these, 94% (17/18) were P[8] with multiple point mutations at the VP4 primer-binding site. Another sample turned out to be a rare genotype P[9], which was closely related to feline rotavirus. The predominant genotype was G1P[8] (46.4%), followed by G3P[8] (32.9%) and G2P[4] (12.2%). A number of unusual combinations including, G1P[4] (1.2%), G2P[8] (1.2%), G3P[9] (1.2%), G1G3P[8] (1.2%), and G2G3P[8] (3.7%), were also detected. A new nomenclature of P[8] was proposed, in which worldwide rotavirus P[8] strains were classified into four sub-lineages, namely IA, IB, IIA, and IIB. A wide range of amino acid substitutions (up to 22) specific for P[8] lineages and sub-lineages were also identified. Interestingly, only short amino acid motifs located at positions 32-35, 121-135, and 195-236 of VP4 correctly defined the phylogenetic P[8] lineages and sub-lineages. Of note, at least two distinct clusters of rotavirus P[8] were co-circulating in the Japanese pediatric population studied.