The molecular epidemiology of norovirus outbreaks in Victoria, 2016.

Noroviruses are a leading cause of outbreaks of gastroenteritis. This study examined the incidence and molecular characteristics of norovirus outbreaks in Victoria, Australia in 2016. Norovirus was detected in 52.4% of gastroenteritis outbreaks surveyed and the year was notable in that there was no significant temporal peak in norovirus outbreaks. Norovirus Open Reading Frame (ORF)2 (capsid) genotypes were successfully identified in 84 of 110 norovirus outbreaks and included GI.3, GI.6, GI.9, GII.2, GII.3, GII.4, GII.6, and GII.17. Norovirus GII.4 was the most common ORF2 genotype detected (55.9%). Other relatively common ORF2 genotypes included GII.2 (19.0%), GII.17 (9.5%), GI.3 (7.1%) and GII.3 (4.8%). The GII.P4_NewOrleans_2009/GII.4_Sydney_2012 recombinant emerged as an important new GII.4 form. The study also confirmed the identity of three ORF1/ORF2 recombinant forms as follows: GII.P16/GII.2, GII.P16/GII.3 and GII.P16/GII.4. Statistical analysis indicated GII.4 (ORF2) was much more common in healthcare settings than in non-healthcare settings. The study indicates 2016 was a transition year in Victoria, Australia, in that the previous norovirus epidemic strain had diminished to the point where it was no longer dominant but as yet no replacement epidemic strain had become obvious.

An outbreak of foodborne norovirus gastroenteritis linked to a restaurant in Melbourne, Australia, 2014.

INTRODUCTION: In May 2014 an outbreak of norovirus occurred among patrons of a restaurant in Melbourne, Australia. Investigations were conducted to identify the infectious agent, mode of transmission and source of illness, and to implement controls to prevent further transmission. METHODS: A retrospective case-control study was conducted to test the hypothesis that food served at the restaurant between 9 and 15 May 2014 was the vehicle for infection. A structured questionnaire was used to collect demographic, illness and food exposure data from study participants. To ascertain whether any food handlers had experienced gastroenteritis symptoms and were a possible source of infection, investigators contacted and interviewed staff who had worked at the restaurant between 9 and 16 May 2014. RESULTS: Forty-six cases (including 16 laboratory-confirmed cases of norovirus) and 49 controls were interviewed and enrolled in the study. Results of the analysis revealed a statistically significant association with illness and consumption of grain salad (OR: 21.6, 95% CI: 1.8-252.7, P = 0.015) and beetroot dip (OR: 22.4, 95% CI: 1.9-267.0, P = 0.014). An interviewed staff member who reported an onset of acute gastrointestinal illness on 12 May 2014 had prepared salads on the day of onset and the previous two days. DISCUSSION: The outbreak was likely caused by person-to-food-to-person transmission. The outbreak emphasizes the importance of the exclusion of symptomatic food handlers and strict hand hygiene practices in the food service industry to prevent contamination of ready-to-eat foods and the kitchen environment.

Evolutionary changes in the capsid P2 region of Australian strains of the norovirus GII.Pe_GII.4.

PURPOSE: The protruding (P) 2 region of the norovirus capsid is thought to include hypervariable sites involved in receptor binding. This study examines the changes that occurred in the P2 region of GII.Pe_GII.4 norovirus in the course of its evolution from a precursor phase (2008-2009), to an intermediate phase (2010) and finally to an epidemic phase (2012-2015). METHODOLOGY: Twenty-two P2 region amino acid (aa) sequences (166 aa long) from all phases of the evolution of the virus were compared and the changes analysed.Results/key findings. Twenty sites in the P2 region underwent aa change and of these, 10 corresponded to previously proposed hypervariable sites and 10 to novel hypervariable sites. It was notable that aa changes at two sites, X and Y, only emerged as the epidemic phase progressed. 3D computer modelling of the P2 region indicated that neither X nor Y were in the uppermost 'crown', but further down in the 'neck' portion. The location of X and Y and the nature of aa change at Y suggest these sites were important in enhancing the structural integrity of the capsid, which in turn may have facilitated the longer term viability of the virus. CONCLUSION: The current study helps establish the validity of previously proposed hypervariable sites in the P2 region as well as indicating new ones. It also provides quantitative and qualitative data on how these sites changed over the evolutionary history of a particular norovirus strain.

The molecular epidemiology of norovirus outbreaks in Victoria, 2014 to 2015
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Noroviruses are a leading cause of outbreaks of gastroenteritis. This study examined the incidence and molecular characteristics of norovirus outbreaks in healthcare and non-healthcare settings in Victoria, Australia, over 2 years (2014-2015). Norovirus was detected in 65.7% and 60.4% of gastroenteritis outbreaks investigated for the years 2014 and 2015 respectively. There was a significant decline in the number of norovirus outbreaks in the period 2014 to 2015 although in both years norovirus outbreaks peaked in the latter part of the year. Norovirus Open Reading Frame (ORF) 2 (capsid) genotypes identified included GI.2, GI.3, GI.4, GI.5, GI.6, GI.9, GII.2, GII.3, GII.4, GII.6, GII.7, GII.8, GII.13 and GII.17. GII.4 was the most common genotype detected. In addition, the following ORF 1/ORF 2 recombinant forms were confirmed: GII.P4_NewOrleans_2009/GII.4_Sydney_2012, GII.P12/GII.3, GII.Pb (GII.21)/GII.3, GII.Pe/GII.2 and GII.Pe/GII.4_Sydney_2012. A significant decline was noted in the chief norovirus strain GII.Pe/GII.4_Sydney_2012 between 2014 and 2015 but there was a re-emergence of a GII.P4_ NewOrleans _2009 norovirus strain. Outbreaks involving the GII.P17/GII.17 genotype were also detected for the first time in Victoria. GI genotypes circulating in Victoria for the 2 years 2014 and 2015 underwent a dramatic change between the 2 years of the survey. Many genotypes could occur in both healthcare and non-healthcare settings although GI.3, GII.6, and GII.4 were significantly more common in healthcare settings. The study emphasises the complex way in which norovirus circulates throughout the community.

The Comparative Molecular Epidemiology of GII.P7_GII.6 and GII.P7_GII.7 Norovirus Outbreaks in Victoria, Australia, 2012-2014.

The comparative molecular epidemiology of the related GII.P7_GII.6 and GII.P7_GII.7 noroviruses has not been examined in detail. ORF 1, ORF 2 and ORF 1/ORF 2 RT-PCR as well as sequencing and phylogeny analysis were carried out on faecal specimens from 873 gastroenteritis outbreaks in Victoria, Australia (2012-2014). There were 575 (66%) detected as positive for norovirus by means of ORF 1 RT-PCR and/or ORF 2 RT-PCR. Of these, 24 (4.2%) were GII.6 (ORF 2) outbreaks, 7 (1.2%) were GII.7 (ORF 2) outbreaks, and 1 outbreak (0.2%) involved both GII.6 (ORF 2) and GII.7 (ORF 2) noroviruses. The median age of patients identified with GII.6 (ORF 2) (84 years) was significantly different from that of patients identified with GII.7 (ORF 2) (39 years). ORF 2 GII.6 and ORF 2 GII.7 sequences were always associated with a GII.P7 ORF 1 sequence, and GII.P7 sequences fell into two clusters, with one corresponding to the GII.6 ORF 2 genotype and the other to the GII.7 ORF 2 genotype, thereby indicating that the ORF 1 has been evolving separately for the two viruses. Thus, two closely related noroviruses can have a markedly different incidence and epidemiology.

Emergence of GII.Pg norovirus in gastroenteritis outbreaks in Victoria, Australia.

The ORF 1 GII.Pg genotype represents an obligatory recombinant comprising the ORF 1 GII.Pg genotype and a number of ORF 2 genotypes. The emergence, incidence, and molecular features of GII.Pg norovirus have never been considered in detail and are the subject of the current study. Over the period 2002-2013, GII.Pg norovirus was detected in 16 outbreaks in Victoria, Australia. It was first identified in 2009 and thereafter was detected at low level in each year of the study. GII.Pg norovirus outbreaks occurred in both healthcare and non-healthcare settings and could be found in individuals with a broad range of ages. The seasonality of GII.Pg norovirus outbreaks was significantly different from that of all other (non-GII.Pg) norovirus outbreaks. For the 15 GII.Pg norovirus outbreaks where ORF 2 sequencing data were available, two ORF 2 recombinant genotypes were found: GII.1 in 5 (33%) outbreaks and GII.12 in 10 (67%) outbreaks. The ORF 1 phylogenetic tree shows that the GII.Pg ORF 1 genotype fell into two distinct groups. The ORF 2 phylogenetic tree indicates that the GII.1 and GII.12 clusters each corresponded to one of the groups in the ORF 1 tree. This indicates the two recombinant forms were evolving in parallel and not one from the other. Analysis of age data indicates the GII.1 and GII.12 recombinant forms circulated in different ways in the community. J. Med. Virol. 88:1521-1528, 2016. © 2016 Wiley Periodicals, Inc.

Electron microscope detection of tubular aggregates in the mosquito cell line C6/36 treated with Culex australicus (mosquito) homogenate.

'Tubular aggregates' are morphologically distinct cytoplasmic structures that have been linked to a variety of pathological conditions. This report documents the presence of tubular aggregates in an insect cell line (C6/36 cells derived from Aedes albopictus) following inoculation of the cells with material derived from cell culture passaged homogenized Culex australicus mosquitoes. The tubular aggregates were detected in ∼2% of treated cells and had three morphological forms that were termed primary, secondary and tertiary, with progressively greater levels of structural complexity. The findings indicate that tubular aggregates can be induced in an insect cell culture system by an unidentified agent present in some mosquitoes.

Chronic norovirus infection in a patient with a past history of Burkitt lymphoma.

The noroviruses are a leading cause of gastroenteritis worldwide. Although the illness is normally mild and self-limiting, there is a growing literature documenting the chronic excretion of norovirus in the immunocompromised. The aim of the current study was to examine the molecular features of chronic norovirus excretion in an immunocompromised patient with a past history of Burkitt lymphoma. During the 241 day course of the study from December 2013 to August 2014, seven faecal specimens were collected from the patient, tested for norovirus by RT-PCR and further analysed in the open reading frame (ORF) 1 and ORF 2 regions. All seven specimens were positive for norovirus by RT-PCR. Molecular sequencing in the polymerase (ORF 1) and capsid (ORF 2) regions indicated that the norovirus could be classified as GII.4 (2006b)/GII.4 (unknown). No significant mutation was found in the ORF 1 or ORF 2 regions analysed over the period of the study. The current report appears to be the first to document chronic norovirus excretion in a patient with a past history of Burkitt lymphoma. It is also the first to indicate long term norovirus excretion in a given individual need not involve major genetic change in key regions of the genome.

Evaluation of the updated RIDA®QUICK (Version N1402) immunochromatographic assay for the detection of norovirus in clinical specimens.

The sensitivity and specificity of the R-Biopharm RIDA(®)QUICK (N1402) immunochromatography assay for norovirus detection was examined using fecal material from Australian gastroenteritis incidents. The study involved the analysis of 3 groups of specimens; group 1 comprised 100 norovirus open reading frame (ORF) 1 RT-PCR positive specimens; group 2 comprised 100 ORF 1 RT-PCR norovirus negative specimens and group 3 comprised 12 specimens containing common gastroenteritis viruses other than norovirus. The RIDA(®)QUICK (N1402) assay detected both GI and GII norovirus and had an overall sensitivity of 87%. Genotype analysis of the capsid region of the genome (ORF 2) indicated the RIDA(®)QUICK (N1402) assay could detect a range of genotypes including GI.1, GI.2, GI.3, GI.4, GI.5, GII.3, GII.4 (including variants GII.4 (2009-like), GII.4 (2012), GII.4 (2012-like) and GII.4 (unknown)), GII.6, GII.13 and GII.21. The assay had good sensitivity for both GI and GII norovirus. The assay had a specificity of 97% and did not cross react with a number of common fecal viruses. However, one of eight rotavirus positive, norovirus negative specimens gave a positive result; rotavirus cannot be taken as the cause of such a false positive but cannot be excluded either. The kit was quick and easy to use and would be valuable in point-of-care testing.

Norovirus genotype diversity associated with gastroenteritis outbreaks in Victoria in 2013.

The noroviruses are now considered a leading cause of outbreaks of non-bacterial gastroenteritis worldwide. Vaccine strategies against norovirus are currently under consideration but depend on a detailed knowledge of the capsid genotypes. This study examined the incidence of norovirus outbreaks in Victoria over 1 year (2013) and documented the genotypes occurring in the different outbreak settings (healthcare and non-healthcare) and age groups. It was found that 63.1% of gastroenteritis outbreaks were associated with norovirus, thereby showing norovirus to be the major viral cause of illness in gastroenteritis outbreaks. Sixteen capsid genotypes were identified and included GI.2, GI.3, GI.4, GI.6, GI.7, GI.8, GI.9, GII.1, GII.2, GII.3, GII.4, GII.5, GII.6, GII.7, GII.13 and an as yet unclassified GII genotype. All genotypes found in the study, with the exception of GI.9, were detected in the elderly, indicating prior exposure to a norovirus genotype did not appear to confer long term immunity in many cases. The incidence of genotypes GII.1, GII.4 and GII.7 was linked with setting and age. As setting and age were correlated it was not possible to determine which variable was critical with the exception of GII.7, which appeared to be linked to age. The findings indicate that norovirus vaccine strategies should encompass a broad range of genotypes and, as setting or age may be important in determining genotype incidence, this should be taken into account as well.

Norovirus genotype diversity in community-based sporadic gastroenteritis incidents: a five-year study.

Although norovirus is a known cause of sporadic gastroenteritis, the incidence and genotypes of norovirus associated with sporadic community-based gastroenteritis are poorly understood. The current study examined this issue by using material from alleged food poisoning incidents in the state of Victoria, Australia, for the period 2008-2012. Norovirus was identified, by either ORF (open reading frame) 1 or ORF 2 RT-PCR methodology, in 159 of 379 (42.0%) sporadic gastroenteritis incidents, thereby showing that norovirus was an important cause of sporadic gastroenteritis. The number of sporadic norovirus incidents did not vary significantly from year to year, indicating that the pool of circulating norovirus remained constant. Norovirus ORF 1 genotypes identified included GI.1, GI.2, GI.3, GI.4, GI.b, GI.d, GII.2, GII.4 (including variants 2006a, 2006b, 2007, and 2009), GII.16, GII.22, GII.b, GII.e, and GII.g. Norovirus ORF 2 genotypes identified included GI.1, GI.2, GI.3, GI.4, GI.6, GII.2, GII.3, GII.4 (variants 2006b, 2009, 2009-like, 2012, and "unknown"), GII.6, GII.7, GII.9, GII.12, and GII.13. Five ORF 1/ORF 2 norovirus recombinant forms were confirmed: GII.b/GII.3, GII.e/GII.4 (2012), GII.e/GII.4 (unknown), GII.g/GII.12 and GII.16/GII.2. Although the incidence of ORF 2 GI.3 was significantly higher in children than in adults, this was not the case for other major ORF 2 genotypes (GII.2, GII.4, and GII.6) which occurred equally in all age groups. The findings demonstrate the importance and diverse nature of norovirus in sporadic community-based gastroenteritis incidents and indicate that the development of successful vaccine strategies may be difficult.

Evaluation of the Bioline Standard Diagnostics SD immunochromatographic norovirus detection kit using fecal specimens from Australian gastroenteritis incidents.

Human norovirus is a major cause of both sporadic cases and outbreaks of gastroenteritis and comprises two main genogroups (GI and GII) which, in turn, comprise a variety of genotypes. The current study examined the efficacy of the Bioline SD kit using fecal material from Australian gastroenteritis incidents. At best, the SD kit had a sensitivity of 62%. Freezing and thawing specimens before testing significantly improved sensitivity. The SD kit had a specificity of 98.6%. Genotype analysis (Open Reading Frame 2) indicated the SD kit could detect a range of genotypes and genotype variants including GI.1, GI.3, GI.4, GII.1, GII.3, GII.4 (unclassified), GII.4 (2006b), GII.4 (2009), GII.4 (2012) and GII.6 but the kit failed to detect GI.2 and GII.2 norovirus. The kit did not cross-react with a number of common fecal viruses including astrovirus, sapovirus, rotavirus or adenovirus. The kit was very easy to use and would be valuable in point-of-care testing.

Electron microscope detection of an endogenous infection of retrovirus-like particles in L20B cells.

L20B cells are a cell line commonly used for the isolation of poliovirus. The current study indicates that L20B cells are chronically infected with a retrovirus-like particle that replicates in the cytoplasm and buds through the plasma membrane. The findings indicate that care is needed in the use of L20B cells for certain virus isolation studies and emphasize the importance of electron microscope studies as an adjunct to the development of diagnostic virology protocols.

Molecular and epidemiological features of gastroenteritis outbreaks involving genogroup I norovirus in Victoria, Australia, 2002-2010.

GI noroviruses are relatively rare and systematic studies of the molecular epidemiology of GI norovirus outbreaks are lacking. The current study examined the molecular virology of GI norovirus outbreaks in Victoria, Australia (2002-2010). Of 1,617 norovirus outbreaks identified, 69 (4.3%) were associated with GI norovirus alone, 1,540 (95.2%) with GII norovirus alone and 8 (0.5%) with GI + GII. Some differences between GI and GII outbreak epidemiology were found. GI outbreaks peaked in the 2-month period November/December whereas GII outbreaks peaked in the 2-month period September/October and GI norovirus outbreaks were significantly more common in non-healthcare settings (37.7%) than GII outbreaks (9.5%). ORF 1/ORF 2 genotypes found in the 69 outbreaks involving GI norovirus alone were: GI.2/GI.2, 7 outbreaks; GI.2/GI.6, 18 outbreaks; GI.3b/GI.3, 14 outbreaks; GI.4/GI.4, 21 outbreaks; GI.8/GI.8, one outbreak; GI.d/GI.3, four outbreaks; and GI.e/GI.13, one outbreak. The current study appears to be the first to have identified the recombinant form, GI.2/GI.6. Whereas GI.2/GI.6 and GI.3b/GI.3 outbreaks occurred with equal frequency in both healthcare and non-healthcare settings, GI.4/GI.4 occurred predominantly in healthcare settings. GI ORF 1/ORF 2 genotypes found in the eight outbreaks involving GI + GII norovirus were GI.2/GI.6, GI.3b/GI.3, and GI.4/GI.4, indicating GI genotypes in GI + GII outbreaks were similar to those found in outbreaks involving GI alone. Apparent differences in the evolution of different GI genotypes were noted. GI.2/GI.2, GI.2/GI.6, and GI.4/GI.4 strains tended to undergo periodic shifts in nucleotide sequence whereas various GI.3b/GI.3 strains tended to circulate simultaneously.

The dynamics of norovirus outbreak epidemics: recent insights.

Noroviruses are a major cause of gastroenteritis outbreaks worldwide. Norovirus outbreaks frequently occur as epidemics which appear to be related to both genetic and environmental factors. This review considers recent progress in understanding these factors. The norovirus genome undergoes continuous change and this appears to be important in the persistence of the virus in the community. Studies on the common GII.4 genotype have shown that some norovirus outbreak epidemics involving this genotype are correlated with specific changes in the genome. In contrast to the growing understanding of the role of genetic factors in norovirus outbreak epidemics, the role of environmental factors is less well understood. Topics reviewed here include long term excretion of norovirus in some individuals, long term survivability of norovirus in the environment, the role of meteorological factors in the control of norovirus outbreaks and the possible zoonotic transmission of the virus.

Evaluation of the RIDA(®)QUICK immunochromatographic norovirus detection assay using specimens from Australian gastroenteritis incidents.

A range of laboratory methods is now available for the detection of norovirus, a major cause of gastroenteritis. Recently, a commercial immunochromatographic assay for norovirus detection, the RIDA(®)QUICK assay, has become available, but there is still only limited information on its efficacy. This study examined the sensitivity and specificity of the RIDA(®)QUICK assay, using faecal material received for testing in a major diagnostic/reference laboratory in Australia. The sensitivity of the assay was found to be 83% and the specificity was 100%. No false positive norovirus results were found and the assay did not cross-react with common faecal viruses such as rotavirus, astrovirus, sapovirus and adenovirus. The assay was less reliable for genogroup I (GI) noroviruses than for genogroup II (GII) noroviruses. Genotypes detected by the assay included GII.1, GII.2, GII.3, GII.4, GII.6 and GII.7. The assay failed to detect any GI specimens in the test group. Genotypes not detected included GI.4 and GI.6. The assay was simple and quick to perform. It is valuable in a point-of-care situation or as a backup in a laboratory where a rapid initial norovirus result is required.

Norovirus GII.4 variant 2006b caused epidemics of acute gastroenteritis in Australia during 2007 and 2008.

BACKGROUND: Over the last decade, four epidemics of norovirus-associated gastroenteritis have been reported in Australia. These epidemics were characterized by numerous outbreaks in institutional settings such as hospitals and nursing homes, as well as increases in requests for NoV testing in diagnostic centers. During 2007 and 2008, widespread outbreaks of acute gastroenteritis were once again seen across Australia, peaking during the winter months. OBJECTIVES: The primary objective of this study was to characterize two winter epidemics of NoV-associated gastroenteritis in 2007 and 2008 in Australia. Following this, we aimed to determine if these epidemics were caused by a new GII.4 variant or a previously circulating NoV strain. STUDY DESIGN: NoV-positive fecal samples (n=219) were collected over a 2-year period, December 2006 to December 2008, from cases of acute gastroenteritis in Australia. NoV RNA was amplified from these samples using a nested RT-PCR approach targeting the 5' end of the capsid gene, termed region C. Further, characterization was performed by sequence analysis of the RdRp and capsid genes and recombination was identified using SimPlot. RESULTS: From 2004 to 2008, peaks in the numbers of NoV-positive EIA tests from the Prince of Wales Hospital Laboratory correlated with the overall number of gastroenteritis outbreaks reported to NSW Health, thereby supporting recent studies showing that NoV is the major cause of outbreak gastroenteritis. The predominant NoV GII variant identified during the 2007-2008 period was the GII.4 pandemic variant, 2006b (71.51%, 128/179), which replaced the 2006a variant identified in the previous Australian epidemic of 2006. Four novel GII variants were also identified including the three GII.4 variants: NoV 2008, NoV Osaka 2007 and NoV Cairo 2007, and one novel recombinant NoV designated GII.e/GII.12. CONCLUSION: The increase in acute gastroenteritis outbreaks in 2007 and 2008 were associated with the spread of the NoV GII.4 variant 2006b.

The incidence of norovirus-associated gastroenteritis outbreaks in Victoria, Australia (2002-2007) and their relationship with rainfall.

The relationship between the incidence of norovirus-associated gastroenteritis outbreaks (NAGOs) in Victoria, Australia for the period 2002-2007 and rainfall was examined. Statistical analysis involving the correlation between time series indicated that there was a statistically significant (p < 0.05) correlation between monthly NAGO incidence and average monthly rainfall. There was a lag of an average of about three months between peak average rainfall and a NAGO epidemic. The findings thus indicate rainfall can influence NAGO incidence. In an era where there is concern about the potential effects of global warming on weather patterns, it should be borne in mind that future changes in NAGO incidence may reflect altered world weather patterns.

Molecular changes associated with altered patterns of norovirus outbreak epidemics in Victoria, Australia, in 2006 to 2007.

Noroviruses (NoVs) are now considered the most common cause of outbreaks of nonbacterial gastroenteritis, but the factors which control the incidence of NoVs are poorly understood. In 2006, the pattern of NoV outbreak epidemics in Victoria, Australia, changed compared to the pattern for 2002 to 2005 and 2007. This study examined molecular correlates of the changed NoV periodicity. For the period of 2002 to 2007, 8,507 fecal specimens from 1,495 gastroenteritis outbreaks were tested for NoV by reverse transcription-PCR, and 1,018 NoV outbreaks were identified. Nucleotide sequence analysis was used to define genotypes and GII.4 variants. For 2002 to 2007, GII.4 was the predominant genotype. For the period of 2002 to 2005 and 2007, a single NoV outbreak epidemic occurred in warmer months of each year, but in 2006 two epidemics occurred in 1 year, one in colder months and one in warmer months of the year. For 2002 to 2007, four major GII.4 variants, "2002 Oxford/Farmington Hills," "2004 Hunter," "2006a," and "2006b," were identified. Each NoV outbreak epidemic was linked principally to one of these four variants, and there was a time link, a delay of 2 to 6 months, between the first detection of a GII.4 variant and the first outbreak epidemic in which it was the principal variant. The unusual 2006 pattern of outbreak epidemics can then be correlated with the appearance of two GII.4 variants within a short space of time, resulting in two outbreak epidemics in a short space of time, i.e., in the 1 year. This study provides a potentially greater ability to predict the characteristics of NoV epidemics.

The effect of fecal turbidity on norovirus detection by reverse transcriptase polymerase chain reaction.

A 10-min fecal preparation results in greater specimen turbidity than a 45-min protocol, but reverse transcriptase polymerase chain reaction (RT-PCR) norovirus test sensitivity is essentially the same. Feces processed so that particle size does not exceed approximately 560 nm do not display greater norovirus RT-PCR inhibitory effects than those that have undergone greater purification.