Skip to main content

Molecular epidemiology of norovirus in Edinburgh healthcare facilities, Scotland 2007–2011

  • G. McALLISTER (a1), A. HOLMES (a1), L. GARCIA (a1), F. CAMERON (a2), K. CLOY (a2), J. DANIAL (a2), J. A. CEPEDA (a3), P. SIMMONDS (a4) and K. E. TEMPLETON (a1)...

Norovirus (NoV) is a leading cause of outbreaks of gastroenteritis worldwide, and a major burden for healthcare facilities. This study investigated the NoV genotypes responsible for outbreaks in Edinburgh healthcare facilities between June 2008 and July 2011, and studied their temporal distribution to enable a better understanding of the epidemiology of the outbreaks. A total of 287 samples positive for NoV genogroup II (GII) RNA by reverse transcription–polymerase chain reaction (RT–PCR) during routine diagnostic testing were investigated. Nested RT–PCR (nRT–PCR) and sequencing was used to genotype the NoV strains. Overall, a total of 69 NoV strains belonging to six different genoclusters (GII.1, GII.2, GII.3, GII.4, GII.6, GII.13) were detected. The predominant genotype was GII.4 that included four variants, GII.4 2006a, GII.4 2006b, GII.4 2007 and GII.4 2010. Importantly, increases in NoV activity coincided with the emergence of new GII.4 strains, highlighting the need for an active surveillance system to allow the rapid identification of new strains.

Corresponding author
*Author for correspondence: Dr K. E. Templeton, Specialist Virology Centre, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK. (Email:
Hide All
1.Siebenga, JJ, et al. Norovirus illness is a global problem: emergence and spread of norovirus GII.4 variants, 2001–2007. Journal of Infectious Diseases 2009; 200: 802812.
2.Lopman, BA, et al. Increase in viral gastroenteritis outbreaks in Europe and epidemic spread of new norovirus variant. Lancet 2004; 363: 682688.
3.Bull, RA and White, PA. Mechanisms of GII.4 norovirus evolution. Trends in Microbiology 2011; 19: 233240.
4.Pang, XL, et al. Influence of novel norovirus GII.4 variants on gastroenteritis outbreak dynamics in Alberta and the northern territories, Canada between 2000 and 2008. PLoS ONE 2010; 5: 18.
5.Tu, ET, et al. Epidemics of gastroenteritis during 2006 were associated with the spread of norovirus GII.4 variants 2006a and 2006b. Clinical Infectious Diseases. 2008; 46: 1320.
6.Kroneman, A, et al. Increase in norovirus activity reported in Europe. Eurosurveillance 2006; 11: E061214.1.
7.Belliot, G, et al. Evidence of emergence of new GGII.4 norovirus variants from gastroenteritis outbreak survey in France during the 2007–2008 and 2008–2009 winter seasons. Journal of Clinical Microbiology 2010; 48: 994998.
8.Ramirez, S, et al. Emerging GII.4 norovirus variants affect children with diarrhoea in Palermo, Italy in 2006. Journal of Medical Virology 2009; 81: 139145.
9.Harris, JP, et al. Deaths from Norovirus among the elderly, England and Wales. Emerging Infectious Diseases 2008; 14: 15461552.
10.Hansen, S, et al. Closure of medical departments during nosocomial outbreaks: data from a systemic analysis of the literature. Journal of Hospital Infection 2006; 65: 343353.
11.Health Protection Scotland.Increase in norovirus infection in Scotland. Weekly Report 2006; 40: pp. 125.
12.Adamson, WE, et al. Emergence of a new norovirus variant in Scotland in 2006. Journal of Clinical Microbiology 2007; 45: 40584060.
13.Kaplan, JE, et al. The frequency of a Norwalk-like pattern of illness in acute gastroenteritis. American Journal of Public Health 1982; 72: 13291332.
14.Bull, RA, et al. Emergence of a new norovirus genotype II.4 variant associated with global outbreaks of gastroenteritis. Journal of Clinical Microbiology 2006; 44: 327333.
15.Mattison, K, et al. Multicentre comparison of two norovirus ORF-2-based genotyping protocols. Journal of Clinical Microbiology 2009; 47: 39273932.
16.Lopman, BA, et al. Clinical manifestation of norovirus gastroenteritis in health care settings. Clinical Infectious Diseases 2004; 39: 318324.
17.Kroneman, A, et al. 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. Journal of Clinical Microbiology 2008; 46: 29562965.
18.Food-Borne Viruses in Europe. Genotype profile and emerging novel noroviruses in Europe, 2008 until 15 May 2011 [unpublished report].
19.Nayak, MK, et al. A new variant of norovirus GII.4/2007 and inter-genotype recombinant strains of NVGII causing acute watery diarrhoea among children in Kolkata, India. Journal of Clinical Virology 2009; 45: 223229.
20.Motomura, K, et al. Divergent evolution of norovirus GII/4 by genome recombination from May 2006 to February 2009 in Japan. Journal of Virology 2010; 84: 80858097.
21.Kamel, AH, et al. Predominance and circulation of enteric viruses in the region of greater Cairo, Egypt. Journal of Clinical Microbiology 2008; 43: 346348.
22.Mathijs, E, et al. Novel norovirus recombinants and GII.4 sub-lineages associated with outbreaks between 2006 and 2010 in Belgium. Virology Journal 2010; 8: 113.
23.Kaplan, NM, et al. Detection and molecular characterisation of rotavirus and norovirus infections in Jordanian children with acute gastroenteritis. Archives of Virology 2011; 156: 14771480.
24.Cannon, JL, et al. Herd immunity to GII.4 noroviruses is supported by outbreak patient sera. Journal of Virology 2009; 83: 53635374.
25.Hutson, AM, Atmar, RL, Estes, MK. Norovirus disease: changing epidemiology and host susceptibility factors. Trends in Microbiology 2004; 12: 279287.
26.Lopman, BA, et al. Host, weather and virological factors drive norovirus epidemiology: time-series analysis of laboratory surveillance data in England and Wales. PLoS ONE 2009; 4: e6671.
27.Rohayem, J. Norovirus seasonality and the potential impact of climate change. Clinical Microbiology and Infection 2009; 15: 524527.
28.Gallimore, M, et al. Inter-seasonal diversity of norovirus genotypes: emergence and selection of virus variants. Archives of Virology 2007; 152: 12951303.
29.Gallimore, CL, et al. Diversity of noroviruses co-circulating in the North of England from 1998 to 2001. Journal of Clinical Virology 2004; 42: 13961401.
30.Siebenga, J, et al. Epochal evolution of GGII.4 norovirus capsid proteins from 1995 to 2006. Journal of Virology 2007; 81: 99329941.
31.Allen, DJ, et al. Analysis of amino acid variation in the P2 domian of the GII-4 norovirus VP1 protein reveals putative variant-specific epitopes. PLoS ONE 2008; 3: e1485.
32.Allen, DJ, et al. Characterisation of a GII-4 norovirus variant-specific surface-exposed site involved in antibody binding. Virology Journal 2009; 6: 150.
33.Vega, E, Vinjé, J. Novel GII.12 Norovirus strain, United States, 2009–2010. Emerging Infectious Diseases 2011; 17: 15161518.
34.Bok, K, et al. Evolutionary dynamics of GII.4 noroviruses over a 34-year period. Journal of Virology 2009; 83: 1189011901.
35.Bull, RA, et al. Norovirus recombination in ORF1/ORF2 overlap. Emerging Infectious Diseases 2005; 11: 10791085.
36.Bull, RA, Tanaka, MM, White, PA. Norovirus recombination. Journal of General Virology 2007; 88: 33473359.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 9
Total number of PDF views: 28 *
Loading metrics...

Abstract views

Total abstract views: 193 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 25th March 2018. This data will be updated every 24 hours.