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. 2010 Apr;16(4):617-24.
doi: 10.3201/eid1604.090723.

Use of norovirus genotype profiles to differentiate origins of foodborne outbreaks

Linda Verhoef  1 , Harry Vennema, Wilfrid van Pelt, David Lees, Hendriek Boshuizen, Kathleen Henshilwood, Marion Koopmans; Food-Borne Viruses in Europe Network
Collaborators, Affiliations

Use of norovirus genotype profiles to differentiate origins of foodborne outbreaks

Linda Verhoef et al. Emerg Infect Dis. 2010 Apr.

Abstract

Because secondary transmission masks the connection between sources and outbreaks, estimating the proportion of foodborne norovirus infections is difficult. We studied whether norovirus genotype frequency distributions (genotype profiles) can enhance detection of the sources of foodborne outbreaks. Control measures differ substantially; therefore, differentiating this transmission mode from person-borne or food handler-borne outbreaks is of public health interest. Comparison of bivalve mollusks collected during monitoring (n = 295) and outbreak surveillance strains (n = 2,858) showed 2 distinguishable genotype profiles in 1) human feces and 2) source-contaminated food and bivalve mollusks; genotypes I.2 and I.4 were more frequently detected in foodborne outbreaks. Overall, approximately 21% of all outbreaks were foodborne; further analysis showed that 25% of the outbreaks reported as food handler-associated were probably caused by source contamination of the food.

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Figures

Figure A1
Figure A1
Norovirus genotype profiles detected in foodborne outbreaks, showing strains detected in A) food or B) humans; C) person-borne outbreaks; D) food handler–borne outbreaks; E) outbreaks with an unknown mode of transmission; and F) routine monitored bivalve mollusks. The genotypes are sorted for their relevance in unknown outbreaks.
Figure A2
Figure A2
Estimated proportion of norovirus genotypes based on proportions as detected in foodborne outbreaks (i.e., detected in food or humans; gray bars) and person-borne outbreaks (white bars). *Indicates significance.
Figure
Figure
Two-dimensional display of the correspondence analysis of 6 norovirus genotype profiles based on nucleotide sequences in which points close to each other are similar with regard to the pattern of relative frequencies across genotypes. Dimension 1 explains 59.12% and dimension 2 an additional 31.40%. In dimension 1, foodborne-feces (FB-feces; i.e., outbreak reported to be caused by food with the outbreak strain detected in human feces only) and bivalve mollusk (BM) genotype profiles are mutually similar and differ from other profiles; the most distinct profile is person-borne (PB; i.e., an outbreak reported to be caused by person-to-person transmission with the outbreak strain detected in human feces). In dimension 2, food handler–borne (FHB; i.e., outbreak reported to be caused by an infected food handler contaminating the food with the outbreak strain detected in human feces), FB-feces, and unknown (UN; i.e., mode of transmission was not reported or was reported to be unknown with the outbreak strain detected in human feces) mutually correspond and differ from the mutually corresponding foodborne-food (FB-food; i.e., outbreak reported to be caused by food with the outbreak strain detected in food), BM, and PB.
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References

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