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Review
. 2014 Jan;30(1):25-33.
doi: 10.1097/MOG.0000000000000022.

Epidemiology of human noroviruses and updates on vaccine development

Sasirekha Ramani  1 , Robert L Atmar, Mary K Estes
Affiliations
Review

Epidemiology of human noroviruses and updates on vaccine development

Sasirekha Ramani et al. Curr Opin Gastroenterol. 2014 Jan.

Abstract

Purpose of review: Noroviruses (NoVs) are the most common cause of epidemic and sporadic cases of acute gastroenteritis worldwide. This review summarizes recent NoV disease burden estimates, epidemiology findings and provides an update on virus-like particle (VLP) vaccine studies.

Recent findings: NoVs are the leading cause of food-borne gastroenteritis and are replacing rotavirus as the predominant gastrointestinal pathogen in pediatric populations. Genogroup II, genotype 4 NoVs (GII.4) remain the dominant genotype worldwide. Increased NoV activity reported in late 2012 was associated with the emergence of a new GII.4 variant called Sydney 2012. New studies suggest that human NoVs can bind a larger range of histoblood group antigens, a susceptibility factor for NoV illness, thus expanding the susceptible population pool for infection. Intranasal immunization with a monovalent GI NoV VLP vaccine showed proof-of-concept efficacy. Studies using intramuscular immunization with a bivalent formulation including GII.4 VLPs are now underway.

Summary: The importance of NoVs as a major gastrointestinal pathogen underscores the need for well tolerated and effective vaccines. Results of VLP vaccine trials appear promising. However, the rapid evolution of NoV genotypes through antigenic drift and changing glycan specificities provide new challenges to epidemiology studies and vaccine trials.

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Conflict of interest statement

Conflicts of interest

R.L.A. has received grant support and acted as unpaid consultant for Takeda Pharmaceuticals USA (formerly LigoCyte Pharmaceuticals, Inc.). M.K.E. has a patent on the use of norovirus virus-like particles as a vaccine and has served as a consultant to Ligocyte Pharmaceuticals, Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed apart from those disclosed.

Figures

FIGURE 1
FIGURE 1
Phylogenetic analysis of noroviruses (NoVs). (a) NoVs are classified into genogroups and genotypes based on the amino acid sequence of the capsid protein VP1. Human NoVs belong to genogroups I, II and IV and some porcine viruses are also detected within GII (dotted circle). The predominant human NoV genotype described worldwide is GII.4 (highlighted in the grey box). New variants emerge every 2–3 years and replace the previously dominant GII.4 variant. (b) From the 1990s to 2013, seven different GII.4 variants have been associated with global epidemics of gastroenteritis. These include the US 1996/96 variant in 1996, the Farmington Hills variant in 2002, the Hunter variant in 2004, the 2006a, 2006b variants in 2007–08, the New Orleans variant from 2009 to 2012 and Sydney 2012 in late 2012. The timeline of emergence and circulation of predominant GII.4 variants is shown. The line above the variant name indicates when the variant emerged to when it was last detected.
See this image and copyright information in PMC

References

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    1. Hall AJ, Lopman BA, Payne DC, et al. Norovirus disease in the United States. Emerg Infect Dis. 2013;19:1198–1205. Most recent estimates of NoV disease burden in the United States providing incidence rates for deaths, hospitalizations, emergency and outpatient visits and total illnesses.

    1. Atmar RL, Estes MK. Norovirus vaccine development: next steps. Expert Rev Vaccines. 2012;11:1023–1025. - PMC - PubMed
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