Brown, JR;
Roy, S;
Shah, D;
Williams, CA;
Williams, R;
Dunn, H;
Hartley, J;
... Breuer, J; + view all
(2019)
Norovirus transmission dynamics in a paediatric hospital using full genome sequences.
Clinical Infectious Diseases
, 68
(2)
pp. 222-228.
10.1093/cid/ciy438.
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Abstract
Background: Norovirus is a leading cause of worldwide and nosocomial gastroenteritis. This study aimed to assess the utility of molecular epidemiology using full genome sequences, compared to routine Infection Prevention and Control (IPC) investigations. Norovirus genomes were generated from new episodes of norovirus at a pediatric tertiary referral hospital over 19 months (n=182). Phylogeny identified clusters of related sequences which were verified using epidemiological and clinical data. Results: Twenty four clusters of related norovirus sequences ("sequence clusters") were observed, including eight previously identified by IPC investigations ("IPC outbreaks"). Seventeen sequence clusters (involving 77/182 patients) were corroborated by epidemiological data ("epidemiologically supported clusters"), suggesting transmission between patients. Linked infections were identified among 44 patients who were missed by IPC investigations. 33% of norovirus sequences were linked suggesting nosocomial transmission. 24% of patients had nosocomial infections from an unknown source. 43% were norovirus positive on admission. Conclusions: We show that there are frequent introductions of multiple norovirus strains with extensive onward nosocomial transmission of norovirus in a paediatric hospital with a high proportion of immunosuppressed patients nursed in isolation. Phylogenetic analysis using full genome sequences is more sensitive than classical IPC investigations for identifying linked cases and should be considered when investigating norovirus nosocomial -transmission. Sampling of staff, visitors and the environment may be required for complete understanding of the sources of infection and transmission routes in patients with nosocomial infections that are not linked to other patients and among patients with phylogenetically linked cases but no evidence of direct contact.
| Type: | Article |
|---|---|
| Title: | Norovirus transmission dynamics in a paediatric hospital using full genome sequences |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/cid/ciy438 |
| Publisher version: | https://doi.org/10.1093/cid/ciy438 |
| Language: | English |
| Additional information: | Copyright © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
| Keywords: | Norovirus, epidemiology, molecular epidemiology, sequencing, whole genome |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Genetics and Genomic Medicine Dept UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10050366 |
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