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Early detection of epidemic GII-4 norovirus strains in UK and Malawi: Role of surveillance of sporadic acute gastroenteritis in anticipating global epidemics

Lookup NU author(s): Professor Sarah O'Brien



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2016 Allen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Noroviruses are endemic in the human population, and are recognised as a leading cause of acute gastroenteritis worldwide. Although they are a highly diverse group of viruses, genogroup-II genotype-4 (GII-4) noroviruses are the most frequently identified strains worldwide. The predominance of GII-4 norovirus strains is driven by the periodic emergence of antigenic variants capable of evading herd protection. The global molecular epidemiology of emerging GII-4 strains is largely based on data from outbreak surveillance programmes, but the epidemiology of GII-4 strains among sporadic or community cases is far less well studied. To understand the distribution of GII-4 norovirus strains associated with gastroenteritis in the wider population, we characterised the GII-4 norovirus strains detected during studies of sporadic cases of infectious gastroenteritis collected in the UK and Malawi between 1993 and 2009. Our data shows that GII-4 norovirus strains that have emerged as strains of global epidemic importance have circulated in the community up to 18 years before their recognition as pandemic strains associated with increases in outbreaks. These data may suggest that more comprehensive surveillance programmes that incorporate strains associated with sporadic cases may provide a way for early detection of emerging strains with pandemic potential. This may be of particular relevance as vaccines become available.

Publication metadata

Author(s): Allen DJ, Trainor E, Callaghan A, O'Brien SJ, Cunliffe NA, Iturriza-Gomara M

Publication type: Article

Publication status: Published

Journal: PLoS ONE

Year: 2016

Volume: 11

Issue: 4

Online publication date: 26/04/2016

Acceptance date: 22/12/2015

Date deposited: 22/08/2019

ISSN (electronic): 1932-6203

Publisher: Public Library of Science


DOI: 10.1371/journal.pone.0146972

PubMed id: 27115152


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