Abstract
Noroviruses are a common cause of both endemic and epidemic gastroenteritis. These highly infectious viruses usually cause self-limited disease, but chronic infections occur in highly immunocompromised patients and unusual manifestations are also being described in some populations. Histoblood-group antigen expression is now recognized as an important susceptibility factor for many norovirus strains, but a correlate of acquired immunity to infection or illness has not yet been identified. Currently, treatment and prevention strategies rely on non-specific measures. However, virus-like particles containing capsid antigens are undergoing evaluation as a vaccine candidate for illness prevention. This article reviews the biologic properties, epidemiology, clinical features, host susceptibility, diagnosis, and treatment and prevention of norovirus infection.
Similar content being viewed by others
References
Atmar, R. L., & Estes, M. K. (2001). Diagnosis of noncultivatable gastroenteritis viruses, the human caliciviruses. Clinical Microbiology Reviews, 14(1), 15–37.
Atmar, R. L., & Estes, M. K. (2006). The epidemiologic and clinical importance of norovirus infection. Gastroenterology Clinics of North America, 35(2), 275–290.
Atmar, R. L., Opekun, A. R., Gilger, M. A., Estes, M. K., Crawford, S. E., Neill, F. H., et al. (2008). Norwalk virus shedding after experimental human infection. Emerging Infectious Diseases, 14(10), 1553–1557.
Ball, J. M., Graham, D. Y., Opekun, A. R., Gilger, M. A., Guerrero, R. A., & Estes, M. K. (1999). Recombinant Norwalk virus-like particles given orally to volunteers: Phase I study. Gastroenterology, 117(1), 40–48.
Bull, R. A., Tanaka, M. D., & White, P. A. (2007). Norovirus recombination. Journal of General Virology, 88, 3347–3359.
Carling, P. C., Bruno-Murtha, L. A., & Griffiths, J. K. (2010). Cruise ship environmental hygiene and the risk of norovirus infection outbreaks: An objective assessment of 56 vessels over 3 years. Clinical Infectious Diseases, 49(9), 1312–1317.
Carlsson, B., Kindberg, E., Buesa, J., Rydell, G. E., Lidon, M. F., Montava, R., et al. (2009). The G428A nonsense mutation in FUT2 provides strong but not absolute protection against symptomatic GII.4 norovirus infection. PLoS ONE, 4(5), e5593.
Centers for Disease Control and Prevention (CDC). (2002). Outbreak of acute gastroenteritis associated with Norwalk-like viruses among British military personnel—Afghanistan, May 2002. Morbidity and Mortality Weekly Report, 51(22), 477–479.
Centers for Disease Control and Prevention (CDC). (2007). Norovirus activity—United States, 2006–2007. Morbidity and Mortality Weekly Report, 56(33), 842–846.
Chang, K. O., & George, D. W. (2007). Interferons and ribavirin effectively inhibit Norwalk virus replication in replicon-bearing cells. Journal of Virology, 81(22), 12111–12118.
Cheetham, S., Souza, M., Meulia, T., Grimes, S., Han, M. G., & Saif, L. J. (2006). Pathogenesis of a genogroup II human norovirus in gnotobiotic pigs. Journal of Virology, 80(21), 10372–10381.
Chen, S. Y., Tsai, C. N., Lai, M. W., Chen, C. Y., Lin, K. L., Lin, T. Y., et al. (2009). Norovirus infection as a cause of diarrhea-associated benign infantile seizures. Clinical Infectious Diseases, 48(7), 849–855.
de Roda Husman, A. M., Bijkerk, P., Lodder, W., van den Berg, H., Pribil, W., Cabaj, A., et al. (2004). Calicivirus inactivation by nonionizing (253.7-nanometer-wavelength [UV]) and ionizing (gamma) radiation. Applied and Environmental Microbiology, 70(9), 5089–5093.
de Wit, M. A., Koopmans, M. P., Kortbeek, L. M., Wannet, W. J., Vinjé, J., van Leusden, F., et al. (2001). Sensor, a population-based cohort study on gastroenteritis in the Netherlands: Incidence and etiology. American Journal of Epidemiology, 154(7), 666–674.
Duizer, E., Pielaat, A., Vennema, H., Kroneman, A., & Koopmans, M. (2007). Probabilities in norovirus outbreak diagnosis. Journal of Clinical Virology, 40(1), 38–42.
Duizer, E., Schwab, K. J., Neill, F. H., Atmar, R. L., Koopmans, M. P. G., & Estes, M. K. (2004). Laboratory efforts to cultivate noroviruses. Journal of General Virology, 85(Pt 1), 79–87.
Estes, M. K., Ball, J. M., Guerrero, R. A., Opekun, A. R., Gilger, M. A., Pacheco, S. S., et al. (2001). Norwalk virus vaccines: Challenges and progress. Journal of Infectious Diseases, 181(Suppl 2), S367–S373.
Falkenhorst, G., Krusell, L., Lisby, M., Madsen, S. B., Bottiger, B., & Molbak, K. (2005). Imported frozen raspberries cause a series of norovirus outbreaks in Denmark, 2005. Eurosurveillance, 10(38), E050922.2.
Florescu, D. F., Hill, L. A., McCartan, M. A., & Grant, W. (2008). Two cases of Norwalk virus enteritis following small bowel transplantation treated with oral human serum immunoglobulin. Pediatric Transplantation, 12(3), 372–375.
Friesema, I. H., Vennema, H., Heijne, J. C., de Jager, C. M., Teunis, P. F., van der Linde, R., et al. (2009). Differences in clinical presentation between norovirus genotypes in nursing homes. Journal of Clinical Virology, 46(4), 341–344.
Glass, R. I., Parashar, U. D., & Estes, M. K. (2009). Norovirus gastroenteritis. New England Journal of Medicine, 361(18), 1776–1785.
Graham, D. Y., Jiang, X., Tanaka, T., Opekun, A. R., Madore, H. P., & Estes, M. K. (1994). Norwalk virus infection of volunteers: New insights based on improved assays. Journal of Infectious Diseases, 170(1), 34–43.
Gray, J. J., Kohli, E., Ruggeri, F. M., Vennema, H., Sanchez-Fauquier, A., Schreir, E., et al. (2007). European multicenter evaluation of commercial enzyme immunoassays for detecting norovirus antigen in fecal samples. Clinical and Vaccine Immunology, 14(10), 1349–1355.
Green, K. Y. (2007). Caliciviridae: The noroviruses. In D. M. Knipe, P. M. Howley, D. E. Griffin, R. A. Lamb, M. A. Martin, B. Roizman, et al. (Eds.), Fields virology (5th ed., pp. 949–979). Philadelphia, PA: Lippincott Williams & Wilkins.
Harris, J. P., Lopman, B. A., & O-Brien, S. J. (2010). Infection control measures for norovirus: A systematic review of outbreaks in semi-enclosed settings. Journal of Hospital Infection, 74(1), 1–9.
Huang, P., Farkas, T., Zhong, W., Tan, M., Thornton, S., Morrow, A. L., et al. (2005). Norovirus and histo-blood group antigens: Demonstration of a wide spectrum of strain specificities and classification of two major binding groups among multiple binding patterns. Journal of Virology, 79(11), 6714–6722.
Hutson, A. M., Airaud, F., LePendu, J., Estes, M. K., & Atmar, R. L. (2005). Norwalk virus infections associates with secretor status genotyped from sera. Journal of Medical Virology, 77, 116–120.
Hutson, A. M., Atmar, R. L., & Estes, M. K. (2004). Norovirus disease: Changing epidemiology and host susceptibility factors. Trends in Microbiology, 12(6), 279–287.
Hutson, A. M., Atmar, R. L., Graham, D. Y., & Estes, M. K. (2002). Norwalk virus infection and disease is associated with ABO histo-blood group type. Journal of Infectious Diseases, 185(9), 1335–1337.
Hutson, A. M., Atmar, R. L., Marcus, D. M., & Estes, M. K. (2003). Norwalk virus-like particle hemagglutination by binding to H histo-blood group antigens. Journal of Virology, 77(1), 405–415.
Iritani, N., Kaida, A., Kubo, H., Abe, N., Murakami, T., Vennema, H., et al. (2008). Genetic analysis of the capsid gene of genotype GII.2 noroviruses. Journal of Virology, 82(15), 7336–7345.
Jansen, A., Stark, K., Kunkel, J., Schreier, E., Ignatius, R., Liesenfeld, O., et al. (2008). Aetiology of community-acquired, acute gastroenteritis in hospitalised adults: A prospective cohort study. BMC Infectious Diseases, 8, 143.
Kageyama, T., Shinohara, M., Uchida, K., Fukushi, S., Hoshino, F. B., Kojima, S., et al. (2004). Coexistence of multiple genotypes, including newly identified genotypes, in outbreaks of gastroenteritis due to norovirus in Japan. Journal of Clinical Microbiology, 42(7), 2988–2995.
Kaplan, J. E., Feldman, R., Campbell, D. S., Lookabaugh, C., & Gary, G. W. (1982). The frequency of a Norwalk-like pattern of illness in outbreaks of acute gastroenteritis. American Journal of Public Health, 72(12), 1329–1332.
Katayama, K., Shirato-Horikoshi, H., Kojima, S., Kageyama, T., Oka, T., Hoshino, F., et al. (2002). Phylogenetic analysis of the complete genome of 18 Norwalk-like viruses. Virology, 299(2), 225–239.
Kaufman, S. S., Chatterjee, N. K., Fuschino, M. E., Morse, D. L., Morotti, R. A., Magid, M. S., et al. (2005). Characteristic of human calicivirus enteritis in intestinal transplant recipients. Journal of Pediatric Gastroenterology and Nutrition, 40(3), 328–333.
Khan, R. R., Lawson, A. D., Minnich, L. L., Martin, K., Nasir, A., Emmett, M. K., et al. (2009). Gastrointestinal norovirus infection associated with exacerbation of inflammatory bowel disease. Journal of Pediatric Gastroenterology and Nutrition, 48(3), 328–333.
Kindberg, E., Akerlind, B., Johnsen, C., Knudsen, J. D., Heltberg, O., Larson, G., et al. (2007). Host genetic resistance to symptomatic norovirus (GGII.4) infections in Denmark. Journal of Clinical Microbiology, 45(8), 2720–2722.
Kingsley, D. H., Holliman, D. R., Calci, K. R., Chen, H., & Flick, G. J. (2007). Inactivation of a norovirus by high-pressure processing. Applied and Environmental Microbiology, 73(2), 581–585.
Klement, E., & Halperin, T. (2008). Reply to Chan et al., Tan and Jiang, and St. Clair and Patel. Journal of Infectious Diseases, 198(6), 942–943.
Le Guyader, F. S., Krol, J., Ambert-Balay, K., Ruvoen-Clouet, N., Desaubliaux, B., Parnaudeau, S., et al. (2010). Comprehensive analysis of a norovirus-associated gastroenteritis outbreak, from the environment to the consumer. Journal of Clinical Microbiology, 48(3), 915–920.
Le Guyader, F. S., Le Saux, J. C., Ambert-Balay, K., Krol, J., Serais, O., Parnaudeau, S., et al. (2008). Aichi virus, norovirus, astrovirus, enterovirus, and rotavirus involved in clinical cases from a French oyster-related gastroenteritis outbreak. Journal of Clinical Microbiology, 46(12), 4011–4017.
Le Guyader, F. S., Loisy, F., Atmar, R. L., Hutson, A. M., Estes, M. K., Ruvoen-Clouet, N., et al. (2006). Norwalk virus-specific binding to oyster digestive tissues. Emerging Infectious Diseases, 12(6), 931–936.
Le Guyader, F. S., Mittelholzer, C., Haugarreau, L., Hedlund, K. O., Alsterlund, R., Pommepuy, M., et al. (2004). Detection of noroviruses in raspberries associated with a gastroenteritis outbreak. International Journal of Food Microbiology, 15(2), 179–186.
Le Guyader, F. S., Neill, F. H., Dubois, E., Bon, F., Loisy, F., Kohli, E., et al. (2003). A semi-quantitative approach to estimate Norwalk-like virus contamination of oysters implicated in an outbreak. International Journal of Food Microbiology, 87(1–2), 107–112.
Le Guyader, F. S., Pommepuy, M., & Atmar, R. L. (2009). Monitoring viral contamination in shellfish-growing areas. In G. Burnell & G. Allan (Eds.), New technologies in aquaculture (pp. 542–579). New York: CRC Press.
Lindesmith, L. C., Donaldson, E., Leon, J., Moe, C. L., Frelinger, J. A., Johnston, R. E., et al. (2010). Heterotypic humoral and cellular immune responses following Norwalk virus infection. Journal of Virology, 84(4), 1800–1815.
Lindesmith, L. C., Donaldson, E. F., Lobue, A. D., Cannon, J. L., Zheng, D. P., Vinjé, J., et al. (2008). Mechanisms of GII.4 norovirus persistnec in human populations. PLoS Medicine, 5(2), e31.
Lindesmith, L., Moe, C., LePendu, J., Frelinger, J. A., Treanor, J., & Baric, R. S. (2005). Cellular and humoral immunity following Snow Mountain Virus challenge. Journal of Virology, 79(5), 2900–2909.
Lindesmith, L., Moe, C., Marionneau, S., Ruvoen, N., Jiang, X., Lindblad, L., et al. (2003). Human susceptibility and resistance to Norwalk virus infection. Nature Medicine, 9(5), 548–553.
Lo, S. V., Connolly, A. M., Palmer, S. R., Wright, D., Thomas, P. D., & Joynson, P. D. (1994). The role of the pre-symptomatic food handler in a common source outbreak of food-borne SRSV gastroenteritis in a group of hospitals. Epidemiology and Infection, 113(3), 513–521.
LoBue, A. D., Lindesmith, L., Yount, B., Harrington, P. R., Thompson, J. M., Johnston, R. E., et al. (2006). Multivalent norovirus vaccines induce strong mucosal and systemic blocking antibodies against multiple strains. Vaccine, 24(24), 5220–5234.
Lopman, B., Armstrong, B., Atchison, C., & Gray, J. J. (2009). Host, weather and virological factors drive norovirus epidemiology: Time-series analysis of laboratory surveillance data in England and Wales. PLoS One, 4(8), e6671.
Lopman, B. A., Reacher, M. H., Vipond, I. B., Hill, D., Perry, C., Halladay, T., et al. (2004a). Epidemiology and cost of nosocomial gastroenteritis, Avon, England, 2002–2003. Emerging Infectious Diseases, 10(10), 1827–1834.
Lopman, B. A., Reacher, M. H., Vipond, I. B., Sarangi, J., & Brown, D. W. (2004b). Clinical manifestations of norovirus gastroenteritis in health care settings. Clinical Infectious Diseases, 39(3), 318–324.
Matsui, S. M., & Greenberg, H. B. (2001). Immunity to caliciviruses. Journal of Infectious Diseases, 181(Suppl. 2), S331–S335.
Mattison, K., Shukla, A., Cook, A., Pollari, F., Friendship, R., Kelton, D., et al. (2007). Human noroviruses in swine and cattle. Emerging Infectious Diseases, 13(8), 1184–1188.
Mattner, F., Sohr, D., Heim, A., Gastmeier, P., Vennema, H., & Koopmans, M. (2006). Risk groups for clinical comoplications of norovirus infections: An outbreak investigation. Clinical Microbiology & Infection, 12(1), 69–74.
Nilsson, M., Hedlund, K. O., Thorhagen, M., Larson, G., Johansen, K., Ekspong, A., et al. (2003). Evolution of human calicivirus RNA in vivo: Accumulation of mutations in the protruding P2 domain of the capsid leads to structural changes and possibly a new phenotype. Journal of Virology, 77(24), 13117–13124.
Noel, J. S., Ando, T., Leite, J. P., Green, K. Y., Dingle, K. E., Estes, M. K., et al. (1997). Correlation of patient immune responses with genetically characterized small round-structured viruses involved in outbreaks of nonbacterial acute gastroenteritis in the United States, 1990 to 1995. Journal of Medical Virology, 53(4), 372–383.
Nordgren, J., Kindberg, E., Lindgren, P.-E., Matussek, A., & Svensson, L. (2010). Norovirus gastroenteritis outbreak with a secretor-independent susceptibility pattern, Sweden. Emerging Infectious Diseases, 16(1), 81–87.
Parashar, U., Quiroz, E. S., Mounts, A. W., Monroe, S. S., Fankhauser, R. L., Ando, T., et al. (2001). Norwalk-like viruses. Public health consequences and outbreak management. MMWR Recommendations and Reports, 50(RR-9), 1–17.
Parrino, T. A., Schreiber, D. S., Trier, J. S., Kapikian, A. Z., & Blacklow, N. R. (1977). Clinical immunity in acute gastroenteritis cause by Norwalk agent. New England Journal of Medicine, 197(2), 86–89.
Patel, M. M., Widdowson, M. A., Glass, R. I., Akazawa, K., Vinje, J., & Parashar, U. D. (2008). Systematic literature review of role of noroviruses in sporadic gastroenteritis. Emerging Infectious Diseases, 14(8), 1224–1231.
Patterson, T., Hutchings, P., & Palmer, S. (1993). Outbreak of SRSV gastroenteritis at an international conference traced to food handled by a post-symptomatic caterer. Epidemiology and Infection, 111(1), 157–162.
Rockx, B., De Wit, M., Vennema, H., Vinjé, J., De Bruin, E., Van Duynhoven, Y., et al. (2002). Natural history of human calicivirus infection: A prospective cohort study. Clinical Infectious Diseases, 35(3), 246–253.
Roddie, C., Paul, J. P., Benjamin, R., Gallimore, C. I., Xerry, J., Gray, J. J., et al. (2009). Allogeneic hematopoietic stem cell transplantation and norovirus gastroenteritis: A previously unrecognized cause of morbidity. Clinical Infectious Diseases, 49(7), 1061–1068.
Sandora, T. J., Shih, M.-C., & Goldmann, D. A. (2008). Reducing absenteeism from gastrointestinal and respiratory illness in elementary school students: A randomized, controlled trial of an infection-control intervention. Pediatrics, 121(6), e1555–e1562.
Schwab, K. J., Neill, F. H., Fankhauser, R. L., Daniels, N. A., Monroe, S. S., Bergmire-Sweat, D. A., et al. (2000). Development of methods to detect “Norwalk-like viruses” (NLVs) and hepatitis A virus in delicatessen foods: Application to a food-borne NLV outbreak. Applied and Environmental Microbiology, 66(1), 213–218.
Shirato, H., Ogawa, S., Ito, H., Sato, T., Kameyama, A., Narimatsu, H., et al. (2008). Noroviruses distinguish between type 1 and type 2 histo-blood group antigens for binding. Journal of Virology, 82(21), 10756–10767.
Siebenga, J. J., Vennema, H., Duizer, E., & Koopmans, M. P. G. (2007). Gastroenteritis caused by norovirus GGII.4, the Netherlands, 1994–2005. Emerging Infectious Diseases, 13(1), 144–146.
Siebenga, J. J., Vennema, H., Zheng, D. P., Vinjé, J., Lee, B. E., Pang, X. L., et al. (2009). Norovirus illness is a global problem: Emergence and spread of norovirus GII.4 variants, 2001–2007. Journal of Infectious Diseases, 200(5), 802–812.
Souza, M., Azevedo, M. S., Jung, K., Cheetham, S., & Saif, L. J. (2008). Pathogenesis and immune responses in gnotobiotic calves after infection with the genogroup II.4-HS66 strain of human norovirus. Journal of Virology, 82(4), 1777–1786.
Tacket, C. O., Sztein, M. B., Losonsky, G. A., Wasserman, S. S., & Estes, M. K. (2003). Clinical Immunology, 108(3), 241–247.
Tan, M., Jin, M., Duan, Z., Jiang, X., & Fang, Z. (2008). Outbreak Studies of a GII-3 and a GII-4 norovirus revealed an association between HBGA phenotypes and viral infection. Journal of Medical Virology, 80(7), 1296–1301.
Teunis, P. F., Moe, C. L., Liu, P., Miller, S. E., Lindesmith, L., Baric, R. S., et al. (2008). Norwalk virus: How infectious is it? Journal of Medical Virology, 80(8), 1468–1476.
Thorven, M. A., Grahn, A., Hedlund, K.-O., Johansson, H., Wahlfrid, C., Larson, G., et al. (2005). A homozygous nonsense mutation (428G → A) in the human secretor (FUT2) gene provides resistance to symptomatic norovirus (GGII) infections. Journal of Virology, 79(12), 15351–15355.
Treanor, J. J., Jiang, X., Madore, H. P., & Estes, M. K. (1993). Subclass-specific serum antibody responses to recombinant Norwalk virus capsid antigen (rNV) in adults infected with Norwalk, Snow Mountain, or Hawaii virus. Journal of Clinical Microbiology, 31(6), 1630–1634.
Trujillo, A. A., McCaustland, K. A., Zheng, D. P., Hadley, L. A., Vaughn, G., Adams, S. M., et al. (2006). Use of TaqMan real-time reverse transcription-PCR for rapid detection, quantification, and typing of norovirus. Journal of Clinical Microbiology, 44(4), 1405–1412.
Turcios, R. M., Widdowson, M. A., Sulka, A. C., Mead, P. S., & Glass, R. I. (2006). Reevaluation of epidemiological criteria for identifying outbreaks of acute gastroenteritis due to norovirus: United States, 1998–2000. Clinical Infectious Diseases, 42(7), 964–969.
Turcios-Ruiz, R. M., Axelrod, P., St. John, K., Bullitt, E., Donahue, J., Robinson, N., et al. (2008). Outbreak of necrotizing enterocolitis caused by norovirus in a neonatal intensive care unit. Journal of Pediatrics, 153(3), 339–344.
Verhoef, L., Depoortere, E., Boxman, I., Duizer, E., van Duynhoven, Y., Harris, J., et al. (2008). Emergence of new norovirus variants on spring cruise ships and prediction of winter epidemics. Emerging Infectious Diseases, 14(2), 238–243.
Westhoff, T. H., Vergoulidou, M., Loddenkemper, C., Schwartz, S., Hofmann, J., Schneider, T., et al. (2009). Chronic norovirus infection in renal transplant recipients. Nephrology, Dialysis, Transplantation, 24(3), 1051–1053.
Wiechers, C., Bissinger, A. L., Hamprecht, K., Kimmig, P., Jahn, G., & Poets, C. F. (2008). Apparently non-specific results found using a norovirus antigen immunoassay for fecal samples from neonates. Journal of Perinatology, 28(1), 79–81.
Wobus, C. E., Karst, S. M., Thackray, L. B., Chang, K. O., Sosnovtsev, S. V., Belliot, G., et al. (2004). Replication of norovirus in cell culture reveals a tropism for dendritic cells and macrophages. PLoS Biology, 2(12), e432.
World Health Organization. (2008). The global burden of disease: 2004 update. Geneva: World Health Organization.
Wyatt, R. G., Dolin, R., Blacklow, N. R., DuPont, H. L., Buscho, R. F., Thornhill, T. S., et al. (1974). Comparison of three agents of acute infectious non-bacterial gastroenteritis by cross-challenge in volunteers. Journal of Infectious Diseases, 129(6), 709–714.
Yee, E. L., Palacio, H., Atmar, R. L., Shah, U., Kilborn, C., Faul, M., et al. (2007). Widespread outbreak of norovirus gastroenteritis among evacuees of Hurricane Katrina residing in a large “megashelter” in Houston, Texas: Lessons learned for prevention. Clinical Infectious Diseases, 44(8), 1032–1039.
Zheng, D. P., Ando, T., Fankhauser, R. L., Beard, R. S., Glass, R. I., & Monroe, S. S. (2006). Norovirus classification and proposed strain nomenclature. Virology, 346(2), 312–323.
Acknowledgements
This work was performed with support from the National Institutes of Health (N01-AI-25465, P01-AI-057788, M01-RR-00188, P30-DK-56338, and U54-AI-057156). The contents are solely the responsibility of the author and do not necessarily represent the official views of the NIH.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Atmar, R.L. Noroviruses: State of the Art. Food Environ Virol 2, 117–126 (2010). https://doi.org/10.1007/s12560-010-9038-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12560-010-9038-1