Norovirus Variant GII.4/Sydney/2012, Bangladesh

Passive protection against lethal enterovirus 71 infection in newborn mice by neutralizing antibodies elicited by a synthetic peptide. Microbes To the Editor: Noroviruses (NoVs) are the most common cause of foodborne and waterborne outbreaks of gastroenteritis in persons from all age groups in industrialized and developing countries (1). Although NoV outbreaks occur throughout the year, activity increases in the winter months, especially in the countries with a temperate climate. As expected, during the last few months of 2012, outbreaks of NoV gastroenteritis markedly increased in Europe and the United States (2–4). These increases corresponded with the emergence of a variant of genotype GII.4, Sydney/2012, which was first reported from Austra-We identified the NoV GII.4 variant Sydney/2012 through hospital surveillance on diarrhea etiology in Bangladesh in December 2011 and then throughout 2012. These strains came from 3 hospitals in Dhaka, Mat-lab, and Mirzapur, where ≈150,000 patients with diarrhea are treated annually. We randomly selected 795 fe-cal specimens from patients of all ages who sought treatment for diarrhea in by performing real-time PCR (8). For characterization, we amplified and se-quenced 108 samples on the basis of the capsid genes (9). Ages of diarrhea patients with NoV infection ranged from 1 month to 91 years (median 15 months; mean 11.9 years). Most (66%) NoV-positive patients were <5 years of age. Infection rates were lowest in patients <3 months (2.1%) and 5–18 years (2.5%) of age. A high number of NoV infections were recorded in adults (28.8% in patients >18 years of age). NoVs were detected throughout the year, and no clear seasonal peaks were observed. Overall, GII was the most predominant genogroup (66.1%), followed by GI (18.1%) and GIV (3.9%). Mixed infections were detected in 11.8% of samples. We observed a high diversity in the GII genogroup and identified at least 11 different genotypes within the group, in which GII.4 constituted 30.1% of all GII strains. Until December 2011, the GII.4 variant NewOrleans/2009 was the most predominant strain (Figure). However, the new GII.4 variant, Sydney/2012, replaced the old variant and appeared as the dominant strain in 2012. We constructed a phylogenetic tree on the basis of 1,026 bases around the junction region of pol and cap genes, and it revealed that the newly identified variant has evolved from previous NoV GII.4 variants Apeldoorn/2007 and NewOrleans/2009 (data not shown). NoVs, old and new, remain a substantial threat to human health, with a new variant …