61c9cb87fa8ce54a75fa7acb049e3561 283364.pdf 36c6ec8df842ca040ef3b96b24e3535252008420 283364.pdf f4a8893ee9b624e8ab0223bf70c90268b1a825901567cd23846ee4faf1086d45 283364.pdf Title: Detection of Norovirus in Saliva Samples from Acute Gastroenteritis Cases and Asymptomatic Subjects: Association with Age and Higher Shedding in Stool Subject: Norovirus infections are a leading cause of acute gastroenteritis outbreaks worldwide and across all age groups, with two main genogroups (GI and GII) infecting humans. The aim of our study was to investigate the occurrence of norovirus in saliva samples from individuals involved in outbreaks of acute gastroenteritis in closed and semiclosed institutions, and its relationship with the virus strain, virus shedding in stool, the occurrence of symptoms, age, and the secretor status of the individual. Epidemiological and clinical information was gathered from norovirus outbreaks occurring in Catalonia, Spain during 2017–2018, and stool and saliva samples were collected from affected and exposed resident individuals and workers. A total of 347 saliva specimens from 25 outbreaks were analyzed. Further, 84% of individuals also provided a paired stool sample. For GII infections, norovirus was detected in 17.9% of saliva samples from symptomatic cases and 5.2% of asymptomatic individuals. Positivity in saliva occurred in both secretors and nonsecretors. None of the individuals infected by norovirus GI was positive for the virus in saliva. Saliva positivity did not correlate with any of the studied symptoms but did correlate with age 65 years old. Individuals who were positive in saliva showed higher levels of virus shedding in stool. Mean viral load in positive saliva was 3.16 1.08 log10 genome copies/mL, and the predominance of encapsidated genomes was confirmed by propidium monoazide (PMA)xx-viability RTqPCR assay. The detection of norovirus in saliva raises the possibility of oral-to-oral norovirus transmission during the symptomatic phase and, although to a lesser extent, even in cases of asymptomatic infections. Keywords: human norovirus; saliva; acute gastroenteritis; PMAxx-viability RTqPCR; asymptomatic infection; FUT2 genotyping Author: Eduard Anfruns-Estrada, Aurora Sabrià, Cristina Fuentes, Sara Sabaté, Efrén Razquin, Thais Cornejo, Rosa Bartolomé, Nuria Torner, Conchita Izquierdo, Nuria Soldevila, Lorena Coronas, Angela Dominguez, Rosa M. Pintó, Albert Bosch, Susana Guix and on behalf of the Working Group for the Study of Outbreaks of Acute Gastroenteritis in Catalonia (PI16/02005) Creator: LaTeX with hyperref package Producer: pdfTeX-1.40.18 CreationDate: Tue Dec 1 05:19:24 2020 CET ModDate: Wed Dec 2 12:09:25 2020 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 14 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1055291 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- PURWBA+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 MJZJPM+Pxsy Type 1 Builtin yes yes no 15 0 TSIDJD+VnURWPalladioL Type 1 Custom yes yes no 19 0 QPZZSJ+URWPalladioL-Ital Type 1 Custom yes yes no 23 0 FYDLGT+URWPalladioL-Bold Type 1 Custom yes yes no 28 0 XYBOVT+Rpxb Type 1 Builtin yes yes no 32 0 FYHKCS+URWPalladioL-Roma Type 1 Custom yes yes no 36 0 OFLXAT+Rpxr Type 1 Builtin yes yes no 40 0 QTLELQ+Pxbsy Type 1 Builtin yes yes no 44 0 HOWKDX+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 52 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 74 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 78 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 82 0 TGMEOR+Rpcxr Type 1 Builtin yes yes no 92 0 OVNEXW+EURM10 Type 1 Builtin yes yes no 96 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes no 121 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-10-14 02:27:54 CEST RepresentationInformation: 283364.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-10-13 13:50:07 CEST Size: 1055291 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 319 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Children: Item: Title: Definitions and Sample Collection Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: HuNoV Testing Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: Secretor Status Genotyping Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Item: Title: HuNoV Genotyping Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Item: Title: HuNoV PMAxx-Viability RTqPCR Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Item: Title: Statistical Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@a38d7a3 Children: Item: Title: Epidemiological Features of Studied Outbreaks Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77f99a05 Item: Title: Occurrence of HuNoV RNA in Saliva Samples Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@63440df3 Item: Title: Analysis of Factors Associated with HuNoV RNA Saliva Positivity Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@3aeaafa6 Item: Title: Occurrence of HuNoV RNA in Saliva and Levels of Shedding in Stool Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@76a3e297 Item: Title: Analysis of HuNoV Capsid Integrity in Saliva Using a Viability PMA RTqPCR Assay Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@4d3167f4 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@ed9d034 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@6121c9d6 Info: Title: Detection of Norovirus in Saliva Samples from Acute Gastroenteritis Cases and Asymptomatic Subjects: Association with Age and Higher Shedding in Stool Author: Eduard Anfruns-Estrada, Aurora Sabrià, Cristina Fuentes, Sara Sabaté, Efrén Razquin, Thais Cornejo, Rosa Bartolomé, Nuria Torner, Conchita Izquierdo, Nuria Soldevila, Lorena Coronas, Angela Dominguez, Rosa M. Pintó, Albert Bosch, Susana Guix and on behalf of the Working Group for the Study of Outbreaks of Acute Gastroenteritis in Catalonia (PI16/02005) Subject: Norovirus infections are a leading cause of acute gastroenteritis outbreaks worldwide and across all age groups, with two main genogroups (GI and GII) infecting humans. The aim of our study was to investigate the occurrence of norovirus in saliva samples from individuals involved in outbreaks of acute gastroenteritis in closed and semiclosed institutions, and its relationship with the virus strain, virus shedding in stool, the occurrence of symptoms, age, and the secretor status of the individual. Epidemiological and clinical information was gathered from norovirus outbreaks occurring in Catalonia, Spain during 2017 2018, and stool and saliva samples were collected from affected and exposed resident individuals and workers. A total of 347 saliva specimens from 25 outbreaks were analyzed. Further, 84% of individuals also provided a paired stool sample. For GII infections, norovirus was detected in 17.9% of saliva samples from symptomatic cases and 5.2% of asymptomatic individuals. Positivity in saliva occurred in both secretors and nonsecretors. None of the individuals infected by norovirus GI was positive for the virus in saliva. Saliva positivity did not correlate with any of the studied symptoms but did correlate with age 65 years old. Individuals who were positive in saliva showed higher levels of virus shedding in stool. Mean viral load in positive saliva was 3.16 1.08 log10 genome copies/mL, and the predominance of encapsidated genomes was confirmed by propidium monoazide (PMA)xx-viability RTqPCR assay. The detection of norovirus in saliva raises the possibility of oral-to-oral norovirus transmission during the symptomatic phase and, although to a lesser extent, even in cases of asymptomatic infections. 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