1. Next-generation whole genome sequencing identifies the direction of norovirus transmission in linked patients.
- Author
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Kundu S, Lockwood J, Depledge DP, Chaudhry Y, Aston A, Rao K, Hartley JC, Goodfellow I, and Breuer J
- Subjects
- Caliciviridae Infections epidemiology, Child, Child, Preschool, Cluster Analysis, Cross Infection epidemiology, Cross Infection transmission, Cross Infection virology, Female, Gastroenteritis epidemiology, Genome, Viral, Genotype, High-Throughput Nucleotide Sequencing, Humans, Infant, Male, Molecular Epidemiology, Molecular Sequence Data, Norovirus genetics, Phylogeny, Caliciviridae Infections transmission, Caliciviridae Infections virology, Gastroenteritis virology, Norovirus classification, Norovirus isolation & purification, RNA, Viral genetics
- Abstract
Background: Noroviruses are a highly transmissible and major cause of nosocomial gastroenteritis resulting in bed and hospital-ward closures. Where hospital outbreaks are suspected, it is important to determine the routes of spread so that appropriate infection-control procedures can be implemented. To investigate a cluster of norovirus cases occurring in children undergoing bone marrow transplant, we undertook norovirus genome sequencing by next-generation methods. Detailed comparison of sequence data from 2 linked cases enabled us to identify the likely direction of spread., Methods: Norovirus complementary DNA was amplified by overlapping polymerase chain reaction (PCR) from 13 stool samples from 5 diagnostic real-time PCR-positive patients. The amplicons were sequenced by Roche 454, the genomes assembled by de novo assembly, and the data analyzed phylogenetically., Results: Phylogenetic analysis indicated that patients were infected by viruses similar to 4 distinct GII.4 subtypes and 2 patients were linked by the same virus. Of the 14 sites at which there were differences between the consensus sequences of the 2 linked viral genomes, 9 had minor variants present within one or the other patient. Further analysis confirmed that minor variants at all 9 sites in patient B w ere present as the consensus sequence in patient A., Conclusions: Phylogenetic analysis excluded a common source of infection in this apparent outbreak. Two of 3 patients on the same ward had closely related viruses, raising the possibility of cross-infection despite protective isolation. Analysis of deep sequencing data enabled us to establish the likely direction of nosocomial transmission.
- Published
- 2013
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