Viral gastroenteritis associated with genogroup II norovirus among U.S. military personnel in Turkey, 2009

• Published in: PloS one Vol. 7; no. 5; p. e35791
• Main Authors: Ahmed, Salwa F, Klena, John D, Mostafa, Manal, Dogantemur, Jessica, Middleton, Tracy, Hanson, James, Sebeny, Peter J
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 11-05-2012; Public Library of Science (PLoS)
• Subjects: Adult; Age; Analysis; Armed forces; Bacteria; Biology; Caliciviridae Infections - epidemiology; Caliciviridae Infections - virology; Capsid Proteins - genetics; Cladistic analysis; Development and progression; Disease Outbreaks; Disease prevention; Female; Gastroenteritis; Gastroenteritis - epidemiology; Gastroenteritis - virology; Genes, Viral; Genotype; Genotype & phenotype; Genotypes; Humans; Infections; Male; Medical research; Medicine; Military; Military aspects; Military bases; Military facilities; Military Personnel; Norovirus - classification; Norovirus - genetics; Norovirus - isolation & purification; Occupational exposure; Outbreaks; Pathogens; Persian Gulf War; Phylogeny; Polymerase chain reaction; Public health; Turkey - epidemiology; United States - ethnology; Viruses; Waterborne infections; Young Adult; United States; Turkey; United States > US; Afghanistan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0035791

The present study demonstrates that multiple NoV genotypes belonging to genogroup II contributed to an acute gastroenteritis outbreak at a US military facility in Turkey that was associated with significant negative operational impact. Norovirus (NoV) is an important pathogen associated with acute gastroenteritis among military populations. We describe the genotypes of NoV outbreak occurred at a United States military facility in Turkey. Stool samples were collected from 37 out of 97 patients presenting to the clinic on base with acute gastroenteritis and evaluated for bacterial and viral pathogens. NoV genogroup II (GII) was identified by RT-PCR in 43% (16/37) stool samples. Phylogenetic analysis of a 260 base pair fragment of the NoV capsid gene from ten stool samples indicated the circulation of multiple and rare genotypes of GII NoV during the outbreak. We detected four GII.8 isolates, three GII.15, two GII.9 and a sole GII.10 NoV. Viral sequences could be grouped into four clusters, three of which have not been previously reported in Turkey. The fact that current NoV outbreak was caused by rare genotypes highlights the importance of norovirus strain typing. While NoV genogroup II is recognized as causative agent of outbreak, circulation of current genotypes has been rarely observed in large number of outbreaks.