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Norovirus (NoV) is a leading causative agent of non-bacterial gastroenteritis in humans worldwide. NoV is genetically classified into five distinct genogroups in which genogroups I (GI), II, and rarely IV infect humans. Each genogroup is further subdivided into different genotypes. Previous local surveillance studies demonstrated that NoV GII, in particular the genotype 4 (GII/4) strain, is the predominant genogroup circulating in Hong Kong since 2001. Similar epidemiologic observations were also reported in the US, Europe, UK, Australia, and Japan, highlighting the enormous pandemic and epidemic potential of this genogroup. However, explanation for its predominance has been lacking. In this study, we demonstrated that NoV GII, comprised mostly of the GII/4 strain, showed an increased median viral RNA level in fecal specimens which was at least 100-fold higher than that of GI. The high level of viral shedding may confer greater opportunity for transmission of GII strains through the fecal-oral route. We also demonstrated that fecal viral RNA level correlated positively and independently with diarrhea duration in NoV GII/4 infections. The median fecal viral level in patients with protracted (last for ≥4 days) diarrhea was 100-fold higher than that in patients with only limited diarrhea. Longer infectivity period may also confer greater opportunity for virus transmission through the fecal-oral route. Higher chance of transmission may result in more efficient person-to-person transmission and rapid dissemination, maintaining a high level of NoV GII persistence in the community. In summer 2006, a territory-wide gastroenteritis outbreak attributed to NoV has occurred with more than 3,000 cases of laboratory-confirmed NoV infections in Hong Kong. Phylogenetic analysis showed that the virus causing this unprecedented outbreak was a novel NoV GII/4 variant distinct from all previously reported global pandemic and local epidemic strains. In this 2006 variant, we identified two hypervariable regions when compared with previous local epidemic strains in 2005: protruding domain 2 (P2 domain) of viral protein 1 (VP1) and VP1-binding domain of VP2. We mapped frequent amino acid substitutions to the modeled antigenic loop regions of P2 domain. We also identified in carboxyl-terminus of VP1 an epidemiologically important, putative conformational epitope that alternates between two 3-amino acid signatures during pandemic NoV GII/4 strains evolution since 1995. Our findings reflect the rapid evolution of NoV GII/4 under immunological pressure and suggest that immune evasion might be a potential mechanism for pandemic NoV GII/4 strains emergence. Taken together, high level of fecal viral shedding, longer infectivity period, and periodic emergence of novel variant may underlie the global predominance of NoV GII. Further investigations are warranted to better understand the public health and biological importance of NoV GII. / Chan, Chi Wai. / Adviser: Wai K. Leung. / Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 0818. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 124-143). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / School code: 1307.

Louis, Tong Kwok-leung. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (leaves 121-130). / Abstracts in English and Chinese. / ABSTRACT --- p.I / ACKNOWLEDGEMENTS --- p.III / LIST OF CONTENTS --- p.IV / LIST OF TABLES --- p.VIII / LIST OF FIGURES --- p.X / ABBREVIATIONS --- p.XII / GENERAL ABBREVIATIONS --- p.XII / VARIOUS NOMENCLATURES OR ABBREVIATIONS FOR SRSVS --- p.XIII / OBJECTIVES OF THE STUDY --- p.XIV / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter 1.1 --- HISTORICAL PERSPECTIVE --- p.2 / Chapter 1.2 --- CLINICAL FEATURES OF HUMAN SRSV INFECTION --- p.10 / Chapter 1.3 --- EPIDEMIOLOGY --- p.12 / Chapter 1.4 --- PHYSICAL CHARACTERISTICS OF SRSV --- p.14 / Chapter 1.5 --- STABILITY OF NORWALK VIRUS --- p.15 / Chapter 1.6 --- DIAGNOSTIC TOOLS FOR SRSVS --- p.15 / Chapter 1.7 --- GENOMIC ORGANIZATION OF SRSVS --- p.16 / Chapter 1.8 --- MOLECULAR TECHNOLOGIES --- p.19 / Chapter CHAPTER 2 --- MATERIALS --- p.20 / Chapter 2.1 --- FAECAL SAMPLES FROM 1986 TO 1992 --- p.21 / Chapter 2.2 --- OTHER FAECAL SAMPLES FROM 1995 TO 1998 --- p.21 / Chapter 2.3 --- AGE GROUPS OF ALL THE SAMPLES --- p.21 / Chapter CHAPTER 3 --- METHODS --- p.23 / Chapter 3.1 --- EXTRACTION OF RNA FROM PATIENT STOOL OR VOMIT SAMPLES --- p.24 / Chapter 3.2 --- REVERSE TRANSCRIPTION - POLYMERASE CHAIN REACTION (RT-PCR) FOR SRSVS --- p.25 / Chapter 3.2.1 --- Principle of RT-PCR assay for SRSV --- p.25 / Chapter 3.2.2 --- Reverse transcription (cDNA Synthesis) --- p.26 / Chapter 3.2.3 --- Polymerase chain reaction --- p.26 / Chapter 3.2.4 --- Electrophoresis (in the PCR product room) --- p.31 / Chapter 3.2.5 --- Controls for PCR assay --- p.32 / Chapter 3.2.6 --- Interpretation of SRSV polymerase gene PCR --- p.32 / Chapter 3.3 --- RT-PCR USING INOSINE CONTAINING PRIMERS FOR THE CAPSID REGIONS --- p.34 / Chapter 3.3.1 --- RT-PCR for the capsid region of SRSV genome --- p.34 / Chapter 3.3.2 --- Interpretation of SRSV capsid gene PCR --- p.36 / Chapter 3.4 --- SOLID PHASE IMMUNE ELECTRON MICROSCOPY FOR THE DETECTION OF SRSV --- p.37 / Chapter 3.5 --- OPTIMIZATION OF CONDITIONS FOR SRSV RT-PCR --- p.37 / Chapter 3.5.1 --- Titration of primers --- p.37 / Chapter 3.5.2 --- Titration of MgCl2 --- p.38 / Chapter 3.5.3 --- "Titration ofdNTPs, MgCl2 and Taq polymerase (pH 9.0)" --- p.38 / Chapter 3.6 --- SPECIFICITY OF SRSV RT-PCR --- p.38 / Chapter 3.7 --- PURIFICATION OF PCR PRODUCTS PRIOR TO CLONING …… --- p.38 / Chapter 3.8 --- CLONING OF THE PURIFIED DNA INTO pGEM-T EASY VECTOR --- p.39 / Chapter 3.8.1 --- Introduction --- p.39 / Chapter 3.8.2 --- Sequence of the pGEM-T Easy Vector --- p.42 / Chapter 3.8.3 --- Ligation --- p.44 / Chapter 3.8.4 --- Transformation of competent bacterial cells --- p.44 / Chapter 3.8.5 --- Small-scale preparations of plasmid DNA --- p.45 / Chapter 3.8.6 --- Purification of miniprep using QIAprep Miniprep --- p.45 / Chapter 3.8.7 --- Restriction analysis of small-scale preparations of plasmid DNA --- p.45 / Chapter 3.9 --- CYCLE SEQUENCING OF CLONED SRSV AMPLICONS --- p.46 / Chapter 3.9.1 --- Targets for Sequencing --- p.46 / Chapter 3.9.2 --- Procedures of cycle sequencing --- p.46 / Chapter 3.9.3 --- Gel electrophoresis --- p.48 / Chapter 3.9.4 --- Sequencing conditions --- p.49 / Chapter 3.10 --- SEQUENCE ANALYSIS --- p.49 / Chapter CHAPTER 4 --- REAGENTS AND BUFFERS --- p.51 / Chapter 4.1 --- REAGENTS AND BUFFERS FOR RNA EXTRACTION --- p.52 / Chapter 4.2 --- REAGENTS AND BUFFERS FOR REVERSE TRANSCRIPTION (cDNA SYNTHESIS) --- p.52 / Chapter 4.3 --- REAGENTS AND BUFFERS FOR PCR --- p.53 / Chapter 4.4 --- GEL ELECTROPHORESIS OF PCR PRODUCTS --- p.53 / Chapter 4.5 --- PURIFICATION OF PCR PRODUCTS --- p.54 / Chapter 4.6 --- REAGENTS FOR CLONING THE DNA INSERT INTO pGEM-T EASY VECTOR --- p.54 / Chapter 4.6.1 --- "pGEM-T Easy Vector System (Promega Corporation, USA)" --- p.54 / Chapter 4.6.2 --- Isopropylthio-β-D-galactoside (IPTG) stock solution --- p.54 / Chapter 4.6.3 --- X-Gal --- p.54 / Chapter 4.6.4 --- Luria-Bertani (LB) medium --- p.55 / Chapter 4.6.5 --- LB plates with ampicillin --- p.55 / Chapter 4.6.6 --- LB plates with ampicillin/IPTG/X-Gal --- p.55 / Chapter 4.6.7 --- SOC medium --- p.55 / Chapter 4.6.8 --- Mini-prep purification --- p.56 / Chapter 4.6.9 --- Mini-prep analysis --- p.56 / Chapter 4.6.9.1 --- Lambda DNA-Hind IIIφX-174 DNA-Hae III Digest --- p.56 / Chapter 4.6.9.2 --- Not I --- p.58 / Chapter 4.7 --- REAGENTS AND BUFFERS FOR CYCLE SEQUENCING --- p.58 / Chapter 4.7.1 --- SequiTherm EXCEĹёØ II Long-Rea´dёØ DNA Sequencing Kit-AL´FёØ --- p.58 / Chapter 4.7.2 --- Sequencing primers --- p.59 / Chapter 4.8 --- REAGENTS FOR SEQUENCING GEL CASTING --- p.59 / Chapter CHAPTER 5 --- RESULTS --- p.61 / Chapter 5.1 --- RESULTS OF RT-PCR OPTIMIZATION --- p.62 / Chapter 5.1.1 --- Magnesium chloride and pH of PCR reaction buffer --- p.62 / Chapter 5.1.2 --- Concentration of primers --- p.64 / Chapter 5.1.3 --- "Titration of dNTPs, MgCl2 and Taq polymerase (pH 9.0)" --- p.65 / Chapter 5.2 --- RESULT OF SENSITIVITY TEST --- p.66 / Chapter 5.3 --- RESULTS OF SPECIFICITY TEST --- p.67 / Chapter 5.4 --- RESULTS OF THE PCR USING INOSINE CONTAINING POL PRIMERS --- p.70 / Chapter 5.5 --- RESULTS OF PCR USING INOSINE CONTAINING CAPSID PRIMERS --- p.73 / Chapter 5.6 --- RESULTS OF SOME SAMPLES RETESTED BY SPIEM --- p.75 / Chapter 5.7 --- RESULTS OF SPORADIC OUTBREAKS --- p.77 / Chapter 5.7.1 --- A sporadic outbreak in 1996 --- p.77 / Chapter 5.7.2 --- Sporadic outbreak in a kindergarten in 1997 --- p.79 / Chapter 5.7.3 --- Sporadic outbreak at a hotel in 1998 --- p.79 / Chapter 5.7.4 --- Application of the RT-PCR to contaminated shellfish --- p.80 / Chapter 5.8 --- RESULTS OF MINI PREP ANALYSIS WITH NOT I DIGESTION --- p.85 / Chapter 5.9 --- RESULT OF ELECTROPHEROGRAM OF A SELECTED SPECIMEN FROM THE AUTOMATIC SEQUENCING --- p.86 / Chapter 5.9 --- RESULT OF ELECTROPHEROGRAM OF A SELECTED SPECIMEN FROM THE AUTOMATIC SEQUENCING --- p.86 / Chapter 5.10 --- RESULTS OF ALL TRIMMED DNA SEQUENCES --- p.87 / Chapter CHAPTER 6 --- DISCUSSION --- p.112 / REFERENCES --- p.122 / APPENDIX --- p.131 / APPENDIX I: Electron micrograph of SRSV particles --- p.132 / APPENDIX II: Confirmation for specificity test --- p.133 / APPENDIX III: Sequencing amplicons using capsid primers --- p.135 / APPENDIX IV: Sequencing amplicons (outbreak) using pol primers --- p.136 / APPENDIX V: Electropherogram (direct sequencing) --- p.138 / APPENDIX VI: Other RT-PCR results using pol primers --- p.139 / APPENDIX VII: Results of RT-PCR using capsid primers --- p.149 / APPENDIX VIII: Mini prep analysis --- p.158

[Truncated abstract] Gastroenteritis is frequently associated with a food or water borne source and the investigation of such cases is undertaken to identify potential sources of infection. Where contaminated food or water are identified as the source of infection/intoxication, action may be taken to limit or prevent further people being affected, and in so doing limit costs to the health care system. This study was undertaken to determine if there is a more effective and efficient way to collect information from patients with certain enteric illnesses. This was based on a trial process of posting self-administered questionnaires with a reply-paid return envelope to the patient and compared with the existing process where local government Environmental Health Officers interview the patient and provide a report to the Department of Health. A limiting factor in the existing process is the time lapse between the onset of illness and follow-up by Environmental Health Officers (EHOs), which results in difficulties in contacting the patient and obtaining a dietary history. Furthermore, the existing system is resource intense, requiring officers to individually interview patients either in person or by telephone. The study was of those patients living in the Perth metropolitan area whose doctor notified the Department of Health that the patient had contracted any of three notifiable enteric illnesses (campylobacterosis, giardiasis or salmonellosis), and the patient was not part of a known outbreak and was assessed as not requiring urgent follow-up. The trial process was used for patients living in five local government areas and the return rate, timeliness of return and completeness of questionnaires in the trial process was compared with the reports returned under the existing process of investigation and reporting by EHOs from 24 metropolitan local government areas that were not part of the trial process. An estimate of the potential costs to local government and the Department of Health was undertaken for both the existing and trial processes of collecting information from patients. A survey of local government EHOs in the metropolitan area was also undertaken to assess the perception of EHOs about roles and responsibilities in the follow-up investigation, the use of the Enteric Disease Investigation Report (EDIR) and the limitations that they identified in the current investigation process.