Norovirus transmission mediated by asymptomatic family members in households

PLoS One. 2020 Jul 23;15(7):e0236502. doi: 10.1371/journal.pone.0236502. eCollection 2020.

Abstract

The transmission of human norovirus excreted from infected persons occasionally causes sporadic infections and outbreaks. Both symptomatic patients and asymptomatic carriers have been reported to contribute to norovirus transmission, but little is known about the magnitude of the contribution of asymptomatic carriers. We carried out a 1-year survey of residents of a district of Bangkok, Thailand to determine the percentage of norovirus transmissions originating from asymptomatic individuals. We screened 38 individuals recruited from 16 families from May 2018 to April 2019 for GI and GII genotypes. Norovirus was detected every month, and 101 of 716 stool samples (14.1%) from individuals with no symptoms of acute gastroenteritis were norovirus-positive. The average infection frequency was 2.4 times per person per year. Fourteen genotypes were identified from the positive samples, with GII.4 being detected most frequently. Notably, 89.1% of the norovirus-positive samples were provided by individuals with no diarrhea episode. Similar to cases of symptomatic infections in Thailand, asymptomatic infections were observed most frequently in December. We detected 4 cases of NV infection caused by household transmission, and 3 of the 4 transmissions originated from asymptomatic individuals. We also identified a case in which norovirus derived from an asymptomatic individual caused diarrhea in a family member. These results suggest that asymptomatic individuals play a substantial role in both the maintenance and spreading of norovirus in a community through household transmission.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Asymptomatic Infections / epidemiology*
  • Caliciviridae Infections / pathology
  • Caliciviridae Infections / transmission*
  • Caliciviridae Infections / virology
  • Child
  • Diarrhea / pathology
  • Diarrhea / virology
  • Disease Outbreaks
  • Feces / virology
  • Female
  • Gastroenteritis / pathology
  • Gastroenteritis / virology*
  • Genotype
  • Humans
  • Male
  • Middle Aged
  • Norovirus / pathogenicity*
  • Phylogeny
  • RNA, Viral / genetics
  • RNA, Viral / isolation & purification
  • Young Adult

Substances

  • RNA, Viral

Grants and funding

This research was supported by the Japan Initiative for Global Research Network on Infectious Diseases from the Japan Agency for Medical Research and Development (J-GRID, Grant Number, JP18fm0108003) (to YM). The funding agencies had no role in the study design, the data collection or analysis, the decision to publish, or the preparation of the manuscript.