Molecular and epidemiological features of norovirus-associated gastroenteritis outbreaks in Victoria, Australia in 2001.

Norovirus was identified in 30 of 59 gastroenteritis outbreaks occurring in the state of Victoria, Australia in 2001 by RT-PCR and/or electron microscopy (EM). Norovirus outbreaks occurred in hostels/nursing homes (27%), hospitals (13%), youth refuges (3%), social gatherings associated with food consumption (27%), school outings/camps (13%), and pre-school/child-minding centers (17%). Norovirus outbreaks tended to occur in the warmer months. Phylogenetic analysis identified six clusters, one within genogroup 1 (G1) and five within genogroup 2 (G2). Cluster 1, which incorporates the G2 Camberwell/Lordsdale strains, was the most common (39% of outbreaks). In 2 of 27 outbreaks, strains from two G2 clusters, 1 and 5, occurred. Norovirus G2 was more common in the young and very old than in those in intermediate years. Norovirus G2 detection rate was higher in females than in males for adults (>15 years) and the susceptibility of adult females to norovirus G2 infection relative to males increased with age. In one outbreak analyzed, some sequences had a single base substitution, but this did not result in an amino acid (aa) change. The two most common norovirus clusters (G2 clusters 1 and 4) occurred in the capital of Victoria, Melbourne, and regional Victoria, but the least common clusters (G2 clusters 2 and 3 and G1 cluster 8) only occurred in inner Melbourne. Norovirus was occasionally detected by EM but not by RT-PCR. The occurrence of norovirus outbreaks is modulated by a large group of factors, which will have to be considered in any epidemiological model.