Molecular epidemiology of noroviruses detected in seasonal outbreaks of acute nonbacterial gastroenteritis in Osaka City, Japan, from 1996-1997 to 2008-2009.

In seasons from 1996-1997 through 2008-2009, noroviruses (NoVs) were detected in 505 outbreaks (71%) of nonbacterial gastroenteritis in Osaka City, Japan using molecular diagnosis with reverse transcription (RT)-PCR or real-time RT-PCR. The occurrences of NoV-associated outbreaks were related with the cold season during November-March (85.3%), and occasionally small epidemics of NoVs occurring during April-June were observed. Oyster-associated outbreaks were dominant transmission modes (25-61.1%) before the 2003-2004 season, and decreased (5-20.5%) from the 2003-2004 season, although outbreaks attributable to food-borne transmission (except for oysters) and person-to-person contact increased from the 2003-2004 season. The NoV strains were characterized into genotypes based on sequence analysis of partial capsid regions. Genotyping analyses identified at least 30 genotypes (12 in genogroup I [GI] and 18 in genogroup II [GII]) of NoV. The most common genotype was GII.4 (44.6%), followed in order by GII.3, GII.6, GII.2, and GII.5. The number of GII.4 NoVs increased greatly from the 2003-2004 season, eventually comprising a large share among the NoV- associated outbreaks (97.4%) of the 2006-2007 season. Occasional increased prevalence of genotypes other than GII.4 was observed during this study period. This study showed the appearance, spread, and disappearance of various genotypes and the change of NoV epidemic in a limited geographic region. Continuous NoV molecular surveillance is important for understanding NoV infections and for improving measures for their control and prevention.