諾如病毒研究進展及一起郵輪諾如病毒感染疫情的實驗室檢測

1、會計學1諾如病毒研究進展及一起郵輪諾如病毒諾如病毒研究進展及一起郵輪諾如病毒感染疫情的實驗室檢測感染疫情的實驗室檢測 Source: Foodborne Outbreak Reporting System /foodborneoutbreaks/Cruise-ship virus）Slutsker L, et al. Ann Intern Med 1997; 126:505-13食源性急性胃腸炎的防控仍然是食源性急性胃腸炎的防控仍然是很大的挑戰(zhàn)！很大的挑戰(zhàn)！In 1929, Zahorsky proposed the name “winter vomiting

2、 disease” to describes outbreaks of presumed viral gastroenteritis In the 1940s, Gordon demonstrated that pooled stool filtrates obtained from patients in an institutional outbreak of nonbacterial gastroenteritis could infect inoculated volunteersIn 1968, CDC investigated an outbreak of vomiting dis

3、ease in an elementary school in Norwalk OH: 50% of students and teachers developed gastroenteritisKaplan used immune electronmicroscopy to identify viral particles in the stools of volunteers infected with the “Norwalk” strainVirus initially classified as small round viruses, later reclassified as c

4、aliciviruses when genome clonedn Dr. Albert Kapikiann 1972, electron microscopyn Small Round-Structured Virus (SRSV)n 27 nmKapikian AZ, et al. Visualization by immune electron microscopy of a 27-nm particle associated with acute infectious nonbacterial gastroenteritis. J Virol, 1972, 10 (5): 1075-10

5、81. 流行現(xiàn)狀：流行現(xiàn)狀：我國流行現(xiàn)狀我國流行現(xiàn)狀我國流行現(xiàn)狀我國流行現(xiàn)狀u 發(fā)病率高、致病劑量低、抵抗力強，被WHO定為B類病原體；u 對加熱、低溫具有較強抵抗性（能耐受零度以下到60）；u 對酸堿和去污劑等具有較強的抵抗性 (通常10ppm或10mg/L含氯去污劑處理30分鐘不能有效殺滅病原體）；u 無法培養(yǎng)，無有效小動物模型；u 型別眾多，無有效保護性抗體，常引起重復感染；nGenus Lagovirus (rabbit, hare)nGenus Vesivirus (cat, pig, sea lion, other)nGenus Norovirus (human, bovine,

6、swine, mouse)nGenus Sapovirus (human, swine)53HelProPolORF 1ORF 2ORF 3155358537469506950758876541789530212CapsidSource: GenBank M87661GIII.1_JenaGIII.2_CH126GI.3_Desert ShieldGI.7_WinchesterGI.8_BoxerGI.4_ChibaGI.5_MusgroveGI.2_SouthamptonGI.6_HesseGI.1_NorwalkGV.1_MurineGIV.1_AlphatronGII.15_J23GII

7、.4_BristolGII.11_SW918GII.8_AmsterdamGII.9_Virginia BeachGII.14_M7GII.7_LeedsGII.12_WortleyGII.1_HawaiiGII.16_TiffinGII.2_MelkshamGII.5_HillingdonGII.10_ErfurtGII.13_FayettevilleGII.17_CS-E1GII.3_TorontoGII.6_Seacroft.10GVGIVGIIIGIIGIClusters differ by 20% amino acid pairwise distanceGenogroups diff

8、er by 44-55% amino acid pairwise distance1nCell culture: no (human strains)nAnimal model: no (chimpanzees)流行現(xiàn)狀：nCauses an estimated 23 million infections per year in the USnCauses 60% of illness due to knownnAccounts for 70-95% of gastroenteritis outbreaks感染劑量: 10-100 viruses：傳播途徑：n Fecal-oral trans

9、mission (shedding for up to 2-3 weeks)n Droplet transmission? (via ingestion of airborne droplets of virus containing particles)n Common cause of travelers diarrhean May cause chronic infection in transplant recipients Person-to-person Foodborne Waterborne Mixed Vomitus 腹瀉86%嘔吐78%腹部疼痛或絞痛 30%惡心（無嘔吐）

10、15%嗜睡8%發(fā)熱7%肌肉疼痛7%頭痛6%頭暈4%脫水4%寒顫3%喉嚨疼痛1%鼻出血1%1234567Exposed to the VirusSymptoms (Vomiting and/or Diarrhea)Life Cycle of Virus by DaysContagious Time Frame (even when symptoms are no longer present)Unpublished results by Wang J. and Zhang Z.確定檢測項目，檢測方法排查方案（一）排查方案（二）結果：TIPS: for sample cellection1.最好采集水樣便或稀便；2.最好采集發(fā)病48-72小時之間的糞便樣本；3. 直腸拭子或嘔吐物標本一般作參考磷鎢酸負染，40,000 電鏡觀察檢測過程總結：Slutsker L, et al. Ann Intern Med 1997; 126:5