Uyar Yavuz, Carhan Ahmet, Ozkaya Etem, Ertek Mustafa
Refik Saydam Hifzissihha Merkezi Başkanliği, Salgin Hastaliklar Araştirma Müdürlüğü, Viroloji Tani ve Araştirma Laboratuvari, Ankara.
Mikrobiyol Bul. 2008 Oct;42(4):607-15.
Norovirus (NoV) is one of the most prominent agents of gastroenteritis and water/food-borne outbreaks affecting all of the age groups in the world. As the identification of the etiologic agent is important during gastroenteritis outbreaks, it is recommended to combine two different methods for rapid and reliable laboratory diagnosis of NoV. Although NoV outbreaks have been observed in many different countries of the world, there was no report on "NoV outbreak" in Turkey till 2008 due to the absence of a regular surveillance system for non-bacterial gastroenteritis. This study aimed to present the laboratory results for "the first NoV outbreak" in Turkey in 2008. A number of cases with diarrhea and nausea/vomiting initially emerged in Aksaray (located at the southern part of central Anatolia) in May 2008, followed by cases from Sereflikochisar, Kirsehir, and Adana provinces (located at central and southern Anatolia; geographically closer regions). However, regional laboratories declared that no known bacterial (Salmonella spp., Shigella spp., enterotoxigenic Escherichia coli), viral (Rotavirus, Adenovirus) and parasitic agents were detected. A total of 50 stool samples were sent to the Virology Reference Laboratory (Refik Saydam Hygiene Center, Ankara) for further investigations including NoV. For the investigation of NoV, the samples were analysed by using antigen-ELISA (Ridascreen, R-Biopharm, Germany) and real-time polymerase chain reaction(PCR) (Roche Diagnostics GmbH, Germany) methods. Of the samples, 26% (13/50) were found antigen positive, whereas 33% (13/40) were positive for viral nucleic acids. The positivity rates determined by ELISA and PCR were as follows, respectively; 57% (4/7) and 71% (5/7) in Aksaray, 25% (1/4) and 25% (1/4) in Sereflikochisar, 28% (7/25) and 40% (6/15) in Kirsehir, 7% (1/14) and 7% (1/14) in Adana. Nine (69.2%), and 4 (30.8%) out of 13 positive samples were genotyped as NoV GI and GII, respectively. The sensitivity and specificity of antigen-ELISA method were found as 61.5% and 100%, respectively, when compared with real-time PCR. In conclusion, further epidemiological studies and genomic analysis are needed for the detection and control of circulating strains in Turkey, since NoV outbreaks spread rapidly and cause serious economical and workforce loss.
诺如病毒（NoV）是引起肠胃炎以及水/食物传播疫情的最主要病原体之一，影响着全球所有年龄组。由于在肠胃炎疫情期间确定病原体很重要，因此建议结合两种不同方法对诺如病毒进行快速可靠的实验室诊断。尽管在世界许多不同国家都观察到了诺如病毒疫情，但由于缺乏针对非细菌性肠胃炎的常规监测系统，直到2008年土耳其都没有关于“诺如病毒疫情”的报告。本研究旨在呈现2008年土耳其“首例诺如病毒疫情”的实验室结果。2008年5月，阿克萨赖（位于安纳托利亚中部南部）最初出现了一些腹泻及恶心/呕吐病例，随后锡雷利科希萨尔、基尔希尔和阿达纳省（位于安纳托利亚中部和南部；地理上较近的地区）也出现了病例。然而，地区实验室宣称未检测到任何已知的细菌（沙门氏菌属、志贺氏菌属、产肠毒素大肠杆菌）、病毒（轮状病毒、腺病毒）和寄生虫病原体。总共50份粪便样本被送往病毒学参考实验室（安卡拉雷菲克·赛达姆卫生中心）进行包括诺如病毒在内的进一步调查。为了调查诺如病毒，采用抗原酶联免疫吸附测定法（Ridascreen，德国R - 生物制药公司）和实时聚合酶链反应（PCR）（德国罗氏诊断有限公司）方法对样本进行分析。在这些样本中，26%（13/50）被发现抗原呈阳性，而33%（13/40）病毒核酸呈阳性。酶联免疫吸附测定法和PCR测定的阳性率分别如下：阿克萨赖为57%（4/7）和71%（5/7），锡雷利科希萨尔为25%（1/4）和25%（1/4），基尔希尔为28%（7/25）和40%（6/15），阿达纳为7%（1/14）和7%（1/14）。13份阳性样本中，9份（69.2%）和4份（30.8%）分别被基因分型为诺如病毒GI型和GII型。与实时PCR相比，抗原酶联免疫吸附测定法的灵敏度和特异性分别为61.5%和100%。总之，由于诺如病毒疫情传播迅速并造成严重的经济和劳动力损失，土耳其需要进一步开展流行病学研究和基因组分析以检测和控制流行毒株。
