一篇关于诺如病毒流行病学、生物学及疫苗研发挑战的叙述性综述。

A narrative review of norovirus epidemiology, biology, and challenges to vaccine development.

作者信息

Carlson Katherine B, Dilley Anne, O'Grady Thomas, Johnson Jordan A, Lopman Ben, Viscidi Emma

机构信息

Moderna, Inc., Cambridge, MA, USA.

Epidemiologic Research & Methods, LLC, Atlanta, GA, USA.

出版信息

NPJ Vaccines. 2024 May 29;9(1):94. doi: 10.1038/s41541-024-00884-2.

Abstract

Norovirus is a leading cause of acute gastroenteritis (AGE) globally. AGE resulting from norovirus causes significant morbidity and mortality in countries of all income levels, particularly among young children and older adults. Prevention of norovirus AGE represents a unique challenge as the virus is genetically diverse with multiple genogroups and genotypes cocirculating globally and causing disease in humans. Variants of the GII.4 genotype are typically the most common genotype, and other genotypes cause varying amounts of disease year-to-year, with GII.2, GII.3, and GII.6 most prevalent in recent years. Noroviruses are primarily transmitted via the fecal-oral route and only a very small number of virions are required for infection, which makes outbreaks of norovirus extremely difficult to control when they occur. Settings like long-term care facilities, daycares, and hospitals are at high risk of outbreaks and can have very high attack rates resulting in substantial costs and disease burden. Severe cases of norovirus AGE are most common in vulnerable patient populations, such as infants, the elderly, and immunocompromised individuals, with available treatments limited to rehydration therapies and supportive care. To date, there are no FDA-approved norovirus vaccines; however, several candidates are currently in development. Given the substantial human and economic burden associated with norovirus AGE, a vaccine to prevent morbidity and mortality and protect vulnerable populations could have a significant impact on global public health.

摘要

诺如病毒是全球急性胃肠炎(AGE)的主要病因。诺如病毒引起的AGE在所有收入水平国家都导致了显著的发病率和死亡率,尤其是在幼儿和老年人中。预防诺如病毒AGE是一项独特的挑战,因为该病毒基因多样,有多个基因组和基因型在全球共同传播并导致人类发病。GII.4基因型的变体通常是最常见的基因型,其他基因型每年导致的疾病数量各不相同,近年来GII.2、GII.3和GII.6最为普遍。诺如病毒主要通过粪口途径传播,感染仅需极少量的病毒粒子,这使得诺如病毒爆发时极难控制。长期护理机构、日托中心和医院等场所爆发疫情的风险很高,且发病率可能非常高,会导致巨大的成本和疾病负担。诺如病毒AGE的重症病例在脆弱患者群体中最为常见,如婴儿、老年人和免疫功能低下者,现有治疗方法仅限于补液疗法和支持性护理。迄今为止,尚无FDA批准的诺如病毒疫苗;不过,目前有几种候选疫苗正在研发中。鉴于诺如病毒AGE带来的巨大人力和经济负担,一种预防发病和死亡并保护脆弱人群的疫苗可能会对全球公共卫生产生重大影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b2ea/11137017/97956612ae5f/41541_2024_884_Fig1_HTML.jpg

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