Send to

Choose Destination
Lancet Infect Dis. 2018 May;18(5):545-553. doi: 10.1016/S1473-3099(18)30059-8. Epub 2018 Jan 26.

Molecular surveillance of norovirus, 2005-16: an epidemiological analysis of data collected from the NoroNet network.

Author information

Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands; Centre for Infectious Diseases Research, Diagnostics and Screening, National Institute of Public Health and the Environment, Bilthoven, Netherlands.
Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands.
Department of Health Security, National Institute for Health and Welfare, Helsinki, Finland.
Virus Reference Department, Public Health England, London, UK; Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Health Protection Research Unit in Gastrointestinal Infections, National Institute for Health Research, UK.
National Reference Centre for Gastroenteritis Viruses, University Hospital of Dijon Bourgogne, Dijon, France; AgroSup Dijon PAM UMR A 02.102, University Bourgogne Franche-Comté, Dijon, France.
Scientific Service of Foodborne Pathogens, Institute of Public Health, Brussels, Belgium.
Microbial Typing Unit, The Public Health Agency of Sweden, Stockholm, Sweden.
Viral Gastroenteritis Research Group, Department of Microbiology, University of Valencia, Valencia, Spain.
Enterovirus and Viral Gastroenteritis Unit, Instituto de Salud Carlos III, Madrid, Spain; Translational Research Network in Pediatric Infectious Diseases, Instituto de Investigación Sanitaria de la Paz, Madrid, Spain.
Department of Microbiology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.
Gastroenteric, Vectorborne and Zoonotic Unit, Health Protection Surveillance Centre, Dublin, Ireland.
Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanita, Rome, Italy.
Enteric Virus Laboratory, University of Barcelona, Barcelona, Spain.
Norovirus Reference Laboratory, Institute of Environmental Science and Research, Porirua, New Zealand.
Department of Microbiology, Osaka Institute of Public Health, Osaka, Japan.
Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, China, Beijing, China.
Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany.
Reference Centres and Reference Laboratories, Austrian Agency for Health and Food Safety, Vienna, Austria.
Department of Medical Virology, University of Pretoria, Pretoria, South Africa.
Department of Veterinary Medicine, University of Bari, Bari, Italy.
Department of Food Hygiene and Environmental Health, University of Helsinki, Helsinki, Finland.
Specialist Virology Centre, Royal Infirmary Edinburgh, Edinburgh, UK.
Consultant Laboratory for Noroviruses, Robert Koch Institute, Berlin, Germany.
Department of Medical Microbiology, Division of Clinical Virology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
RussianFederal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor), Central Research Institute of Epidemiology, Moscow, Russia.
Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Department of Virus & Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark.
Department of Medical Microbiology and Immunology, Medical School, University of Pécs, Pécs, Hungary.
National Virus Reference Laboratory, University College Dublin, Dublin, Ireland.
Centre for Infectious Diseases Research, Diagnostics and Screening, National Institute of Public Health and the Environment, Bilthoven, Netherlands.
Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands; Centre for Infectious Diseases Research, Diagnostics and Screening, National Institute of Public Health and the Environment, Bilthoven, Netherlands. Electronic address:



The development of a vaccine for norovirus requires a detailed understanding of global genetic diversity of noroviruses. We analysed their epidemiology and diversity using surveillance data from the NoroNet network.


We included genetic sequences of norovirus specimens obtained from outbreak investigations and sporadic gastroenteritis cases between 2005 and 2016 in Europe, Asia, Oceania, and Africa. We genotyped norovirus sequences and analysed sequences that overlapped at open reading frame (ORF) 1 and ORF2. Additionally, we assessed the sampling date and country of origin of the first reported sequence to assess when and where novel drift variants originated.


We analysed 16 635 norovirus sequences submitted between Jan 1, 2005, to Nov 17, 2016, of which 1372 (8·2%) sequences belonged to genotype GI, 15 256 (91·7%) to GII, and seven (<0·1%) to GIV.1. During this period, 26 different norovirus capsid genotypes circulated and 22 different recombinant genomes were found. GII.4 drift variants emerged with 2-3-year periodicity up to 2012, but not afterwards. Instead, the GII.4 Sydney capsid seems to persist through recombination, with a novel recombinant of GII.P16-GII.4 Sydney 2012 variant detected in 2014 in Germany (n=1) and the Netherlands (n=1), and again in 2016 in Japan (n=2), China (n=8), and the Netherlands (n=3). The novel GII.P17-GII.17, first reported in Asia in 2014, has circulated widely in Europe in 2015-16 (GII.P17 made up a highly variable proportion of all sequences in each country [median 11·3%, range 4·2-53·9], as did GII.17 [median 6·3%, range 0-44·5]). GII.4 viruses were more common in outbreaks in health-care settings (2239 [37·2%] of 6022 entries) compared with other genotypes (101 [12·5%] of 809 entries for GI and 263 [13·5%] of 1941 entries for GII non-GII.Pe-GII.4 or GII.P4-GII.4).


Continuous changes in the global norovirus genetic diversity highlight the need for sustained global norovirus surveillance, including assessment of possible immune escape and evolution by recombination, to provide a full overview of norovirus epidemiology for future vaccine policy decisions.


European Union's Horizon 2020 grant COMPARE, ZonMw TOP grant, the Virgo Consortium funded by the Dutch Government, and the Hungarian Scientific Research Fund.

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center