In this edition Also - Eurosurveillance

More documents

Recommendations

Info

to the appropriate genotype consensus sequence. The alignment of both nucleotide and amino acid query sequence and the genotype consensus are displayed within the web browser along with a table of mutations that are recognised as causing resistance to HBV inhibitors. When resistance mutations within the query sequence are detected, these mutations are listed along with the inhibitors that they impact upon and a literature citation for that mutation. As well as providing the user with additional information, continuous dynamic assessment of the relationships between HBV polymorphisms and treatment histories may allow new resistance mutations to be identified. The mutation annotator tool demonstrates the clinical usefulness of HepSEQ and as a consequence of this we are constantly updating the tool to incorporate new information as it becomes available. The resistance reporting aspect within HepSEQ has proved hugely successful and we are in the process of developing further the clinical and surveillance aspects of the application. Repeated resistance testing generates longitudinal sequence and clinical datasets for individual patients. HepSEQ has the capacity to capture this repeat testing information and we are designing interfaces that will present temporal data such as viral load, resistance mutations, treatment history and alanine transaminase (ALT) levels for a single patient. This interface will provide a single unified mechanism for collating, presenting and interpreting all available patient data, thus facilitating clinical treatment decisions. Monitoring the prevalence of HBV drug resistance mutations and their transmission, coupled with correlates of disease progression, requires an extensive epidemiological data set that is representative of the population. At present, only HepSEQ contains such a dataset, which covers only the UK. However, these analyses are critical for the whole of Europe, and we are actively seeking European partners to facilitate this. We envisage that the tools within HepSEQ will provide an invaluable resource for other countries to analyse and interpret these data. We hope that other national centres in Europe will be encouraged to contribute information on hepatitis B cases. This will allow the tracking of specific strains across Europe, and identify links between specific risk groups due to migration and travel. In addition, the increased use across Europe of selective and universal hepatitis B vaccination and of antiviral therapy may contribute to the emergence of specific mutations. Tracking these strains will have particularly important implications for the prevention and management of hepatitis B in Europe. The identification of increasing numbers of clinically important mutations amongst acute cases in one country may provide warning to neighbouring countries. Acknowledgements This work was supported by funding from the Department of Health (UK) and by the Health Protection Agency (UK). References 1. Norder H, Couroucé AM, Coursaget P, Echevarria JM, Lee SD, Mushahwar IK, et al. Genetic diversity of hepatitis B virus strains derived worldwide: genotypes, subgenotypes, and HBsAg subtypes. Intervirology. 2004;47(6):289-309. 2. Couroucé AM, Lee H, Drouet J, Canavaggio M, Soulier JP. Monoclonal antibodies to HBsAg: a study of their specificities for eight different HBsAg subtypes. Dev Biol Stand. 1983;54:527-34. 3. Ding X, Mizokami M, Yao G, Xu B, Orito E, Ueda R, et al. Hepatitis B virus genotype distribution among chronic hepatitis B virus carriers in Shanghai, China. Intervirology. 2001;44(1):43-7. 4. Fujie H, Moriya K, Shintani Y, Yotsuyanagi H, Iino S, Koike K. Hepatitis B virus genotypes and hepatocellular carcinoma in Japan. Gastroenterology. 2001;120(6):1564-5. 5. Kao JH, Wu NH, Chen PJ, Lai MY, Chen DS. Hepatitis B genotypes and the response to interferon therapy. J Hepatol. 2000;33(6):998-1002. 6. Gnaneshan S, Ijaz S, Moran J, Ramsay M, Green J. HepSEQ: International Public Health Repository for Hepatitis B. Nucleic Acids Res. 2007;35(Database issue):D367-70. 7. Tenney DJ, Levine SM, Rose RE, Walsh AW, Weinheimer SP, Discotto L, et al. Clinical emergence of entecavir-resistant hepatitis B virus requires additional substitutions in virus already resistant to Lamivudine. Antimicrob Agents Chemother. 2004 ;48(9):3498-507. 8. Lai CL, Dienstag J, Schiff E, Leung NW, Atkins M, Hunt C, et al. Prevalence and clinical correlates of YMDD variants during lamivudine therapy for patients with chronic hepatitis B. Clin Infect Dis. 2003; 36(6):687-96. 9. Günther S. Genetic variation in HBV infection: genotypes and mutants. J Clin Virol. 2006; 36 Suppl 1:S3-S11. This article was published on 8 May 2008. Citation style for this article: Myers R, Gnaneshan S, Ijaz S, Tedder R, Ramsay M, Green J, HepSEQ Steering Committee. HepSEQ – an Integrated Hepatitis B Epidemiology and Sequence Analysis Platform. Euro Surveill. 2008;13(19):pii=18866. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18866 178 EUROSURVEILLANCE Vol. 13 · Issues 14–26 · Apr–Jun 2008 · www.eurosurveillance.org
Special issue: Molecular typing for public health purposes Perspectives T y p i n g d a Ta b a s e f o r n o r o v i r u s e s E Duizer 1 , A Kroneman 1 , J Siebenga 1 , L Verhoef 1 , H Vennema 1 , M Koopmans 1 , the FBVE network (fbve@rivm.nl) 1. Laboratory for Infectious Diseases, Virology, Department, National Institute for Public Health and the Environment, Bilthoven, the Netherlands The FBVE network The FBVE (Food-borne Viruses in Europe) network was initiated during a research project funded by the European Commission (contract QLK1-1999-00594). The aim of the network is to establish a framework for rapid, (pre-publication) exchange of epidemiological, virological and molecular diagnostic data on outbreaks of viral gastroenteritis and acute hepatitis due to hepatitis A and E viruses for both surveillance and research purposes. Surveillance of (viral) gastroenteritis is not harmonised across Europe as surveillance systems are different in each country. The present FBVE network includes 26 actively participating institutes in 13 countries. Each participating country is represented by at least one virologist and one epidemiologist. Since the focus of this paper and issue is on typing tools, we do not show extensive documentation on quality of the data (for reference see [1] and [2]). In September 2001, the FBVE network launched a web-based database for reporting outbreaks of viral gastroenteritis. The FBVE database (www.fbve.nl, password protected) is accessible to all members of the network for online outbreak reporting and to search or download the complete dataset. In addition, sequences can be matched against the complete dataset: the results are presented as a table showing homologous strains detected earlier and their characteristics such as year, country, setting of the outbreak, and mode of transmission. More than 16,000 outbreaks have been entered in the database to date. Another feature is a public genotyping tool that allows ‘visitors’ to upload partial sequences of specific genomic NoV regions. These sequences are subsequently assigned a NoV genotype (see below). Norovirus Noroviruses (NoV) are small single-strand RNA viruses without an envelope and are classified to the family Caliciviridae. They are highly contagious and are transmitted via faeces and vomit, either directly through contact with infected people or through objects touched by them, or indirectly via contaminated environmental surfaces. The incubation period is about one to three days. The main symptoms of NoV infections are diarrhoea, abdominal pain and vomiting. Infection can occur at all ages, but young children and the elderly are particularly at risk from dehydration. Currently there are no drugs or vaccines that can control or prevent NoV infections [3]. NoV can be divided in five genogroups (G), of which viruses belonging to GI, GII and GIV cause infections in humans. They are further classified into genotypes or genetic clusters, according to the sequence diversity of their capsids. Most prevalent in humans are NoV of GII, and in this group, genotype GII.4 has in recent years been identified as the cause of global epidemics. From time to time, new variants of this genotype appear and rapidly displace the resident dominant variant [4]. There is some evidence for differences in severity of illness [5] and modes and/or efficacy of transmission between viruses that belong to different genotypes. In addition, GII viruses have been found in animals, which raises questions about their zoonotic potential. Added value of NoV typing Genotyping is presently done almost exclusively at the national level as part of surveillance, research projects or outbreak investigations. Several regions of the genome are targeted by a range of RT-PCR assays (Figure). Regions A and C [6]. are most widely used, but other genomic regions have been used as diagnostic targets as well. For monitoring trends, region A and C can be used. However, aggregation of data needs to be done with caution because recombination is quite common in NoV, i.e. a recombinant strain may have region A from one genotype and region C from another. Therefore, recombinant strains could erroneously be labelled as distinct, if region A and region C typing results of different strains are compared and sequences from only one of the regions per strain are available. Typing tool To harmonise the international comparison of NoV sequences, a quick typing tool was set up by the FBVE network. The availability of a common set of reference sequences with universally accepted Figure Norovirus genome and sequencing regions A and C ORF1 Open reading frame (ORF) 1: RNA-dependent RNA polymerase ORF 2: Major capsid protein (VP1) EUROSURVEILLANCE Vol. 13 · Issues 14–26 · Apr–Jun 2008 · www.eurosurveillance.org 179 A C ORF2 ORF3
Page 1 and 2: EUROPEAN CENTRE FOR DISEASE PREVENT
Page 3 and 4: Special issue: World Hepatitis Day
Page 5 and 6: oth measles and mumps in certain ag
Page 7 and 8: to be done. Twenty-nine of the 53 c
Page 9 and 10: Editorial W o r l d He pat i t i s
Page 11 and 12: Editorials M o l e c u l a r t y p
Page 13 and 14: 5. Fooks A. Rabies remains a ‘neg
Page 15 and 16: Statistical analysis The antibody p
Page 17 and 18: mumps that we noticed between males
Page 19 and 20: Among the cases, 3,683 (61.8%) were
Page 21 and 22: [5] Given the periodicity of outbre
Page 23 and 24: sequences (GenBank NIH, Bethesda) p
Page 25 and 26: Special issue: European Immunizatio
Page 31 and 32: No. of reported rubella cases Speci
Page 33 and 34: Special issue: Molecular typing for
Page 35 and 36: From these discussions, and by test
Page 37 and 38: 15. Hæggman S, Rhod Larsen A, Vain
Page 39 and 40: Table 1 SeqNet.org participating me
Page 41 and 42: first line typing method, besides o
Page 43 and 44: Special issue: Molecular typing for
Page 45 and 46: criteria are combined, (iii) the or
Page 47 and 48: Retrospective surveillance data fro
Page 49: Special issue: Molecular typing for
Page 53 and 54: Special Issue: World Hepatitis Day
Page 55 and 56: Table Number of notifications of he
Page 57 and 58: 5. Hoffmann G, Berglund G, Elmståh
Page 59 and 60: Our epidemiological and molecular i
Page 61 and 62: The questionnaire was structured ac
Page 63 and 64: Table 2 HIV and hepatitis C testing
Page 65 and 66: to be paid regarding HCV. The repor
Page 67 and 68: Table 1 Summary of hepatitis B surv
Page 69 and 70: of the different genotypes vary bot
Page 71 and 72: Figure The incidence of reported he
Page 73 and 74: 33. Veldhuijzen IK, Smits LJ, van d
Page 75 and 76: Figure 1 The natural history of HCV
Page 77 and 78: successful engagement with and trea
Page 79 and 80: Table 1 Definitions of HCV infectio
Page 81 and 82: not available for surveillance purp
Page 83 and 84: Special Issue: World Hepatitis Day
Page 85 and 86: Surveillance and outbreak reports E
Page 87 and 88: Distributed information about the e
Page 89 and 90: Surveillance and outbreak reports A
Page 91 and 92: Table 1 Survey data regarding surve
Page 93 and 94: For the presented period of the pas
Page 95 and 96: or individuals who acquired the inf
Page 97 and 98: Surveillance and outbreak reports A
Page 99 and 100: analysable fragment of 457 bp, and
Page 101 and 102:
the application of HNIG to close co
Page 103 and 104:
HCV co-infection was defined as pos
Page 105 and 106:
[18] had been observed in HIV-HBV c
Page 107 and 108:
Microbiological investigation All h
Page 109 and 110:
References 1. American Public Healt
Page 111 and 112:
Telephone calls are handled by a tw
Page 113 and 114:
At that time, the daily monitoring
Page 115 and 116:
Research articles S u r v e i l l a
Page 117 and 118:
It has been suggested that longer d
Page 119 and 120:
Virological data collection Stool s
Page 121 and 122:
Discussion Our combined epidemiolog
Page 123 and 124:
Acknowledgements We are grateful to
Page 125 and 126:
The total study sample consisted of
Page 127 and 128:
Table Multivariate model of associa
Page 129 and 130:
Euroroundups S u r v e y o f eu r o
Page 131 and 132:
event. The survey included question
Page 133 and 134:
Laboratories report anonymised case
Page 135 and 136:
8. European Union. Commission decis
Page 137 and 138:
two females aged six years and 56 y
Page 139 and 140:
Table 2 Salmonella infections with
Page 141 and 142:
17. The Community Summary Report on
Page 143 and 144:
the number of registered cases in E
Page 145 and 146:
protected vaccinees annually) [6].
Page 147 and 148:
Romania Risk of tick-borne encephal
Page 149 and 150:
34. Pavlidou V, Geroy S, Diza E, An
Page 151 and 152:
European Commission and the EU Memb
Page 153 and 154:
10. Strauss R, Muchl R, Kunze M, Hr
Page 155 and 156:
Existing monitoring efforts in Euro
Page 157 and 158:
with existing efforts in influenza
Page 159 and 160:
Obtaining a true picture of the bur
Page 161 and 162:
of being too clean, concerns about
Page 163 and 164:
single case of the disease while in
Page 165 and 166:
Rapid communications E m E rg E n c
Page 167 and 168:
Development and Food. More specific
Page 169 and 170:
Rapid communications I n c r e a s
Page 171 and 172:
immunity was high enough to prevent
Page 173 and 174:
Control measures Information about
Page 175 and 176:
• The importance of ensuring that
Page 177 and 178:
Letters A u t h o r s r e p ly : pr
Page 179 and 180:
UNITED KINGDOM England and Wales He
show all

In this edition Also - Eurosurveillance

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?