宁夏地区5株GI型诺如病毒的全基因组序列分析

为分析宁夏地区GI型诺如病毒全基因组序列，了解其基因结构特点及进化特征。对2019-2021年宁夏腹泻患者粪便标本进行GI/GII型诺如病毒初筛，GI型阳性样本扩增其聚合酶（RdRp）-衣壳蛋白（Capsid）区基因，利用BLAST及诺如病毒在线分型网站进行型别鉴定后，选取Ct≤30的样本进行全基因组序列测序，使用MEGA-7、Simplot和BioEdit等软件进行相关分析。本研究共收集腹泻患者粪便标本4 249份，检出GI型诺如病毒阳性样本57份，获得RdRp-Capsid区基因序列11株及全基因组序列5株。11株GI型诺如病毒鉴定后分别属于GI.3[P13]、GI.3[P10]、GI.5[P4]和GI.6[P11]4种型别。5株全基因组株中，SZS21-047和HY21-029在靠近ORF1与ORF2重叠区发生重组，3个GI.3型及1个GI.5型毒株与各型原型株之间在衣壳蛋白P2区存在多处位点变异。宁夏地区GI型NoV型别多样，重组和变异频繁，故应加强本地区诺如病毒监测，为疫情防控提供理论依据。     

湖州市非细菌性急性胃肠炎暴发中诺如病毒的分子生物学特点初步研究

本文初步研究了湖州市非细菌性急性胃肠炎暴发中检出的诺如病毒的分子生物学特征。收集湖州市2008年和2009年2起非细菌性急性胃肠炎暴发疫情中采集的患者粪便标本,采用荧光定量RT-PCR方法对其进行诺如病毒核酸检测,并对核酸阳性标本进行RNA多聚酶部分区域的RT-PCR扩增。选取阳性扩增产物进行纯化及序列测定,结合诺如病毒GI、GII各基因型参考株进行核苷酸序列遗传进化分析。结果2起疫情均同时检出了GI和GII型诺如病毒。随后对其中4份RNA多聚酶区扩增阳性的标本进行测序及序列分析,结果发现2008年检出的2株GI型诺如病毒均为GI/2基因型;而2009年检出的1株GI型诺如病毒为GI/3基因型,另一株GII型诺如病毒则与近些年欧洲和亚洲相继出现的遗传组GII的新基因型GIIb的各代表株同源性最高,为GIIb基因型。这说明湖州地区流行的诺如病毒存在很高的遗传多样性,并且不同时间流行的基因型也存在一定差异。这也是国内首次在急性病毒性胃肠炎暴发中检出诺如病毒GIIb变异株。     

贵州省2011年急性胃肠炎诺如病毒的哨点监测及其基因特征分析

为了解贵州省2011年诺如病毒的基因型,监测了2011年5月至12月于贵州省人民医院就诊的急性胃肠炎病例,收集粪便标本,采用荧光定量逆转录-聚合酶链反应(Real-time RT-PCR)初步鉴定,并对阳性株的VP1基因区克隆及测序。检测标本70份,GⅠ型诺如病毒阳性1株,阳性率1.43%,GⅡ型诺如病毒阳性34株,阳性率48.57%,获得7份GⅡ型诺如病毒VP1基因序列,3株为GⅡ.4亚型,为新型变异株(GⅡ4 2011),与GⅡ4 2006b变异株的亲缘关系最近,有1个氨基酸位发生了回复突变;4株为GⅡ.3亚型,分为2个基因簇,1簇与2008～2009年韩国株(HM635118)及上海株(GU991355)的亲缘关系最近,1簇与2010年日本株(AB629943)及2007年印度株(EU921389)等的亲缘关系最近,有4个氨基酸位点易发生回复突变。     

GI型诺如病毒湖州株2008/Huzhou/N11进行全基因组序列测定与分析

为了对GI型诺如病毒湖州株2008/Huzhou/N11进行全基因组序列测定,了解其分子特征及基因类型。方法是根据GenBank上下载的GI型诺如病毒各基因型代表株保守序列设计特异性引物对2008/Huzhou/N11进行全基因组测序,并与GI型诺如病毒各基因型的原型株进行全序列的比对,使用MEGA 4.0软件绘制系统进化树。利用Simplot3.5.1软件进行相似性分析,对基因重组加以验证。结果表明,诺如病毒2008/Huzhou/N11基因组全长7 691bp,有3个开放阅读框(ORF)。ORF1长5 367bp(5~5 371nt),ORF2长1 623bp(5 355~6 977nt),ORF3长630bp(6 977~7 606nt)。RNA聚合酶区(4 320~5 091bp)系统进化分析显示2008/Huzhou/N11属于GI.2基因型,VP1区(5 355~6 977bp)和VP2区(6 977~7 606bp)的系统进化分析显示2008/Huzhou/N11属于GI.6基因型。进一步的Simplot分析提示2008/Huzhou/N11为GI.2/GI.6重组株,重组位点位于ORF1和ORF2重叠区的上游。本文确定了我国GI型诺如病毒湖州株2008/Huzhou/N11为GI.2/GI.6重组株,可为国内诺如病毒的遗传进化研究提供序列参考。     

2005～2008年广东省诺如病毒胃肠炎暴发的分子流行病学特征

为研究广东省诺如病毒胃肠炎暴发疫情的分子流行病学特点,我们采集了2005～2008年期间24起急性暴发性胃肠炎患者的粪便和肛拭子标本,使用诺如病毒特异性引物,通过逆转录-聚合酶链反应(RT-PCR)技术进行检测,再经核苷酸序列测定以分析诺如病毒的基因型,同时收集急性暴发性胃肠炎患者的相关流行病学资料。结果显示:24起急性暴发性胃肠炎中19起由诺如病毒引起,时间主要集中在每年的10月至次年2月,2005年病毒胃肠炎暴发疫情是由GⅡ-3基因型病毒引起,主要为幼儿园和小学,发生地主要在内陆山区,2006年秋季疫情以后则均为GⅡ-4型的变异株2006b引起,主要为大学和社区,2007年疫情数比其他年份高1倍,发生地遍及广东全省。广东省诺如病毒变异株2006b在个别特殊的基因位点呈现出高度的地域一致性。随着诺如病毒流行株的基因型由GⅡ-3变为GⅡ-4型,广东省诺如病毒流行的强度大大增加,新出现诺如病毒变异株2006b引起的暴发波及地方多,涉及人群从低幼儿童为主扩展到全年龄组,表明GⅡ-4新变异株比其它毒株具有更高的侵袭力。     

上海地区部分婴幼儿腹泻标本中诺如病毒基因分析

目的了解2006年上海哨点医院婴幼儿疑似病毒性腹泻散发病例中诺如病毒基因型别和基因特征。方法应用反转录-聚合酶链反应(RT-PCR)扩增标本中诺如病毒核酸,测序后使用DNAstar基因分析软件与Genbank中的参考株进行核酸序列分析。结果13份测序结果均属于诺如病毒GⅡ遗传组,以GⅡ.4基因型为主。其中2份核酸序列与2006年德国汉堡毒株序列同源性相近,分别为86.2%和88.2%;2份核酸序列与2006年荷兰乌得勒支毒株序列同源性相近,均为83.9%;其余9份核酸序列与2004年中国广西、2004年和2005年日本东京毒株序列同源性相近,为87.3%～97.5%。结论2006年上海哨点医院婴幼儿疑似病毒性腹泻标本中存在诺如病毒GⅡ.4基因型散发病例,不同病毒株之间差异较大。     

大连地区食源性腹泻病例中诺如病毒基因特征分析

目的了解大连地区食源性腹泻病例中诺如病毒的基因特征。方法采用荧光定量RT-PCR对2016年大连市食源性疾病监测哨点医院采集的1 900份粪便标本进行诺如病毒核酸检测,用逆转录PCR对阳性毒株的ORF1-ORF2连接区扩增并测序,分析其基因亚型和同源性。结果 1 900份标本中,检出诺如病毒核酸阳性25份,阳性率1.32%,其中GⅠ型阳性3份,GⅡ型阳性19份,GⅠ型和GⅡ型均阳性3份。26株病毒基因序列比对,发现3株为GⅠ.3,2株为GⅠ.6,9株为GⅡ.17,5株为GⅡ.4,2株为GⅡ.2,GⅡ.3、GⅡ.6、GⅡ.13、GⅡ.14、GⅡ.15各1株。结论大连地区食源性腹泻病例中诺如病毒呈基因多样性,2016年流行优势株为GⅡ.17。GⅡ.2、GⅡ.3、GⅡ.6、GⅡ.13、GⅡ.14、GⅡ.15在大连地区首次检出。     

宁夏地区2019-2020年诺如病毒所致感染性腹泻流行特征和病原学分析

了解宁夏地区感染性腹泻患者中诺如病毒的流行特征和基因进化规律，为该地区诺如病毒所致腹泻防控策略的制定提供科学依据。在宁夏自治区5个市的15家哨点医院开展腹泻症状监测，收集患者粪便标本和相关信息并采用Real-time RT-PCR方法进行诺如病毒初筛检测，阳性标本扩增其聚合酶（RdRp）-衣壳蛋白（Capsid）区基因，扩增产物测序后使用Sequencher 4.1.4软件进行序列拼接和编辑，并用MEGA-X、DNASTAR生物软件进行序列比对、系统进化分析以及同源性分析，应用SPSS 25.0软件进行相关统计学分析。结果显示2019-2020年共收集感染性腹泻患者粪便标本2 358份，诺如病毒检出率为13.44%(317/2 358)。主要为GⅡ基因群（285/317），其中，0～2岁年龄组阳性率最高，为18.43%(188/1 020);60～70岁年龄组阳性率最低，为3.36%(4/119)，各年龄组阳性率差异有统计学意义（P<0.05）。不同地区、年份、季节间阳性率比较，差异有统计学意义。GⅠ基因群（32/2 358）以GⅠ.P13/GⅠ.3(75.0%)为流行优势株，G...     

诺如病毒新型GII.4流行株Sydney2012在上海地区的检出和鉴定

为了解上海地区诺如病毒相关急性胃肠炎疫情的流行病学特点及流行株基因型的演化情况,2012年3月至2013年2月,收集上海市两处哨点医院成人急性胃肠炎粪便样本进行诺如病毒的分子检测并对其基因特征进行系统分析。在502份样本中,GI群共检出19例,检出率3.78%,呈现低位流行、全年散发的状态,无明显的季节分布;GII群检出86例,检出率17.13%,在10¹2月出现高位流行,并发现中老年人群GII群诺如病毒检出率显著高于青年个体（P<0.05）。同时首次于2012年9月在上海地区检出新型GII.4变异株Sydney₂012,证实是该变异株引发了2012年秋冬季诺如病毒急性胃肠炎的高位流行。序列分析表明该变异株为GII.e型开放阅读框（Open reading frame,ORF）1与GII.4型ORF2的重组体,目前已成为本地区的优势流行株。研究发现,2012年上海地区出现GII.4新型变异株Sydney₂012,并引发秋冬季诺如病毒急性胃肠炎的高位流行。     

双重荧光定量一步RT-PCR法同时检测GⅠ、GⅡ型诺如病毒

建立一种可同时检测诺如病毒GⅠ和GⅡ型的双重荧光定量一步法RT-PCR方法。应用针对GⅠ型和GⅡ型诺如病毒的特异性引物以及Taqman探针,优化反应体系及条件,建立双重荧光定量一步法RT-PCR方法。对该方法的灵敏度、特异性、重复性进行评估,并对粪便标本进行检测,以传统RT-PCR方法作为参考评价此方法。结果表明,该方法特异性强,与肠道腺病毒、轮状病毒、星状病毒均无交叉反应,对GⅠ和GⅡ型诺如病毒核酸的最低检出限分别可达103拷贝/μL,具有很好的重复性。对100份粪便标本进行检测,诺如病毒的阳性率为31%,其中GⅠ型为3%,GⅡ型为28%,而传统RT-PCR法的检出率为22%。本文建立的双重荧光定量一步RT-PCR法能同时对GI和GII型诺如病毒进行快速检测,其灵敏度高、特异性好,可应用于胃肠炎病人中检测诺如病毒。     

Evolutionary Phylodynamics of Korean Noroviruses Reveals a Novel GII.2/GII.10 Recombination Event

Viral gastroenteritis is the most common causal agent of public health problems worldwide. Noroviruses cause nonbacterial acute gastroenteritis in humans of all ages. In this study, we investigated the occurrence of norovirus infection in children with acute gastroenteritis admitted to university hospitals in South Korea. We also analyzed the genetic diversity of the viruses and identified novel recombination events among the identified viral strains. Of 502 children with acute gastroenteritis admitted to our three hospitals between January 2011 and March 2012, genotyping of human noroviruses was performed in 171 (34%) norovirus-positive samples. Of these samples, 170 (99.5%) were in genogroup II (GII), while only one (0.5%) was in genogroup I (GI). The most common GII strain was the GII.4-2006b variant (n = 96, 56.5%), followed by GII.6 (n = 23, 13.5%), GII.12 (n = 22, 12.9%), GII.3 (n = 20, 11.8%), GII.2 (n = 6, 3.5%), GII.b (n = 2, 1.2%), and GII.10 (n = 1, 0.6%). Potential recombination events (polymerase/capsid) were detected in 39 GII strains (22.9%), and the most frequent genotypes were GII.4/GII.12 (n = 12, 30.8%), GII.4/GII.6 (n = 12, 30.8%), GII.4/GII.3 (n = 8, 20.5%), GII.b/GII.3 (n = 3, 7.7%), GII.16/GII.2 (n = 2, 5.1%), GII.4/GII.2 (n = 1, 2.6%), and GII.2/GII.10 (n = 1, 2.6%). For the first time, a novel GII.2/GII.10 recombination was detected; we also identified the GII.16/GII.2 strain for the first time in South Korea. Our data provided important insights into new recombination events, which may prove valuable for predicting the emergence of circulating norovirus strains with global epidemic potential.     

Rapid Emergence of Novel GII.4 Sub-Lineages Noroviruses Associated with Outbreaks in Huzhou,China, 2008–2012

Infection caused by noroviruses (NoVs) is one of the most important causes of acute gastroenteritis in humans worldwide. To gain insight into the epidemiology of and genetic variation in NoV strains, stool samples collected from 18 outbreaks of acute gastroenteritis in Huzhou, China, between January 2008 and December 2012 were analyzed. Samples were tested for NoVs by real-time RT-PCR. Partial sequences of the RNA- dependent RNA polymerase (RdRp) and capsid gene of the positive samples were amplified by RT-PCR, and the PCR products were sequenced and used for phylogenetic analysis. NoVs were found to be responsible of 88.8% of all nonbacterial acute gastroenteritis outbreaks in Huzhou over the last 5 years. Genogroup II outbreaks largely predominated and represented 93% of all outbreaks. A variety of genotypes were found among genogroups I and II, including GI.4, GI.8, GII.4, and GII.b. Moreover, phylogenetic analyses identified two recombinant genotypes (polymerase/capsid): GI.2/GI.6 and GII.e/GII.4 2012 Sydney. GII.4 was predominant and involved in 8/10 typed outbreaks. During the study period, GII.4 NoV variants 2006b, New Orleans 2009, and Sydney 2012 were identified. This is the first report of the detection of GII.4 New Orleans 2009 variant, GII.e/GII.4 Sydney 2012 recombinant in outbreaks of acute gastroenteritis in China.     

Norovirus Recombinant Strains Isolated from Gastroenteritis Outbreaks in Southern Brazil, 2004–2011

Noroviruses are recognized as one of the leading causes of viral acute gastroenteritis, responsible for almost 50% of acute gastroenteritis outbreaks worldwide. The positive single-strand RNA genome of noroviruses presents a high mutation rate and these viruses are constantly evolving by nucleotide mutation and genome recombination. Norovirus recombinant strains have been detected as causing acute gastroenteritis outbreaks in several countries. However, in Brazil, only one report of a norovirus recombinant strain (GII.P7/GII.20) has been described in the northern region so far. For this study, 38 norovirus strains representative of outbreaks, 11 GII.4 and 27 non-GII.4, were randomly selected and amplified at the ORF1/ORF2 junction. Genetic recombination was identified by constructing phylogenetic trees of the polymerase and capsid genes, and further SimPlot and Bootscan analysis of the ORF1/ORF2 overlap. Sequence analysis revealed that 23 out of 27 (85%) non-GII.4 noroviruses were recombinant strains, characterized as: GII.P7/GII.6 (n = 9); GIIP.g/GII.12 (n = 4); GII.P16/GII.3 (n = 4); GII.Pe/GII.17 (n = 2); GII.P7/GII.14 (n = 1); GII.P13/GII.17 (n = 1); GII.P21/GII.3 (n = 1); and GII.P21/GII.13 (n = 1). On the other hand, among the GII.4 variants analyzed (Den Haag_2006b and New Orleans_2009) no recombination was observed. These data revealed the great diversity of norovirus recombinant strains associated with outbreaks, and describe for the first time these recombinant types circulating in Brazil. Our results obtained in southern Brazil corroborate the previous report for the northern region, demonstrating that norovirus recombinant strains are circulating more frequently than we expected. In addition, these results emphasize the relevance of including ORF1/ORF2-based analysis in surveillance studies as well as the importance of characterizing strains from other Brazilian regions to obtain epidemiological data for norovirus recombinant strains circulating in the country.     

Covariation of major and minor viral capsid proteins in norovirus genogroup II genotype 4 strains

We report sequence hypervariability in the viral protein 1 (VP1) interaction domain of VP2 in the norovirus (NoV) genogroup II genotype 4 (GII.4) lineage on 3 levels: (i) the global evolution of pandemic/epidemic strains from the mid-1970s through post-2006, (ii) the local emergence of an epidemic strain, and (iii) an immunocompromised patient chronically shedding NoV. When a quantitative yeast two-hybrid assay was used, VP2 was found to interact with VP1 in a time-ordered, strain-dependent manner among 3 NoV GII.4 strains. Our findings suggest that VP1 and VP2 may covary in virus evolution and that sequence hypervariability of VP2 may be functionally driven. Further investigations are warranted.     

Influence of Novel Norovirus GII.4 Variants on Gastroenteritis Outbreak Dynamics in Alberta and the Northern Territories,Canada between 2000 and 2008

Background

Norovirus GII.4 is the predominant genotype circulating worldwide over the last decade causing 80% of all norovirus outbreaks with new GII.4 variants reported in parallel with periodic epidemic waves of norovirus outbreaks. The circulating new GII.4 variants and the epidemiology of norovirus outbreaks in Alberta, Canada have not been described. Our hypothesis is that the periodic epidemic norovirus outbreak activity in Alberta was driven by new GII.4 variants evolving by genetic drift.

Methodology/Principal Findings

The Alberta Provincial Public Health Laboratory performed norovirus testing using RT-PCR for suspected norovirus outbreaks in the province and the northern Territories between 2000 and 2008. At least one norovirus strain from 707 out of 1,057 (66.9%) confirmed norovirus outbreaks were successfully sequenced. Phylogenetic analysis was performed using BioNumerics and 617 (91.1%) outbreaks were characterized as caused by GII.4 with 598 assigned as novel variants including: GII.4-1996, GII.4-2002, GII.4-2004, GII.4-2006a, GII.4-2006b, GII.4-2008a and GII.4-2008b. Defining July to June of the following year as the yearly observation period, there was clear biannual pattern of low and high outbreak activity in Alberta. Within this biannual pattern, high outbreak activity followed the emergence of novel GII.4 variants. The two variants that emerged in 2006 had wider geographic distribution and resulted in higher outbreak activity compared to other variants. The outbreak settings were analyzed. Community-based group residence was the most common for both GII.4 variants and non-GII.4 variants. GII.4 variants were more commonly associated with outbreaks in acute care hospitals while outbreaks associated non-GII.4 variants were more commonly seen in school and community social events settings (p<0.01).

Conclusions/Significance

The emergence of new norovirus GII.4 variants resulted in an increased norovirus outbreak activity in the following season in a unique biannual pattern in Alberta over an eight year period. The association between antigenic drift of GII.4 strains and epidemic norovirus outbreak activity could be due to changes in host immunity, viral receptor binding efficiency or virulence factors in the new variants. Early detection of novel GII.4 variants provides vital information that could be used to forecast the norovirus outbreak burden, enhance public health preparedness and allocate appropriate resources for outbreak management.     

The G428A Nonsense Mutation in FUT2 Provides Strong but Not Absolute Protection against Symptomatic GII.4 Norovirus Infection

In November 2004, 116 individuals in an elderly nursing home in El Grao de Castellón, Spain were symptomatically infected with genogroup II.4 (GII.4) norovirus. The global attack rate was 54.2%. Genotyping of 34 symptomatic individuals regarding the FUT2 gene revealed that one patient was, surprisingly, a non-secretor, hence indicating secretor-independent infection. Lewis genotyping revealed that Lewis-positive and negative individuals were susceptible to symptomatic norovirus infection indicating that Lewis status did not predict susceptibility. Saliva based ELISA assays were used to determine binding of the outbreak virus to saliva samples. Saliva from a secretor-negative individual bound the authentic outbreak GII.4 Valencia/2004/Es virus, but did not in contrast to secretor-positive saliva bind VLP of other strains including the GII.4 Dijon strain. Amino acid comparison of antigenic A and B sites located on the external loops of the P2 domain revealed distinct differences between the Valencia/2004/Es and Dijon strains. All three aa in each antigenic site as well as 10/11 recently identified evolutionary hot spots, were unique in the Valencia/2004/Es strain compared to the Dijon strain. To the best of our knowledge, this is the first example of symptomatic GII.4 norovirus infection of a Le^a+b− individual homozygous for the G428A nonsense mutation in FUT2. Taken together, our study provides new insights into the host genetic susceptibility to norovirus infections and evolution of the globally dominating GII.4 viruses.     

Characterization of norovirus infections in Seoul,Korea

The present study has determined the detection rate of norovirus (NoV) with acute gastroenteritis (AGE) in hospitalized children and describes the molecular epidemiology of NoV circulating in Seoul, Korea. Six hundred and eighty‐three (9.8%) of samples were positive for NoV. Of these, the NoV GII genogroup was the most commonly found, with a prevalence of 96.2% (683 of 710). Only 27 samples were positive for the NoV GI genogroup. Ten kinds of GI genotype (GI/1, GI/2, GI/3, GI/4, GI/5, GI/6, GI/7, GI/9, GI/12, and GI/13) and eight kinds of GII genotype (GII/2, GII/3, GII/4, GII/8, GII/14, GII/15, GII/16, and GII/17) were identified in children with AGE during the years 2008–2011.     

Noroviruses distinguish between type 1 and type 2 histo-blood group antigens for binding

Norovirus (NoV) is a causative agent of acute gastroenteritis. NoV binds to histo-blood group antigens (HBGAs), namely, ABH antigens and Lewis (Le) antigens, in which type 1 and type 2 carbohydrate core structures constitute antigenically distinct variants. Norwalk virus, the prototype strain of norovirus, binds to the gastroduodenal junction, and this binding is correlated with the presence of H type 1 antigen but not with that of H type 2 antigen (S. Marionneau, N. Ruvoen, B. Le Moullac-Vaidye, M. Clement, A. Cailleau-Thomas, G. Ruiz-Palacois, P. Huang, X. Jiang, and J. Le Pendu, Gastroenterology 122:1967-1977, 2002). It has been unknown whether NoV distinguishes between the type 1 and type 2 chains of A and B antigens. In this study, we synthesized A type 1, A type 2, B type 1, and B type 2 pentasaccharides in vitro and examined the function of the core structures in the binding between NoV virus-like particles (VLPs) and HBGAs. The attachment of five genogroup I (GI) VLPs from 5 genotypes and 11 GII VLPs from 8 genotypes, GI/1, GI/2, GI/3, GI/4, GI/8, GII/1, GII/3, GII/4, GII/5, GII/6, GII/7, GII/12, and GII/14, to ABH and Le HBGAs was analyzed by enzyme-linked immunosorbent assay-based binding assays and Biacore analyses. GI/1, GI/2, GI/3, GI/4, GI/8, and GII/4 VLPs were more efficiently bound to A type 2 than A type 1, and GI/8 and GII/4 VLPs were more efficiently bound to B type 2 than B type 1, indicating that NoV VLPs distinguish between type 1 and type 2 carbohydrates. The dissociation of GII/4 VLPs from B type 1 was slower than that from B type 2 in the Biacore experiments; moreover, the binding to B type 1 was stronger than that to B type 2 in the ELISA experiments. These results indicated that the type 1 carbohydrates bind more tightly to NoV VLPs than the type 2 carbohydrates. This property may afford NoV tissue specificity. GII/4 is known to be a global epidemic genotype and binds to more HBGAs than other genotypes. This characteristic may be linked with the worldwide transmission of GII/4 strains. GI/2, GI/3, GI/4, GI/8, GII/4, and GII/7 VLPs bound to Le(a) expressed by nonsecretors, suggesting that NoV can infect individuals regardless of secretor phenotype. Overall, our results indicated that HBGAs are important factors in determining tissue specificity and the risk of transmission.