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Epidemiology of human noroviruses and updates on vaccine development

Ramani, Sasirekhaa; Atmar, Robert L.a,b; Estes, Mary K.a,b

Current Opinion in Gastroenterology: January 2014 - Volume 30 - Issue 1 - p 25–33
doi: 10.1097/MOG.0000000000000022

Purpose of review Noroviruses (NoVs) are the most common cause of epidemic and sporadic cases of acute gastroenteritis worldwide. This review summarizes recent NoV disease burden estimates, epidemiology findings and provides an update on virus-like particle (VLP) vaccine studies.

Recent findings NoVs are the leading cause of food-borne gastroenteritis and are replacing rotavirus as the predominant gastrointestinal pathogen in pediatric populations. Genogroup II, genotype 4 NoVs (GII.4) remain the dominant genotype worldwide. Increased NoV activity reported in late 2012 was associated with the emergence of a new GII.4 variant called Sydney 2012. New studies suggest that human NoVs can bind a larger range of histoblood group antigens, a susceptibility factor for NoV illness, thus expanding the susceptible population pool for infection. Intranasal immunization with a monovalent GI NoV VLP vaccine showed proof-of-concept efficacy. Studies using intramuscular immunization with a bivalent formulation including GII.4 VLPs are now underway.

Summary The importance of NoVs as a major gastrointestinal pathogen underscores the need for well tolerated and effective vaccines. Results of VLP vaccine trials appear promising. However, the rapid evolution of NoV genotypes through antigenic drift and changing glycan specificities provide new challenges to epidemiology studies and vaccine trials.

aDepartment of Molecular Virology and Microbiology

bDepartment of Medicine, Baylor College of Medicine, Houston, Texas, USA

Correspondence to Dr Mary K. Estes, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, USA. Tel: +1 713 798 3585; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins