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

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

2024 | Katherine B. Carlson, Anne Dilley, Thomas O'Grady, Jordan A. Johnson, Ben Lopman & Emma Viscidi
Norovirus is a leading cause of acute gastroenteritis (AGE) globally, responsible for millions of cases and deaths annually. It is highly contagious, spreads easily through the fecal-oral route, and causes severe illness in vulnerable populations such as young children, the elderly, and immunocompromised individuals. Norovirus outbreaks are common in healthcare settings, long-term care facilities, and other closed environments, leading to high attack rates and significant economic and clinical burdens. Despite its high prevalence, there are no FDA-approved vaccines, though several candidates are in development. Norovirus is genetically diverse, with multiple genogroups and genotypes circulating globally. GII.4 is the most common genotype, but other genotypes such as GII.2, GII.3, and GII.6 also contribute to disease. The virus has a short incubation period and high transmissibility, making outbreaks difficult to control. Transmission occurs through person-to-person contact, contaminated food, or water, and asymptomatic individuals can also shed the virus. Immunity to norovirus is limited and often short-lived, with no clear cross-genotype protection. Vaccine development is challenging due to the virus's genetic diversity and the lack of a robust cell culture system. Current vaccine candidates include virus-like particles (VLPs), mRNA, and adenovirus vectors. A bivalent vaccine targeting GII.4 and GI.1 has shown promise in clinical trials, but more research is needed to evaluate its effectiveness. Norovirus causes substantial morbidity and mortality, with significant economic and healthcare impacts. The lack of standardized testing outside outbreak settings makes it difficult to estimate the true burden of the disease. A vaccine could significantly reduce the global burden of norovirus-related illness and death, particularly in vulnerable populations. Continued research and surveillance are essential to improve understanding of norovirus epidemiology and to develop effective prevention strategies.Norovirus is a leading cause of acute gastroenteritis (AGE) globally, responsible for millions of cases and deaths annually. It is highly contagious, spreads easily through the fecal-oral route, and causes severe illness in vulnerable populations such as young children, the elderly, and immunocompromised individuals. Norovirus outbreaks are common in healthcare settings, long-term care facilities, and other closed environments, leading to high attack rates and significant economic and clinical burdens. Despite its high prevalence, there are no FDA-approved vaccines, though several candidates are in development. Norovirus is genetically diverse, with multiple genogroups and genotypes circulating globally. GII.4 is the most common genotype, but other genotypes such as GII.2, GII.3, and GII.6 also contribute to disease. The virus has a short incubation period and high transmissibility, making outbreaks difficult to control. Transmission occurs through person-to-person contact, contaminated food, or water, and asymptomatic individuals can also shed the virus. Immunity to norovirus is limited and often short-lived, with no clear cross-genotype protection. Vaccine development is challenging due to the virus's genetic diversity and the lack of a robust cell culture system. Current vaccine candidates include virus-like particles (VLPs), mRNA, and adenovirus vectors. A bivalent vaccine targeting GII.4 and GI.1 has shown promise in clinical trials, but more research is needed to evaluate its effectiveness. Norovirus causes substantial morbidity and mortality, with significant economic and healthcare impacts. The lack of standardized testing outside outbreak settings makes it difficult to estimate the true burden of the disease. A vaccine could significantly reduce the global burden of norovirus-related illness and death, particularly in vulnerable populations. Continued research and surveillance are essential to improve understanding of norovirus epidemiology and to develop effective prevention strategies.
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