Emergence of norovirus GII.17[P16] in adult patients with acute gastroenteritis in Thailand during 2021−2023

Abstract

Background Human norovirus is a major cause of acute gastroenteritis across all age groups. This study investigated the prevalence, genotypes, and viral loads of noroviruses in adult patients with acute gastroenteritis. Methods A hospital-based cross-sectional study was conducted between December 2021 and March 2023 in Thailand. The presence of noroviruses GI and GII in stool samples from patients with acute gastroenteritis were tested using RT-nested PCR and DNA sequencing. All norovirus GII-positive samples were further characterized by polymerase-capsid typing assay and semi-nested RT-PCR. Norovirus GII concentrations were determined by RT-qPCR. Results Norovirus GII was detected in 11.2% (28/250) of stool samples. Genotyping of the VP1 and RdRp genes identified GII.4 Sydney 2012[P31], GII.17[P17], and GII.17[P16], with GII.17[P16] being the most frequently detected. Of 28 norovirus GII-positive samples, the most common genotype was GII.17 (35.7%), followed by GII.17[P16] (32.1%), GII.17[P17] (14.3%), GII.4 Den Haag (7.1%), and GII.4 Sydney 2012[P31], GII.3 and GII.2 (3.6% each). GII.4 Sydney[P31] infections had the highest viral load (8.3×10⁹ genome copies/g), followed by GII.17[P17] (8.9×10⁵−4.5×10⁸ genome copies/g) and GII.17[P16] (3.7×10⁴−1.6×10⁷ genome copies/g). GII.3 (2.4×10⁴ genome copies/g), GII.4 Den Haag (1.7×10⁴ and 3.8×10⁴ genome copies/g) and GII.17 (2.4×10^3–7.4×104 genome copies/g) exhibited lower viral concentrations. Conclusions These findings provide important epidemiological insights into norovirus circulation, highlighting the emergence of GII.17[P16] and informing future outbreak preparedness and vaccine development.