title: Epidemic spread of recombinant noroviruses with four capsid types in Hungary.
abstract: BACKGROUND
  Noroviruses are common pathogens in gastro-enteritis outbreaks in humans worldwide. Noroviruses are genetically diverse group of viruses with multiple genogroups (GG) and genotypes. More recently, naturally occurring recombinant noroviruses were described. These viruses had a distinct polymerase gene sequence (designated GGIIb/Hilversum) and were disseminated through waterborne and food-borne transmission in Europe.
  
  
  OBJECTIVE
  Our aim was to characterize these emerging recombinant noroviruses causing outbreaks of gastro-enteritis in Hungary.
  
  
  METHODS
  From January 2001 to May 2004, samples containing "GGIIb/Hilversum polymerase" (GGIIb-pol) were selected for analysis of the viral capsid region (ORF2) by reverse transcription-polymerase chain reaction (RT-PCR) and sequencing.
  
  
  RESULTS
  Thirty-four (14.4%) of 236 confirmed norovirus outbreaks were caused by the variant lineage with the GGIIb-pol. Four different recombinants were detected with capsids of Hu/NLV/GGII/Mexico/1989 (n=9, 43%), Hu/NLV/GGII/Snow Mountain/1976 (n=6, 28%), Hu/NLV/GGII/Hawaii/1971 (n=4, 19%) and Hu/NLV/GGII/Lordsdale/1993 (n=1, 5%).
  
  
  CONCLUSIONS
  In Hungary, emerging recombinant noroviruses became the second most common norovirus variants-next to GGII-4/Lordsdale virus-causing epidemics of gastroenteritis in the last 4 years.
authors.affiliation: Regional Laboratory of Virology, ANTSZ Baranya County Institute of State Public Health Service, Szabadság ut 7, H-7623 Pécs, Hungary. reuterg@baranya.antsz.hu
authors.forename: Gábor
authors.initials: G
authors.lastname: Reuter
authors.forename: Harry
authors.initials: H
authors.lastname: Vennema
authors.forename: Marion
authors.initials: M
authors.lastname: Koopmans
authors.forename: György
authors.initials: G
authors.lastname: Szücs
mesh_terms: D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D002213:Capsid / Q000145:classification*; D021821:Communicable Diseases, Emerging / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D004196:Disease Outbreaks; D005759:Gastroenteritis / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D017720:Molecular Epidemiology; D008969:Molecular Sequence Data; D029322:Norovirus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D010802:Phylogeny; D011995:Recombination, Genetic; D017422:Sequence Analysis, DNA