title: Detection of norovirus in mouthwash samples from patients with acute gastroenteritis.
abstract: BACKGROUND
  Norovirus infection is characteristically associated with vomiting which is known to contain a high concentration of viral particles. The oral cavity is therefore likely to become contaminated with norovirus during episodes of gastroenteritis.
  
  
  OBJECTIVE
  To investigate the oral detection of norovirus in patients with norovirus gastroenteritis.
  
  
  METHODS
  Faecal and oral mouthwash samples were collected in two separate settings. In the first setting, samples were collected repeatedly over a 3-week period from six family members experiencing a domestic outbreak of norovirus gastroenteritis. Secondly, samples were collected at a single time point following disease onset from 59 patients hospitalised with norovirus gastroenteritis. Norovirus detection in oral and faecal samples was undertaken by RT-PCR.
  
  
  RESULTS
  In the family study, norovirus was detected in early morning mouthwash samples for 10-15 days following disease onset from each of six family members. In the hospital study, 14/59 hospitalised adults with norovirus infection had norovirus detected in mouthwashes (24%; 14-37% 95% C.I.). For the hospitalised adults, the detection of norovirus in mouthwash samples was associated with the presence of vomiting (p=0.1); and in those patients with norovirus infection whose mouthwash samples were collected within 24h of the onset of vomiting, 59% (10/17) had norovirus detected.
  
  
  CONCLUSIONS
  Oral mouthwashes may provide an adjunct to faecal sampling to support the diagnosis of norovirus infection. The detection of norovirus in orally-derived material raises the possibility of oral-to-oral norovirus transmission, and that this potential for transmission may extend beyond the immediate symptomatic period.
authors.affiliation: School of Infection & Host Defence, University of Liverpool, 8th Floor Duncan Building, Daulby Street, Liverpool L69 3GA, UK. amk@liv.ac.uk
authors.forename: Andrew
authors.initials: A
authors.lastname: Kirby
authors.forename: Winifred
authors.initials: W
authors.lastname: Dove
authors.forename: Lynne
authors.initials: L
authors.lastname: Ashton
authors.forename: Mark
authors.initials: M
authors.lastname: Hopkins
authors.forename: Nigel A
authors.initials: NA
authors.lastname: Cunliffe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017250:Caliciviridae Infections / Q000821:virology*; D005243:Feces / Q000821:virology; D005759:Gastroenteritis / Q000821:virology*; D006801:Humans; D008875:Middle Aged; D009055:Mouth / Q000821:virology*; D029322:Norovirus / Q000235:genetics / Q000302:isolation & purification*; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification; D020133:Reverse Transcriptase Polymerase Chain Reaction; D007507:Therapeutic Irrigation
chemical_list: D012367:RNA, Viral