title: An outbreak of norovirus genogroup II associated with New South Wales oysters.
abstract: Currently available antigen tests for norovirus (NoV) have excellent specificity but negative results do not always rule out infection. Real-time reverse transcription polymerase chain reaction (RT-PCR) is a useful method for detecting and genotyping NoV in humans and oysters. An outbreak of NoV associated with oyster consumption in northern New South Wales confirmed the value of real-time RT-PCR where immunochromatography (ICT) tests were negative.
  
  
  
  Eight cases of gastrointestinal illness in northern NSW, clinically suggestive of NoV infection, were associated with consumption of oysters. A joint environmental investigation was conducted by the New South Wales Food Authority and local council. One human sample was collected and tested for NoV using ICT and real-time RT-PCR. Oyster samples were tested for NoV utilising real-time RT-PCR.
  
  
  
  The patient with a stool sample had NoV genogroup II (GII) confirmed by real-time RT-PCR after testing negative by ICT. Illness in all cases was consistent with NoV with median incubation and duration of 36 and 50.5 hours respectively. All cases consumed oysters that were harvested from the same area. Three oyster samples from the harvest area were also positive for NoV GII. A nearby leaking sewer line was identified as the likely source of the contamination with hydrological studies confirming its potential to contaminate implicated oyster leases.
  
  
  
  This investigation confirmed the value of real-time RT-PCR testing of human specimens where ICT tests are negative and clinical illness is suggestive of NoV infection. NoV real-time RT-PCR and epidemiological evidence effectively linked human infection with oyster contamination to motivate a thorough environmental investigation and appropriate action to mitigate further public health risk.
authors.affiliation: OzFoodNet, Hunter New England Population Health, Wallsend, New South Wales and Australian National University, Acton, Australian Capital Territory.
authors.forename: Tove L
authors.initials: TL
authors.lastname: Fitzgerald
authors.affiliation: OzFoodNet, Hunter New England Population Health, Wallsend, New South Wales.
authors.forename: Tony D
authors.initials: TD
authors.lastname: Merritt
authors.affiliation: NSW Shellfish Program, New South Wales Food Authority, New South Wales.
authors.forename: Anthony
authors.initials: A
authors.lastname: Zammit
authors.affiliation: South Australian Research and Development Institute, South Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: McLeod
authors.affiliation: South Australian Research and Development Institute, South Australia.
authors.forename: Lina M
authors.initials: LM
authors.lastname: Landinez
authors.affiliation: School of Biotechnology and Biomolecular Sciences.
authors.forename: Peter A
authors.initials: PA
authors.lastname: White
authors.affiliation: OzFoodNet, Hunter New England Population Health, Wallsend, New South Wales.
authors.forename: Sally A
authors.initials: SA
authors.lastname: Munnoch
authors.affiliation: Hunter Medical Research Institute, Newcastle, New South Wales.
authors.forename: David N
authors.initials: DN
authors.lastname: Durrheim
mesh_terms: D000368:Aged; D000818:Animals; D017250:Caliciviridae Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission*; D004196:Disease Outbreaks; D005260:Female; D005517:Foodborne Diseases / Q000175:diagnosis / Q000453:epidemiology; D005759:Gastroenteritis / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology*; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D029322:Norovirus / Q000145:classification* / Q000235:genetics*; D010125:Ostreidae; D011159:Population Surveillance