Comment
than 5 years.4 With the widespread availability of effective rotavirus vaccines, the burden of norovirus-induced gastroenteritis will inevitably increase, especially in children. In fact, in countries where universal vaccination against rotavirus disease has been introduced and undertaken for more than 2 years, noroviruses have become the main cause of acute gastroenteritis in children.9–11 Therefore the study by Ahmed and colleagues4 supports the endeavors to develop norovirus vaccines. Large challenges still exist in the development of vaccine strategies that would provide broadly cross-protective immune responses. The inability to propagate human norovirus in cell culture has substantially hindered the identification of neutralising antibody epitopes, although these restrictions have been partly overcome. Thus, the development of a universal, probably multivalent norovirus vaccine might be well within reach.12 This development makes research on norovirus biology, virus– host associations, epidemiology, and evolution much more important.
We declare no competing interests.
Ulrich Desselberger, Ian Goodfellow
12
Department of Medicine (UD), Division of Virology, Department of Pathology (IG), University of Cambridge, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK [email protected]
1
2
3 4
5 6
7
8 9
10 11
Kapikian AZ, Wyatt RG, Dolin R, Thornhill TS, Kalica AR, Chanock RM. Visualization by immune electron microscopy of a 27-nm particle associated with acute infectious nonbacterial gastroenteritis. J Virol 1972; 10: 1075–81. Bishop RF, Davidson GP, Holmes IH, Ruck BJ. Virus particles in epithelial cells of duodenal mucosa from children with acute non-bacterial gastroenteritis. Lancet 1973; 2: 1281–83. Flewett TH, Bryden AS, Davies H. Letter: Virus particles in gastroenteritis. Lancet 1973; 2: 1497. Ahmed SM, Hall AJ, Robinson AE, et al. The global prevalence of norovirus among cases of gastroenteritis: a systematic review and meta-analysis. Lancet Infect Dis 2014; published online June 27. http://dx.doi.org/10.1016/S14733099(14)70767-4 Hall AJ, Lopman BA, Payne DC, et al. Norovirus disease in the United States. Emerg Infect Dis 2013; 19: 1198–205. Patel MM, Widdowson MA, Glass RI, Akazawa K, Vinjé J, Parashar UD. Systematic literature review of role of noroviruses in sporadic gastroenteritis. Emerg Infect Dis 2008; 14: 1224–31. Donaldson EF, Lindesmith LC, Lobue AD, Baric RS. Viral shape-shifting: norovirus evasion of the human immune system. Nat Rev Microbiol 2010; 8: 231–41. Bok K, Green KY. Norovirus gastroenteritis in immunocompromised patients. N Engl J Med 2012; 367: 2126–32. Koo HL, Neill FH, Estes MK, et al. Noroviruses: the most common pediatric viral enteric pathogen at a large university hospital after introduction of rotavirus vaccination. J Pediatr Infect Dis Soc 2013; 2: 57–60. Payne DC, Vinjé J, Szilagyi PG, et al. Norovirus and medically attended gastroenteritis in US children. N Engl J Med 2013; 368: 1121–30. Hemming M, Räsänen S, Huhti L, Paloniemi M, Salminen M, Vesikari T. Major reduction of rotavirus, but not norovirus, gastroenteritis in children seen in hospital after the introduction of RotaTeq vaccine into the National Immunization Programme in Finland. Eur J Pediatr 2013; 172: 739–46. Debbink K, Lindesmith LC, Baric RS. The state of norovirus vaccines. Clin Infect Dis 2014; 58: 1746–52.
In May this year, the World Health Assembly endorsed the Every Newborn Action Plan—the first global plan to end preventable deaths in newborn babies and stillbirths.1,2 Melinda Gates assured the delegates at the Assembly that the Bill & Melinda Gates Foundation is committed to the “triple investment” of preventing maternal and newborn deaths and stillbirths,2 and The Lancet has published the Every Newborn Series. These initiatives should be seen in the context of the efforts to achieve the Millennium Development Goal, during which child mortality (
than 5 years.4 With the widespread availability of effective rotavirus vaccines, the burden of norovirus-induced gastroenteritis will inevitably increase, especially in children. In fact, in countries where universal vaccination against rotavirus disease has been introduced and undertaken for more than 2 years, noroviruses have become the main cause of acute gastroenteritis in children.9–11 Therefore the study by Ahmed and colleagues4 supports the endeavors to develop norovirus vaccines. Large challenges still exist in the development of vaccine strategies that would provide broadly cross-protective immune responses. The inability to propagate human norovirus in cell culture has substantially hindered the identification of neutralising antibody epitopes, although these restrictions have been partly overcome. Thus, the development of a universal, probably multivalent norovirus vaccine might be well within reach.12 This development makes research on norovirus biology, virus– host associations, epidemiology, and evolution much more important.
We declare no competing interests.
Ulrich Desselberger, Ian Goodfellow
12
Department of Medicine (UD), Division of Virology, Department of Pathology (IG), University of Cambridge, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK [email protected]
1
2
3 4
5 6
7
8 9
10 11
Kapikian AZ, Wyatt RG, Dolin R, Thornhill TS, Kalica AR, Chanock RM. Visualization by immune electron microscopy of a 27-nm particle associated with acute infectious nonbacterial gastroenteritis. J Virol 1972; 10: 1075–81. Bishop RF, Davidson GP, Holmes IH, Ruck BJ. Virus particles in epithelial cells of duodenal mucosa from children with acute non-bacterial gastroenteritis. Lancet 1973; 2: 1281–83. Flewett TH, Bryden AS, Davies H. Letter: Virus particles in gastroenteritis. Lancet 1973; 2: 1497. Ahmed SM, Hall AJ, Robinson AE, et al. The global prevalence of norovirus among cases of gastroenteritis: a systematic review and meta-analysis. Lancet Infect Dis 2014; published online June 27. http://dx.doi.org/10.1016/S14733099(14)70767-4 Hall AJ, Lopman BA, Payne DC, et al. Norovirus disease in the United States. Emerg Infect Dis 2013; 19: 1198–205. Patel MM, Widdowson MA, Glass RI, Akazawa K, Vinjé J, Parashar UD. Systematic literature review of role of noroviruses in sporadic gastroenteritis. Emerg Infect Dis 2008; 14: 1224–31. Donaldson EF, Lindesmith LC, Lobue AD, Baric RS. Viral shape-shifting: norovirus evasion of the human immune system. Nat Rev Microbiol 2010; 8: 231–41. Bok K, Green KY. Norovirus gastroenteritis in immunocompromised patients. N Engl J Med 2012; 367: 2126–32. Koo HL, Neill FH, Estes MK, et al. Noroviruses: the most common pediatric viral enteric pathogen at a large university hospital after introduction of rotavirus vaccination. J Pediatr Infect Dis Soc 2013; 2: 57–60. Payne DC, Vinjé J, Szilagyi PG, et al. Norovirus and medically attended gastroenteritis in US children. N Engl J Med 2013; 368: 1121–30. Hemming M, Räsänen S, Huhti L, Paloniemi M, Salminen M, Vesikari T. Major reduction of rotavirus, but not norovirus, gastroenteritis in children seen in hospital after the introduction of RotaTeq vaccine into the National Immunization Programme in Finland. Eur J Pediatr 2013; 172: 739–46. Debbink K, Lindesmith LC, Baric RS. The state of norovirus vaccines. Clin Infect Dis 2014; 58: 1746–52.
In May this year, the World Health Assembly endorsed the Every Newborn Action Plan—the first global plan to end preventable deaths in newborn babies and stillbirths.1,2 Melinda Gates assured the delegates at the Assembly that the Bill & Melinda Gates Foundation is committed to the “triple investment” of preventing maternal and newborn deaths and stillbirths,2 and The Lancet has published the Every Newborn Series. These initiatives should be seen in the context of the efforts to achieve the Millennium Development Goal, during which child mortality (
