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Journal of Clinical Microbiology, September 2000, p. 3370-3374, Vol. 38, No. 9
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.
Molecular Characterization of Rotavirus in Ireland:
Detection of Novel Strains Circulating in the Population
F.
O'Halloran,1
M.
Lynch,2,3
B.
Cryan,2
H.
O'Shea,4 and
S.
Fanning1,*
Molecular Diagnostics
Unit1 and Department of Biological
Sciences,4 Cork Institute of Technology,
Bishopstown, and Department of Medical Microbiology, Cork
University Hospital, Wilton,2 Cork, Ireland, and
Viral Gastroenteritis Section, MS G-04, Centers for Disease
Control and Prevention, Atlanta, Georgia 303333
Received 10 April 2000/Returned for modification 31 May
2000/Accepted 12 July 2000
 |
ABSTRACT |
A collection of three hundred thirty rotavirus-positive stool
samples from children with diarrhea in the southern and eastern regions
of Ireland between 1997 and 1999 were submitted to the Molecular
Diagnostics Unit of the Cork Institute of Technology, Cork, Ireland,
for investigation. These strains were characterized by several methods,
including polyacrylamide gel electropherotyping and G and P genotyping.
A subset of the G types was confirmed by nucleic acid sequencing. The
most prevalent types found in this collection included G1P[8]
(n = 106; 32.1%), G2P[4] (n = 94;
28.5%), and G4P[8] (n = 37; 11.2%). Novel strains
were also detected, including G1P[4] (n = 19;
5.8%), and G4P[4] (n = 2; 0.6%). Interestingly,
mixed infections accounted for 18.8% (n = 62) of the
total collection, with only 3% (n = 10) which were not G and/or P typeable. Significantly, six G8 and five G9 strains were
identified as part of mixed infections. These strains have not
previously been identified in Irish children, suggesting a greater
diversity in rotavirus strains currently circulating in Ireland.
 |
INTRODUCTION |
Rotavirus is the primary etiological
agent of gastroenteritis in infants and young children worldwide
(26). In developing countries, it is estimated that
rotavirus is responsible for one-third of all diarrhea-associated
hospitalizations and 873,000 deaths annually (8, 23). In
industrialized countries, where mortality due to rotavirus is low,
infection is widespread and nearly all children experience an episode
of rotavirus diarrhea in the first 5 years of life (42, 50).
National surveillance data from the Infoscan platform confirmed that
rotavirus is the most common pathogen among Irish children hospitalized
for gastroenteritis (10). Availability of a rotavirus
vaccine would have the potential to reduce the impact of rotavirus
disease in these settings (7, 25, 48).
Characterization of the rotavirus genome by gel electrophoresis is a
technique widely used to distinguish virus isolates and monitor virus
transmission (45). Migration of the double-stranded RNA
segments in polyacrylamide gels is the most frequently used method,
generating distinct electropherotype patterns. Serotypes are defined by
antigen-based methods (e.g., enzyme immunoassays) or molecular methods,
including reverse transcriptase (RT)-mediated PCR. The combined use of
electropherotype and serotyping protocols is useful in defining the
epidemiology of rotavirus and identifying any novel strains in
circulation (3).
A dual system of reporting rotavirus serotypes exists due to the
neutralizing response evoked by two viral proteins, VP7 and VP4
(15). The VP7-related serotypes are designated G types, and
those derived from VP4 are described as P types. To date, 14 G
serotypes have been defined by neutralization assays and 10 of these
have been identified in humans (13, 44). Genetic studies on
human rotavirus gene segment 4 have revealed 20 different P genotypes,
and at least 7 of these were confirmed by serological assay (9,
32). An association between certain G and P types has been
observed (22).
Extensive epidemiological studies in several health care systems
characterizing rotavirus strains have identified the prevalent serotypes circulating in children within different populations. The
predominating G types were G1 to G4 (5, 19, 38, 49). Recently, these strains were also confirmed in a small group of rotavirus isolates from Irish children presenting with diarrhea (34). The first licensed human rotavirus vaccine, the rhesus rotavirus vaccine, was withdrawn recently because of an association between vaccination and increased rates of intussusception among vaccine recipients (6). This vaccine was formulated to
produce serotype-specific protection against the four common serotypes, G1 to G4 (15). However, other, unconventional serotypes are now being reported, including G5, G8, and G10 in Brazil (1, 29,
44) and G9 in Bangladesh (49), India, and the United States (12, 37, 38). Serotype G8 has also been detected in
the United Kingdom, South Africa, and Australia (11, 35, 46). The efficacy of the recently suspended rhesus vaccine is unknown in these settings, and future candidate rotavirus vaccines may
need to incorporate other serotypes.
To extend these observations to a larger collection of 330 Irish
rotavirus strains, we examined the distribution of G and P types by
molecular methods and polyacrylamide gel electropherotyping. A higher
proportion of mixed-type infections, together with unconventional serotypes, were noted, suggesting that a complex pool of rotavirus exists which has not been identified previously.
 |
MATERIALS AND METHODS |
Rotavirus detection.
Three hundred thirty fecal samples from
Irish children with ages ranging from 1 month to 2 years were obtained
from four large centers in the southern and eastern regions of Ireland.
The samples were identified as rotavirus positive by antigen detection
strategies, including enzyme immunoassays (Abbott Laboratories, Dublin,
Ireland) and latex agglutination tests (Orion Diagnostics, Espoo,
Finland). Fecal filtrates were stored at
20°C prior to analysis.
RNA extraction and polyacrylamide gel electropherotyping.
The double-stranded RNA segmented genome characteristic of rotavirus
was isolated from samples using a standard phenol-chloroform extraction
method with ethanol precipitation (17). Samples were analyzed by agarose gel electrophoresis, and RNA was treated with DNase
1 (Roche Molecular Biochemicals, East Sussex, United Kingdom) to remove
contaminating genomic DNA. Electropherotypes of strains were determined
using a 10% polyacrylamide gel with a discontinuous buffer system
(27), followed by silver staining by the method of Herring
et al. (21).
Rotavirus typing.
To determine the G and P types, RT-PCR
assays were performed. Initially, 1,062-bp (full-length) gene segment
9, encoding the VP7 glycoprotein in human group A rotaviruses, was
amplified using primer Beg9 (5'-GGC TTT AAA AGA GAG AAT TTC CGT CTG
G-3') in the forward direction and primer End9 (5'-GGT CAC ATC ATA CAA
TTC TAA TCT AAG-3') in the reverse direction. This was followed by multiplex heminested PCR using the serotype-specific primers which identify G types (17). To identify P genotypes, a DNA
fragment of 867 bp, from gene segment 4 (encoding VP4), was amplified
using primers Con2 (5'-ATT TCG GAC CAT TTA TAA CC-3'; forward) and Con3 (5'-TGG CTT CGC CAT TTT ATA GAC A-3'; reverse), followed by genotyping with P-typing primers (14).
Amplified products from the RT-PCR assays were analyzed in conventional
1.5 and 2% agarose gels stained with ethidium bromide (0.1 mg/ml) and
visualized over a transilluminator. Tissue culture-adapted control
strains included Wa (G1P[8]), DS-1 (G2P[4]), P(G3P[8]), ST3
(G4P[6]), and F45(G9P[8]) (22). These were stored at
80°C.
Nucleic acid sequencing.
A subset of DNA fragments were
chosen to confirm the authenticity of the resulting DNA amplicons after
G typing. These amplicons were cloned and sequenced using dye
terminator chemistry protocols with cycle sequencing (Beckman
Instruments, Inc., Fullerton, Calif.). BLAST analysis identified them
as G1, G2, and G4 serotypes, confirming the accuracy of the RT-PCR
typing protocol.
Nucleotide sequence accession numbers.
Three of the
VP7-encoded sequences described here were submitted to the GenBank
database and assigned accession numbers AF254138, AF254139, and
AF254140.
 |
RESULTS |
Fecal specimens (330 in total) were collected from Irish infants
and children with clinically defined gastroenteritis between 1997 and
1999. Samples were identified as positive for rotavirus by antigen
detection strategies, including enzyme immunoassays and latex
agglutination tests. Rotavirus RNA was purified and used as the
template to characterize each isolate.
Determination of G and P genotypes.
The application of RT-PCR
to characterize rotavirus G and P genotypes is a widely used and
sensitive technique (9, 13, 31). The distribution of the
genotypes found over the 3-year period, as identified by this method,
is described in Table 1. Only 3%
(n = 10) of the isolates tested could not be assigned a
G and/or P type. Three of the four most common strains found worldwide
were also found to predominate in this collection. The most prevalent
type was G1P[8], accounting for 32.1% (n = 106) of
the strains. The frequency of G2P[4] was similar at 28.5%
(n = 94), and G4P[8] strains comprised 11.2%
(n = 37) of the collection. G3 serotypes were not found
as single infections but were identified as components of mixed
infections with G1. Of interest was the detection of some uncommon
types, including G1P[4] (5.8%) and G4P[4] (0.6%). These strains
have not previously been identified in this country. The number of
mixed infections was also high, constituting 18.8% (n = 62) of the collection, and several unconventional G and P type
combinations were detected, although at low frequency. Mixed infections
were present in all age groups from 1 through 24 months. Significantly,
G8 and G9 serotypes were identified in the mixed infections. Five G9
strains were found in mixed infections with G4 (Fig. 1, lanes 6 and
7) and associated with a P[8] genotype. These strains were isolated in 1998 (Table 1). G8 serotypes occurred with both G1 and G2 types. One sample was identified by PCR typing as
containing G2, G4, and G8 serotypes (Fig. 1, lane 12). The number of G8
mixed infections increased from two in 1997 to four in 1998. No G8
serotypes were detected in 1999, although the number of isolates tested
was lower.

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FIG. 1.
Representative G types determined by RT-PCR and detected
by conventional 2% agarose gel electrophoresis. Lanes: M 100-bp
molecular size marker ladder (Roche Biochemicals); 1 and 4, G1 types; 2 and 5, G2 types; 3, G4 type; 6 through 12, mixed G types, including, in
lanes 6 and 7, mixed G4 and G9 types; 8, mixed G1 and G3 types; 9, 11, and 12, mixed types with G8; 10, G1 type mixed with G2.
|
|
Examination of electropherotypes.
Many studies have used
electropherotyping as a means of characterizing rotaviruses (20,
24, 28, 41, 43, 45, 46, 51). While no absolute correlation can be
made between the electropherotype and serotype, associations between
"short" migration patterns and G2 serotypes have been reported
(39, 45). Similarly, the G1, G3, and G4 serotypes are most
often associated with a "long" electropherotype pattern. This
method is useful for detecting reassortant rotavirus strains and
analyzing the heterogeneity of human isolates (40).
Electropherotypes were identified for 220 of the 330 isolates in the
collection and representative predominant patterns are shown in Fig.
2a. The G1P[8] and G4P[8] strains
displayed only long migration patterns (Fig. 2a, lanes 1 and 4). All of the G2P[4] strains had short migration patterns (Fig. 2a, lanes 5 and
6). The unconventional type G1P[4] strains had predominately short
electropherotypes (Fig. 2a, lane 7). Two G4P[4] strains displayed
short patterns, and mixed infections with G9P[8] and G8P[4]
produced long and short electropherotypes, respectively. The mixed
types of G1-G3P[8] were associated with a long migration pattern
(Fig. 2a, lane 2). Mixed infections of G1 and G2 serotypes were found
to have short electropherotypes when the P[4] genotype was associated
and long patterns when the P genotype was P[8]. Distinct
electropherotype patterns with additional RNA segments were recognized
for two strains with mixed G (G1 + G2P[4]) and P (G4P[8+4])
genotypes. An example of the corresponding electropherotype for the
latter mixed infection is shown in Fig. 2b.

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FIG. 2.
(a) Representative electropherotype variants detected in
Irish children. Lanes: 1 through 4, long electropherotype patterns; 5 through 7, short electropherotype patterns. (b) Mixed infection
identified by polyacrylamide gel electrophoresis.
|
|
 |
DISCUSSION |
Rotavirus is the principal cause of infantile diarrhea worldwide
and has a significant impact on mortality and morbidity in both
developing and industrialized countries. Antigenic- and
molecular-analysis-based methods available for the characterization of
rotavirus have facilitated the identification of the predominant
serotypes circulating globally, as well as the detection of other
unconventional strains. The degree of diversity among rotavirus strains
has been reported to be higher in some regions of the world than in
others (44). Uncommon human strains such as G5, G8, G9, and
G10 were, until recently, found only in countries such as Brazil and
India (12, 29, 37). However, these strains are emerging as
global strains (1, 11, 36, 46). This observation has
implications for the development of a suitable rotavirus vaccine.
In this study, 330 Irish rotavirus samples were investigated. Analysis
of these data indicated a greater diversity in rotavirus strains
currently circulating in this country than previously reported
(34). Ninety-seven percent (n = 320) of the
isolates were assigned a G and P type. The predominant strains
identified included serotypes G1P[8] (32.1%), G2P[4] (28.5%), and
G4P[8] (11.2%), accounting for 71.8% of this collection, and these
are the most common previously reported serotypes (2, 13, 35, 44,
49, 50). However, the detection of unconventional strains and the
high incidence of mixed infections (18.8%) were interesting features
of this study, suggesting a previously unrecognized and greater
diversity among Irish rotavirus infections. Higher numbers of mixed
infections may provide a suitable environment for reassortment of
rotaviruses, with the inevitable emergence of novel strains.
Furthermore, polyacrylamide gel electrophoresis revealed at least seven
distinct predominating electropherotype variants characterized in
accordance with the scheme proposed by Lourenco et al. (30). Two strains were shown to contain a greater number of double-stranded RNA genomic segments. These data suggest a possible explanation for the
emergence of novel strains, including those with unusual combinations
of G and P types. In addition, the detection of G9 and G8 serotypes,
albeit as mixed infections in this study, is significant when the size
of the Irish population is compared to those of other countries where
similar isolations were reported (11, 12). The G9P[8]
strains were identified as mixed with G4P[8]. According to previous
hybridization studies, both of these types belong to subgroup 2 of
group A human rotaviruses and it has been suggested that these are
related at the genetic level. Coinfection of host cells with strains of
these serotype was shown to yield stable reassortants (39).
In this case, the corresponding electropherotype was the same for all
of the strains, consistent with a long migration pattern.
Serotypes G6, G8, and G10 are more frequently associated with
infections in animals, particularly cattle (18, 47).
Nevertheless, G8 and G10 types have also been recovered in humans
(16, 35, 44). We report here the identification of G8
strains as part of a mixed infection in Irish children. The majority of
these were mixed with serotype G2, having a P[4] genotype and
displaying a short electropherotype pattern. A single G8-G1P[8]
combination was detected with a long electropherotype pattern. Similar
strains were formerly identified in other European countries as single infections (16, 46). In Brazil, the G8 serotype was
initially reported as part of a mixed infection together with G5 before it emerged as a single-strain infection (44). G8 strains are thought to be reassortants of animal and human viruses (33), and their detection in Ireland may be consistent with our economic dependence on agriculture-based industries. It is unlikely that travel
to exotic destinations (such as Brazil or India) occurred.
In conclusion, results of this study highlight important aspects of
rotavirus strain diversity in Ireland not previously recognized. We
have presented evidence of reassortment between rotavirus strains together with the emergence of novel strains, both aspects of which
contribute to the diversity of the existing virus pool. In this study,
the presence of mixed infections cannot be attributed to the use of the
rhesus rotavirus vaccine, as it was never launched in Ireland. As the
number(s) of unconventional strains being discovered increases in
different geographical regions, future attempts to develop a suitable
vaccine must take this apparent additional rotavirus strain diversity
into account. Importantly, the potential genome dynamics of the
rotavirus necessitates continuous surveillance to monitor rotavirus
infection and facilitate the detection of these novel strains.
 |
ACKNOWLEDGMENTS |
We thank our colleagues at the Departments of Medical
Microbiology at Cork University Hospital, Limerick Regional Hospital, Waterford Regional Hospital, and Temple Street Children's Hospital for
supplying rotavirus strains. We also thank Jon Gentsch at CDC, Atlanta,
Ga., and Jim Grey, Biochemistry Department, Cambridge University,
Cambridge, United Kingdom, for the kind gifts of the reference strains
used. We also acknowledge John Murphy at CIT for technical support and
Linda Walsh at the DNA Sequencing Facility, National University of
Ireland, Cork, for help with sequencing.
Financial support from Irish Government Scientific Funding Agencies is
gratefully acknowledged (grants GTP 96/CR/028 and ARG 98/226). Wyeth
Lederle (Ireland) is also thanked for its financial contribution.
 |
FOOTNOTES |
*
Corresponding author. Mailing address: Molecular
Diagnostics Unit, Cork Institute of Technology, Bishopstown, Cork,
Ireland. Phone: (353-21) 432 6306. Fax: (353-21) 432 6851. E-mail:
sfanning{at}cit.ie.
 |
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Journal of Clinical Microbiology, September 2000, p. 3370-3374, Vol. 38, No. 9
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Copyright © 2000, American Society for Microbiology. All rights reserved.
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