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This study identified norovirus in children presenting with acute gastroenteritis and determined the capsid genotypes of the circulating norovirus strains in multiple regions in Thailand during October 2004 to December 2006 and March 2008 to August 2010. A total of 7,420 stool samples were collected from both cases (3621) and controls (3799). The stool samples were screened by two real-time RT-PCR assays to detect genogroup I and genogroup II noroviruses. Norovirus-positive samples were identified in 516 cases (14.3%) and 181 controls (4.8%) with more than half of norovirus positive samples from 7–24 months old children. Positive samples were sequenced and genotyped for the capsid gene. GII.4 was the genotype observed most frequently (56.4%) followed by GII.3 (28.2%). Five peaks of infection were observed, with predominant capsid genotypes that alternated during the surveillance periods between GII.4 and GII.3. Analyses of positive samples showed variation in genotype from each region as well as from different study periods. This emphasizes the importance of multi-site studies to investigate norovirus epidemiology. Additionally, the observed regional and temporal variations suggest that a systematic nation-wide surveillance effort in Thailand is needed to track the continually changing norovirus epidemiology. J. Med. Virol. 87:664–674, 2015. © 2015 Wiley Periodicals, Inc.

Campylobacter continues to be a major cause of bacteriamediated diarrheal diseases, both for Thai citizens and travelers to Thailand. For field epidemiological studies, appropriate methods for storage, intralaboratory transport of patients specimens and use of enrichment culture to isolate this organism is critical. Study A, represents patient stool specimens collected in Bangkok and processed for Campylobacter culture within three hours after collection. Study B, represents stool specimens collected from patients in northeast and Southern regions of Thailand in modified CaryBlair transport medium. These specimens were transported and processed for Campylobacter in Bangkok at varying intervals ranging from 1 to 7 days. Of 900 diarrheal samples examined in study A, a total of 158 were Campylobacter positive through culture. Of these, 145 and 141 isolates were cultured by direct plating and enrichment plating respectively (P = 0.5839). From 1,168 diarrheal stool samples examined in study B, 184 were positive for Campylobacter. Direct and enrichment plating resulted in 139 and 168 culture isolates; respectively (P = 0.0003). Samples from study B delayed in processing for 1 to 3 days, resulted in 46 and 50 isolated by direct and enrichment plating; respectively (P = 0.4545). However, among samples delayed in processing for 4 to 7 days, a total of 128 Campylobacter isolates were cultured, having cultured 93 and 118 isolates through direct and enrichment plating; respectively (P = 0.0003). At present these studies demonstrate that enrichment culture has no benefit when stool specimen collection and immediate processing occur and when there is a processing delay period of 1 - 3 days. However, enrichment culture was beneficial in instances where transport and processing was delayed 4 - 7 days.

This study identified norovirus in children presenting with acute gastroenteritis and determined the capsid genotypes of the circulating norovirus strains in multiple regions in Thailand during October 2004 to December 2006 and March 2008 to August 2010. A total of 7,420 stool samples were collected from both cases (3621) and controls (3799). The stool samples were screened by two real-time RT-PCR assays to detect genogroup I and genogroup II noroviruses. Norovirus-positive samples were identified in 516 cases (14.3%) and 181 controls (4.8%) with more than half of norovirus positive samples from 7-24 months old children. Positive samples were sequenced and genotyped for the capsid gene. GII.4 was the genotype observed most frequently (56.4%) followed by GII.3 (28.2%). Five peaks of infection were observed, with predominant capsid genotypes that alternated during the surveillance periods between GII.4 and GII.3. Analyses of positive samples showed variation in genotype from each region as well as from different study periods. This emphasizes the importance of multi-site studies to investigate norovirus epidemiology. Additionally, the observed regional and temporal variations suggest that a systematic nation-wide surveillance effort in Thailand is needed to track the continually changing norovirus epidemiology.