Swab Sampling Method for the Detection of Human Norovirus on Surfaces

Summary

A macrofoam based sampling methodology was developed and evaluated for the detection and quantification of norovirus on environmental hard surfaces.

Abstract

Human noroviruses are a leading cause of epidemic and sporadic gastroenteritis worldwide. Because most infections are either spread directly via the person-to-person route or indirectly through environmental surfaces or food, contaminated fomites and inanimate surfaces are important vehicles for the spread of the virus during norovirus outbreaks.

We developed and evaluated a protocol using macrofoam swabs for the detection and typing of human noroviruses from hard surfaces. Compared with fiber-tipped swabs or antistatic wipes, macrofoam swabs allow virus recovery (range 1.2-33.6%) from toilet seat surfaces of up to 700 cm². The protocol includes steps for the extraction of the virus from the swabs and further concentration of the viral RNA using spin columns. In total, 127 (58.5%) of 217 swab samples that had been collected from surfaces in cruise ships and long-term care facilities where norovirus gastroenteritis had been reported tested positive for GII norovirus by RT-qPCR. Of these 29 (22.8%) could be successfully genotyped. In conclusion, detection of norovirus on environmental surfaces using the protocol we developed may assist in determining the level of environmental contamination during outbreaks as well as detection of virus when clinical samples are not available; it may also facilitate monitoring of effectiveness of remediation strategies.

Introduction

Human noroviruses are a leading cause of epidemic and sporadic acute gastroenteritis worldwide ^1,2,3. The virus is extremely contagious and transmission occurs through direct person to person interaction or indirectly through contact with contaminated food, water or environmental surfaces. Noroviruses can be shed for extended periods and prolonged survival of the virus on environmental surfaces has been documented ^1,2,3. During peak shedding, billions of virus particles are released ....

Protocol

1. Swab Sampling in the Field

1. Wear a clean pair of gloves.
2. Measure the size of the sampling area without touching the surface using a measuring tape or ruler. Try to estimate the area as accurately as possible and fill out a report form (Supplementary Table 1).
3. Check the swab kit for possible leakages and label sample transport bags and swab kits.
4. Move the swab across the sampling area as follows: one stroke in horizontal direction, one stroke in vertical direction, and one stroke in a diagonal direction. Do not swab a surface area larger than 700 cm².
5. Place each swab into a tube and tight....

Results

Figure 1 presents a flowchart of the swab sampling protocol. This protocol consists of four main steps; 1) sample collection, 2) sample storage and transportation, 3) viral RNA purification and concentration and 4) RT-qPCR assay and genotyping.

Discussion

Noroviruses have a 50% human infectious dose between 18 and 10³ virus particles²⁰. Therefore, even low-level contamination of surfaces may pose a public health risk. Several aspects of the swab sampling protocol were evaluated including: 1) different swab materials, 2) storage condition swabs during transport, 3) viral RNA concentration, and 4) coliphage MS2 as internal extraction control.

Until recently, only the performance of swabs made from cotton, polyes.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Generic name for kits
Macrofoam swab	Premoistened EnviroMax Swab kit	Puritan	2588060PFUW
RNA Lysis buffer	CDC UNEX buffer	Microbiologics	Cat No MR0501
RNA extraction spin column	Midi column	Omega Biotek	Cat No R6664-02
RNA purification spin column	Zymol RNA Clean and Concentrator kit	Zymo Research	Cat No R1016
Real time RT-PCR kit	AgPath kit One-Step RT-PCR Kit	Life Technologies	Cat No 4387391
Conventional RT-PCR kit	Qiagen one step RT-PCR kit	Qiagen kit	Cat No 210212
Gel extraction kit	Qiagen QIAquick gel extraction kit	Qiagen kit	Cat No 28704 or 28706
	Coliphage MS2	ATCC	Cat No 15597-B1
	RNA run-off transcripts
	Realtime PCR platform	Applied Biosystems	Model ABI 7500
	Optical 96-well reaction plate	Thermo Scientific	Cat No 4316813
	MicroAmp Clear Adhesive Film	Thermo Scientific	Cat No 4306311