Variation in Severity of Symptoms Associated with Two Snow Mountain
Virus Inocula
Abstract
Background: Norovirus (NoV) is a leading cause of epidemic non-bacterial
acute gastroenteritis in young children and adults globally. Snow
Mountain Virus (SMV), the prototype of genogroup II and genotype II NoV,
has been used in three human challenge studies to examine the
infectivity, pathogenicity, and immune response to NoV. Methods: This is
a secondary data analysis. Clinical and laboratory data from two
previously completed SMV human challenge trials using two different
inocula (Inoculum 1 and Inoculum 2) were analyzed to compare
infectivity, illness (including modified Vesikari severity scores of
gastroenteritis in those subjects with clinical symptoms), viral
shedding, and serum IgG conversion. SMV Inoculum 2 is a
second-generation inoculum prepared from a stool sample collected from a
study subject who was infected with SMV Inoculum 1. Results: Of 15
subjects orally challenged with SMV Inoculum 1 between 2000 and 2002,
nine were infected, and seven presented with acute gastroenteritis. Of
33 subjects orally challenged with SMV Inoculum 2 between 2016 and 2018,
25 were infected, and nine presented with acute gastroenteritis. There
were no statistically significant differences in overall infection and
illness rates between subjects challenged with Inoculum 1 vs. Inoculum
2. However, subjects infected with Inoculum 1 experienced more severe
clinical symptoms of acute gastroenteritis and had higher severity
scores (6.00 vs. 2.94, P = 0.003) compared with those infected with
Inoculum 2. We also observed that infection with Inoculum 2 resulted in
longer viral shedding compared with Inoculum 1. This analysis also
indicated that secretor-positive subjects had more severe
gastroenteritis than secretor-negative subjects. Among ill subjects, no
association was observed between challenge dose and severity of acute
gastroenteritis. Conclusions: Understanding the differences between
these two SMV inocula is critical for NoV vaccine evaluation because
illness and viral shedding are two important outcomes in NoV challenge
studies to determine vaccine efficacy. Using a less pathogenic inoculum
for a vaccine trial will require more participants to meet the target
reduction in illness when evaluating the efficacy of candidate vaccines.