Hand, foot and mouth disease (HFMD) risk has become an increasing concern in the Beijing–Tianjin–Hebei region, which is the biggest urban agglomeration in north-eastern Asia. In the study, spatiotemporal epidemiological features of HFMD were analysed, and a Bayesian space–time hierarchy model was used to detect local spatial relative risk (RR) and to assess the effect of meteorological factors. From 2009 to 2013, there was an obvious seasonal pattern of HFMD risk. The highest risk period was in the summer, with an average monthly incidence of 4·17/103, whereas the index in wintertime was 0·16/103. Meteorological variables influenced temporal changes in HFMD. A 1 °C rise in air temperature was associated with an 11·5% increase in HFMD (corresponding RR 1·122). A 1% rise in relative humidity was related to a 9·51% increase in the number of HFMD cases (corresponding RR 1·100). A 1 hPa increment in air pressure was related to a 0·11% decrease in HFMD (corresponding RR 0·999). A 1 h increase in sunshine was associated with a 0·28% rise in HFMD cases (corresponding RR 1·003). A 1 m/s rise in wind speed was related to a 6·2% increase in HFMD (corresponding RR 1·064). High-risk areas were mainly large cities, such as Beijing, Tianjin, Shijiazhuang and their neighbouring areas. These findings can contribute to risk control and implementation of disease-prevention policies.

We report the outcome of an 11-year programme monitoring sewage water and acute flaccid paralysis (AFP) cases as part of the World Health Organization (WHO) strategy for polio eradication in the Slovak Republic (SR). Polioviruses (PV) and non-polio enteroviruses (NPEV), prior to and after the change in polio vaccination strategy, were detected. Sewage treatment plant samples from 48 localities spread over the Western, Central and Eastern regions and clinical material from AFP cases were examined. The WHO standard procedures were followed with regard to virus isolation and identification. There were 538 commonly detected human enteroviruses (HEVs) including 213 (40%) coxsackie B viruses (CBV), 200 (37%) echoviruses and 113 (21%) Sabin-like PVs (PV1, 2, 3) including vaccine-derived poliovirus (VDPV) isolates. The percentage of PV isolates fell from 66% to 30% during 2001–2005 and thereafter fell to zero. CBV5, CBV2 and echovirus 3 were the NPEVs endemic during the study period.

Supplementary immunization activities (SIAs) are important in achieving high levels of population immunity to measles virus. Using data from a 2006 survey of measles vaccination in Lusaka, Zambia, we developed a model to predict measles immunity following routine vaccination and SIAs, and absent natural infection. Projected population immunity was compared between the current programme and alternatives, including supplementing routine vaccination with a second dose, or SIAs at 1-, 2-, 3-, 4- and 5-year intervals. Current routine vaccination plus frequent SIAs could maintain high levels of population immunity in children aged <5 years, even if each frequent SIA has low coverage (e.g. ⩾72% for bi-annual 60% coverage SIAs vs. ⩾69% for quadrennial 95% coverage SIAs). A second dose at 12 months with current coverage could achieve 81% immunity. Circulating measles virus will only increase population immunity. Public health officials should consider frequent SIAs when resources for a two-dose strategy are unavailable.

Louping-Ill as is now known from the work carried out at the Moredun Institute, Edinburgh, during the last 10 years can be transmitted by the tick Ixodes ricinus. Under natural conditions the disease is probably most commonly spread by this means. The possibility that infection might result, at any rate under experimental conditions, by other means than the intervention of an arthropod vector has been the starting point of the following investigation. The nasopharynx as a possible portal of entry was considered first because it is so often incriminated in many of the virus diseases of man. Furthermore, Webster and Fite (1933) and Elford and Galloway (1933) have shown that mice can be infected with the virus of louping-ill by the nasal instillation of potent filtrates or suspensions of infective brain. Fresh importance has been added to this alternative route of entry of the virus by the occurrence of a number of cases of laboratory infections amongst those who have studied the experimental disease. Rivers and Schwentker (1934), who have recorded these cases, give reasons for incriminating the nose as the portal of entry.

Measles is regarded as a disease that can be eliminated by vaccination; however, disease epidemics still occur in Wuhan, China. This study explored the effect of measles control programmes on the periodic structure of disease epidemics in Wuhan. The monthly reported measles incidence from 1953 to 2008 was divided into pre-vaccine range (1953–1965) and post-vaccine range (1966–2008). For the incidence in each range, spectral analysis was conducted and power spectral density (PSD) was obtained. In PSD for the pre-vaccine range, the most dominant spectral line was observed at a 2·0-year period, as in the case of Japan. It was confirmed that spectral lines of periodic modes longer than a 1-year cycle of the incidence rates behave in response to the introduction of measles control programmes. The investigation of periodic structures of measles epidemics will contribute to effective measles control programmes in Wuhan.

The coronavirus disease (COVID-19), while mild in most cases, has nevertheless caused significant mortality. The measures adopted in most countries to contain it have led to colossal social and economic disruptions, which will impact the medium- and long-term health outcomes for many communities. In this paper, we deliberate on the reality and facts surrounding the disease. For comparison, we present data from past pandemics, some of which claimed more lives than COVID-19. Mortality data on road traffic crashes and other non-communicable diseases, which cause more deaths each year than COVID-19 has so far, is also provided. The indirect, serious health and social effects are briefly discussed. We also deliberate on how misinformation, confusion stemming from contrasting expert statements, and lack of international coordination may have influenced the public perception of the illness and increased fear and uncertainty. With pandemics and similar problems likely to re-occur, we call for evidence-based decisions, the restoration of responsible journalism and communication built on a solid scientific foundation.

A comparison was made of beef cooked in conventional and moist air (Rapidaire) ovens. In both large (ca. 4·5 kg.) and small (ca. 2·7 kg.) joints, spores of Clostridium welchii survived after cooking but vegetative cells, Escherichia coli, and Staphylococcus aureus, did not, regardless of the type of oven used

Cooling at room temperature after cooking permitted growth of Cl. welchii. Although some multiplication also occurred in the centre of large roasts cooled under refrigeration, the viable counts were considered too low to constitute a potential health risk

The results so far obtained have raised many questions and answered few of them. The important rôle played in the spread of epidemic disease by the re-accumulation of a susceptible population is clearly indicated. It seems not unreasonable to hope that valuable information as to the effect produced by variations in the rate of such re-accumulation, and on other matters, may be obtained by the satisfying method of direct experiment. The bearing of such information on the well-known fluctuations in the incidence of epidemic diseases, and especially perhaps of those which fall most heavily on children, are too obvious to need emphasising.

The following conclusions seem permissible at the present stage:

(1) If susceptible mice be continuously added to an infected population the spread of infection will continue over a long period of time. There is no evidence that this period has a limit.

(2) When susceptible mice are added continuously and at a constant rate to an infected population, the spread of infection, as judged by a mortality curve, is propagated in regularly recurring waves. These waves are most easily observed by noting the fluctutations in the total cage-population. It seems probable that the period of these fluctuations will be found to depend on the rate of addition of susceptible individuals, but this point has still to be determined.

(3) The actual deaths may occur in large groups, with intervals during which deaths are few and far between, or they may fall in a succession of smaller groups, increasing and diminishing in size to form the larger waves. In all cases there is this tendency for the occurrence of such small groups of deaths with definite maximal points. There would seem to be two fluctuating processes, the one superimposed upon the other.

(4) The average survival-time of mice added to the cage, and their chance of ultimate survival if no more susceptible mice are introduced, vary according to the phase at which they are added. If they gain entrance to the cage during the rise of a wave they are unlikely to live for long. If they are introduced during the fall of a wave their chances of survival are greatly increased, and they will usually outlive mice which are added at a later date but at a time before the commencement of the next wave.

(5) The rate of extinction of a population, among which infection is actively spreading, will be far less rapid if they are kept isolated, than if further susceptible individuals continuously gain access to them. A proportion of the infected population, which would have survived indefinitely under the former circumstances, will die under the latter.

(6) The ultimate survivors among such a population have not escaped infection, but have successfully resisted it. A considerable proportion of them are harbouring the causative parasite in their tissues.

My sincere thanks are due to my colleagues, Dr H. B. Weir and Dr G. S. Wilson, for their constant help, and to Mrs Phyllis Worthington whose assistance in this work I have been able to obtain by the aid of the Medical Research Council.

Eight strains of influenza C virus isolated in various areas of Japan between January 1985 and January 1989 were compared using monoclonal antibodies to the haemagglutinin-esterase (HE) glycoproteins and by oligonucleotide mapping of total vRNA. Five of six strains isolated during 1986–9 were closely related to one another and also resembled the virus, C/Aichi/1/81, isolated in 1981 in Aichi prefecture. This suggests that the C/Aichi/l/81-related viruses had an epidemiological advantage over any co-circulating viruses at least during that period. One of two 1985 isolates (C/Nara/1/85) was antigenically indistinguishable from the C/Mississippi/1/80 strain though their oligonucleotide patterns were markedly different from each other. This raises the possibility that C/Nara/1/85 may be a recombinant virus which receives its HE gene from the C/Mississippi/l/80-related parent.

The following summarises the findings elicited from the investigation, the significance we attach to the results and the conclusions we have drawn:

A careful study has been made of the reputed Wassermann reaction exhibited by theserum of certain normal animals with a view to throwing light on the nature of the reacting substance or principle in syphilitic serum.

The heated (55° C.) serum of various normal adult animals may fix complement along with the antigen used in the Wassermann test, e.g. rabbit, ox, sheep, horse, mouse, cat, dog, macacus, pig.

The complement-fixation reaction may be associated with the flocculation effect similar to that of syphilitic serum.

These reactions apparently represent a natural or normal property of the serum and do not appear to depend on any pathological condition.

Certain species, including man, are characterised by negative reactions, e.g. white rat, guinea-pig, frog.

The serum of the white rat in the unheated state, however, yields a definite but weakly positive flocculation reaction which is annulled on heating the serum to 55° C., showing that this species is not devoid of the particular principle. In some species there is great uniformity in the occurrence of both reactions (e.g. rabbit, ox, sheep, horse). Such uniformity has led us to regard the reaction as a natural one. In other species there is less regularity and both reactions in certain individuals may be quite negative. In certain animals there may be dissociation of the two reactions: the Wassermann reaction may be negative while the flocculation effect is positive (e.g. pig, pigeon, fowl, cat): the reverse may occur, the Wassermann reaction being positive, the flocculation test negative (e.g. dog, mouse, rabbit).

Certain positively reacting species are characterised by uniformly weak reactions, e.g. mouse.

The Wassermann reaction in normal animals is always limited in degree, contrasting in this respect with the very marked effects obtained with the serum from cases of active syphilis.

In species in which adult animals exhibit positive reactions, very young animals, e.g. up to 3–8 weeks of age, react negatively. The reacting power (observed in rabbits) is thereafter progressive in development and is parallel with the development of a natural antibody (anti-sheep haemolysin). This parallelism supports the view that these reactions are due to antibody-like principles in the serum.

No constant difference in thermostability of the reacting substances can be established between normal animal serum and the serum in syphilis. The degree of thermostability seems to vary slightly among individuals. The flocculating property is more stable than the complement-fixing principle both in animals and in syphilis.

These reactions in normal animals seem to be homologous with the corresponding reactions in syphilis. Our observations suggest that the syphilis serum reactions are due to antibody-like substances homologous with antibodies natural to certain species and widely distributed among animals.

The Wassermann and flocculation reactions in individual rabbits tested at intervals are relatively constant.

Marked augmentation of the Wassermann reaction has been produced experimentally in rabbits: (a) by immunisation with heterophile antigen, as originally shown by Taniguchi; (b) by experimental infection with B. tuberculosis. The effects of other non-specific agents have also been studied but marked alterations have not been observed.

Repeated subcutaneous injection of alcohol in rabbits abolishes the Wassermann property. The injection of certain other chemical substances also produces a weakening influence. Parallel effects are observed on the antisheep haemolysin.

An analytical study has been made of the Wassermann and flocculating substances in the serum of normal animals and human syphilitic serum. For this purpose carbon-dioxide fractioning of the serum has been used. The results have been recorded and differences have been elicited in the behaviour of the serum fractions between normal animals and human syphilitics. These differences probably depend on the total content of the reacting substances in the serum and their distribution in the serum fractions.

The carbonic-acid-insoluble fraction of normal human serum and the serum of negatively reacting animals even after heating at 55° C. may yield a weak complement-fixation effect with the Wassermann antigen. This property is “masked” in whole serum. It is lost on heating above 60° C. and is more marked in the unheated fraction.

The deviation effect produced by the unheated fraction is contributed to by an independent complement-deviation reaction with the alcohol present in the antigen suspension but is still manifest with alcohol-free antigen preparations, showing it is partly a true reaction with the lipoids proper. This effect of the carbonic-acid-insoluble fraction has not been paralleled in the flocculation test unless in certain exceptional instances.

These observations seem to indicate that the principle in serum responsible for the Wassermann reaction is present normally in minimal amount and in a masked state even in those animals which are negative reactors when tested in the usual way. It might be supposed, therefore, that the diagnostic reaction is due to the non-specific augmentation of this natural antibody-like substance.

The influence of various non-specific agents and different infective conditions on the content of the reacting substances in the serum of normal animals requires further investigation.

The complement-deviation reaction of fresh serum with diluted alcohol (substituted for antigen) has been studied in animals and man. The fact has been elicited that the heated carbonic-acid-insoluble fraction of the serum of animals (positive in the usual Wassermann test) and of syphilitic sera yields, along with diluted alcohol, a definite though weak complement-deviation reaction. This may also occur with heated whole serum. This effect is absent from heated normal human serum and the heated serum of “Wassermannnegative” animals. This reaction shows some analogy with the Wassermann reaction and the alcohol of the Wassermann antigen suspensions seems to be a contributory factor to the total complement-fixation in the Wassermann test. If heated serum is used, no fallacy is introduced in the diagnostic test even when the concentration of the alcohol is 1: 12.

The dissociation of the Wassermann and flocculating properties in syphilitic sera is evidenced as a result of carbon-dioxide fractioning—the soluble fraction being more active in the flocculation test, the insoluble moietybeing more active in the Wassermann test, though in some cases the dissociation is less obvious and may be quite absent.

It is suggested from the observations recorded that the Wassermann syphilis reaction represents an increase of a “lipoidophile” antibody naturally present in the serum in minimal amount and in a masked state, which in syphilis is non-specifically augmented in an analogous manner to the augmentation of the natural anti-sheep haemolysin by heterologous stimuli.

Since the start of the coronavirus disease-2019 (COVID-19) pandemic, there has been interest in using wastewater monitoring as an approach for disease surveillance. A significant uncertainty that would improve the interpretation of wastewater monitoring data is the intensity and timing with which individuals shed RNA from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into wastewater. By combining wastewater and case surveillance data sets from a university campus during a period of heightened surveillance, we inferred that individual shedding of RNA into wastewater peaks on average 6 days (50% uncertainty interval (UI): 6–7; 95% UI: 4–8) following infection, and that wastewater measurements are highly overdispersed [negative binomial dispersion parameter, k = 0.39 (95% credible interval: 0.32–0.48)]. This limits the utility of wastewater surveillance as a leading indicator of secular trends in SARS-CoV-2 transmission during an epidemic, and implies that it could be most useful as an early warning of rising transmission in areas where transmission is low or clinical testing is delayed or of limited capacity.

Antimicrobial use in pig farming is influenced by a range of risk factors, including herd characteristics, biosecurity level, farm performance, occurrence of clinical signs and vaccination scheme, as well as farmers’ attitudes and habits towards antimicrobial use. So far, the effect of these risk factors has been explored separately. Using an innovative method called multiblock partial least-squares regression, this study aimed to investigate, in a sample of 207 farrow-to-finish farms from Belgium, France, Germany and Sweden, the relative importance of the six above mentioned categories or ‘blocks’ of risk factors for antimicrobial use in pig production. Four country separate models were developed; they showed that all six blocks provided useful contribution to explaining antimicrobial use in at least one country. The occurrence of clinical signs, especially of respiratory and nervous diseases in fatteners, was one of the largest contributing blocks in all four countries, whereas the effect of the other blocks differed between countries. In terms of risk management, it suggests that a holistic and country-specific mitigation strategy is likely to be more effective. However, further research is needed to validate our findings in larger and more representative samples, as well as in other countries.

Salmonella Typhimurium (STM) infection in pigs represents a considerable food safety concern. This study used mathematical modelling to evaluate the effectiveness of cleaning (faeces removal) as a measure to control STM spread among grower-finisher pigs. A modified Susceptible-Infected-Recovered-Susceptible (SIRS) model of STM transmission through a contaminated environment was developed. Infected pigs were divided into three states according to the pathogen level being shed in their faeces. Infection transmission was evaluated using the basic reproduction number (R0) and the prevalence of infectious pigs at slaughter age. Although increased frequency and efficiency of cleaning did reduce the prevalence of STM shedding at the time of slaughter, these efforts alone were not capable of eliminating the infection from the population. The level of STM faecal shedding by infectious pigs strongly influenced the infection spread and prevalence at slaughter. To control STM in pigs, cleaning should be combined with vaccination and/or isolation of high-level shedders.

An outbreak of non-bacterial food poisoning presumed due to small round, structured viruses (SRSV) occurred at a national conference.

A detailed postal survey of all conference attenders was carried out to ascertain the cause of the outbreak and 355 questionnaires were returned.

Univariate analysis showed that mussels in the seafood cocktail were the likely vehicle of infection. A dose–response relationship between the amount of seafood cocktail consumed and the risk of illness was demonstrated. Dose–response has not previously been documented in a food-borne outbreak due to small round structured virus.

Detailed quantitative food histories can be useful in eliciting dose-response relationships and may be crucial in establishing the vehicle of infection when investigating food poisoning following consumption of a set-menu meal. Their use should be considered in other outbreak situations.

In England, hospital admissions for severe staphylococcal boils and abscesses trebled between 1989 and 2004. We investigated this trend using routine data from primary and secondary care. We used The Health Improvement Network (THIN), a large primary-care database and national data on hospital admissions from Hospital Episode Statistics (HES). Time trends in the incidence of primary-care consultations for boils and abscesses were estimated for 1995–2010. HES data were used to calculate age-standardized hospital admission rates for boils, abscesses and cellulitis. The incidence of boil or abscess was 450 [95% confidence interval (CI) 447–452] per 100 000 person-years and increased slightly over the study period (incidence rate ratio 1·005, 95% CI 1·004–1·007). The rate of repeat consultation for a boil or abscess increased from 66 (95% CI 59–73) per 100 000 person-years in 1995 to peak at 97 (95% CI 94–101) per 100 000 person-years in 2006, remaining stable thereafter. Hospital admissions for abscesses, carbuncles, furuncles and cellulitis almost doubled, from 123 admissions per 100 000 in 1998/1999 to 236 admissions per 100 000 in 2010/2011. Rising hospitalization and recurrence rates set against a background of stable community incidence suggests increased disease severity. Patients may be experiencing more severe and recurrent staphylococcal skin disease with limited treatment options.

Clinical features, treatment and outcome were assessed retrospectively by means of a questionnaire in 174 patients in general practice whose vaginal swabs yielded bcta-haemolytic streptococci. These were compared with 96 patients whose swabs yielded no recognized microbial pathogens. Patients with group B streptococci did not differ in any of these parameters from the control group, but those with group A streptococci were more likely to have vaginal soreness, a purulent discharge. and to respond to anti-streptococcal antibiotics. Implications for laboratory reporting are discussed.

It was possible to demonstrate from retrospective records that a link existed between contaminated animal feedstuffs, turkeys and an outbreak of Salmonella senftenberg infection at Ryhope Hospital. Possibly infected or contaminated turkeys were supplied to the hospital from two turkey farms in one of which the birds were fed on contaminated white fish meal and the other had had infected birds.

This work was carried out months after the events described and would not have been possible without the help and co-operation of the Public Health Laboratory Service, The Veterinary Field, Investigation and Research Services, Houghton Poultry Research Station, The Medical Officer of Health for Brighton, Dr Rosetta Parker, and the various feed companies involved, who very kindly made their records available to us.

1. Compressed air above 5 atm. lessens the CO2 output, and lowers the body temperature in mice, rats, and young rabbits.

2. Oxygen at and above 1 atm. has the same effect. It is a sign of oxygen poisoning.

3. Compressed air at 10 atm. is more damaging–at least to small animals—than oxygen at 2 atm.

4. Compressed air increases the loss of body heat both because it is a better conductor, and because it is saturated with moisture.

5. The saturation of the air with moisture in caissons does not prevent evaporation from the body because the skin temperature is above that of the air. The wet air by damping fur or clothes increases loss of heat.

6. Highly compressed air may possibly interfere with the diffusion of CO2 from the alveolar air, and may, owing to increased friction, hinder the passage of air in and out of the air-tubes.

7. The nitrogen output in dogs is not altered in any noteworthy degree by exposure for six hours to 8 atm. air.

8. Inflammation and consolidation of the lungs is produced by exposure to 8 atm. air for over 24 hours. 1½ atm. of pure oxygen has a similar effect. The higher the oxygen tension the more rapidly does the inflammation ensure, e.g. 6 atm. O2 produces marked congestion in 2 hours.

9. It does not seem likely that inflammation of the lungs should be produced in the pressures and times of exposure usual in caissons.

10. Excised frog's hearts, muscles, and nerves are not rapidly poisoned by even 50 atm. O2. A heart will beat more than an hour exposed to this pressure. The vagus nerve endings appear to be paralysed by such exposure, while inhibition can be obtained by stimulating the crescent. The thin sartorius muscle is much more easily affected than the gastrocnemius, and soon gives a curve like a fatigue curve.

11. All animals investigated, vertebrates and invertebrates, are instantly convulsed and killed by exposure to 50 atm. O2.

12. Convulsions are frequently produced in vertebrates by exposure to 4—5 atm. O2, while exposure to 6—25 atm. O2 produces dyspnoea and coma, and the convulsive stage does not usually appear. Cleaning movements, salivation, gaping, jerky deep respiration, are symptoms which precede the convulsions, and coma soon follows them.

13. We have not observed convulsions with air pressures up to 12 atm. Salivation, dyspnoea, and coma are the symptoms.

14. The blood-gases increase in compressed air or oxygen according to Dalton's law, but the process of complete saturation of blood and tissues takes some time.

15. The circulation is unaffected mechanically by compressed air.

16. The cause of caisson-sickness is the escape of gas bubbles in the blood vessels and tissue fluids on decompression. An animal exposed for 4 hours to 8 atm. air and quickly decompressed is like an opened bottle of soda-water. The fluids of the body generally effervesce.

17. The effervescence can be studied in the circulation of the frog's web or bat's wing, the animals being enclosed in a suitable chamber. It takes a little time for the bubbles to grow to an appreciable size.

18. Recompression causes the bubbles to go into solution, and if applied quickly enough the circulation recommences.

19. The bubbles after rapid decompression can be seen post-mortem in the blood vessels, in the heart, retinae, aqueous humour, connective tissue spaces, etc. The alimentary canal is blown out with gas. The bubbles produce cyst-like cavities in solid organs, e.g. in the central nervous system, the liver. The cells are compressed round these cysts.

20. In the case of oxygen an animal may recover after an extraordinary amount of this gas has been set free by rapid decompression. The nerve cells are not killed by the oxygen bubbles, and the animals are convulsed and exhibit hyper-reflex-excitability.

21. The varying symptoms of caisson-sickness are due to the varying seat of the air emboli.

22. Young men escape caisson-sickness owing to the elasticity of their tissues, and greater facility for collateral pathways of circulation.

23. Animals can be safely exposed to 8 atm. of air for 4 hours if 2 hours be spent in gradual decompression. Such exposure can be safely repeated three times a week.

24. By the choice of suitable men, and proper regulation of the period of compression and decompression, caisson and diver's sickness can be avoided.

Cultures of C. albicans have been classified into two groups by means of a double diffusion precipitin test employing rabbit antisera and polysaccharide extracts. In the present series it has been found that 75% of cultures belong to group A and 25% to group B, and it is suggested that the higher incidence of group B strains occurring in the sputum of hospital in-patients with chest disease may be the result of reinfection by attenuated forms which persist in the environment.

My thanks are due to many colleagues who provided me with the strains of C. albicans, and to Prof. H. Hare for helpful criticism in the preparation of this paper.

Norovirus (NoV) is a leading cause of outbreaks of gastroenteritis worldwide, and a major burden for healthcare facilities. This study investigated the NoV genotypes responsible for outbreaks in Edinburgh healthcare facilities between June 2008 and July 2011, and studied their temporal distribution to enable a better understanding of the epidemiology of the outbreaks. A total of 287 samples positive for NoV genogroup II (GII) RNA by reverse transcription–polymerase chain reaction (RT–PCR) during routine diagnostic testing were investigated. Nested RT–PCR (nRT–PCR) and sequencing was used to genotype the NoV strains. Overall, a total of 69 NoV strains belonging to six different genoclusters (GII.1, GII.2, GII.3, GII.4, GII.6, GII.13) were detected. The predominant genotype was GII.4 that included four variants, GII.4 2006a, GII.4 2006b, GII.4 2007 and GII.4 2010. Importantly, increases in NoV activity coincided with the emergence of new GII.4 strains, highlighting the need for an active surveillance system to allow the rapid identification of new strains.