Epidemiologia molecular de rotavírus em rebanhos bovinos no estado de São Paulo no período de 2006 a 2010

Pós-graduação em Medicina Veterinária - FCAV

Cost-effectiveness analysis of universal childhood hepatitis A vaccination in Brazil: Regional analyses according to the endemic context

Objective: To To conduct a cost-effectiveness analysis of a universal childhood hepatitis A vaccination program in Brazil. Methods: An age and time-dependent dynamic model was developed to estimate the incidence of hepatitis A for 24 years. The analysis was run separately according to the pattern of regional endemicity, one for South + Southeast (low endemicity) and one for the North + Northeast + Midwest (intermediate endemicity). The decision analysis model compared universal childhood vaccination with current program of vaccinating high risk individuals. Epidemiologic and cost estimates were based on data from a nationwide seroprevalence survey of viral hepatitis, primary data collection, National Health Information Systems and literature. The analysis was conducted from both the health system and societal perspectives. Costs are expressed in 2008 Brazilian currency (Real). Results: A universal immunization program would have a significant impact on disease epidemiology in all regions, resulting in 64% reduction in the number of cases of icteric hepatitis, 59% reduction in deaths for the disease and a 62% decrease of life years lost, in a national perspective. With a vaccine price of R$16.89 (US$7.23) per dose, vaccination against hepatitis A was a cost-saving strategy in the low and intermediate endemicity regions and in Brazil as a whole from both health system and society perspective. Results were most sensitive to the frequency of icteric hepatitis, ambulatory care and vaccine costs. Conclusions: Universal childhood vaccination program against hepatitis A could be a cost-saving strategy in all regions of Brazil. These results are useful for the Brazilian government for vaccine related decisions and for monitoring population impact if the vaccine is included in the National Immunization Program. (C) 2012 Elsevier Ltd. All rights reserved.

Colibacillosis in lambs is associated to type I heat-stable enterotoxin in a farm in Sao Paulo State, Brazil

Twenty seven (48.2%) culture supernatants of 56 Escherichia coli isolated from diarrheic lamb feces (7 to 10 days old) in Sao Paulo State, Brazil, presented positive results to suckling mice assay (fluid accumulation) but none caused cytopathic effects on Vero and CHO cells, indicating that these strains did not produced LT or VT toxins. PCR assays showed that these 27 E. coli strains harbored estA, that codifies for STa, but not for stx1, stx2 or cnf genes. The positive STa strains were checked for genes that codify for F41, F17 and K99 fimbriae, wich are considered colonization factors in ETEC. Only F17 was detect in two samples (7.4%). Twelve of 27 STa positive carried hlyA gene and presented hemolytic activity in blood Agar. Presence of rotavirus was not detected among the diarrheic feces. These data suggests that STa must be an important diarrheagenic factor to small ruminants in Sao Paulo State.

Emergence of enteric viruses in production chickens is a concern for avian health

Several viruses have been identified in recent years in the intestinal contents of chickens and turkeys with enteric problems, which have been observed in commercial farms worldwide, including Brazil. Molecular detection of these viruses in Brazil can transform to a big threat for poultry production due to risk for intestinal integrity. This disease is characterized by severely delayed growth, low uniformity, lethargy, watery diarrhea, delayed feed consumption, and a decreased conversion rate. Chicken astrovirus (CAstV), rotavirus, reovirus, chicken parvovirus (ChPV), fowl adenovirus of subgroup I (FAdV-1), and avian nephritis virus (ANV) were investigated using the conventional polymerase chain reaction (PCR) and the reverse transcription polymerase chain reaction (RT-PCR). In addition, the infectious bronchitis virus (IBV), which may play a role in enteric disease, was included. The viruses most frequently detected, either alone or in concomitance with other viruses, were IBV, ANV, rotavirus, and CAstV followed by parvovirus, reovirus, and adenovirus. This study demonstrates the diversity of viruses in Brazilian chicken flocks presenting enteric problems characterized by diarrhea, growth retard, loss weight, and mortality, which reflects the multicausal etiology of this disease

Diseases in neonatal foals. Part 2: potential risk factors for a higher incidence of infectious diseases during the first 30 days post partum

REASON FOR PERFORMING STUDY: The development of clinical illness in foals is usually predetermined by perinatal history, management or stressful environmental conditions. OBJECTIVES: To determine potential risk factors for an increased incidence of infectious diseases during the first 30 days post partum. METHODS: The population consisted of Thoroughbred foals born on stud farms in the Newmarket (UK) area in 2005 (n = 1031). They were followed for their first 30 days. Factors suspected to influence the incidence of infectious neonatal diseases were examined in a logistic regression approach for each of the 3 outcomes (total infectious diseases, systemic disease with diarrhoea and total infectious diseases excluding diarrhoea). All 28 factors were either foal or mare or stud farm related. RESULTS: Several significant risk factors for a higher disease incidence, such as birth complications, colostrum intake by stomach tube and leucocytosis 12-48 h post partum were identified. The factor 'boarding stud' seemed to be protective against disease. CONCLUSION: Some factors, such as the mare's time at stud before foaling, the mare's rotavirus vaccination schedule and fibrinogen-values that empirically had been linked to the outcome previously were not confirmed as relevant. This included the reported useful prophylactic treatment with antimicrobial drugs. POTENTIAL RELEVANCE: Factors to be considered when evaluating newborn foals include: stud management, the birth process, route of colostrum intake, white and red blood cells, and the date of birth. These may help to detect foals at risk to develop an infection so that targeted prophylactic measures can be initiated.

Laribacter hongkongensis: a potential cause of infectious diarrhea

In this study, we describe the isolation of Laribacter hongkongensis, a recently described genus and species of bacterium, in pure culture on charcoal cefoperazone deoxycholate agar from the stool of six patients with diarrhea. Three patients were residents of Hong Kong, and three of Switzerland. In none of the stool samples obtained from these six patients was Salmonella, Shigella, enterohemorrhagic Escherichia coli, Vibrio, Aeromonas, Plesiomonas, or Campylobacter recovered. Rotavirus antigen detection, electron microscopic examination for viruses, and microscopic examinations for ova and cysts were all negative for the stool samples obtained from the three patients in Hong Kong. Enterotoxigenic E. coli was recovered from one of the patients in Hong Kong. Unlike L. hongkongensis type strain HKU1, all the six strains were motile with bipolar flagellae. Sequencing of the 16S ribosomal RNA genes of the six strains showed that they all had sequences with only 0-2 base differences to that of the type strain. Pulsed field gel electrophoresis of the SpeI digested genomic DNA of the six isolates and that of the type strain revealed that the seven isolates were genotypically unrelated strains. More extensive epidemiologic studies should be carried out to ascertain the causative association between L. hongkongensis and diarrhea and to define the reservoir and modes of transmission of L. hongkongensis.

Geographic variation of the etiology of travelers' diarrhea

Introduction. Traveler's Diarrhea is an important public health program in travelers from industrialized nations to the developing world with a prevalence rate of between 13 and 60%. Although studies are found on the etiology of traveler's diarrhea, these studies have not described the etiology over different regions of the world. The objective of this study was to identify the frequency of specific etiology of traveler's diarrhea by geographic area of the world. In addition to this, it was also examined whether there are any regional differences in the isolation rate of ETEC and conventional pathogens and variation, if any, in frequency of these pathogens in different regions over time.^ Material and methods. This is a systematic review of the studies on the etiology of traveler's diarrhea by geographic regions. The search databases used were Medline Pubmed and Medline Ovid and key words used for the search were Etiology of traveler's diarrhea, travelers' diarrhea and acute diarrhea of travelers. The articles were selected according to the inclusion and exclusion criteria and relevant data was extracted which was statistically analyzed.^ Results. Out of 110 studies from 1970 to 2004, 52 studies were included and 58 were excluded from the review. All the 52 studies were grouped according to the geographic regions of interest. Latin America (25 studies), Asia (7 studies), Africa (9 studies), and others/Mixed (11 studies), were the 4 major groups of regions studied. The overall most common pathogen was ETEC (29.10%) in this study and other common pathogens were EAEC (14.42%), norovirus (10.95%), EPEC (6%) and rotavirus (5.23%). ETEC and Shigella show a decreasing trend in Latin America & Caribbean but increasing trend in Asia.^ Conclusion. ETEC is the single most common cause of travelers' diarrhea in the world. Potent vaccines against ETEC are required to prevent travelers' diarrhea and thus reduce the attack rate. Also, PCR based studies are required to identify the causes of pathogen negative diarrhea. ^

A systematic review of the evidence for use of herbal medicine for the treatment of acute diarrhea

Background. Acute diarrhea (AD) is an important cause of morbidity and mortality among both children and adults. An ideal antidiarrheal treatment should be safe, effective, compatible with Oral Rehydration Solution, and inexpensive. Herbal medicines, if effective, should fit these criteria as well or better than standard treatment. ^ Objective. The objective of the present study was to assess the effectiveness of plant preparations in patients with AD in reports of randomized and non-randomized controlled trials. ^ Aims. The aims of the present study were to identify effective antidiarrheal herbs and to identify potential antidiarrheal herbs for future studies of efficacy through well designed clinical trials in human populations. ^ Methods. Nineteen published studies of herbal management of AD were examined to identify effective plant preparations. Ten plant preparations including Berberine (Berberis aristata), tormentil root ( Potentialla tormentilla), baohauhau (from the baobaosan plant), carob (Ceratonia siliqua), pectin (Malus domestica), wood creosote (Creosote bush), guava (Psidium guajava L.), belladonna (Atropa belladonna), white bean (Phaseolis vulgaris), and wheat (Triticum aestivum) were identified. ^ Results. Qualitative data analysis of nineteen clinical trials indicated berberine’s potentially valuable antisecretory effects against diarrhea caused by Vibrio cholerae and enterotoxigenic Escherichia coli. Tormentil root showed significant efficacy against rotavirus-induced diarrhea; carob exhibited antidiarrheal properties not only by acting to detoxify and constipate but by providing a rich source of calories; guava and belladonna are antispasmodics and have been shown to relieve the symptoms of AD. Finally, white bean and wheat yielded favorable clinical and dietary outcomes in children with diarrhea. ^ Conclusion. The present study is the first to review the evidence for use of herbal compounds for treatment of AD. Future randomized controlled trials are needed to evaluate their efficacy and safety.^

AVIAN ROTAVIRUSES

The prevalence of antirotavirus antibodies in chickens and turkeys in the Gonzales, Texas and Llano, Texas areas was studied. Caged layer chicken flocks were found to have a prevalence of 64% when samples were taken randomly. This compares to 45% in chicken broiler breeder flocks and 92% in turkey breeding flocks. The natural occurrence of turkey rotavirus infection in two separate field studies showed an increase in mortality varying from 9% to 45% above expected death losses. Clinically, pasted vents, lacitude, and general malaise were noted in affected poults. Lesions noted on post mortem examination were; slight ballooning of the small intestine, excessively large ceca, and mild hyperemia of the small and large intestines.^ The use of maternal antibody from simian rotavirus immunized chickens' eggs for preventing murine rotavirus infection in infant mice was investigated. There was a reduction from 91% to 15% incidence when infant mice were treated twice daily with egg yolk immunoglobulin.^ The need for a convenient, easily grown and rapidly reproducing model for avian and mammalian rotaviruses led to the use of coturnix chicks. The turkey rotavirus was adapted to the quail chicks be serial passage. Transmission and scanning electron microscopy as well as micropathological methods were used in the study of the pathogenesis of rotavirus infection in quail and infant mice. ^

The evidence for groundwater as a source of enteric illness in developing countries: A systematic review of the literature

Groundwater constitutes approximately 30% of freshwater globally and serves as a source of drinking water in many regions. Groundwater sources are subject to contamination with human pathogens (viruses, bacteria and protozoa) from a variety of sources that can cause diarrhea and contribute to the devastating global burden of this disease. To attempt to describe the extent of this public health concern in developing countries, a systematic review of the evidence for groundwater microbially-contaminated at its source as risk factor for enteric illness under endemic (non-outbreak) conditions in these countries was conducted. Epidemiologic studies published in English language journals between January 2000 and January 2011, and meeting certain other criteria, were selected, resulting in eleven studies reviewed. Data were extracted on microbes detected (and their concentrations if reported) and on associations measured between microbial quality of, or consumption of, groundwater and enteric illness; other relevant findings are also reported. In groundwater samples, several studies found bacterial indicators of fecal contamination (total coliforms, fecal coliforms, fecal streptococci, enterococci and E. coli), all in a wide range of concentrations. Rotavirus and a number of enteropathogenic bacteria and parasites were found in stool samples from study subjects who had consumed groundwater, but no concentrations were reported. Consumption of groundwater was associated with increased risk of diarrhea, with odds ratios ranging from 1.9 to 6.1. However, limitations of the selected studies, especially potential confounding factors, limited the conclusions that could be drawn from them. These results support the contention that microbial contamination of groundwater reservoirs—including with human enteropathogens and from a variety of sources—is a reality in developing countries. While microbially-contaminated groundwaters pose risk for diarrhea, other factors are also important, including water treatment, water storage practices, consumption of other water sources, water quantity and access to it, sanitation and hygiene, housing conditions, and socio-economic status. Further understanding of the interrelationships between, and the relative contributions to disease risk of, the various sources of microbial contamination of groundwater can guide the allocation of resources to interventions with the greatest public health benefit. Several recommendations for future research, and for practitioners and policymakers, are presented.^

Caracterización y optimización de estructuras biofotónicas y técnicas avanzadas de interrogación para desarrollo de biosensores ópticos

El núcleo fundamental de esta tesis doctoral es un modelo teórico de la interacción de la luz con un tipo particular de biosensor óptico. Este biosensor se compone de dos regiones: en la región inferior puede haber capas de materiales con diferentes espesores y propiedades ópticas, apiladas horizontalmente; en la zona superior, sobre la que incide directamente el haz de luz, puede haber estructuras que hacen que las propiedades ópticas cambien tanto en el plano horizontal como en la dirección vertical. Estos biosensores responden ópticamente de forma diferente al ser iluminados dependiendo de que su superficie externa esté, en mayor o menor medida, recubierta con diferentes tipos de material biológico. En esta tesis se define un modelo analítico aproximado que permite simular la respuesta óptica de biosensores con estructuras en su región más externa. Una vez comprobada la validez práctica del modelo mediante comparación con medidas experimentales, éste se utiliza en el diseño de biosensores de rendimiento óptimo y en la definición de nuevas técnicas de interrogación óptica. En particular, el sistema de transducción IROP (Increased Relative Optical Power), basado en el efecto que produce la presencia de material biológico, en la potencia total reflejada por la celda biosensora en determinados intervalos espectrales, es uno de los sistemas que ha sido patentado y es objeto de desarrollo por la empresa de base tecnológica BIOD [www.biod.es/], estando ya disponibles en este momento varios dispositivos de diagnóstico basados en esta idea. Los dispositivos basados en este sistema de transducción han demostrado su eficiencia en la detección de proteínas y agentes infecciosos como los rotavirus y el virus del dengue. Finalmente, el modelo teórico desarrollado se utiliza para caracterizar las propiedades ópticas de algunos de los materiales de los que se fabrican los biosensores, así como las de las capas de material biológico formadas en las diferentes fases de un inmunoensayo. Los parámetros ópticos de las capas mencionadas se obtienen mediante el método general de ajuste por mínimos cuadrados a las curvas experimentales obtenidas en los inmunoensayos. ABSTRACT The core of this thesis is the theoretical modeling of the interaction of light with a particular type of optical biosensor. This biosensor consists of two parts: in the lower region may have layers of materials with different thicknesses and optical properties, stacked horizontally; at the top, on which directly affects the light beam, there may be structures that make optical properties change in both, the horizontal and in the vertical direction. These biosensors optically respond differently when illuminated depending on its external surface is greater or lesser extent, coated with different types of biological material. In this thesis an approximate analytical model to simulate the optical response of biosensors with structures in its outer region is defined. After verifying the practical validity of the model by comparison with experimental measurements, it is used in the design of biosensors with optimal performance and the definition of new optical interrogation techniques. In particular, the transduction system IROP (Increased Relative Optical Power) based on the effect of the presence of biological material in the total power reflected from the biosensor cell in certain spectral ranges, has been patented and is under development by the startup company BIOD [www.biod.es/], being already available at this time, several diagnostic devices based on this idea. Devices based on this transduction system have proven their efficiency in detecting proteins and infectious agents such as rotavirus and virus of dengue. Finally, the developed theoretical model is used to characterize the optical properties of some of the materials from which biosensors are fabricated, as well as the optical properties of the biological material layers formed at different stages of an immunoassay. The optical parameters of the layers above are obtained by the general method of least squares fit to the experimental curves obtained in immunoassays.

Reovirus reverse genetics: Incorporation of the CAT gene into the reovirus genome

We have modified the infectious reovirus RNA system so as to generate a reovirus reverse genetics system. The system consists of (i) the plus strands of nine wild-type reovirus genome segments; (ii) transcripts of the genetically modified cDNA form of the tenth genome segment; and (iii) a cell line transformed so as to express the protein normally encoded by the tenth genome segment. In the work described here, we have generated a serotype 3 reovirus into the S2 double-stranded RNA genome segment of which the CAT gene has been cloned. The virus is stable, replicates in cells that have been transformed (so as to express the S2 gene product, protein σ2), and expresses high levels of CAT activity. This technology can be extended to members of the orbivirus and rotavirus genera. This technology provides a powerful system for basic studies of double-stranded RNA virus replication; a nonpathogenic viral vector that replicates to high titers and could be used for clinical applications; and a system for providing nonselectable viral variants (the result of mutations, insertions, and deletions) that could be valuable for the construction of viral vaccine strains against human and animal pathogens.

Análise multigênica de rotavírus do grupo A em suínos

Os rotavírus do grupo A (RVA) são importantes causadores de diarreias virais em crianças e animais jovens de diferentes espécies, com impactos na saúde pública e animal. Visando contribuir para o entendimento e prevenção das rotaviroses assim como suas possíveis relações zoonóticas, caracterizou-se os 11 segmentos de dsRNA de rotavírus codificadores das proteínas estruturais e não estruturais presentes em amostras fecais positivas de suínos coletadas nos anos de 2012-2013, em 2 estados brasileiros. Mediante o emprego de RT-PCR, sequenciamento nucleotídico e análises filogenéticas, todos os segmentos genéticos oriundos de 12 amostras de RVA detectados em suínos foram analisados e comparados com os de outras amostras descritas previamente. As sequências obtidas para os genes codificadores das proteínas NSP2, NSP3 e VP6 contemplaram a open reading frame (ORF) completa do gene, enquanto que a ORF parcial foi determinada para os genes codificadores das proteínas VP1, VP2, VP3, VP4, VP7, NSP1, NSP4, NSP5 e NSP6. Os genotipos de rotavírus suíno provenientes das regiões amostradas concordam com os mais frequentemente descritos nesta espécie animal, apresentando, assim, uma matriz genética suína com a maioria dos segmentos pertencentes à constelação genotípica 1, com exceção dos genes codificadores das proteínas VP6 e NSP1, os quais foram os genotipos I5 e A8, respectivamente. Apesar de predominar o genotipo 1 (Wa-like) nas sequências deste estudo, a análise genômica sugere a existência de uma variação intragenotípica no genoma do rotavírus do grupo A atualmente circulante nas populações suína amostradas dos estados de São Paulo e Mato Grosso. Adicionalmente, buscou-se identificar os aminoácidos relacionados com a adaptação dos rotavírus no hospedeiro e assinaturas genéticas que distinguissem RVA suíno e humano. Para isso, as sequências obtidas neste estudo foram comparadas com outras cepas de RVA detectadas nestas duas espécies e pertencentes ao genotipo 1 (Wa-like) disponíveis no Genbank. Como resultados foram encontrados mais de 75 sítios de mudanças deaminoácidos que diferenciam RVA suíno e humano além de sítios de substituiçãopresentes em algumas proteínas virais que frequentemente covariaram entre elas. Estes resultados proporcionam um maior entendimento da diversidade viral circulante em unidades de produção suína e uma melhor compreensão dos animaiscomo reservatórios genéticos de cepas de rotavírus emergentes em humanos.

Impacto da vacinação contra rotavírus nas consultas de pronto-socorro e internações por doença diarreica aguda em crianças menores de cinco anos de idade

INTRODUÇÃO: A doença diarreica aguda é a segunda causa de morte em crianças abaixo de 5 anos de idade. No Brasil, entre 2003 e 2009, a diarreia aguda foi responsável por cerca de 100.000 internações por ano, e por 4% das mortes em crianças abaixo de 5 anos de idade. O rotavírus é a principal etiologia de diarreia aguda grave no mundo todo, sendo responsável por 40% das internações por diarreia aguda, e 29% de todas as mortes por diarreia aguda. A vacina monovalente (RV1) contra o rotavírus foi introduzida no Programa Nacional de Imunizações em 2006. OBJETIVOS: Verificar o impacto da vacina monovalente contra rotavírus nas consultas de pronto-socorro e internações por doença diarreica aguda em crianças menores de 5 anos de idade, verificar a positividade do exame \"pesquisa de rotavírus nas fezes\", e verificar a presença ao ausência de imunidade de rebanho. METODOLOGIA: Foi realizado um estudo ecológico retrospectivo no Hospital Universitário da Universidade de São Paulo. O período foi dividido em pré-vacina (2003 a 2005) e pós-vacina (2007 a 2009). Foram incluídas todas as crianças abaixo de 5 anos que passaram em consulta no pronto-socorro e verificado o diagnóstico do atendimento e internação através de registro eletrônico. Foram obtidas as taxas de consultas no pronto-socorro e internações por doença diarreica aguda, foram selecionadas as crianças não vacinadas para cálculo da imunidade de rebanho, e verificado se houve coleta do exame pesquisa de rotavírus nas fezes. A redução nas taxas foi obtida através da fórmula: redução (%) = (1 - odds ratio) x 100. RESULTADOS: No período pré-vacina a taxa de consultas por diarreia aguda foi de 85,8 consultas por 1.000 consultas gerais, no período pós vacina a taxa de consultas por diarreia aguda foi 80,9 por 1.000, e a redução foi 6% (IC 95%, 4% a 9%, p < 0,001), chegando a 40% (IC 95%, 36% a 44%, p<0,001) nos meses de maio e junho. A taxa de internação por diarreia aguda era 40,8 internações por 1.000 e caiu para 24,9 por 1.000, redução de 40% (IC 95%, 22% a 54%, p < 0,001), chegando a 82% (IC 95%, 62% a 92%, p < 0,001) nos meses de maio e junho. Nas crianças não vacinadas não houve redução na taxa de consultas de pronto-socorro (IC 95%, -4% a 5%, p=0,903), e não se pode afirmar se houve redução ou aumento das internações por diarreia aguda (IC 95%, -212% a 35%, p=0,381). Houve queda da positividade do exame pesquisa de rotavírus em 2009 (redução de 70%, IC 95%, 26% a 88%, p=0,007). CONCLUSÕES: Após a introdução da vacina contra rotavírus (RV1) houve uma redução de 6% nas consultas por diarreia aguda no pronto-socorro, de 40% nas internações por diarreia aguda e de 70% na positividade do exame pesquisa de rotavírus nas fezes. Não foi detectada imunidade de rebanho

KATSAUS NORO- JA ROTAVIRUSDIAGNOSTIIKAN MONIMUOTOISUUTEEN SEKÄ NOPEAN RNA-TESTIN KEHITYS NOROVIRUKSELLE

Gastroenteriitti on akuuttitila, jossa oireita ovat esimerkiksi oksentelu ja ripulointi. Yleisimpiä taudin aiheuttajia ovat bakteerit ja virukset. Erityisesti norovirus (NoV) ja rotavirus kykenevät aiheuttamaan laajoja epidemioita. Haasteena näiden diagnostiikassa ovat näytematriisit, jotka häiritsevät määrityksiä. Muita haasteita ovat esimerkiksi kustannustehokkuus ja kiire, sillä yksittäiset infektiot leviävät herkästi epidemiaksi asti. Lisäksi testien olisi sovelluttava sekä kliinisiin laboratorioihin että kenttätyöhön. Immunodiagnostiikkaan perustuvat määritykset ovat rutiinikäytössä tehokkaita seulontatarkoituksessa. Tarkempaa seulontaa varten on ratkaisuksi ehdotettu nukleiinihappodiagnostiikkaa. Menetelmänä se on tehokas ja erittäin spesifinen. Heikkoutena on hitaus ja alhainen soveltuvuus kenttäolosuhteisiin. Tämän takia on kehitetty isotermisiä monistustekniikoita, jotka eivät olisi sidottu kliiniseen laboratorioympäristöön. Yksi tällainen tekniikka on monivaiheinen nukleiinihapposekvenssiin perustuva monistus (NASBA). Tutkielman kokeellisessa osassa tutkittiin lantanidikelaattien komplementaatioon perustuvan reportterimenetelmän soveltuvuutta NASBA-tekniikkaan. Reaaliaikaisen käänteiskopiointipolymeraasiketjureaktion tuloksista havaittiin, että monistumisen kanssa oli haasteita. NoV-reaktiot monistuivat vaihtelevasti ja NASBA-monistuksissa havaittiin, että NoV-reaktiot eivät monistuneet vaikka reaktio-olosuhteita muunnettiin. Syyksi tähän muodostui sekundaarimallinnuksessa templaatin sekundaarirakenteet, jotka muodostuvat NASBA-monistuksen syklisessä vaiheessa. Rakenteet kykenevät hidastamaan ja keskeyttämään käytettyjen entsyymien toimintaa. NASBA-tekniikka on haasteellinen, mutta potentiaalinen tekniikka, jota kyettäisiin käyttämään myös kenttäolosuhteissa. Tekniikan etuja ovat kehitettävyys ja muokattavuus, sillä se ei ole sidottu yhteen tiettyyn leima- tai laiteteknologiaan.