INTRODUCTION
Human noroviruses (HuNoV) are a major cause of viral gastroenteritis worldwide, with an estimated 3 million cases each year in the United Kingdom alone (
1). HuNoV are members of the
Caliciviridae family, which have a single-stranded positive-sense RNA genome and can cause a variety of disease manifestations in a wide range of species. The
Norovirus genus itself is divided into at least six different genogroups based on capsid sequences (
2,
3). HuNoV strains fall into genogroups I, II, and IV (GI, GII, and GIV). GII strains are responsible for 96% of HuNoV cases worldwide, with GII.4 genotypes being the most prevalent overall (
4). In humans, HuNoV typically causes acute diarrhea, vomiting, and abdominal cramps, with the illness lasting on average 28 to 60 h (
5). Infection is most common in health care institutions such as hospitals and long-term-care facilities (
6), but outbreaks are often reported in association with schools, restaurants, cruise ships, and other settings such as military bases (
7).
Transmission of HuNoV is via contact with feces or vomit, which occurs predominantly through direct person-to-person contact or contaminated food and water (
8). Zoonotic transmission of HuNoV has also been proposed as a hypothetical route of infection (
9). Both cattle and pigs have come under scrutiny for their potential role in transmitting HuNoV over the past decade. This has been precipitated by the identification of GII.4 HuNoV RNA in the stools of farmed pigs and cattle (
10,
11). Furthermore, over half of the pigs in a U.S. report were seropositive to both GI and GII human noroviruses (
12). This finding was supported by a study that demonstrated that human strains can replicate and induce an immune response in gnotobiotic pigs (
13).
Dogs were first suggested to be potential zoonotic vectors of HuNoV in 1983, following an outbreak of norovirus gastroenteritis in an elderly-care home (
14). Just prior to development of clinical symptoms in humans, the owner's dog was sick on multiple occasions around the home. Serological testing of the dog later revealed a moderate titer to HuNoV antigen by electron microscopy, whereas control dogs were all seronegative. Later evidence linking dogs with HuNoV infections in humans followed in an epidemiological study that showed that seropositivity to HuNoV in humans was higher if there was a dog in the household (
15), and anti-HuNoV antibodies have recently been identified in dogs across Europe (
16).
In 2012 it was reported that HuNoV could be detected in stool samples from pet dogs (
17). Samples were collected from 92 dogs if the dog or owner had recently suffered from diarrhea or vomiting. Canine stool samples were tested for the presence of GI, GII, and GIV HuNoV, and 4 dogs were found to be positive for GII HuNoV. In one case, the HuNoV strain identified was identical to that isolated from stools of the owner. While the presence of identical sequences does not formally confirm active replication in dogs, the levels of viral RNA observed would suggest that at least limited replication had occurred.
The primary step for HuNoV infection of cells requires HuNoV binding to complex carbohydrates known as histo-blood group antigens (HBGAs) (
18). As well as being expressed on erythrocytes, HBGAs are expressed on the surface of epithelial cells of the gastrointestinal, genitourinary, and respiratory tracts and can be secreted by these cells into bodily fluids, including saliva (
19). Internalization of viral particles into cells occurs following HuNoV attachment to HBGAs
in vitro, and therefore it has been proposed that the primary step for HuNoV uptake into cells is HuNoV binding to the HBGAs. The importance of HBGA binding in human infections has been demonstrated by experimental challenge studies. These have shown that susceptibility to HuNoV infection is related to expression of HBGAs in the gastrointestinal tract (
20,
21). Approximately 20% of Caucasians do not express gastrointestinal HBGAs due to the lack of a functional fucosyltransferase 2 (
FUT2) gene (“nonsecretors”), and consequently these individuals have a significantly reduced susceptibility to infection with noroviruses.
For dogs to be susceptible to human norovirus, it is reasoned that dogs must express HBGAs in their gastrointestinal tracts. Although canine blood types bear no resemblance to the human system, and indeed canine erythrocytes cannot be agglutinated by HuNoV (
22), we have recently demonstrated that dogs do express HBGAs in their saliva and on the surface of intestinal epithelial cells (
23). This indicates that dogs express the relevant attachment factors for the primary step in HuNoV infection, which is indicative of a theoretical susceptibility to HuNoV.
With approximately 10 million dogs in the United Kingdom, divided among 31% of the households (
24), the suggestion that HuNoV may be transmissible between these species is of considerable public health concern. This study aimed to investigate the ability of HuNoV to infect dogs and the frequency with which this might be occurring in the United Kingdom. This has been achieved by first exploring the relationship between canine HBGA expression and HuNoV binding to canine tissues, and second by determining the occurrence of current and past HuNoV infections in dogs using an HuNoV RNA survey of canine stool samples and a serological survey of canine serum.
MATERIALS AND METHODS
Ethics statement.
Collection of canine saliva samples was a nonregulated procedure, and hence ethical approval was not required. Similarly, no ethical approval was required for collection of canine stool and serum samples, as these were either animal waste products, surplus to diagnostic requirements, or derived from a previously published and ethically approved study (
25). Canine gastrointestinal tissue samples were donated by a large pharmaceutical company; the six dogs had been bred for scientific research but were deemed unsuitable for this purpose and were humanely euthanized. Human saliva samples were collected as part of a previous study (
26), approved by the Nantes University Hospital Review Board (study no. BRD02/2-P), with informed written consent obtained from all saliva donors.
Samples.
Stool samples were collected from dogs admitted to six participating United Kingdom veterinary clinics in Suffolk, Kent, Lincolnshire, Middlesex, and Cambridgeshire. Dogs were recruited to the study if they passed stools while hospitalized, and with owner consent, stools were collected by veterinary personnel. An additional 10 samples were collected from Wood Green Animal Shelter, Cambridgeshire, United Kingdom, from dogs suspected to have infectious gastroenteritis. All stool samples were stored at −20°C until and during transportation to the laboratory, whereafter they were stored at −80°C prior to extraction of RNA. Control stool samples from non-veterinary patients were collected from healthy dogs owned by veterinary staff, as well as from dogs at participating boarding kennels. Basic case data were recorded for each dog from which a stool sample was collected, including age, breed, sex, reason for admission, and any recent history of enteric disease.
Canine serum samples were obtained from two separate dog populations. Samples from 1999 to 2001 were collected from a rehoming kennel as part of an existing study (
25). Serum samples from 2012 to 2013 were surplus to diagnostic requirements, obtained from veterinary patients at the Royal Veterinary College, London, from which blood was collected for biochemical analysis for diagnostic purposes.
Canine saliva samples were collected from 23 dogs at Wood Green Animal Shelter, Huntingdon, United Kingdom (numbered 1 to 23), and a further 3 samples were collected from three of the dogs at a pharmacological research company in the United Kingdom (labeled D, E, and F). The dogs at the animal shelter were mixed breeds, whereas the research dogs were beagles. Sample collection was achieved using a children's swab (Salimetrics, Newmarket, United Kingdom), from which saliva was extracted. Human saliva samples were collected as part of a previous study (
26).
Canine tissue samples were donated from six healthy 18-month-old female dogs (labeled A to F) that had been humanely euthanized as surplus to industry research requirements. Sections of the gastrointestinal tract (1 cm
2) were dissected as previously described (
23). Briefly, either samples from the duodenum, jejunum, ileum, cecum, and colon were fixed and then embedded in paraffin and sectioned, or sections were lysed and homogenized to generate scraping samples.
RNA extraction and reverse transcription-quantitative PCR (qRT-PCR).
Stools were diluted 10% (wt/vol) in phosphate-buffered saline (PBS) (pH 7.2), and solids were removed by centrifugation at 8,000 × g for 5 min. Viral nucleic acid was extracted from 140μl of each clarified stool suspension with the GenElute mammalian total RNA miniprep kit (Sigma-Aldrich) according to the manufacturer's instructions.
An internal extraction control was added to each sample during nucleic acid extraction to verify removal of PCR inhibitors and enable precise quantification of viral nucleic acid. A fixed amount of equine arteritis virus (EAV) RNA was added with the lysis buffer to each sample to obtain an EAV concentration of approximately 1 × 10
8 copies per ml of fecal suspension. qRT-PCR was used to screen for genogroup I (GI) and genogroup (GII) HuNoV using previously published primer-probe sets (
27). Samples were also screened for canine-specific noroviruses using a primer-probe set designed to identify six different strains of canine norovirus (CNV) (
Table 1) as well as canine parvovirus (CPV) and canine enteric coronavirus (CECoV) in a duplex assay as previously reported (
28).
Using a 1-step qRT-PCR protocol, 2μl of extracted RNA was added to 2× Precision OneStep qRT-PCR MasterMix (PrimerDesign Ltd.), 6 pmol/μl primers, and 3 pmol/μl probe. The thermal cycle protocol, used with a ViiA7 qPCR machine (AB Applied Biosystems), was as follows: 55°C for 30 min, inactivation of reverse transcriptase at 95°C for 5 min, and then 40 cycles consisting of denaturation at 95°C for 15 s and then annealing and elongation at 60°C for 1 min.
VLP production.
Virus-like particles (VLPs) of seven different HuNoV genotypes (GI.1, GI.2, GI.3, GII.3, GII.4, GII.6, and GII.12) and VLPs of three strains of CNV were produced using a previously described method (
28–30). Accession numbers for the HuNoV strains used to generate the VLPs for this study are listed in
Table 2. Recombinant baculoviruses containing human or canine norovirus VP1 protein were generated, and then VLPs were produced by infection of Hi5 insect cells. VLPs were released from the infected Hi5 cells by freeze-thawing and then clarified by removing cellular debris (6,000 ×
g, 30 min) and baculovirus (14,000 ×
g, 30 min). VLPs were partially purified through a 30% (wt/vol) sucrose cushion in TNC buffer (50 mM Tris HCl [pH 7.4], 150 mM NaCl, 10 mM CaCl
2) containing the protease inhibitor leupeptin at 150,000 ×
g for 2 h. The pelleted VLPs were resuspended in TNC and further purified by isopycnic centrifugation in cesium chloride (150,000 ×
g, 18 h). The resultant VLP bands were collected by puncture, and the solution containing VLPs was dialyzed against PBS prior to quantification by the bicinchoninic acid (BCA) protein assay (Thermo Scientific) and storage at −80°C. GI.1 and GII.4 VLPs were visualized by electron microscopy to confirm correct particle assembly (
Fig. 1), and as all VLPs in this study were made using an identical protocol and formed a defined band on a cesium chloride gradient, this was deemed sufficient to confirm VLP formation for each genotype.
Enzyme-linked immunosorbent assay (ELISA) procedure.
Ninety-six-well polystyrene microtiter plates (Nunc Maxisorb; Fisher Scientific) were coated overnight at 4°C with 25 ng of each GI strain (3 strains, total of 75 ng/well) or each GII strain (4 strains, total of 100 ng/well) in 0.05 M carbonate-bicarbonate buffer (pH 9.6). Plates were washed three times with 0.05% Tween 20 in phosphate-buffered saline (PBS-T) before blocking in 5% skim milk–PBS-T for 1 h at 37°C and then three PBS-T washes. Plates were then incubated for 3 h at 37°C with a 1:50 dilution of each serum sample in duplicate in 5% skim milk–PBS-T. Pooled human sera (Sigma-Aldrich), diluted 1:400, and 100 ng pooled GII human norovirus VLPs were used as a positive control. After three washes with PBS-T, 50 μl of horseradish peroxidase (HRP)-conjugated anti-canine or anti-human IgG antibody (both from Sigma-Aldrich) diluted 1:5,000 or 10,000, respectively, in 5% milk–PBS-T was added to each well and incubated at 37°C for 1 h. The plates were washed three times with PBS-T and bound antibody detected with 50 μl tetramethylbenzidine (TMB) (Sigma-Aldrich), followed by incubation at room temperature for 10 min. The reaction was stopped with 1 N H2SO4, and the optical density at 450 nm (OD450) was read (Spectromax M2 plate reader; Molecular Devices).
To eliminate the possibility that nonspecific components of the VLP preparation were identified by the canine sera, an antigenically distinct vesivirus 2117 VLP was included in the assay. The OD450s of serum samples incubated on either carbonate-bicarbonate buffer-coated wells or vesivirus 2117-coated wells were highly comparable, with the exception of 8% of dogs which displayed reactivity to vesivirus 2117, which was a limitation of this methodology (data not shown). It was suspected that reactivity to vesivirus 2117 could be due to cross-reactivity with the related canine calicivirus, but no correlation between seropositivity to HuNoV or seropositivity to vesivirus 2117 was shown (see Fig. S1 in the supplemental material). Subsequently, the background signal for each sample was determined by measuring the OD450 of serum samples incubated with carbonate-bicarbonate buffer alone. The background signal was then subtracted from the OD450 of VLP-coated wells to generate the corrected OD450 value. A threshold value was established as the mean of the OD450s of all buffer-coated cells plus 3 standard deviations. A serum sample was considered positive when the corrected OD450 was higher than the threshold. Any serum samples showing a positive response to pooled HuNoV VLPs were subjected to further testing with individual HuNoV VLPs. Plates were coated with 25 ng of individual VLPs in carbonate-bicarbonate buffer and the protocol then repeated as described above.
Evaluation of serological cross-reactivity between different norovirus strains was achieved using VLP competition assays and antibody competition assays. For the VLP competition assays, plates were first coated with 25 ng/well of VLP overnight at 4°C. Canine serum was incubated with a range of concentrations of either pooled GI or GII HuNoV VLPs or pooled CNV VLPs (0.5, 1, 2, and 4 μg/ml) for 1 h at 37°C. Vesivirus 2117 VLP was incubated with the canine sera as a negative control. After the incubation period, 50 μl of each serum-VLP combination was added to the previously VLP-coated plates. The remainder of the ELISA protocol was followed as detailed above. The concentration of VLP required to block 50% binding (50% effective concentration [EC50]) was calculated by fitting sigmoidal curves to the serial dilution data. Samples unable to block 50% of binding at the highest dilution tested were assigned an EC50 of 2.5× the assay upper limit of detection.
For the antibody competition assays, polyclonal anti-norovirus VLP antibodies were generated by immunization of a rabbit (GII.4 HuNoV) or rat (CNV) as previously described (
31). Plates were coated with 25 ng/well of GII.4 VLP overnight at 4°C, and then after blocking for 1 h in 5% skim milk–PBS-T, rabbit anti-GII.4 or rat anti-CNV antibody was added to the wells serially diluted in 5% skim milk–PBS-T for 1 h. Following three washes in PBS-T, GII.4-positive canine serum was added and the remainder of the ELISA protocol followed as described above.
Assays to assess VLP binding to saliva and gastrointestinal scrapings used the ELISA protocol as described above, with the addition of 100 ng HuNoV VLPs per well in 5% skim milk–PBS-T after the 1-h blocking step with 5% skim milk–PBS-T. VLPs were incubated at 37°C for 1 h with the saliva or gastrointestinal scraping samples and then detected using polyclonal anti-GI.1 (rabbit 130) or anti-GII.4 (rabbit 132) primary antibodies. Goat HRP-conjugated anti-rabbit antibody (Interchim, France) was used as the secondary antibody as previously described. The saliva phenotyping assay used the ELISA protocol as detailed above, with variations as described in a previous study (
23).
SDS-PAGE and Western blot analysis.
VLPs were heated to 95°C for 5 min in the presence of SDS loading buffer and electrophoresed on 12.5% SDS-polyacrylamide gels. For Coomassie blue staining, the gels were incubated with Coomassie blue for 1 h at room temperature prior to destaining. Proteins were transferred from SDS-polyacrylamide gels to polyvinylidene difluoride membranes for Western blotting. The membranes were blocked for 1 h at room temperature with 5% milk in PBS-T and then incubated overnight at 4°C with canine serum samples diluted 1:1,000. The excess antibody was washed three times in PBS-T and incubated for 1 h with anti-canine IgG secondary antibody conjugated to horseradish peroxidase (Sigma-Aldrich) diluted 1:10,000 in 5% milk–PBS-T. After washing away excess secondary antibody, the bands were detected using enhanced chemiluminescence reagent (GE Healthcare).
Tissue samples and immunohistochemical analysis.
Tissue sections from the gastrointestinal tracts of six dogs were deparaffinized through baths of LMR-SOL (1-bromopropane, 2-methylpropane-2-ol, and acetonitrile), followed by rehydration with successive baths of 100, 90, 70, and 50% ethanol. Endogenous peroxidase activity was blocked with 0.3% hydrogen peroxide in PBS. Nonspecific binding was blocked with 3% bovine serum albumin (BSA) in PBS. H and A antigen detection was then performed as previously reported (
23). To assess the ability of VLPs to bind to tissue sections, after blocking, 1 μg/ml VLPs was incubated with the sections overnight at room temperature. Anti-HuNoV primary antibody was then incubated with the tissue sections for 1 h at 37°C. After three washes in PBS, sections were incubated with secondary anti-rabbit biotinylated antibody (Vector Laboratories, Burlingame, CA) diluted in 1% BSA in PBS for 1 h. Sections were washed three times in PBS prior to addition of HRP-conjugated avidin D (Vector Laboratories, Burlingame, CA) also diluted in 1% BSA in PBS. Substrate was added to the slides (AEC kit; Vector Laboratories, Burlingame, CA), followed by Mayer's hematoxylin solution (Merck, Whitehouse Station, NJ) for contrast staining.
DISCUSSION
This study sought to investigate the likelihood that dogs can be infected with HuNoV, following initial reports that HuNoV can be detected in the stools of dogs (
17). The results of our serological survey and VLP binding studies strongly suggest that dogs are susceptible to HuNoV. However, the frequency with which this occurs is deemed low based on the epidemiological results from this report. Furthermore, the clinical implications for both dogs and people in contact with dogs still remain to be confirmed.
In humans, it has been shown that HuNoVs bind to cell surface carbohydrates of the HBGA family prior to internalization. HBGAs are expressed on epithelial cells of many species, and we have recently confirmed that this includes dogs (
23). This finding led us to hypothesize that HuNoV would be able to bind to the gastrointestinal tracts of dogs, and the ELISA and IHC data presented in this report were able to confirm this. This demonstrates that the initial step required for HuNoV entry into canine cells is present. However, it should be noted that rabbit hemorrhagic disease virus (RDHV), a related but distinct member of the
Caliciviridae family, can bind to HBGAs (H type 2, A antigen and B antigen) (
35), and yet there is no evidence RHDV can infect any species other than wild and domestic rabbits of the
Oryctolagus cuniculus species. HBGA binding may be an initial step in calicivirus-host interaction, but a subsequent host-restrictive step(s) must be necessary for RHDV infection and potentially for HuNoV infection in dogs.
The viral RNA survey conducted as part of this project did not reveal any canine stool samples containing HuNoV RNA. This implies that the incidence of HuNoV shedding by this population of dogs is negligible, despite samples being collected from healthy dogs (117 animals), dogs with nongastroenteric disease (64 animals), and dogs with severe gastroenteritis requiring veterinary attention (67 animals). Inclusion of samples from the latter two groups was essential, as it has been suggested that HuNoV may be more likely to infect dogs with underlying disease or immunodeficiency (
17), and as canine-specific noroviruses are associated with gastroenteritis in dogs (
3,
36), it was hypothesized that HuNoV infection of dogs may cause signs of gastroenteric disease. Gastroenteritis is a common condition in dogs, with an owner questionnaire reporting diarrhea in 14.9% of dogs within the previous 2-week period (
37) and 6% of canine veterinary consultations addressing gastroenteritis as a primary complaint (
38). Of the 67 dogs with gastroenteritis in our survey, CPV (10 dogs) and CECoV (2 dogs) were detected in 17.9%. This proves that while viral gastroenteritis is relatively common in dogs, noroviruses are not a major cause of viral disease in the population of dogs sampled. The likelihood of HuNoV infection in a dog resulting in clinical signs of gastroenteritis is clearly much lower than that of CPV and CECoV infection, and as such, there is no immediate cause for concern by owners and veterinarians.
The absence of HuNoV-positive stool samples from dogs in this study is in contrast to the results of Summa et al. (
17), who identified HuNoV RNA in 4/92 canine stool samples. However, their sampling strategy was significantly different from our approach; canine stool samples were collected only if the owner had shown symptoms of gastroenteritis within the past week, whereas stool samples in this study were collected with no reference to recent owner illness. HuNoV in humans is typically an acute infection, with peak viral shedding occurring 2 to 4 days after infection. By 3 weeks after infection, only 25% cases are still positive for viral RNA (
39). In addition, although HuNoV is responsible for millions of infections worldwide each year, the virus is only identified in approximately 18% of human diarrheic samples submitted (
40). Detection of HuNoV RNA in feces can be limited by factors such as low virus concentrations, improper storage of samples, inefficient viral RNA extraction, and the presence of fecal reverse transcriptase inhibitors (
41). Overall, this indicates that positive identification of HuNoV shedding in dogs will be possible only within a very narrow time frame and that a proportion of cases will be false negatives. This suggests that in order to confirm that HuNoV can be shed in canine stools and to determine an accurate prevalence rate, a much larger sample size and/or a more focused sampling approach, e.g., collection of stool samples from owners with confirmed HuNoV infection, will be required.
Serological analysis of 325 canine serum samples in this study strongly suggests that dogs mount immune responses against HuNoV. We have demonstrated that almost 20% of dogs sampled in 2012 to 2013 had antibodies that could recognize HuNoV VLPs. This suggests that 1 in 5 dogs has been exposed to HuNoV in the United Kingdom. This proportion was lower than the proportion of dogs (43%) reported to be seropositive to HuNoV by a recent survey across Europe (
16), which may be a reflection of population differences. An important conclusion from both studies is that the HuNoV seroprevalence rate identified in dogs is substantially lower than HuNoV seropositivity among human populations. In the United Kingdom nearly 100% of people are seropositive for GII.4 (
42). This indicates that either dogs are exposed much more rarely to HuNoV or they are much less susceptible to infection than humans. Given that in one questionnaire-based study, 96% of dogs slept in their owners' houses and that when owners are at home almost 60% dogs were allowed anywhere in the house (
43), it seems unlikely that dogs would not be exposed to HuNoV in a household with infected humans. Therefore, we propose that dogs are susceptible to HuNoV but at a much lower level than humans.
It could be argued that the anti-HuNoV antibodies identified in canine sera may have been generated in response to infection with related nonhuman noroviruses and are merely cross-reactive with HuNoV. For example, anti-CNV antibodies were detected in 45.2% of serum samples used in this study (
28). To investigate this further, a series of blocking assays were performed using canine serum samples and serum samples from rats inoculated with CNV VLPs. These were able to show that the anti-GII HuNoV antibodies were specific for GII HuNoV VLPs and not three different strains of CNV (GIV and GVI). It is acknowledged that there are other nonhuman and noncanine noroviruses to which dogs may have been exposed, for example, swine, bovine, and feline noroviruses, cross-reactivity to which was not assessed. However, cross-reactivity between genogroups is known to be limited (
34), and thus antibodies specific for feline noroviruses (GIV.2 genotype, the same as certain canine noroviruses) (
44) or bovine noroviruses (GIII) are highly unlikely to cross-react with GII human noroviruses. Swine noroviruses, however, are classified into GII alongside human strains (
45), and thus there is a greater risk of cross-reactivity. Nevertheless, due to United Kingdom farming practices, the frequency with which dogs in the study population would come into contact with pigs was deemed to be significantly lower than the frequency of contact with humans. In addition, although the feeding of raw pork to dogs does infrequently occur, animal noroviruses are extremely unlikely to be found in commercial pet food due to United Kingdom manufacturing processes and regulations (
46).
The initial serosurvey demonstrated that dogs were more likely to be seropositive to GII HuNoV strains than to GI strains. This was in line with the findings from a recent European study (
16). To explore this further, any HuNoV-positive samples were entered into a second round of ELISAs with VLPs from seven individual genotypes. This showed that the highest seroprevalence was to GII.4 strains. This is remarkable, as this is the most common genotype infecting humans worldwide. This also correlates with the report which identified HuNoV in the stools of four dogs (
17). GII.4 HuNoV was detected by qPCR in the stools of 3 dogs and GII.12 in the stools of 1 dog.
Comparison of canine serum samples from two time periods (1999 to 2001 and 2012 to 2013) allowed analysis of the change in the prevalence of anti-HuNoV antibodies over time. Although the two study populations are not directly comparable (the earlier group was from a rehoming kennel and the later from a veterinary referral hospital) and the range of HuNoV strains studied was limited, it was shown that the proportion of dogs seropositive for HuNoV increased over this period. The prevalence of HuNoV in humans in United Kingdom has increased over a similar time period, from 6% in 1999 to approximately 16% in 2009 (
47). It is possible to speculate that the rise in HuNoV seroprevalence in dogs from 1999 onwards is a reflection of the increased levels of infection in the human population.
Overall, this study supports the hypothesis that dogs can become infected with HuNoV. However, there are many questions still outstanding. First, it is unknown whether HuNoV infection has the potential to cause clinical disease in dogs. To answer this definitively, experimental studies will be required. Second, assuming that dogs can become infected with HuNoV, it is unknown whether dogs will shed virus in their stools in sufficient quantities to infect humans. It has been estimated that as few as 18 HuNoV particles may be sufficient to cause infection in humans (
48), so it is likely that very low levels of shedding will be infectious. However, differences in the physiology of the canine and human gastrointestinal tracts (e.g., pH [
49]) mean that it is possible that particle infectivity varies between the species. A third unanswered question is whether dogs play a significant role in the epidemiology of certain HuNoV outbreaks. The majority of HuNoV outbreaks do not occur in places where dogs are commonly found, e.g., outbreaks on cruise ships or in hospitals, but a role for dogs perpetuating outbreaks in communities cannot be ruled out. A final question is whether there is potential for dogs to be coinfected with CNV and HuNoV simultaneously. There is also concern than CNV may be zoonotic based on serological and receptor studies (
23,
50); hence, CNV/HuNoV coinfections may also be possible in humans. If coinfections can occur, there would be a theoretical risk for recombination between virus strains, leading to generation of a novel norovirus. This may have altered virulence in canine and human hosts, and ongoing surveillance for such recombinants is deemed important.
In summary, whereas HuNoV infection of dogs has been shown to be theoretically possible, the risk of this causing significant clinical disease in dogs is believed to be very low. As for the potential for HuNoV infection being transmitted between dogs and their owners, this has yet to be established, though it is recommended that sensible hygiene precautions be taken around pets, especially when gastroenteritis in either humans or dogs is present in a household.