ABSTRACT Conditions related to the acquired immune deficiency syndrome (AIDS) are still a significant cause of morbidity and mortality among people living with HIV (PLHIV). Longer survival in this population were reported to increase the risk of developing noncommunicable chronic diseases (NCDs). This study aimed to estimate the survival and causes of death according to age group and sex among PLHIV monitored at two referral centers in the Northeastern Brazil. This is a prospective, retrospective cohort with death records from 2007 to 2018, based on a database that registers causes of death using the International Classification of Disease (ICD-10), which were subsequently coded following the Coding Causes of Death in HIV (CoDe). A total of 2,359 PLHIV participated in the study, with 63.2% being men, with a follow-up period of 13.9 years. Annual mortality rate was 1.46 deaths per 100 PLHIV (95% CI: 1.33 – 1.60) with a frequency of 20.9%. Risk of death for men increased by 49% when compared to women, and the risk of death in PLHIV increased by 51% among those aged 50 years and over at the time of diagnosis. It was observed that 73.5% accounted for AIDS-related deaths, 6.9% for non-AIDS defining cancer, 6.3% for external causes, and 3.2% for cardiovascular diseases. Among the youngest, 97.2% presented an AIDS-related cause of death. Highest frequency of deaths from neoplasms was among women and from external causes among men. There is a need for health services to implement strategies ensuring greater adherence to treatment, especially among men and young people. Moreover, screening for chronic diseases and cancer is essential, including the establishment of easily accessible multidisciplinary care centers that can identify and address habits such as illicit drug use and alcoholism, which are associated with violent deaths. AIDS (AIDS PLHIV. . (PLHIV) NCDs. NCDs (NCDs) Brazil prospective 200 2018 ICD10, ICD10 ICD 10 , (ICD-10) CoDe. CoDe (CoDe) 2359 2 359 2,35 632 63 63.2 followup follow up 139 13 9 13. 146 1 46 1.4 95% 95 (95 CI 133 33 1.3 1.60 160 60 209 20 20.9% 49 51 5 diagnosis 735 73 73.5 AIDSrelated 69 6 6.9 nonAIDS non 3 6.3 32 3.2 youngest 972 97 97.2 treatment Moreover essential alcoholism (PLHIV (NCDs 201 ICD1 (ICD-10 (CoDe 235 35 2,3 63. 14 4 1. (9 1.6 16 20.9 7 73. 6. 3. 97. (ICD-1 23 2, ( 20. (ICD- (ICD

ABSTRACT The worldwide monkeypox (mpox) outbreak in 2022 showed a high frequency of sexually transmitted infections (STI). A cross-sectional study was carried out using secondary data from the Brazilian official mpox surveillance systems. A total of 10,169 mpox cases were identified, with a median age of 32 years. Among them, 92.3% were male at birth and 57.5% were men who have sex with other men (MSM). Approximately 11% were diagnosed with STI, including 5.8% with syphilis and 2.5% with genital herpes. Individuals aged from 25 to 34 years, MSM, individuals with HIV-positive status, and those manifesting skin eruptions or penile edema were associated with STI. Laboratory investigation for mpox must be implemented as a priority in STI clinics (especially for MSM) to mitigate neglected cases, ensure appropriate treatments, and prevent misdiagnoses. (mpox 202 . (STI) crosssectional cross sectional systems 10169 10 169 10,16 identified 3 years them 923 92 92.3 575 57 5 57.5 MSM. MSM (MSM) 11 58 8 5.8 2 2.5 herpes HIVpositive HIV positive status especially treatments misdiagnoses 20 (STI 1016 1 16 10,1 9 92. 57. (MSM 5. 2. 101 10,

ABSTRACT Sporotrichosis is a neglected mycosis that affects human and animal hosts, including domestic cats. In Brazil, its most frequently diagnosed etiological agent is Sporothrix brasiliensis. Zoonotic transmission of S. brasiliensis occurs via direct contact between an infected cat and a susceptible human host. Notification of confirmed cases of feline sporotrichosis is not mandatory in Brazil. The metropolitan area of Goiania city can be considered a silent area for the occurrence of feline sporotrichosis. In this context, voluntary reporting of feline sporotrichosis cases is recommended for all healthcare professionals. This study aimed to report the first occurrence of S. brasiliensis in a cat from the metropolitan area of Goiania city. Cytopathology, mycology, thermal dimorphism and calmodulin gene amplification tests were performed. The mycological and molecular biological diagnoses corresponded to S. brasiliensis. The etiological agent of zoonotic sporotrichosis was detected in the metropolitan area of Goiania city, and therefore there is a risk of the emergence of new cases of cats infected with S. brasiliensis and the occurrence of zoonotic transmission of this fungus. hosts Brazil S host context professionals Cytopathology mycology performed fungus

ABSTRACT Despite being subject to lower AIDS-related mortality rates and having a higher life expectancy, patients with HIV are more prone to develop non-AIDS events. A low CD4+/CD8+ ratio during antiretroviral therapy identifies people with heightened immune senescence and increased risk of mortality. In clinical practice, finding determinants of a low CD4+/CD8+ ratio may be useful for identifying patients who require close monitoring due to an increased risk of comorbidities and death. We performed a prospective study on the evolution of the CD4+/CD8+ ratio in 60 patients infected with HIV (80% males), who were subjected to two different antiretroviral regimens: early and deferred therapy. The initial CD4+/CD8+ ratio was ≤1 for 70% of the patients in both groups. Older age, CD4+ cell count at inclusion, Nadir CD8+T-cell count, and Initial CD4+/CD8+ ratio ≤ 1 were risk factors for lack of ratio recovery. In the multivariate analysis, a CD4+/CD8+ ratio > 1 at the start of the treatment was found to be a determinant factor in maintaining a CD4+/CD8+ ratio > 1. The nadir CD4+T-cell count was lower in the deferred therapy group (p=0.004), and the last CD4+/CD8+ ratio ≤1 was not associated with comorbidities. Ratio recovery was not associated with the duration of HIV infection, time without therapy, or absence of AIDS incidence. A greater improvement was observed in patients treated early (p=0.003). In contrast, the slope of increase was slower in patients who deferred treatment. In conclusion, the increase in the CD4+/CD8+ ratio occurred mostly for patients undergoing early strategy treatment and its extension did not seem to be related to previous HIV-related factors. AIDSrelated expectancy nonAIDS non events CD4CD8 CDCD CD4 CD8 CD CD4+/CD8 practice death 6 80% 80 (80 males, males , males) regimens 70 groups age inclusion CD8+Tcell CD8Tcell CDTcell CD8+T T analysis CD4+Tcell CD4Tcell CD4+T p=0.004, p0004 p p=0.004 0 004 (p=0.004) infection incidence p=0.003. p0003 p=0.003 . 003 (p=0.003) contrast conclusion HIVrelated CD4CD CD4+/CD 8 (8 7 Tcell CD8T CDT CD4T p000 p=0.00 00 (p=0.004 (p=0.003 ( p00 p=0.0 (p=0.00 p0 p=0. (p=0.0 p=0 (p=0. p= (p=0 (p= (p

ABSTRACT This study presents a case of atypical manifestation of secondary syphilis. Diagnosis was initiated prompted by the patient’s complaint of a lower lip lesion, present for three months, resembling a malignant neoplasm. The lesion, a 3 cm (diameter) ulcerated nodule, arising from conjunctive tissue, raised concern. However, further physical examination revealed additional clinical features, including cervical micropolyadenopathy and erythematous skin lesions, prompting a reevaluation of the diagnosis, most likely secondary syphilis. These findings led to a serological investigation, which, ultimately, confirmed the diagnosis of syphilis. The case underscores the importance of recognizing syphilis as a formidable imitator, posing challenges in establishing differential diagnoses of mucocutaneous diseases. patients patient s lesion months neoplasm diameter (diameter nodule tissue concern However features lesions investigation which ultimately imitator diseases

ABSTRACT Bartonella spp. are bacteria responsible for neglected diseases worldwide. Bartonella henselae is the species most associated with human infections. It is associated with a large spectrum of clinical manifestations and is potentially fatal. The identification of Bartonella spp. is considered a challenge in clinical routine. These bacteria are fastidious, and the time required to isolate them varies from one to six weeks. MALDI-TOF mass spectrometry has emerged as an application for research on Bartonella spp. , and has still been little explored. We investigated whether three different B. henselae strains with different growth times—14 and 28 days—could be correctly identified by MALDI-TOF mass spectra fingerprint comparison and matching. We found that the spectra from strains with different growth times do not match each other, leading to misidentification. We suggest creating database entries with multiple spectra from strains with different growth times to increase the chances of accurate identification of Bartonella spp. by MALD-TOF MS. spp worldwide infections fatal routine fastidious weeks MALDITOF MALDI TOF explored B times14 14 times—1 2 dayscould days could matching other misidentification MALDTOF MALD MS times1 1 times—

ABSTRACT Extended-spectrum beta-lactamase producing and ciprofloxacin-non-susceptible Escherichia coli are clinical and environmental issues. We evaluated the susceptibility profile of fosfomycin in non-susceptible E. coli isolated from urine and the environment. We measured the activity of fosfomycin against 319 and 36 E. coli strains from urine and environmental isolates, respectively, collected from rivers. Fosfomycin resistance profiles were investigated using the minimal inhibitory concentration (MIC), according to the Clinical and Laboratory Standards Institute (CLSI) and the European Committee for Antimicrobial Susceptibility Testing (EUCAST) guidelines. Antibiotic susceptibility testing revealed that 5% and 6.6% of urine samples were non-susceptible to fosfomycin according to CLSI and EUCAST guidelines, respectively. The fosfomycin MIC50/90 was 0.5/4 mg/L. Of the 36 E. coli isolates from river water, 11.1% and 13,8% were non-susceptible to fosfomycin according to CLSI and EUCAST, respectively (range ≤0.25 ≥512 mg/L). All the isolates with MIC ≥512 mg/L for fosfomycin showed the fosA3 gene. Fosfomycin resistance was more frequent in the environment than in clinical samples. Extendedspectrum Extended spectrum betalactamase beta lactamase ciprofloxacinnonsusceptible ciprofloxacin non susceptible issues nonsusceptible E 31 3 rivers MIC, , (MIC) (CLSI (EUCAST guidelines 5 66 6 6.6 MIC5090 MIC50 90 MIC50/9 054 0 4 0.5/ mgL mg L water 111 11 1 11.1 138 13 8 13,8 range 025 25 ≤0.2 512 ≥51 . mg/L) fosA gene (MIC 6. MIC509 MIC5 9 MIC50/ 05 0.5 11. 13, 02 2 ≤0. 51 ≥5 0. ≤0 ≥ ≤

ABSTRACT Hepatitis C virus (HCV) infection is a significant cause of morbidity and mortality among hematopoietic stem cell transplant (HCT) recipients. In Brazil, its occurrence in HCT recipients remains undetermined. We now report on HCV prevalence in HCT recipients and its clinical consequences. The medical records of all HCT recipients seen at Hospital das Clinicas, Sao Paulo University Medical School, from January 2010 to January 2020 were reviewed to determine HCV serostatus. A retrospective analysis of medical charts was undertaken on all seropositive cases to determine HCV genotype, presence of liver fibrosis, co-infections with other viruses, previous treatments, and clinical evolution of liver pathology after HCT. Of the 1,293 HCT recipients included in the study, seven (0.54%) were HCV antibody-positive and five (0.39%) were also viremic for HCV-RNA. Four of these individuals had moderate to severe liver fibrosis (METAVIR F2/F3) and one was cirrhotic. Two of the viremic patients developed acute liver dysfunction following transplantation. All patients had their acute episode of liver dysfunction resolved with no further complications. Four of the viremic patients were treated for HCV infection with direct acting agents (DAA). Information regarding HCV treatment was lacking for one of the viremic HCV patients due to loss of follow up. Sustained anti-virologic responses were observed in three cases after the use of DAA. The detection of HCV in hematological adults undergoing HCT and its successful treatment with DAA highlight the necessity of testing for HCV both prior to and following transplantation. (HCV (HCT Brazil undetermined consequences Clinicas School 201 202 serostatus genotype coinfections co infections viruses treatments 1293 1 293 1,29 study 0.54% 054 0 54 (0.54% antibodypositive antibody positive 0.39% 039 39 (0.39% HCVRNA. HCVRNA RNA. RNA HCV-RNA METAVIR F2/F3 F2F3 FF F2 F3 F cirrhotic transplantation complications . (DAA) up antivirologic anti virologic 20 129 29 1,2 0.54 05 5 (0.54 0.39 03 3 (0.39 F2/F F2F (DAA 2 12 1, 0.5 (0.5 0.3 (0.3 0. (0. (0 (

ABSTRACT Currently, there are some concerns about the situation and, in particular, about the future of the COVID-19 pandemic and the new emerging variants of SARS-CoV-2. Rodents are an example of synanthropic animals in urban environments that harbor important zoonoses. Although the molecular identification of SARS-CoV-2 in Rattus norvegicus from New York City had been reported, in other studies, urban wild rodents infected with this virus have not been found. This study aimed to molecularly identify the presence of SARS-CoV-2 in urban wild rodents from Mexico City, trapped along a water channel of a public park as part of a pest control program, at the beginning of the COVID-19 pandemic, during the fall and winter of 2020. Up to 33 Mus musculus and 52 R. norvegicus were captured and euthanized, large intestine samples with feces from the animals were obtained. RNAs were obtained and subjected to qRT-PCR for SARS-CoV-2 identification and threshold cycle (Ct) values were obtained. Four mice (12.1%) and three rats (5.8%) were positive, three rodents exhibited Ct<30. Our results on the frequency of SARS-CoV-2 in urban rats are in line with other previous reports. Thus, similar to other authors, we suggest that surveillance for the detection of SARS-CoV-2 in urban wild rodents, as sentinel animals, should be maintained. Currently particular COVID19 COVID 19 COVID-1 SARSCoV2. SARSCoV2 SARSCoV SARS CoV 2. 2 zoonoses SARS-CoV- reported studies found program 2020 3 5 R euthanized qRTPCR qRT PCR Ct (Ct 12.1% 121 12 1 (12.1% 5.8% 58 8 (5.8% positive Ct30 30 Ct<30 reports Thus authors maintained COVID1 COVID- SARS-CoV 202 12.1 (12.1 5.8 (5.8 Ct3 Ct<3 20 12. (12. 5. (5. Ct< (12 (5 (1 (

ABSTRACT Multiple myeloma (MM) associated with Chagas disease is rarely described. This disease and its therapy suppress T cell and macrophage functions and increase regulatory T cell function, allowing the increase of parasitemia and the risk of Chagas Disease Reactivation (CDR). We aimed to analyze the role of conventional (cPCR) and quantitative Polymerase Chain Reaction (qPCR) for prospective monitoring of T. cruzi parasitemia, searching for markers of preemptive antiparasitic therapy in MM patients with Chagas disease. Moreover, we investigated the incidence and management of hematological diseases and CDR both inside and outside the transplant setting in the MEDLINE database. We found 293 studies and included 31 of them. Around 1.9–2.0% of patients with Chagas disease were reported in patients undergoing Stem Cell Transplantation. One case of CDR was described in eight cases of MM and Chagas disease. We monitored nine MM and Chagas disease patients, seven under Autologous Stem Cell Transplantation (ASCT), during 44.56±32.10 months (mean±SD) using parasitological methods, cPCR, and qPCR. From these patients, three had parasitemia. In the first, up to 256 par Eq/mL were detected, starting from 28 months after ASCT. The second patient dropped out and died soon after the detection of 161.0 par Eq/mL. The third patient had a positive blood culture. Benznidazole induced fast negativity in two cases; followed by notably lower levels in one of them. Increased T. cruzi parasitemia was related to the severity of the underlying disease. We recommend parasitemia monitoring by qPCR for early introduction of preemptive antiparasitic therapy to avoid CDR. (MM function . (CDR) cPCR (cPCR (qPCR Moreover database 29 3 them 1920 1 9 2 0 1.9–2.0 ASCT, ASCT , (ASCT) 44563210 44 56 32 10 44.56±32.1 mean±SD meanSD mean SD (mean±SD methods first 25 EqmL Eq mL detected 1610 161 161. culture (CDR 192 1.9–2. (ASCT 4456321 4 5 44.56±32. 16 19 1.9–2 445632 44.56±32 1.9– 44563 44.56±3 1.9 4456 44.56± 1. 445 44.56 44.5 44.

ABSTRACT Trimethoprim-sulfamethoxazole (TMP-SMX) is the primary therapeutic option for Pneumocystis jirovecii pneumonia (PCP). Gastrointestinal symptoms and cutaneous rash are common side effects, with hyperkalemia being uncommon in patients without kidney dysfunction, and myelotoxicity being even rarer. We present the case of a male patient with hypertension and a recent diagnosis of non-Hodgkin lymphoma, undergoing rituximab treatment for two months. He was admitted to the intensive care unit due to dyspnea, tachypnea, and pleuritic pain, requiring mechanical ventilation. Chest computed tomography showed bilateral and multilobed ground-glass opacities, compromising more than 80% of the lung parenchyma. Pulmonary tuberculosis and COVID-19 were ruled out. An angiotomography and Doppler ultrasound revealed an extensive pulmonary thrombus and deep venous thrombosis. Empiric treatment with TMP-SMX for PCP was initiated, but within four days, the patient experienced metabolic acidosis and severe hyperkalemia, necessitating hemodialysis. He also presented with progressive pancytopenia and critical levels of leukopenia and thrombocytopenia. The hypothesis of TMP-SMX-induced myelotoxicity was suspected. Considering the unavailability of an alternative treatment, it was opted to continue TMP-SMX and initiate a granulocyte-colony-stimulating factor. However, the patient maintained medullary deterioration, becoming refractory to the transfusion of blood derivates. On the 17th day of treatment, a clinical decision was made to suspend TMP-SMX, leading to improvements within 48 hours in marrow and kidney functions, metabolic acidosis, and hyperkalemia. Despite all efforts, the patient died after 35 days of hospitalization due to hospital-acquired infections. This case highlights the importance of clinicians recognizing potential myelotoxicity with TMP-SMX and promptly discontinuing the drug if necessary. Trimethoprimsulfamethoxazole Trimethoprim sulfamethoxazole TMPSMX TMP SMX (TMP-SMX PCP. . (PCP) effects dysfunction rarer nonHodgkin non Hodgkin lymphoma months dyspnea tachypnea pain ventilation groundglass ground glass opacities 80 parenchyma COVID19 COVID 19 COVID-1 out thrombosis initiated hemodialysis thrombocytopenia TMPSMXinduced induced suspected granulocytecolonystimulating granulocyte colony stimulating factor However deterioration derivates th TMPSMX, SMX, 4 functions efforts 3 hospitalacquired hospital acquired infections necessary (PCP 8 COVID1 1 COVID-

ABSTRACT Rocky Mountain Spotted Fever is a rickettsial disease caused by the bacteria Rickettsia rickettsii. In Brazil, the disease is known as Brazilian spotted fever (BSF), being the most significant tick-borne disease in the country. Among the affected patients, only 5% of cases occur in children aged one to nine years. Typical symptoms of the disease are fever, rash, headache and digestive symptoms. Neurological manifestations such as seizures, aphasia and hemiparesis have been described in few patients. This study aimed to describe the case of an infant diagnosed with BSF who presented severe signs of neurological manifestation. rickettsii Brazil BSF, , (BSF) tickborne tick borne country patients 5 years rash seizures manifestation (BSF

ABSTRACT Four cases of people living with HIV/AIDS (PLWHA) with calcified cerebral toxoplasmosis associated with perilesional edema causing a single episode of neurological manifestations have recently been reported. Here, we describe the first detailed description of perilesional edema associated with calcified cerebral toxoplasmosis causing three episodes of neurological manifestations in a PLWHA, including seizures in two of them. These recurrences occurred over approximately a decade. Throughout this period, the patient showed immunological and virological control of the HIV infection, while using antiretroviral therapy regularly. This case broadens the spectrum of an emerging presentation of calcified cerebral toxoplasmosis, mimicking a well-described finding of neurocysticercosis in immunocompetent hosts. HIVAIDS AIDS PLWHA (PLWHA reported Here them decade period infection regularly welldescribed well described hosts

ABSTRACT Hematopoietic stem cell transplant (HSCT) recipients are at -increased risk for severe COVID-19. The aim of this study was to evaluate the burden of COVID-19 in a cohort of HSCT recipients. This retrospective study evaluated a cohort of adult hospitalized HSCT recipients diagnosed with COVID-19 in two large hospitals in São Paulo, Brazil post-HSCT, from January 2020 to June 2022. The primary outcome was all-cause mortality. Of 49 cases, 63.2% were male with a median age of 47 years. Allogeneic-HSCT (51.2%) and autologous-HSCT (48.9%) patients were included. The median time from HSCT to COVID-19 diagnosis was 398 days (IQR: 1211-134), with 22 (44.8%) cases occurring within 12 months of transplantation. Most cases occurred during the first year of the pandemic, in non-vaccinated patients (n=35; 71.4%). Most patients developed severe (24.4%) or critical (40.8%) disease; 67.3% received some medication for COVID-19, primarily corticosteroids (53.0%). The probable invasive aspergillosis prevalence was 10.2%. All-cause mortality was 40.8%, 51.4% in non-vaccinated patients and 14.2% in patients who received at least one dose of the vaccine. In the multiple regression analyses, the variables mechanical ventilation (OR: 101.01; 95% CI: 8.205 – 1,242.93; p = 0.003) and chest CT involvement at diagnosis ≥50% (OR: 26.61; 95% CI: 1.06 – 664.26; p = 0.04) remained associated with all-cause mortality. Thus, HSCT recipients with COVID-19 experienced high mortality, highlighting the need for full vaccination and infection prevention measures. (HSCT increased COVID19. COVID19 COVID 19. 19 COVID-1 Paulo postHSCT, postHSCT post HSCT, post-HSCT 202 2022 allcause all cause 4 632 63 2 63.2 years AllogeneicHSCT Allogeneic 51.2% 512 51 (51.2% autologousHSCT autologous 48.9% 489 48 9 (48.9% included 39 IQR (IQR 1211134, 1211134 1211 134 , 1211-134) 44.8% 448 44 8 (44.8% 1 transplantation pandemic nonvaccinated non vaccinated n=35 n35 n 35 (n=35 71.4%. 714 71.4% . 71 71.4%) 24.4% 244 24 (24.4% 40.8% 408 40 (40.8% disease 673 67 3 67.3 COVID19, 19, 53.0%. 530 53.0% 53 0 (53.0%) 102 10 10.2% Allcause All 514 51.4 142 14 14.2 vaccine analyses OR (OR 101.01 10101 101 01 95 CI 8205 205 8.20 1,242.93 124293 242 93 0.003 0003 003 50 ≥50 26.61 2661 26 61 106 06 1.0 664.26 66426 664 0.04 004 04 Thus measures COVID1 COVID- 20 6 63. 51.2 5 (51.2 48.9 (48.9 121113 121 13 1211-134 44.8 (44.8 n=3 n3 (n=3 71.4 7 24.4 (24.4 40.8 (40.8 67. 53.0 (53.0% 10.2 51. 14. 101.0 1010 820 8.2 1,242.9 12429 0.00 000 00 ≥5 26.6 266 1. 664.2 6642 66 0.0 (51. 48. (48. 12111 1211-13 44. (44. n= (n= 71. 24. (24. 40. (40. 53. (53.0 10. 101. 82 8. 1,242. 1242 ≥ 26. 664. 0. (51 (48 1211-1 (44 (n (24 (40 (53. 1,242 124 (5 (4 1211- (2 (53 1,24 ( 1,2 1,

ABSTRACT Noroviruses are highly infectious, genetically diverse viruses. Global outbreaks occur frequently, making molecular surveillance important for infection monitoring. This cross-sectional descriptive study aimed to monitor cases of norovirus gastroenteritis in the Brazilian Amazon. Fecal samples were tested by immunoenzymatic assay, RT-PCR and genetic sequencing for the ORF1/ORF2 and protease regions. Bayesian inference with a molecular clock was employed to construct the phylogeny. The norovirus prevalence was 25.8%, with a higher positivity rate among children aged 0-24 months. Genogroup GII accounted for 98.1% of the sequenced samples, while GI accounted for 1.9% of them. The GII.P16/GII.4 genotype was the most prevalent, with an evolution rate of 2.87x10−3 and TMRCA estimated in 2012. This study demonstrates that norovirus is a primary causative agent of gastroenteritis and provides data on viral genetic diversity that may facilitate infection surveillance and vaccine development. infectious viruses frequently monitoring crosssectional cross sectional Amazon assay RTPCR RT PCR ORF1ORF2 ORFORF ORF1 ORF2 ORF ORF1/ORF regions phylogeny 258 25 8 25.8% 024 0 24 0-2 months 981 98 1 98.1 19 9 1.9 them GIIP16GII4 GIIPGII P16 4 P GII.P16/GII. prevalent 287x103 x 2 87x10 3 2.87x10− 2012 development ORF1ORF 25.8 02 0- 98. 1. GIIP GIIP16GII P1 GII.P16/GII 287x10 87x1 2.87x10 201 25. 287x1 87x 2.87x1 20 287x 2.87x