Rotaviruses, Astroviruses, and Adenoviruses Emergence and Circulation in Wastewater Causing Acute Viral Gastroenteritis

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20 Rotaviruses, Astroviruses, and Adenoviruses Emergence and Circulation in Wastewater Causing Acute Viral Gastroenteritis Chourouk Ibrahim1,2, Salah Hammami3 and Abdennaceur Hassen1 1

Faculty of Mathematical, Physical and Natural Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia 2Centre of Research and Water Technologies (CERTE), Laboratory of Treatment and Wastewater Valorisation, Tunis, Tunisia 3IRESA, National School of Veterinary Medicine at Sidi Thabet, University of Manouba, Tunis, Tunisia

INTRODUCTION Rotaviruses (RVs) are recognized as the most common and the first pathogenic etiological agent of acute viral gastroenteritis (AGE) in mammalian (especially humans, in particular, children and others) and in avian species (Estes and Greenberg, 2013; Desselberger, 2014, 2017). These viruses are responsible for childhood mortality and morbidity every year in the world (Samdan et al., 2018). In addition, before the introduction of the vaccination against Rotavirus A (RVA), these viruses caused around 3 million episodes each year, requiring 500,000 visits to a doctor and 60,000 hospitalizations (Fischer et al., 2007; Esposito et al., 2011; Desselberger, 2014, 2017). Despite the universal

Emerging and Reemerging Viral Pathogens DOI: https://doi.org/10.1016/B978-0-12-819400-3.00020-X

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mass vaccination practiced using a Rotarix vaccine since the 2006, the illness related to RVs is still responsible for the deaths of more than 200,000 children under 5 years worldwide in 2013 (Tate et al., 2016; Desselberger, 2017). Similarly, astroviruses and adenoviruses are responsible for AGE in mammalian (humans and others) and in avian species (Bosch et al., 2014; Ghebremedhin, 2014; La Rosa et al., 2015; Olortegui et al., 2018). Indeed, RVs are classified in the Reoviridae family, Sedoreovirinae subfamily, and the Rotavirus genus (Desselberger, 2014, 2017; http://www.ictvonline.org/virusTaxonomy.asp). In addition, human astroviruses (HAstVs) and adenoviruses belong to the Astroviridae, Adenoviridae families and in the Mamastrovirus and Mastadenovirus genera, respectively (Bosch et al., 2014; Ghebremedhin, 2014; http://www.ictvonline.org/virusTaxonomy.asp). Moreover, these three types of gastroenteric viruses are nonenveloped and small viruses with icosahedral capsid (Bosch et al., 2014; Ghebremedhin, 2014; Desselberger, 2014, 2017). The RV-viral genome encompasses 10 double-stranded RNA segments monocistronic and one doublestranded RNA molecule polycistronic encoding for nonstructural and structural proteins (Desselberger, 2014, 2017). Similarly, the HAstV genome contains a single-stranded positive-sense RNA molecule, which includes three open reading frames (ORFs) encoding for nonstructural and structural proteins (Bosch et al., 2014). However, the human adenovirus (HAdV) genome includes a double-stranded linear DNA molecule coding for several regions, which correspond to the early genes at late transcribed genes implicated in the structural and nonstructural protein syntheses (Ghebremedhin, 2014). These gastroenteric viruses are characterized by a high genetic diversity, especially, the RVs, which are responsible for the emergence of the new genotype each year (Bosch et al., 2014; Ghebremedhin, 2014; Desselberger, 2014, 2017). These RVs, astroviruses, and adenoviruses emergent new strains are produced mainly by the genetic reassortment mechanism between human and animal (Bosch et al., 2014; Ghebremedhin, 2014; Desselberger, 2014, 2017). The point mutations that occur continuously due to the high rate of rotaviruses and astroviruses with RNA dependant RNA polymerase (RdRp) errors are often involved in zoonotic transmission (Matthijnssens et al., 2011; De Grazia et al., 2014; Bosch et al., 2014; Desselberger, 2014 , 2017). Recently, many environmental and clinical studies conducted on fecal and wastewater samples reported high detection rates and the emergence of new genotypes of these gastroenteric viruses in different regions of the world (Bosch et al., 2014; Ghebremedhin, 2014; Desselberger, 2014, 2017; Ibrahim et al., 2017, 2018; El-Senousy and Abou-Elela, 2017; Olortegui et al., 2018; Samdan et al., 2018). Furthermore, human enteric adenoviruses are considered emerging viruses in aquatic environment and a good virological

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indicator of fecal contamination after enteroviruses in wastewater (Fumian et al., 2013; Adefisoye et al., 2016). Therefore this chapter describes some virological characteristics, such as structure and genetic diversity of these viruses, their virion properties, pathogenesis, diagnosis, and epidemiology of RVs, HAdVs, and astroviruses. In addition, the frequencies and the distribution of the new emergent genotypes of these viruses in wastewater sampled from different wastewater treatment plants are needed and required for the prevention of viral gastroenteritis associated with waterborne diseases.

VIROLOGICAL CHARACTERISTICS OF ROTAVIRUSES, HUMAN ASTROVIRUSES, AND HUMAN ADENOVIRUSES History Rotaviruses RVs were discovered in 1973 in stool samples from children with viral gastroenteritis in Australia (Bishop et al., 1973; Flewett et al., 1973; Desselberger, 2014). Virions, isolated in clusters and visualized by electron microscopy, showed a characteristic morphology in the shape of wheels (Rota in Latin), and the capsid proteins are also grouped in a wheel radius. In 1974 these viruses were named rotavirus by Thomas Henry Flewett (Flewett et al., 1974; Desselberger, 2014). Human Astroviruses Astroviruses were identified and characterized for the first time in 1975 in children’s diarrheal stool using electron microscopy (Appleton and Higgins, 1975; Bosch et al., 2014). They are small viruses 28
30 nm in diameter. Madeley and Cosgrove used the term astrovirus, which comes from the Greek word “Astron” meaning “star,” to describe the star shape of five to six branches (Madeley and Cosgrove, 1975; Bosch et al., 2014). Human Adenoviruses Adenoviruses were identified in 1953 in samples of tonsils and respiratory secretions of children and soldiers with acute respiratory infections (Rowe et al., 1953; Ghebremedhin, 2014). About 2 years later, the name adenovirus was used to designate the pathogen responsible for these infections because of its presence in the tonsils (adeno means “gland”) (Rowe et al., 1953; Ghebremedhin, 2014).

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Taxonomy Rotaviruses Currently, RVs are classified in the Reoviridae family, the Sedoreovirinae subfamily, and in the Rotavirus genus according to the International Committee on Taxonomy of Viruses (http://www.ictvonline.org/virusTaxonomy.asp). The Reoviridae family is composed of two subfamilies, 15 genera, and 90 species. The Sedoreovirinae subfamily was divided into six genera, Cardoreovirus (1 species), Mimoreovirus (1 species), Orbivirus (22 species), Phytoreovirus (3 species), Rotavirus (9 species), and Seadornavirus (3 species). The Spinareovirinae subfamily was also subdivided into 9 genera, Aquareovirus (7 species), Coltivirus (2 species), Cypovirus (16 species), Dinovernavirus (1 species), Fijivirus (9 species), Idnoreovirus (5 species), Mycoreovirus (3 species), Orthoreovirus (6 species), and Oryzavirus (2 species). The classification within the Rotavirus genus is based on the antigenic specificity of the major protein of the virus “VP6” encoded by the highly immunogenic gene 6, which carries antigenic determinants defining the 10 groups or species (Rotavirus A
Rotavirus J) (Matthijnssens et al., 2012; Desselberger, 2014, 2017). Only RVA, RVB, and RVC are linked to human and animal infections, while the other groups (such as RVD, RVE, RVF, RVG, RVH, and RVI) are identified only in animals. RVA is considered the first etiological agent of AGE in children. These viruses are also subdivided into serotypes based on the antigenic reactivity of the two proteins of the outer capsid VP7 and VP4. The major glycoprotein of the outer capsid “VP7” encoded by segment 9 defines the 28 serotypes G (G1
G28; G stands for glycoprotein). The unglycosylated minor protein of the outer capsid “VP4” encoded by gene 4 defines 39 serotypes P (P [1]
P [39]; P stands for protease-sensitive proteins) (Matthijnssens et al., 2012; Desselberger, 2014, 2017; Ba´nyai et al., 2017). Human Astroviruses When compared astroviruses are similar to the Picornaviridae family based on their protein composition or to the Caliciviridae family based on their genomic organization. However, other characteristics, such as the particular morphology, the number of proteins and the intranuclear location, the absence of helix, and the ribosomal shift during translation, made it possible to classify astroviruses into a new family named Astroviridae, which initially includes the only genus in 1995 (Monroe et al., 1995; Bosch et al., 2014; http://www.ictvonline.org/virusTaxonomy.asp). From 2002 to 2018, the Astroviridae family is composed of two genera based on their hosts, Avastrovirus (Avastrovirus 1
Avastrovirus 3) and Mamastrovirus (Mamastrovirus 1
Mamastrovirus 19), which infect, respectively, avian and mammalian species (http://www.ictvonline.org/virusTaxonomy.asp;

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Bosch et al., 2014). Therefore the HAstVs were classified in the Mamastrovirus genus (Bosch et al., 2014). Indeed, the Mamastrovirus 1, 6, 8, and 9 species (MAstV 1, MAstV 6, MAstV 8, and MAstV 9) were detected in humans. However, the other Mamastrovirus species (MAstV 2
MAstV 5; MAstV 10
MastV 19) were detected in mammalian species, such as cats, cheetah, pig, dog, California sea lion, bottlenose dolphins, mink, bat, and sheep (Bosch et al., 2014). Similarly, the three species of Avastrovirus genus (AAstV 1
AAstV 3) were found in feces of bird species, such as turkeys, chicken, guinea fowl, duck, other wild aquatic birds, and pigeons (Bosch et al., 2014). Human Adenoviruses Adenoviruses belong to the Adenoviridae family and form five genera divided into two groups. The genera Mastadenovirus and Aviadenovirus infect mammals or birds, while the genera Atadenovirus, Ichtadenovirus, and Siadenovirus have a wide host range (http://www.ictvonline.org/ virusTaxonomy.asp). HAdVs are part of the genus Mastadenovirus, which is subdivided into 36 different species (Bat mastadenovirus A and B, Bovine mastadenovirus A
C, Canine mastadenovirus A, Dolphin mastadenovirus A, Equine mastadenovirus A and B, Human mastadenovirus A
G, Murine mastadenovirus A
C, Ovine mastadenovirus A and B, Platyrrhini mastadenovirus A, Porcine mastadenovirus A
C, Sea lion mastadenovirus A, Simian mastadenovirus A
H, Skunk mastadenovirus A, and Tree shrew mastadenovirus A) (http://www.ictvonline.org/virusTaxonomy.asp). Therefore 84 diverse serotypes were distributed in seven different HAdV species (A
G) according to their biological properties such as hemagglutination, homology of genome sequence, and nucleotide base content (G 1 C) (Ghebremedhin, 2014; http://hadvwg.gmu.edu/). HAdV subgroups F types 40, 41 were recognized as enteric HAdVs, which were responsible for AGE (Ghebremedhin, 2014).

Structure Rotaviruses RVs are nonenveloped viruses with a diameter of 70 nm and icosahedral symmetry. The capsid is composed of three concentric layers that surround and protect the 11 double-stranded RNA segments, which are associated with the enzymes necessary for mRNA synthesis. In fact, the outermost protein layer or outer capsid consists of the VP7 glycoprotein and the VP4 protein antigens of which determine the serotypes G and P of these viruses. In addition, the intermediate capsid is composed of the single protein VP6, which carries the group and subgroup antigen. Finally, the innermost core or capsid comprises a major protein VP2

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and two minor proteins VP1 (polymerase) and VP3 (Jayaram et al., 2004; Desselberger, 2014, 2017). By electron microscopy, three types of RV-viral particles are distinguished. Indeed, the single-layered viral particle (SLP 5 core 1 envelope) is formed by 120 molecules of viral VP2 protein arranged as 60 dimers surrounding the viral genome. This particle is composed of 11 double-stranded RNA segments, the RNAdependent RNA polymerase, the associated enzymes, as well as the VP1 and VP3 viral proteins. The 11 RNA segments are very short and completely conserved at the level of the terminal nucleotide sequences 50 -GGC. . .ACC-30 . These genomic RNA segments are proposed to form conical cylinders around replication complexes (Jayaram et al., 2004; Desselberger, 2014, 2017). The second type of RVs was double-layered viral particles (DLP, double-layered particle). The viral nucleus is surrounded by 260 trimers of VP6, which form the middle-layered particles and DLPs. The third type of these viruses establishes the whole particle of RV called triple-layered particle (TLP), which constitutes the complete virion with a diameter of approximately 75 nm. The DLPs are in turn covered by 260 trimers of VP7 and 60 trimers of VP4 to form the TLP (Jayaram et al., 2004; Desselberger, 2014, 2017). Human Astroviruses Astroviruses are nonenveloped viruses of a 28
34 nm diameter and have capsid with icosahedral symmetry and a smooth border and a characteristic five- or six-pointed star recognized on the surface of some viral particles (Bosch et al., 2014). The capsid of these viruses with icosahedral symmetry organized as T 5 3, assembled 180 protein subunits, and displayed only 30 dimeric spikes that are situated on icosahedral axes, whereas immature capsids present dimeric 90 points. A loss of 60 points probably plays an important role in viral infection (Dryden et al., 2012). Human Adenoviruses The Adenoviruses are among the most complex nonenveloped viruses with a diameter of 70
90 nm and icosahedral structure capsid (Mangel and San Martı´n, 2014). The capsid of these viruses is an icosa˚ of maximum diameter and hedron with an approximately 950 A pseudo-T 5 25 of triangulation numbers (Mangel and San Martı´n, 2014; Casto´n and Carrascosa, 2013; San Martı´n, 2012). Every adenovirus capsid facade includes three major proteins, such as the hexon (the main envelope protein), a penton pentamer protein situated at each capsid summit, and complexes with a trimer of the projecting fiber protein (Mangel and San Martı´n, 2014; San Martı´n, 2012). In addition, four different minor envelope proteins were also identified called IIIa, VI, VIII, located on the inside capsid and IX, situated on the outside capsid,

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which play an important role in the modulation of quasiequivalent icosahedral interactions (Mangel and San Martı´n, 2014; San Martı´n, 2012). The capsid is composed of 252 capsomers, including 240 hexons and 12 pentons. Each base of penton is extended by a fiber, itself terminated by a sphere. These fibers contain the receptor-binding sites (Okitsu-Negishi et al., 2004; Mangel and San Martı´n, 2014). The hexon presents hexametric symmetry, and the main subunit of the virion showed icosahedral form, it has aroused a lot of interest because it is produced in large quantities in infected cells.

Genomic Organization Rotaviruses The viral genome of RVs comprises 11 double-stranded RNA segments numbered in order of decreasing size from 1 to 11. The total size of viral genome is approximately 18.5 kb. The size of each of the 11 RNA segments ranges from 0.6 to 3.3 kb. Each segment carries 50 and 30 noncoding sequences and encodes a single viral protein (monocistronic), except for gene 11, which has two ORFs and encodes for the NSP5 and NSP6 proteins. Indeed, the RNA segments 1
4, 6, and 7 encode for structural proteins VP1
VP4, VP6, and VP7, respectively. In addition, the RNA segments 5, 8, 9, 10, and 11 encode for nonstructural proteins (NSP1
NSP5/6) (Desselberger, 2014, 2017). Moreover, the RV structural proteins are highly antigenic. These proteins determine G- and P-type specificity, group and subgroup genotype (Jayaram et al., 2004; Desselberger, 2014, 2017). They are also involved in the transcription mechanisms (Jayaram et al., 2004; Desselberger, 2014, 2017). The RV nonstructural proteins play a significant role in the viroplasm formation, viral maturation, RNA replication, virulence, and viral replication (Jayaram et al., 2004; Desselberger, 2014, 2017). Human Astroviruses The HAstVs’ capsid surrounds and protects the viral genome formed by a single-stranded positive-sense polyadenylated RNA molecule of approximately 6.2
7.8 kb in length, with poly(A) tail at the 30 end and viral protein genome (VPg) at the 50 end (Bosch et al., 2011, 2014; Fuentes et al., 2012). The viral genome covers three ORFs, called ORF1a, ORF1b, and ORF2. The first two ORFs (ORF1a and ORF1b) convert many nonstructural proteins (NSPs), such as putative helicase domain, several transmembrane and coiled coil domains, the protease domain, a VPg, a hypervariable region, a nuclear localization signal, and a putative death domain, and the RdRp. All these nonstructural proteins were involved in the viral RNA replication and transcription. However, the

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ORF2 region codes for the structural proteins, the shell proteins, P1 and P2 domains, which comprise the spike proteins (Bosch et al., 2014). Human Adenoviruses The adenovirus viral genome is a double-stranded linear DNA with a diameter that varies between 26 and 44 kb according the serotypes, which encodes for 45 proteins (El Bakkouri et al., 2008; Mangel and San Martı´n, 2014). The icosahedral shell of these viruses surrounds a nonicosahedral core including a linear double-stranded DNA molecule coding for several regions. The early region (E) divided into four parts: E1 (E1A and E1B), E2 (E2A and E2B), E3, and E4, which correspond to the early genes involved in the preparation of the cell for the viral DNA replication (functional proteins) (El Bakkouri et al., 2008; Mangel and San Martı´n, 2014). The late region (L) corresponds to the late transcribed genes (L1, L2, L3, L4, and L5) implicated in the three major external structural protein synthesis: hexon or protein II, penton base or protein III, fiber or protein IV and four minor internal structural proteins: protein IX, protein IIIa, protein VI, and protein VIII (Kennedy and Parks, 2009).

Replication Cycle Rotavirus A RVs mainly multiply in mature enterocytes of the small intestine. During the penetration of these viruses, vacuolation, lysis, and desquamation are observed at the level of the enterocytes. These lesions cause villous atrophy, hypertrophy, and secretory cells increase in crypts. The RV replication cycle is summarized into six steps. In fact, the TLP RVs’ attachment to antigens of sialo-glycans or histo-blood groups situated on the host cell surface, tracked by connections with other cellular coreceptors, containing integrin and Hsc70 cellular receptors. In addition, the viral particle penetration occurs by receptor-mediated endocytosis. Likewise, the decapsidation of RV particle is carried out by the outer layer removal of RVs TLP in the endosome, thus causing the release of RV DLP in the cytoplasm. Moreover, the single-stranded positive-sense RNA molecules synthesis of all genomic segments is transcribed and released in the cytoplasm. These are translated either into viral proteins or act as templates for the dsRNA genomes of the viral particles. Furthermore, cytoplasmic inclusion bodies or “viroplasms” are formed, which contain double-stranded RNA and the two nonstructural proteins NS4 and NS5 packaged in new RV DLPs. Finally, the maturation of TLPs was performed by fixing the two structural proteins (VP7 and VP4) on the DLPs’ surface capsids. The mature viral particles are

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released by a nonclassical vesicular transport mechanism in polarized epithelial cells or by cell lysis (Estes and Greenberg, 2013; Desselberger, 2014, 2017). Human Astroviruses Multiplication of HAstVs is difficult in vitro, it requires the presence of trypsin in the medium and the use of CaCo-2 cells (Mendez et al., 2014; Bosch et al., 2014) in order to confirm the early obtained results for HEK293 cells (Donelli et al., 1992; Bosch et al., 2014). The replication cycle of HAstVs is shortened in eight major steps. In fact, the HAstV replication cycle is initiated by the viral particle attachment with one or more cell receptors (carbohydrate molecule) situated on the host surface (Bosch et al., 2014). In addition, the virus penetration occurs via clathrin-dependent endocytosis (Bosch et al., 2014). Furthermore, the decapsidation of viral particles was carried out following the endosome acidification and maturation (Bosch et al., 2014). Moreover, the mature NSPs are produced after the cleavage of two nonstructural polyproteins (NSP1a and NSP1a1b) (Bosch et al., 2014). Likewise, the negative- and positive-sense RNA strands as well as subgenomic RNA are synthesized following the interaction of the nonstructural protein (NSP1a/4) with RdRp (Bosch et al., 2014). Also, the subgenomic RNAs are formed in high quantities and are used for the capsid protein expression (Bosch et al., 2014). Similarly, the assembly of the structural protein (VP90) with intracellular membranes to constitute immature virions (VP70) (Bosch et al., 2014). Therefore the immature virion VP70 is synthesized after the cleavage of the VP90 polyproteins (Bosch et al., 2014). Finally, the mature infectious virions are obtained by the trypsin action after the release of the immature virions VP70 without cellular lysis (Bosch et al., 2014). Human Adenoviruses The complete adenovirus viral cycle lasts from 30 to 36 hours and comprises schematically three main phases: the early phase, the viral DNA replication phase, and the late phase. In addition, the early phase begins with the interaction of adenovirus particle with the target cell plasma membrane. The replication cycle is initiated with the HAdVs’ attachment to a primary receptor, which has been determined only for HAdV-C2 and HAdV-C5 (Tomko et al., 1997; Hoeben and Uil, 2013). It is the 26 CAR molecules, a common receptor for coxsackievirus B3 (belonging to the family Picornaviridae), hence, its acronym is coxsackievirus and adenovirus receptor (Tomko et al., 1997; Hoeben and Uil, 2013). This membrane glycoprotein that belongs to the immunoglobulins family is present on most cells except hematopoietic cells, a property that participates in the HAdV broad tropism (Tomko et al., 1997; Hoeben and Uil, 2013). Subsequently, the viral particle internalization is

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done by the interaction between the penton and membrane integrin, which facilitates the adenovirus entry by endocytosis (Li et al., 2001; Meier et al., 2002). After sequential stalls of the structural proteins composing the capsid, the core is released into the cytoplasm (Greber et al., 1993). The viral DNA is finally sent to the nucleus, allowing the start of replication as early as 2 hours after infection. Viral transcription during the late phase is under the control of a single major late promoter. Therefore the synthesis of structural proteins is produced, which assemble in the nucleus to form capsids (Schmid and Hearing, 1995).

Pathogenesis Rotaviruses RVs mainly infect mature enterocytes at the top of the villi in the small intestine of the mammalian species, where vacuolation and epithelial loss can be observed, followed by crypt hyperplasia. The pathogenesis of the disease is multifactorial, depending on the host’s age, the homology and heterology of the virus
host interaction, and especially, viral gene products, such as VP3, VP4, VP7, NSP2, NSP3, and NSP4 (Desselberger, 2014, 2017). The factors of the disease mechanism are multiple, such as the poor absorption related to the destruction of the epithelium enterocytes, which causes a secretion of water and electrolytes leading to osmotic diarrhea, the NSP4 action as a viral enterotoxin inducing a water leak followed by a chloride ion secretion and the enteric nervous system activation thus causing vomiting (Estes and Atmar, 2003; Greenberg and Estes, 2009; Desselberger, 2014, 2017). Human Astroviruses Astroviruses infect mature enterocytes of intestinal villi by creating histological lesions responsible for villous atrophy (Bosch et al., 2014). The infection also concerns M cells for bovine astroviruses, mature enterocytes, and subepithelial macrophages for ovine astroviruses in Peyer plates. The infected cells become vacuolated and peeled, leading to inflammation (Bosch et al., 2014). A study in two diarrheal children, eliminating astroviruses in the stool, revealed the presence of these viruses in epithelial cells of the basal part of the villus (Bosch et al., 2014). Other studies conducted on volunteers infected with Astroviruses did not show intestinal histological changes in infections, and only one patient developed gastroenteritis clinical manifestations (Bosch et al., 2014). Human Adenoviruses The infections caused by adenoviruses are diverse, and the sites of infection seem to vary according to the subgroup. Of all serotypes

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responsible for AGE digestive disorders in humans, serotypes 40 and 41 are the most studied. Indeed, adenovirus infections affect respiratory and intestinal epithelia associated with local viral particles replication and its excretion by aerial or fecal route that ensures their transmission and spreading in various environments. After the invasion of these viruses of the host cell, they could cause cellular destruction and release an exudate through the basement membrane (Ghebremedhin, 2014).

Clinical Symptoms Rotaviruses RV infections may remain asymptomatic or lead to acute gastroenteritis with mild-to-severe diarrhea, vomiting, varying degrees of dehydration, abdominal pain, and moderate hyperthermia at 38 C. Vomiting precedes diarrhea that lasts for a shorter time (3
5 days). A massive electrolyte imbalance leads to often severe dehydration that can last from 4 to 7 days requiring hospitalization. Usually, RVA is considered the first etiological agent of AGE in children, related to its high genetic variability (Desselberger, 2014, 2017). The RVB and RVC are also responsible for small gastroenteritis epidemics in adults and in children (Desselberger, 2014, 2017). Human Astroviruses Astrovirus infection is responsible for the classical viral gastroenteritis symptomatology with moderate diarrhea, vomiting, abdominal pain, and fevers; dehydration has been observed in rare cases, which very rarely requires hospitalization or even consultation (Bosch et al., 2014). After an incubation period of 1
2 days (Lee et al., 2013; Bosch et al., 2014), the healing occurs within 4 days of the onset of the symptoms (Bosch et al., 2014). Human Adenoviruses The clinical signs and symptoms that could be observed are vomiting and diarrhea, which could be occurring after an incubation period of 8
10 days, and viral shedding could last between 5 and 12 days. As asymptomatic infections are common, it is sometimes difficult to incriminate adenoviruses in the cases of gastroenteritis epidemics (Ghebremedhin, 2014). However, adenoviruses are estimated to be responsible for 2%
15% of gastroenteritis requiring hospitalization in young children, of which two-thirds are caused by serotypes 40 and 41 (Meqdam and Thwiny, 2007; Ghebremedhin, 2014).

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Immune Responses Rotaviruses • Humoral and cell-mediated immune responses During RV infection, the acquired immune responses are elicited from both B cells producing antibodies directed against specific virus proteins, and from T cells recognizing T cell
specific RV epitopes located on the surface of infected cells in complexes with Class I and II major histocompatibility complex (MHC) antigens. Passive transfer of specific CD81 T-cell RV also showed a protective effect (Offit, 1994; Desselberger, 2014, 2017). The transplacental RV
specific antibodies acquired protect newborns susceptible to infection and interfere with immune responses to RV vaccination (Appaiahgari et al., 2014; Desselberger, 2014, 2017). The humoral antibodies stimulated after repeated infection are directed against both serotypespecific epitopes on the VP4 and VP7 molecules, which is called heterotypic protection (Franco et al., 2006; Desselberger, 2014, 2017). The CD41 T cells specific for human RVs circulating in the blood express the intestinal guide receptor α4β7 (Parra et al., 2014; Desselberger, 2014, 2017). • Innate immune responses (IIR): RV infections immediately trigger various mechanisms of IIR that occur earlier than the acquired specific immune responses to RV (Angel et al., 2012; Desselberger, 2014, 2017). Indeed, the NSP1 protein is able to interact with the following cellular proteins, such as interferon (IFN), regulatory factors (IRF), β-transducing containing repeated protein containing (β-TrCP0), the melanoma differentiation-associated gene 5/ mitochondrial antiviral signaling protein, the tumor suppressor protein (p53), the TNF receptor associated with the factor 2. These last described proteins lead to their degradation by the proteasome thus allowing the prevention or the negative regulation at the beginning of the triggering of an INF response (Bagchi et al., 2013; Bhowmick et al., 2013; Graff et al., 2009; Broquet et al., 2011; Desselberger, 2014, 2017). In addition, NSP1 induces the downregulation of IRF5 and IRF7, targets the retinoic acid inducible gene-I, and interacts with IRF3 (Barro and Patton, 2007; Arnold et al., 2013; Qin et al., 2011; Desselberger, 2014, 2017). RV infection also inhibits STAT1 phosphorylation and translocation of the STAT1/ STAT2/IRF9 complex to the nucleus, stimulating the production of IFN and establishment of antiviral status (Sen et al., 2014; Desselberger, 2014, 2017). Human plasmacytoid dendritic cells do not permit the replication of RV, but they trigger a rapid IFN response that can stimulate B-cell responses (Deal et al., 2013; Desselberger, 2014, 2017).

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Human Astroviruses The specific anti
astrovirus immunity mechanism has not been elucidated; astrovirus-specific T-helper cells in the duodenal mucosa of healthy adult subjects would play an important role in protecting against infection by these viruses. Symptomatic disease is observed mainly in children and hospitalized elderly patients, whereas adults being relatively resistant to the disease. These observations suggest that specific anti
astrovirus antibodies develop during childhood, and that they are responsible for long-term immunity. The efficacy of this immune response would be dependent on the frequency of reexposures and the role of these serotype-specific antibodies in protection against another serotype (Koci, 2005; Bosch et al., 2014). Human Adenoviruses During adenovirus infection, two types of immune responses (humoral and cell-mediated immunity) are activated leading to antibody secretion directed against the adenoviruses and the TNF and IFNγ production by T cells (Ghebremedhin, 2014). The antibodies are directed against the hexon (alpha component) of the viral capsid, which contains the antigenic component common to all mammalian adenoviruses (Ghebremedhin, 2014). The adenovirus-specific CD41 T cells can recognize antigens conserved in different adenovirus serotypes. Therefore infection with an adenovirus serotypes may produce T cell
mediated immunity. However, neutralizing antibodies against HAdV are serotype specific (Ghebremedhin, 2014).

Transmission Mode The fecal
oral mode is the main route of gastroenteric virus transmission, either directly or through the contamination of surfaces that play a role in relaying the virus during an epidemic (Fankhauser et al., 2002). In addition, aerosols created during vomiting may be an opportunistic mode of transmission that further accelerates the spread of the virus in confined communities, such as retirement homes, hospital services, hotels, cruise ships, and baby nursery. Indeed, the involvement of different enteric viruses in waterborne epidemics is highly variable. In addition, once enteric viruses are excreted in the stools of infected persons, they are usually transmitted through the digestive tract, either directly from person to person or from elements soiled with feces. The transmission by direct contact is the main mode of transmission of enteric viruses; it is enhanced by lack of hygiene (Shapiro et al., 1992). The indirect transmission is achieved mainly through water environment either by the consumption of water with a poor virological quality or

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food or soiled objects (Ibrahim et al., 2017, 2018; Werneck et al., 2017). The period and duration of virus excretion and the amount of virus excreted vary considerably depending on the virus involved. Therefore adenoviruses are excreted for 7
14 days at a rate of 106
107 per gram of stool (Nicand et al., 1998). Astroviruses are excreted also with the same rate for a period of 12 days (Nicand et al., 1998). RVs are excreted for 10 days, their elimination is maximal (1012 viral particles per gram of stool) during the first 3
4 days of infection (Gray et Iturriza-Go´mara, 2011).

Diagnosis The enteric virus cell culture technique is reserved for adapted strains in research laboratories, but it cannot be used for virological diagnosis (Bosch et al., 2014; Desselberger, 2014, 2017). In addition, electron microscopy using the negative staining technique remains the reference method given its specificity and feasibility for all kinds of samples (Bosch et al., 2014; Desselberger, 2014, 2017). However, this technique has several disadvantages that limit its use in routine diagnosis since it is expensive, insensitive, requiring high viral particle titers in fecal samples. The enzyme-linked immunosorbent assay techniques using monoclonal antibodies are implemented and allowed great progress in the routine diagnosis of gastroenteric viruses. This technique is simple, sensitive, and specific. Currently, they are also the most suitable for the diagnosis of gastroenteric virus in medical practices (Velasco et al., 2011; Bosch et al., 2014; Desselberger, 2014, 2017). Recently, the molecular virology methods such as reverse transcription polymerase chain reaction (RT-PCR) and real-time RT-PCR have become the standard tools for the gastroenteric virus detection, quantification, genotyping, and epidemiological monitoring (Noel et al., 1995; Allard et al., 2001; Bosch et al., 2014; Desselberger, 2014, 2017). In fact, the RT-PCR technique, which is more sensitive and specific and also suitable for genotyping, has become the standard diagnostic technique in laboratories for the RV genome detection (Iturriza-Go´mara et al., 2004). Due to continuous genomic drift by point mutations, the primers used for RV genotyping need to be changed periodically (Iturriza-Go´mara et al., 2001, 2004; Desselberger, 2014). Moreover, the RT-PCR method uses several primers located in the 30 noncoding region, ORF2 or ORF1a for the HAstVs detection (Noel et al., 1995). Nevertheless, traditional RT-PCR technique has been widely used for the gastroenteric virus diagnosis, but this technique seems to be insufficient for the detection and the typing of these kinds of viruses in wastewater. Therefore traditional RT-PCR method is less sensitive than real-time RT-PCR. This new approach could be considered a powerful tool for rapid gastroenteric virus detection and quantification in

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wastewater (Gutie´rrez-Aguirre et al., 2008; Oka et al., 2006; Ibrahim et al., 2016). Finally, new approaches of sequencing and metagenomic sequencing, such as the next-generation sequencing, have been developed to genotype gastroenteric viruses (Bosch et al., 2014; JamnikarCiglenecki et al., 2017; Fernandez-Cassi et al., 2018).

Genetic Diversity Rotavirus A The main RVA genotypes that are responsible for infections are G1, G2, G3, and G4. For P serotypes, serotypes P [8] and P [4] are most common. The common RV strains in developed countries are G1 [P8], G2P [4], G3P [8], G4P [8], and G9P [8] genotype, with a large predominance of G1P [8] genotype (Desselberger, 2014; Doan et al., 2015; Tatte et al., 2017; Jere et al., 2018; Chan-It and Chanta, 2018; Pradhan and Chitambar, 2018). The emergence of RV strains seems to be linked to interspecies transmission between humans and animals (Matthijnssens et al., 2011; Desselberger, 2014, 2017). This phenomenon is especially observed in developing countries where the mixed infection is more frequent and the human
animal contact is greater (Rajendran and Kang, 2014). These emergent new strains are produced mainly by the genetic reassortment mechanism between human and animal RV origin and the point mutations that occur continuously due to the high rate of RVdependent RNA polymerase errors, often involved in zoonotic transmission (Matthijnssens et al., 2011; De Grazia et al., 2014; Desselberger, 2014, 2017). Indeed, the unusual combination detection G3P [19] RVA was observed in patients in Italy (Ianiro et al., 2014). Similarly, several rare combinations of RVA genotypes such as G1P [4], G3P [9], G3P [8], G4P [6], and G9P [4] have also been identified in Korea (Kim et al., 2014). In addition, the infrequent combinations such as G3P [6] and G2P [6] were detected in Argentina, Europe, South America, and Cameroon (Degiuseppe et al., 2014; Boula et al., 2014). The uncommon combination genotype, such as G26P [19], G9P [4], G6P [14], G12P [6], G8P [6], G8P [4], G4P [6], G12P [8], G8P [14], G10P [15], and G2P [4], were detected in children in Vietnam, Denmark, Peru, Kenya, Brazil Pakistan, Turkey, Hungary, Italy, and India (My et al., 2014; Midgley et al., 2014; Espejo et al., 2014; Kiulia et al., 2014; Kazi et al., 2014; Luchs et al., 2015; Aydin and Akta¸s, 2017; Delogu et al., 2016; Marton et al., 2017; Pradhan and Chitambar, 2018). Human Astroviruses HAstVs belong to the Astroviridae family and the Mamastrovirus 1 genus. Mamastrovirus 1 comprises eight different genotypes (HAstV1
HAstV-8), which share 63%
84% amino acid homology at the capsid

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level (Bosch et al., 2014). In addition, the HAstV genotype 1 (HAstV-1) is divided into six lineages (1a
1f). The HAstV-2 is subdivided into four lineages (2a
2d). The HAstV-3 is classified into two lineages (3a and 3b). Finally, the HAstV-4 is separated into three lineages (4a
4c) (Liu et al., 2008; Martella et al., 2013; Bosch et al., 2014). These lineages were also detected in each serotype, with 93%
95% of nucleotide identity and with a reference strain to be recognized as a novel subtype (Bosch et al., 2014). Human Adenoviruses HAdVs are classified in the Adenoviridae family, Mastadenovirus genus, which contains seven known species, from A to G. Consequently, 54 serotypes have been classified by hemagglutination and serum neutralization reaction, but new types of adenovirus, including several emerging and recombinant viruses have been recently identified based on their genomic data (Ghebremedhin, 2014; La Rosa et al., 2015; http:// hadvwg.gmu.edu/). Recently, more than eight types of adenovirus were identified and were grouped into seven different species (Ghebremedhin, 2014; La Rosa et al., 2015; http://hadvwg.gmu.edu/). Indeed, the HAdV subgroups A and C contain, respectively, three and four different serotypes that could cause gastroenteric, urinary, and respiratory infections. The serotypes of these last two HAdV subgroups are distributed as follows: 12, 18, 31 for subgroup A and 1, 2, 5, 6 for subgroup C. In addition, the HAdV subgroup B includes nine serotypes, such as the 3, 7, 11, 14, 16, 21, 34, 35, and 50 serotypes that are the cause of the gastroenteric, respiratory, and urinary infections associated with conjunctivitis. Moreover, the HAdV subgroup D covers 31 serotypes (8
10, 13, 15, 17, 19, 22
30, 32, 33, 36
39, 42
49, and 51). These serotypes are the source of respiratory infections and conjunctivitis. Finally, the last two HAdV subgroups F and G include two different serotypes, the serotypes 40/41 for the subgroup F, and the serotypes 52/58 for the subgroup G, which are responsible for gastroenteric infections (Ghebremedhin, 2014; http:// hadvwg.gmu.edu/).

Epidemiology Rotavirus A RVA is recognized as the first etiological agent of AGE. Indeed, these viruses cause 5%
10% of viral gastroenteritis in infants and young children under 5 years of age, and 30% of RV disease are severe, requiring treatment in primary care centers or hospitals (Liu et al., 2012; Desselberger, 2014). In addition, before the introduction of RVA vaccination, these viruses caused around 3 million episodes each year,

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requiring 500,000 visits to a doctor and 60,000 hospitalizations, but leading to only 20
40 deaths in the United States (Fischer et al., 2007; Esposito et al., 2011; Desselberger, 2014). Similar findings are found in Europe, except that the number of deaths is around 200 (Van Damme et al., 2007). In developing countries, viral gastroenteritis associated with RVs is responsible for half a million deaths per year with more than 80% of deaths in children (,5 years) (Parashar et al., 2009; Tate et al., 2012; Desselberger, 2014). Despite the universal vaccination mass use, the disease associated with RVs is still responsible for the deaths of more than 200,000 children under 5 years of age worldwide in 2013, confirming that these viruses remain a major public health problem (Tate et al., 2016; Desselberger, 2017). Despite the efficacy of a monovalent-RV vaccine Rotarix, outbreaks of acute gastroenteritis caused by RVB species have been observed in China, Bangladesh, and India (Lahon et al., 2013; Desselberger, 2014). RVC infections are often asymptomatic but can cause diarrhea in adults (Desselberger, 2014). RVD, RVF, and RVG infections are mainly found in birds (Desselberger, 2014). RVH infections are detected in piglets and in human species (Molinari et al., 2014; Desselberger, 2014). RVI infections are isolated in dogs (http://www.ictvonline.org/virusTaxonomy.asp). Human Astroviruses Astroviruses showed a global distribution and they are essentially pathogenic at the extreme ages of life, especially, in children, in the elderly and immunocompromised persons (Bosch et al., 2014). Therefore the HAstV detection rates varied from 1.4% to 16% in children hospitalized for gastroenteritis and between 15% and 17% in communities (De Benedictis et al., 2011; Bosch et al., 2014). In developed countries, HAstVs are responsible for 3%
12% of diarrhea cases in children in Europe, Australia, Japan, America, and Bangladesh (Bosch et al., 2014). Similarly, the HAstV detection in less developed countries are also reported in Egypt, India, and Tunisia (Naficy et al., 2000; Bhattacharya et al., 2006; Sdiri-loulizi et al., 2009). In addition, molecular epidemiology studies conducted in different countries of the world showed that HAstV serotype 1 (HAstV-1) was very frequent (Noel et al., 1995; Sdiri-loulizi et al., 2009; Bosch et al., 2014). However, other HAstV serotypes have been detected, including 2, 3, 4, 5, and 8 serotypes, both in patients and in specimens of environmental sources (Nadan et al., 2003; Morsy El-Senousy et al., 2007; Bosch et al., 2014). Human Adenoviruses Epidemiological studies showed that RVA, astroviruses, norovirus, sapovirus, and enteric adenoviruses (serotypes 40 and 41) are the leading causes of acute gastroenteritis occurring in infants and young

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children (La Rosa et al., 2015). Enteric HAdVs cause acute diarrhea and are considered the third leading cause of diarrhea in children (La Rosa et al., 2015). Enteric adenovirus type 40/41 is detected in children with gastrointestinal symptoms in France, Tunisia, Albania, and in Brazil, with frequencies ranging from 2% to 23.2% (Bon et al., 1999; Sdiriloulizi et al., 2009; La Rosa et al., 2015; Amaral et al., 2015).

Prevention, Treatment, and Vaccination Rotaviruses Prevention: The prevention of infection with gastroenteric viruses is closely related to the adopted conventional hygiene measures. The careful and systematic handwashing can significantly reduce the incidence of gastroenteric virus infections (Desselberger, 2014). The disinfection of soiled or handled objects and surfaces should be systematic. These disinfections must use suitable antiseptic solutions. The hand friction with a hydroalcoholic solution is essential during care or any contact with the patient or his environment. The food production or water areas, oyster beds, irrigation or water distribution are based on upstream controls with the wastewater treatment plants monitoring and/or the ban on wild discards. The respect of hygiene rules is essential to avoid food contamination during their preparation and to limit virus diffusion from person to person. In care or accommodation establishments the prevention is based on hygienic rules and precautions; careful handwashing with water and antiseptic soap or with hydroalcoholic solutions (de Rougemont et al., 2010). Treatment: The treatment against viral gastroenteritis (mainly with RVA infection) essentially aimed at correcting the dehydration states that represent the major disease threat. The main patient care objectives are oral or intravenous rehydration and restoring electrolyte balance to replace fluid and electrolytes lost to diarrhea and vomiting during a gastroenteritis episode (Desselberger, 2014, 2017). Vaccination: Since 40 years, scientists and clinicians have joined forces to develop a vaccine against RV. From studies using animal models, it became clear that protection against infection with RV can be achieved by passive transfer of immune response products (antibodies, T cells) specific to RV or by vaccination (Offit, 1994; Desselberger, 2014, 2017). From 1998 to 2006, three different categories of RV vaccines were established and authorized: RotaShield, RotaTeq, and RotaRix (Centers for Disease Control Prevention (CDC), 1999; Desselberger, 2014, 2017). Indeed, the RotaShield is a quadrivalent vaccine that consisted of nonvirulent attenuated rhesus RV monkey mixture (G3P [5]) and virulent human monoreassortant, which contains the genes encoding the VP7

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protein of human genotypes G1, G2, and G4 (Kapikian et al., 1996). In addition, the RotaTeq is a bovine-human (recombinant virus) pentavalent vaccine, based on the recombination of a bovine RV (strain Wi79 of genotype G6P [5]), with human RVs with G1, G2, G3, G4, and P [8] genotypes (Heaton et al., 2005; Desselberger, 2014, 2017). In 2005 Merck laboratory developed a vaccine (Desselberger, 2014, 2017). Moreover, the RotaRix is a recombinant monovalent vaccine from an attenuated human strain with the G1P [8] genotype, which is industrialized in the 2006 by Glaxo Smith Kline laboratory (Desselberger, 2014, 2017). Both the vaccines were found to be highly effective in developed countries (with protection rates varying from 70% to 90%), with significantly decreasing RV infections associated with acute gastroenteritis (Desselberger, 2014, 2017). Human Astroviruses and Human Adenoviruses Viral gastroenteritis associated with HAstVs and enteric adenoviruses appeared to be of low severity. Therefore these last three gastroenteric virus types do not require special vaccination and treatment. To prevent infections with these enteric viruses, the same strategy as for the prevention of infections with RVs and noroviruses is followed. The only prevention is the reduction of the transmission risks by some hygienic measures (Bosch et al., 2014).

EMERGENT ROTAVIRUSES, ASTROVIRUSES, ADENOVIRUSES, AND WATERBORNE DISEASES Rotaviruses RVA is considered the first etiological agent of severe acute gastroenteritis in infants and young children in various countries in the world (Desselberger, 2014, 2017; Kaplon et al., 2017). In several reports, RVA is described as responsible for waterborne epidemics associated with sewage contamination, drinking water contamination, bathing, and river waters in many other countries of the world (van Zyl et al., 2006; He et al., 2008; Sdiri-Loulizi et al., 2010; Ibrahim et al., 2016; Jovanovi´c Galovi´c et al., 2016; Moreira and Bondelind, 2017; La Rosa et al., 2017; Masachessi et al., 2018). In fact, many environmental studies performed in wastewater samples are reported and described different RVA detection rates with moderate to important viral loads in various wastewater treatment plant situated in many regions in the world such as Venezuela, Iran, France, Italy, Brazil, Tunisia, Germany, Nigeria, China, and Egypt (Rodriguez-Diaz et al., 2009; Kargar et al., 2013; Prevost et al., 2015a; Ruggeri et al., 2015; Staggemeier et al., 2017; Ibrahim et al., 2016;

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Leifels et al., 2016; Motayo et al., 2016; Zhou et al., 2016; El-Senousy and Abou-Elela, 2017). Indeed, the RVA detection rates were about of 73.33%, 100% in influent and of 26.67%, 21% in effluent of the collected wastewater samples in Iran and France, respectively (Kargar et al., 2013; Prevost et al., 2015a). In addition, the RVA frequency fluctuated between 12.3% and 95% of the collected wastewater samples from diverse wastewater treatment plants in Brazil (Miagostovish et al., 2008; Prado et al., 2011; Fumian et al., 2011; Staggemeier et al., 2017). Similarly, the prevalence of these viruses is oscillated from 32% to 72.4% in sewage sampled at different wastewater treatment plants situated in Monastir and the great Tunis regions, Tunisia (Sdiri-Loulizi et al., 2010; Hassine-Zaafrane et al., 2015; Ibrahim et al., 2016). Moreover, low frequencies of RVA were recorded in wastewater samples in Nigeria (14.2%) and in Germany (19%) (Leifels et al., 2016; Motayo et al., 2016). However, high-to-moderate frequencies of RVA were described in sewage samples in Venezuela (50%), China 93.5%, Italy (60.4%), New Caledonia (75%), Egypt (84.6%), and the Uruguay (70%) (Zhou et al., 2016; Ruggeri et al., 2015; Kaas et al., 2016; El-Senousy and Abou-Elela, 2017; Lizasoain et al., 2018). Finally, the RVA viral load fluctuated as follows: 102
105 gc/L in France, 103 up to 109 gc/L in Brazil, 1.1 3 107 6 2.4 3 107 gc/L in Egypt, 1.24 3 103
10 gc/μL in Tunisia, 1.5 3 103
1.3 3 106 gc/L in China, and 5.79 3 101
3.77 3 103 gc/L in Uganda (Prevost et al., 2015a; Staggemeier et al., 2017; Ibrahim et al., 2016; El-Senousy and Abou-Elela, 2017; Zhou et al., 2016; O’Brien et al., 2017). Similarly, the RVA genotype distribution from wastewater showed that the RVA genotype G1 is the most prevalent among G types in previous environmental studies such as Brazil, Venezuela, Argentina, Iran, Italy, Nigeria, and Egypt (Villena et al., 2003; Miagostovish et al., 2008; Rodriguez-Diaz et al., 2009; Aw and Gin, 2010; Kargar et al., 2013; Ruggeri et al., 2015; Motayo et al., 2016; El-Senousy and Abou-Elela, 2017). Another RVG types, such as G2, G8, G10, G12, G9, G4, G6, G3, and G26, were encountered in wastewater samples in Italy, Kenya, Tunisia, Uruguay, Brazil, and Argentina (Kiulia et al., 2010; Grassi et al., 2010; Aw and Gin, 2010; Fumian et al., 2011; Tort et al., 2015; Ruggeri et al., 2015; Ibrahim et al., 2016). Likewise, the molecular epidemiology of RV P types showed that the P [4] and P [8] were the most dominant types in circulation in wastewater in Tunisia, Brazil, Italy, Uruguay, China, and Egypt (Fumian et al., 2011; Tort et al., 2015; Ruggeri et al., 2015; Zhou et al., 2016; El-Senousy and Abou-Elela, 2017). In addition, the RV of P types, such as P [6], P [3], P [9], P [11], P [14], and P [19], are detected in wastewater in Brazil, Egypt, Uruguay, and Italy (Fumian et al., 2011; El-Senousy and Abou-Elela, 2017; Tort et al., 2015; Ruggeri et al., 2015). Moreover, the recent genotyping studies conducted in Tunisia on RVA showed that the G8 genotype (35.5%) was the predominant genotype followed by G9 (16%), G1 (13%), G3 (13%), and G10 (10%) with three unusual combined genotype, such as G3/G9 (3%), G8/G10 (3%), and EMERGING AND REEMERGING VIRAL PATHOGENS

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FIGURE 20.1 Summary of the essential virological characteristics of some specific emerging gastroenteric viruses largely circulating in wastewater: Rotaviruses, Astroviruses and Adenoviruses.

G9/G8 (6.5%) (Ibrahim et al., 2016). These last data showed the emergence of new RV G types, such as G8 and G10 genotype in Tunisian wastewater (Ibrahim et al., 2016). Furthermore, a high genetic diversity of G and P types of RVs. A recent study was reported the circulation of 5G genotypes and 4P genotypes, such as G1, G2, G3, G4, G10, P [4],

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P [8], P [6], and P [11], in an Egyptian environmental study performed on wastewater samples (El-Senousy and Abou-Elela, 2017). Also, the VP7 and VP4 genotyping revealed the detection of seven G (G1, G2, G9, G4, G6, G3, and G26) and six P (P [8], P [4], P [6], P [9], P [14], and P [19]) genotypes in sewage sampled from four different Italian wastewater treatment plants (Ruggeri et al., 2015) (Fig. 20.1). This finding generated by molecular epidemiological studies of RVA highlighted the importance of natural environment monitoring, as a tool to study the RVA epidemiology in the human and environmental population. These findings could be useful for the vaccine surveillance program, the waterborne disease prevention, since wastewater is considered a good screening option for the rapid and economical detection of the different viral genotype, circulating in the pediatric population.

Astroviruses Gastroenteric viruses are generally present in water of different types and are the main cause of waterborne infections and subsequent epidemics (Butler et al., 2015; Cho et al., 2017). Waterborne HAstVs, originating from contaminated wastewater, river water, groundwater, drinking water, and surface water are described in different regions of the world, such as Uruguay, South Africa, Germany, Hungary, Egypt, Italy, Singapore, Brazil, Japan, France, Tunisia, and Argentina (Victoria et al., 2014; Nadan et al., 2003; Pusch et al., 2005; Meleg et al., 2006; Morsy El-Senousy et al., 2007; Anastasi et al., 2008; Aw and Gin, 2010; He et al., 2008, 2012; Fumian et al., 2013; Hata et al., 2015; Prevost et al., 2015a; Ibrahim et al., 2017; Masachessi et al., 2018). HAstVs are encountered with moderate to important frequencies in wastewater samples from different wastewater treatment plants in different areas in the world such as South Africa, Germany, Hungary, Italy, Singapore, China, Japan, France, New Caledonia, Tunisia, and Uruguay (Nadan et al., 2003; Pusch et al., 2005; Meleg et al., 2006; Anastasi et al., 2008; Aw and Gin, 2010; Zhou et al., 2014; Hata et al., 2015; Prevost et al., 2015a; Kaas et al., 2016; Ibrahim et al., 2017; Lizasoain et al., 2015). HAstV detection rates were very high in wastewater samples in Singapore (100%), France (84%), New Caledonia (67%), and Uruguay (60%) (Aw and Gin, 2010; Prevost et al., 2015a; Kaas et al., 2016; Lizasoain et al., 2015). However, this type of gastroenteric viruses is detected with low-to-moderate frequencies in polluted sewage in Hungary (43%), Germany (24%), Italy (4.3%), China (39.1%), and Tunisia (55%) (Pusch et al., 2005; Meleg et al., 2006; Anastasi et al., 2008; Zhou et al., 2014; Ibrahim et al., 2017). A recent environmental study conducted by Ibrahim et al. (2017) showed the first detection and the

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emergence of HAstVs in Tunisian hospital wastewater. Moreover, an important mean viral load values of HAstVs are reported in wastewater samples in France and in Germany (Pusch et al., 2005; Prevost et al., 2015a). These values varied between 3.7 3 103
1.2 3 108 and 103
104 gc/L in France and in Germany (Pusch et al., 2005; Prevost et al., 2015a). Furthermore, the HAstV molecular epidemiology showed that all the genotypes (HAstV-1
HAstV-8) of these viruses were detected in wastewater samples in different regions worldwide such as South Africa, Hungary, Singapore, China, Uruguay, Japan, France, and Tunisia, showing the dominance of HAstV genotype 1 (HAstV-1) (Nadan et al., 2003; Meleg et al., 2006; Aw and Gin, 2010; Zhou et al., 2014; Lizasoain et al., 2015; Hata et al., 2015; Prevost et al., 2015b; Ibrahim et al., 2017). In France, Prevost et al. (2015b) revealed the distribution of the following HAstV genotypes 1, 2, 5, and 6 (HAstV-1, HAstV-2, HAstV-5, and HAstV-6) in wastewater samples. In Tunisia, a recent environmental study showed the emergence of HAstV genotypte 6 (HAstV-6) and the predominance of HAstV genotype 1 (HAstV-1) in hospital wastewater (Ibrahim et al., 2017). In China, four HAstV genotypes (HAstV-1, HAstV-2, HAstV-4, and HAstV-5) are detected in the polluted sewage (Zhou et al., 2014). In Hungary, two HAstV genotypes (HAstV-1 and HAstV-2) are identified in environmental samples (Meleg et al., 2006). In South Africa, HAstV genotypes 1, 2, 3, 4, 5, 7, and 8 (HAstV-1
HAstV-5, HAstV-7, and HAstV-8) are isolated in wastewater samples (Nadan et al., 2003). In Japan, HAstV types 1, 2, 5, and 4/8 (HAstV-1, HAstV-2, HAstV-5, HAstV-4/8) are distinguished in wastewater samples (Hata et al., 2015). In Uruguay, HAstV genotypes 1, 2, and 5 (HAstV-1, HAstV-2, and HAstV-5) are encountered in effluent samples (Lizasoain et al., 2015) (Fig. 20.1).

Adenoviruses Waterborne HAdV outbreaks caused by contaminated surface water, drinking water, groundwater, recreational water, river water, and seawater pose a serious threat to public health (Grøndahl-Rosado et al., 2014; Kuo et al., 2015; Lin and Singh 2015; Vergara et al., 2016; Kaas et al., 2016; Adefisoye et al., 2016; La Rosa et al., 2017; Ibrahim et al., 2018). In fact, HAdVs are detected in several environmental studies with some significant frequencies in wastewater sampled from many wastewater treatment plants situated in diverse regions in the world. The HAdV detection rates were about of 100% in Singapore, 45.5% in Morocco, 100% in Brazil, 92% in Norway, 92.1% in Poland, 27.3% in Taiwan, 92.3% in Greece, 100% in France, 62.5% in South Africa, 96% in Germany, 100% in Egypt, 60% in Italy, 64% in Tunisia, and 100% in Uruguay (Aw and Gin,

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2010; Amdiouni et al., 2012; Fumian et al., 2013; Grøndahl-Rosado et al., 2014; Wieczorek et al., 2015; Lim et al., 2015; Kokkinos et al., 2015; Prevost et al., 2015a; Adefisoye et al., 2016; Leifels et al., 2016; El-Senousy and Abou-Elela, 2017; Iaconelli et al., 2017; Ibrahim et al., 2018; Lizasoain et al., 2015). In addition, the mean viral load values of HAdVs are also reported in environmental studies conducted on Egyptian, Brazilian, African, and French wastewater samples. Indeed, these values are oscillated between 104
105, 103
109, 8.4 3 101
105, and 5.9 3 103
9.9 3 106 gc/L in France, Brazil, South Africa, and Egypt, respectively (Prevost et al., 2015a; Staggemeier et al., 2017; Adefisoye et al., 2016; El-Senousy and Abou-Elela, 2017). Moreover, the HAdV molecular epidemiology reported in different environmental studies showed that the HAdV subgroups F, B, C, and D are identified in wastewater samples, with the predominance of HAdV-F and especially the serotype 41. The only recent Brazilian environmental study reported the detection of four different HAdV subgroups HAdV-B, HAdV-C, HAdV-D, and HAdV-F in effluents collected from 12 different wastewater sites used over the 2016 Summer Olympics (Staggemeier et al., 2017). Similarly, a recent African environmental study showed the detection of two HAdV subgroups in wastewater samples, HAdV-B (serotype 2) and HAdV-F (serotype 41) (Adefisoye et al., 2016). However, the only subgroup and serotype of HAdVs isolated in wastewater is the HAdV-F and the serotype 41 in Singapore, in the United States, Norway, Egypt, Italy, and Tunisia (Aw and Gin, 2010; Wong et al., 2013; El-Senousy and Abou-Elela, 2017; Iaconelli et al., 2017; Ibrahim et al., 2018) (Fig. 20.1). The presence of infectious human enteric adenoviruses at high levels in treated wastewater underscores the strict need for monitoring wastewater treatment. This data confirm and corroborate those obtained in other studies carried out in developed countries, concerning DNA viruses such as enteric adenoviruses, which considered that these viruses are good markers of human fecal contamination in the health control sector (Fumian et al., 2013). Monitoring systems of the epidemiology and genetic diversity of different types of enteric viruses circulating in several types of contaminated water will be useful for the improvement of the virological quality of treated wastewater and for the prevention of waterborne diseases associated with AGE.

CONCLUSION This chapter presented an overview of the main virological characteristics of three different types of gastroenteritis viruses, namely, RVs, adenoviruses, and astroviruses that belonged to the Reoviridae, Adenoviridae, and Astroviridae families, respectively. Indeed, the history, the taxonomy, the structure, the genomic organization, the replication cycle, the pathogenesis, the genetic diversity, the epidemiology, EMERGING AND REEMERGING VIRAL PATHOGENS

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diagnosis methods, the immune responses, the treatment, the prevention, the different vaccines developed for these three types of gastroenteric viruses are well described. In addition, the emergence of a new RV strain and the appearance of HAdVs in the natural environment, especially, in wastewater are also discussed. Despite the universal vaccination mass practice using a Rotarix vaccine against RVs and the effectiveness of wastewater treatment procedures for gastroenteric virus removal, these data showed the detection of these viruses with high and significant frequencies, and by the same the emergence of new strains of these viruses in various environmental samples before their detection in the clinical setting. An understanding and a comprehension of the epidemiology and the genetic evolution of these viruses are required to prevent foodborne and waterborne diseases.

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Further Reading Glass, R.I., Parashar, U.D., Estes, M.K., 2009. Norovirus gastroenteritis. N. Engl. J. Med. 361 (18), 1776
1785. Hodges, K., Gill, R., 2010. Infectious diarrhea: cellular and molecular mechanisms. Gut Microbes 1, 4
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405. Rega Institute, KU Leuven, Belgium. Available from: ,https://rega.kuleuven.be/cev/ viralmetagenomics/virus-classification/7th-RCWG-meeting. (accessed 25.09.17.). Terio, V., Bottaro, M., Pavoni, E., Losio, M.N., Serraino, A., Giacometti, F., et al., 2017. Occurrence of hepatitis A and E and norovirus GI and GII in ready-to-eat vegetables in Italy. Int. J. Food Microbiol. 249, 61
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