Trends in Norovirus Genotypes in South Korea, 2019-2024: Insights from Nationwide Dual Typing Surveillance

Noroviruses are a leading cause of acute gastroenteritis worldwide, with a particularly high burden among children under five years of age. We analyzed nationwide surveillance data from EnterNet-Korea collected between 2019 and 2024-covering both the pre- and post-COVID-19 pandemic periods-to assess norovirus detection rates and genotype distribution. Noroviruses were detected by RT-qPCR, and dual genotyping of capsid (G) and polymerase (P) types was performed by sequencing the ORF1-2 junction region. Among the 67,159 specimens tested, 8.4% (n = 5652) were norovirus-positive, with the highest prevalence observed in children aged 0-5 years (19.9%). In this age group, genotyping was successful in 72.4% (2633/3635) of positive cases, identifying 30 distinct genotypes (GI: 9; GII: 21). The most common strains were GII.4[P31] (38.1%), GII.4[P16] (27.1%), and GII.2[P16] (10.4%), with substantial year-to-year variation. Notably, the emergence of GII.17[P17] in late 2024 indicates shifting genotype dynamics, underscoring the need for strengthened surveillance and reconsideration of vaccine strain selection. To our knowledge, this is the first nationwide dual-typing study in Korea encompassing the COVID-19 pandemic era. These findings provide essential baseline data for integration into global surveillance systems and inform future vaccine development and public health strategies.