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The norovirus epidemiologic triad: Predictors of severe outcomes in U.S. norovirus outbreaks, 2009–2016
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April 16 2019
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Source: J Infect Dis. 219(9):1364-1372
Details:
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Alternative Title:J Infect Dis
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Personal Author:
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Description:Background:
Noroviruses are the leading cause of acute gastroenteritis outbreaks worldwide. Clarifying the viral, host, and environmental factors (epidemiologic triad) associated with severe outcomes can help target public health interventions.
Methods:
Acute norovirus outbreaks reported to the National Outbreak Reporting System (NORS) in 2009–2016 were linked to laboratory-confirmed norovirus outbreaks reported to CaliciNet. Outbreaks were analyzed for differences in genotype (GII.4 vs. non-GII.4), hospitalization, and mortality rates by timing, setting, transmission mode, demographics, clinical symptoms, and health outcomes.
Results:
3,747 norovirus outbreaks were matched from NORS and CaliciNet. Multivariable models showed that GII.4 outbreaks (n=2,353) were associated with healthcare settings (Odds Ratio [OR]: 3.94, 95% Confidence Interval [CI]: 2.99 – 5.23), winter months (Nov. – Apr.; 1.55 [1.24 – 1.93]), and older age of cases (≥50% aged ≥75; 1.37 [1.04 – 1.79]). Severe outcomes were more likely among GII.4 outbreaks (hospitalization rate ratio [RR] 1.54 [1.23 – 1.96; mortality RR 2.77 [1.04 – 5.78]). Outbreaks in healthcare settings were also associated with higher hospitalization (RR 3.22 [2.34 – 4.44]) and mortality rates (RR 5.65 [1.92 – 18.70]).
Discussion:
Severe outcomes more frequently occurred in norovirus outbreaks caused by GII.4 and those in healthcare settings. These results should help guide preventive interventions for targeted populations, including vaccine development.
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Pubmed ID:30445538
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Pubmed Central ID:PMC6939307
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