The epidemiology of published norovirus outbreaks: a systematic review of risk factors associated with attack rate and genogroup

• Type of Material: Article
• Authors: J. E. Matthews, Emory University; B. W. Dickey, Emory University; R. D. Miller, Emory University; J. R. Felzer, Emory University; B. P. Dawson, Emory University; A. S. Lee, Emory University; J. J. Rocks, Emory University; J. Kiel, Emory University; J. S. Montes, Emory University; Christine L Moe, Emory University; J. N. S. Eisenberg, University of Michigan; Juan Leon, Emory University
• Language: English
• Date: 2012-07
• Publisher: Cambridge University Press (CUP): STM Journals
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © Cambridge University Press 2012
• Final Published Version (URL): http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8573279
• Title of Journal or Parent Work: Epidemiology and Infection
• ISSN: 0950-2688
• Volume: 140
• Issue: 7
• Start Page: 1161
• End Page: 1172
• Grant/Funding Information: This work was partially supported by STAR grant RD83172701 from the U.S. Environmental Protection Agency [to C.L.M. and J.N.S.E.], grant 1K01AI087724 – 01 from the NIAID at the NIH, grant 2010-85212-20608 from the National Institute of Food and Agriculture at the U.S. Department of Agriculture, and the Emory University Global Health Institute [to J.S.L.]. We also acknowledge financial support from the Practical Experience Program at the Emory University Rollins School of Public Health (to J.E.M.), the Federal Work Study program at the U.S. Department of Education (to B.W.D.), and the Scholarly Inquiry and Research at Emory program at Emory University [to J.J.R.].
• Research Categories: Health Sciences, Epidemiology

Abstract

SUMMARY The purpose of this study was to examine global epidemiological trends in human norovirus (NoV) outbreaks by transmission route and setting, and describe relationships between these characteristics, viral attack rates, and the occurrence of genogroup I (GI) or genogroup II (GII) strains in outbreaks. We analysed data from 902 RT-PCR-confirmed, human NoV outbreaks extracted from a systematic review of articles published from 1993 to 2011 and indexed under the terms “norovirus” and “outbreak.” Multivariate regression analyses demonstrated that foodservice and winter outbreaks were significantly associated with higher attack rates. Food- and waterborne outbreaks were associated with multiple strains (GI+GII). Waterborne outbreaks were significantly associated with GI strains, while healthcare-related and winter outbreaks were associated with GII strains. These results identify important trends for epidemic NoV detection, prevention, and control.