Burden of Severe Norovirus Disease in Taiwan, 2003-2013

• Type of Material: Article
• Authors: Rachel M Burke, Centers for Disease Control and Prevention; Shuman Shih, National Health Research Institutes, Taiwan; Catherine Yen, Centers for Disease Control and Prevention; Yhu-Chering Huang, Chang Gung Memorial Hospital at Linkou; Umesh D Parashar, Centers for Disease Control and Prevention; Benjamin Lopman, Emory University; Fang Tzy Wu, Centers for Disease Control and Prevention; Chao Agnes Hsiung, National Health Research Institutes, Taiwan; Aron J Hall, Centers for Disease Control and Prevention
• Language: English
• Date: 2018-11-01
• Publisher: Oxford University Press
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © Published by Oxford University Press for the Infectious Diseases Society of America 2018.
• Final Published Version (URL): http://dx.doi.org/10.1093/cid/ciy298
• Title of Journal or Parent Work: Clinical Infectious Diseases
• Volume: 67
• Issue: 9
• Start Page: 1373
• End Page: 1378
• Grant/Funding Information: Taiwan Centers for Disease Control [grant number MOHW105-CDC-C-114-123302]
• Keywords: Science & Technology; DEATHS; ADULTS; EPIDEMIOLOGY; CHILDREN; acute gastroenteritis; NORTHERN TAIWAN; Life Sciences & Biomedicine; norovirus; Microbiology; Immunology; Infectious Diseases; VIRAL GASTROENTERITIS; DIARRHEA; UNITED-STATES; INFECTION
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Background Despite the increasingly recognized role of norovirus in global acute gastroenteritis (AGE), specific estimates of the associated disease burden remain sparse, primarily due to limited availability of sensitive norovirus diagnostics in the clinical setting. We sought to estimate the incidence of norovirus-associated hospitalizations by age group in Taiwan using a previously developed indirect regression method. Methods AGE-related hospitalizations in Taiwan were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes abstracted from a national database; population data were provided from the Department of Household Registration Affairs. Population and hospitalizations were aggregated by month and year (July 2003-June 2013) and grouped by age: <5 years, 5-19 years, 20-64 years, and ≥65 years. Monthly counts of cause-unspecified AGE hospitalizations were modeled as a function of counts of known causes, and the residuals were then analyzed to estimate norovirus-associated hospitalizations. Results Over the study period, an annual mean of 101400 gastroenteritis-associated hospitalizations occurred in Taiwan (44 per 10000 person-years), most of which (83%) had no specified cause. The overall estimated rate of norovirus-associated hospitalizations was 6.7 per 10000 person-years, with the highest rates in children aged <5 years (63.7/10000 person-years). Predicted norovirus peaked in 2006-2007 and 2012-2013. Conclusions Our study is one of the first to generate a population-based estimate of severe norovirus disease incidence in Asia, and highlights the large burden of norovirus in Taiwan, particularly in children. Predicted peak norovirus seasons coincided with the emergence of new strains and resulting pandemics, supporting the validity of the estimates.