Associations of infection control measures and norovirus outbreak outcomes in healthcare settings: a systematic review and meta-analysis

• Type of Material: Article
• Authors: Benjamin Lopman, Emory University; Carly Adams, Emory University; Shenita Peterson, Emory University; Aron J Hall, Centers for Disease Control and Prevention, Atlanta; Umesh Parashar, Centers for Disease Control and Prevention, Atlanta
• Language: English
• Date: 2021-08-03
• Publisher: TAYLOR & FRANCIS LTD
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Rights managed by Taylor & Francis
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1080/14787210.2021.1949985
• Title of Journal or Parent Work: EXPERT REVIEW OF ANTI-INFECTIVE THERAPY
• Volume: 20
• Issue: 2
• Start Page: 279
• End Page: 290
• Grant/Funding Information: Funding for this study was provided by NIH/AHRQ (R01 HS025987) and NIH/NIGMS (R01 GM124280).
• Keywords: Science & Technology; ENVIRONMENTAL CONTAMINATION; healthcare; HOSPITAL OUTBREAK; long-term care facilities; systematic review; hospitals; Pharmacology & Pharmacy; Control measures; Infectious Diseases; TO-PERSON SPREAD; norovirus; Life Sciences & Biomedicine; VIRAL GASTROENTERITIS; outbreaks; ACUTE NONBACTERIAL GASTROENTERITIS; Microbiology; infection control; NOSOCOMIAL TRANSMISSION; gastrointestinal infection; meta-analysis; NURSING-HOME; FACILITY; UNITED-STATES; ROUND STRUCTURED VIRUS

Abstract

Background: Although most norovirus outbreaks in high-income countries occur in healthcare facilities, information on associations between control measures and outbreak outcomes in these settings is lacking. Methods: We conducted a systematic review/meta-analysis to assess associations between norovirus outbreak control measures and outcomes in hospitals and long-term care facilities (LTCFs), globally. Using regression analyses stratified by setting (hospital/LTCF), we compared durations, attack rates, and case counts for outbreaks in which control measures were reportedly implemented to those in which they were not. Results: We identified 102 papers describing 162 norovirus outbreaks. Control measures were reportedly implemented in 118 (73%) outbreaks and were associated with 0.6 (95% CI: 0.3–1.1) times smaller patient case counts and 0.7 (95% CI: 0.4, 1.0) times shorter durations in hospitals but 1.5 (95% CI: 1.1-2.2), 1.5 (95% CI: 1.0–2.1) and 1.6 (95% CI: 1.0–2.6) times larger overall, resident and staff case counts, respectively, and 1.4 (95% CI: 1.0–2.0) times longer durations in LTCFs. Conclusions: Reported implementation of control measures was associated with smaller/shorter outbreaks in hospitals but larger/longer outbreaks in LTCFs. Control measures were likely implemented in response to larger/longer outbreaks in LTCFs, rather than causing them. Prospective observational or intervention studies are needed to determine effectiveness.