Norovirus infection epidemiology and demographics: Difference between revisions

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{{Norovirus infection}}
{{Norovirus infection}}
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==Overview==
Norovirus is the leading cause of [[acute gastroenteritis]] and foodborne illness in all age groups in the United States. It causes approximately 21 million cases of [[gastroenteritis]] yearly. The genogroup II, genotype 4 strain is most commonly involved in large [[outbreaks]] of norovirus.


==Epidemiology and Demographics==
==Epidemiology and Demographics==
'''Norovirus is the leading cause of acute gastroenteritis in all age groups in the United States.'''


Each year, norovirus—


* causes about 21 million cases of acute gastroenteritis, and
===Incidence===
* contributes to about 70,000 hospitalizations and 800 deaths, mostly among young children and older adults
Noroviruses causes about 900 deaths, mostly among adults aged 65 and older; 109,000 [[hospitalizations]]; 465,000 [[emergency]] department visits, mostly in young children; 2,270,000 [[outpatient]] clinic visits annually, mostly in young children and  19 to 21 million cases of vomiting and diarrhea illnesses
norovirus causes about 21 million cases of [[acute gastroenteritis]] yearly. Norovirus accounts for 58% of foodborne illnesses in the United States. Norovirus outbreaks may be observed any time during the year, but it is most common in the winter months. The cost of norovirus illnesses is approximately $60 billion worldwide considering the lost productivity and healthcare costs.<ref name="cdc">Centers for Disease Control and Prevention (2021). Norovirus: Diagnostic Methods. Accessed on January 28, 2021 http://www.cdc.gov/norovirus/php/illness-outbreaks.html </ref><ref>https://www.cdc.gov/norovirus/trends-outbreaks/worldwide.html</ref>


Also, 16% of all acute gastroenteritis in the community is caused by norovirus, and 12% of acute gastroenteritis cases that get outpatient care are caused by norovirus.
===Age===


People can get norovirus illness at any time during the year. But, it is most common in the winter. Also, there can be 50% more norovirus illness in years when there is a new strain of the virus going around.
*Norovirus is the leading cause of acute gastroenteritis and foodborne illness in all age groups in the United States.


'''Norovirus is the leading cause of foodborne illness in the United States.''' It is responsible for—
===Gender===


* 58% of domestically-acquired foodborne illnesses, and
*Norovirus shows no gender predilection.
* 50% of foodborne disease outbreaks due to known agents.


Each year, it costs about $2 billion in the United States for healthcare and lost productivity from foodborne illness caused by norovirus.
===Race===


Most foodborne outbreaks of norovirus illness are caused by eating food that was just contaminated by a food handler. However, widespread outbreaks of norovirus can also be caused by food, such as oysters, raspberries, and leafy greens, that were contaminated at their source.
*Norovirus is common across all races.


Waterborne outbreaks of norovirus illness also occur in community settings. This is often caused by sewage contaminated wells and untreated recreational water.
===Outbreaks===
 
[[CDC]] currently does not conduct active [[disease surveillance|surveillance]] to monitor [[outbreak]]s of [[gastroenteritis]] caused by [[norovirus]]es. [[outbreak|Outbreaks]] are reported to CDC's Viral Gastroenteritis Section, Respiratory and Gastroenteric Viruses Branch, Division of Viral Diseases, National Center for Immunization and Respiratoiry Diseases (NCIRD) when states send specimens for testing or sequencing, or outbreaks are reported directly by states to the electronic database (eFORS) maintained by the Foodborne Diarrheal Diseases Branch.
 
Each year, norovirus causes about 21 million cases of [[acute gastroenteritis]] ([[inflammation]] of the [[stomach]] or [[intestine]]s or both) and contributes to about 70,000 hospitalizations and 800 deaths, mostly among young children and the elderly. One can get norovirus illness at any time during the year. But, it is most common in the winter. Also, there can be 50% more norovirus illness in years when there is a new strain of the virus going around.


===Outbreaks===
*Most noroviruses that infect humans belong to genogroups GI and GII.<ref name="pmid10752550">{{cite journal
Most noroviruses that infect humans belong to genogroups GI and GII.<ref name="pmid10752550">{{cite journal
|author=Vinjé J, Green J, Lewis DC, Gallimore CI, Brown DW, Koopmans MP
|author=Vinjé J, Green J, Lewis DC, Gallimore CI, Brown DW, Koopmans MP
|title=Genetic polymorphism across regions of the three open reading frames of "Norwalk-like viruses"
|title=Genetic polymorphism across regions of the three open reading frames of "Norwalk-like viruses"
Line 43: Line 39:
|url=http://link.springer.de/link/service/journals/00705/bibs/0145002/01450223.htm
|url=http://link.springer.de/link/service/journals/00705/bibs/0145002/01450223.htm
}}</ref>
}}</ref>
Noroviruses from Genogroup II, genotype 4 (abbreviated as GII.4) account for the majority of adult outbreaks of [[gastroenteritis]] and often sweep across the globe.<ref>{{cite journal
*Noroviruses from Genogroup II, genotype 4 (abbreviated as GII.4) account for the majority of adult outbreaks of [[gastroenteritis]] and often sweep across the globe.<ref>{{cite journal
|author=Noel J, Fankhauser RL, Ando T, Monroe SS, Glass RI
|author=Noel J, Fankhauser RL, Ando T, Monroe SS, Glass RI
|title=Identification of a distinct common strain of "Norwalk-like viruses" having a global distribution
|title=Identification of a distinct common strain of "Norwalk-like viruses" having a global distribution
Line 53: Line 49:
|pmid=10228052
|pmid=10228052
|doi=10.1086/314783}}</ref>
|doi=10.1086/314783}}</ref>
Recent examples include US95/96-US strain, associated with global outbreaks in the mid- to late-1990s, [[Farmington Hills]] virus associated with outbreaks in [[Europe]] and the United States in 2002 and in 2004, and Hunter virus was associated with outbreaks in Europe, Japan and Australasia. In 2006, there was another large increase in NoV infection around the globe.<ref name="pmid18177226">{{cite journal
*Recent examples include US95/96-US strain, associated with global [[outbreaks]] in the mid- to late-1990s, Farmington Hills virus associated with outbreaks in Europe and the United States in 2002 and in 2004, and Hunter virus was associated with outbreaks in Europe, Japan and Australasia. In 2006, there was another large increase in NoV infection around the globe.<ref name="pmid18177226">{{cite journal
|author=Tu ET, Bull RA, Greening GE, Hewitt J, Lyon MJ, Marshall JA, McIver CJ, Rawlinson WD, White PA
|author=Tu ET, Bull RA, Greening GE, Hewitt J, Lyon MJ, Marshall JA, McIver CJ, Rawlinson WD, White PA
|title=Epidemics of gastroenteritis during 2006 were associated with the spread of norovirus GII.4 variants 2006a and 2006b
|title=Epidemics of gastroenteritis during 2006 were associated with the spread of norovirus GII.4 variants 2006a and 2006b
Line 65: Line 61:
|url=http://cid.oxfordjournals.org/content/46/3/413
|url=http://cid.oxfordjournals.org/content/46/3/413
}}</ref>
}}</ref>
*Nearly two-thirds of all norovirus outbreaks reported in the United States occur in long-term care facilities. Outbreaks of norovirus illness have also occurred in restaurants, cruise ships, schools, banquet halls, summer camps, and even at family dinners. These are all places where people often eat food handled or prepared by others. In fact, norovirus is the leading cause of illness from contaminated food in the United States. About 50% of all outbreaks of food-related illness are caused by norovirus. Foods that are commonly involved in outbreaks of norovirus illness are:
*Leafy greens (such as lettuce)
*Fresh fruits
*Shellfish (such as oysters)


Most outbreaks of norovirus illness happen when infected people spread the virus to others. But, norovirus can also spread by consuming [[contamination|contaminated]] food or water and touching things that have the virus on them. Healthcare facilities, including nursing homes and hospitals, are the most commonly reported places for norovirus outbreaks in the United States and other industrialized countries. Nearly two-thirds of all norovirus outbreaks reported in the United States occur in long-term care facilities. Outbreaks of norovirus illness have also occurred in restaurants, cruise ships, schools, banquet halls, summer camps, and even at family dinners. These are all places where people often eat food handled or prepared by others. In fact, norovirus is the leading cause of illness from contaminated food in the United States. About 50% of all outbreaks of food-related illness are caused by norovirus. Foods that are commonly involved in outbreaks of norovirus illness are:
[[image:Dsnorovirus_626px.jpg|left|380px|thumb|This graph illustrates outbreaks of acute gastroenteritis in 30 states from January 2007 through April 2010. On average, there were nearly 3 times as many norovirus outbreaks (143 per month) as non-norovirus outbreaks (50 per month) and the number of norovirus outbreaks increased dramatically during the winter months. A new virus strain (GII.4 New Orleans) that first appeared in October 2009 did not lead to more outbreaks.]]
*Leafy greens (such as lettuce),
*Fresh fruits, and
*Shellfish (such as oysters).


However, any food that is served raw or handled after being cooked can get contaminated. Norovirus outbreaks have also been caused by contaminated water from sewage in wells and recreational water, such as pools.
[[image:Dsnorovirus_379px.jpg|none|500px|thumb|This graph illustrates the setting of 1,518 confirmed norovirus outbreaks in the U.S. from 2010 to 2011: Long-term Care Facility 59% (889 Outbreaks); Restaurants 8% (123 Outbreaks); Party & Event 7% (99 Outbreaks); Hospital 4% (65 Outbreaks); School 4% (64 Outbreaks); Cruise Ship 4% (55 Outbreaks); Other & Unknown 14% (223 Outbreaks).]]<br><br><br>
===Reporting===


Currently, state, local, and territorial health departments are not required to report individual cases of norovirus illness to a national surveillance system. They may not know about such cases because most hospitals and doctor’s offices do not have capability to test for norovirus. The virus is usually diagnosed only when an outbreak happens.
===Developing Countries===
 
Health care providers should report all outbreaks of acute gastroenteritis, including suspected outbreaks of norovirus, to the appropriate state, local or territorial health department.
 
====Definition of a Norovirus Outbreak====
 
An outbreak of norovirus is defined as an occurrence of two or more similar illnesses resulting from a common exposure.
 
Health departments are encouraged to report all suspected and confirmed norovirus outbreaks through the National Outbreak Reporting System (NORS) and CaliciNet.


===Surveillance Systems===
*Epidemiological data from developing countries about the importance of norovirus in [[pediatric]] [[diarrhea]] are limited. Recently, in Nicaragua, it has been observed that norovirus is responsible for 11% of the diarrhea cases occurring in children less than five years of age at community level and 15% of the moderate to severe cases requiring [[intravenous]] [[rehydration]].<ref>Bucardo F, Nordgren J, Carlsson B, Paniagua M, Lindgren PE, Espinoza F, Svensson L., "Pediatric norovirus diarrhea in Nicaragua", ''J. Clin. Microbiology'', '''46''': 8 (August 2008), pp. 2573–80.</ref>
====NORS====


NORS was launched by CDC in 2009 to collect information on outbreaks of foodborne, waterborne, and enteric disease that spread from person-to-person, animals, environmental surfaces, and other or unknown ways. Public health agencies can report all outbreaks of gastroenteritis, including norovirus illness, through this web-based system. This information is used to determine where norovirus outbreaks commonly occur, how the virus is spread, and specific food or water sources involved. In turn, this helps with identifying the best ways to prevent and control norovirus illness and outbreaks.
*In the Guangdong province of the People's Republic of China, the Provincial Health Department said on December 17, 2010, that it had confirmed 429 cases of norovirus infection in the November 2010 outbreak in Conghua, Guangzhou, but no one died from it.<ref>[http://english.cntv.cn/20101217/106924.shtml Norovirus infects 429 people in Guangzhou (CNTV reports)]</ref>


====CaliciNet====
==References==
 
CDC developed CaliciNet in 2009. It is a network of public health and food regulatory laboratories that submit norovirus sequences identified from outbreaks into a national database. The information is used to link norovirus outbreaks that may be caused by common sources (such as food), monitor trends, and identify emerging norovirus strains. As of February 2012, public health laboratories in 25 states have been certified by the CDC to participate in CaliciNet. States that are not yet certified may contribute through designated CaliciNet outbreak support centers, including the CDC.
 
====Other Surveillance Systems====
 
CDC is using New Vaccine Surveillance Network (NVSN) and Fooborne Diseases Active Surveillance Network (FoodNet) to do norovirus testing on patients with gastroenteritis. This will help generate new estimates of norovirus illness and monitor trends over time.
 
----
Shown below is a graph that illustrates outbreaks of acute gastroenteritis in 30 states from January 2007 through April 2010. On average, there were nearly 3 times as many norovirus outbreaks (143 per month) as non-norovirus outbreaks (50 per month) and the number of norovirus outbreaks increased dramatically during the winter months. A new virus strain (GII.4 New Orleans) that first appeared in October 2009 did not lead to more outbreaks.
 
[[image:Dsnorovirus_626px.jpg|500px]]
----
Shown below is a graph that illustrates the setting of 1,518 confirmed norovirus outbreaks in the U.S. from 2010 to 2011: Long-term Care Facility 59% (889 Outbreaks); Restaurants 8% (123 Outbreaks); Party & Event 7% (99 Outbreaks); Hospital 4% (65 Outbreaks); School 4% (64 Outbreaks); Cruise Ship 4% (55 Outbreaks); Other & Unknown 14% (223 Outbreaks).
 
[[image:Dsnorovirus_379px.jpg|500px]]
----
 
[[File:Reports by Month of Norovirus.png|thumb|center|350px|Number of Norovirus Laboratory reports by month on average from 2000 to 2011. Source: HPA]]
[[File:Norovirus Cases per Year.png|thumb|center|350px|Laboratory reports of norovirus infections in England and Wales 2000-2012. Source: HPA]]
 
===Epidemiologic Criteria===
Epidemiologic criteria have been proposed for use in determining whether an outbreak of gastroenteritis is of [[viral]] origin. Although quite specific, these criteria are not very [[sensitive]], and therefore the possibility of a viral [[etiology]] should not be discarded if the criteria are not met. Kaplan's criteria for this purpose are as follows:
*A [[mean]] (or [[median]]) illness duration of 12 to 60 hours
*A mean (or median) [[incubation period]] of 24 to 48 hours
*More than 50% of people with vomiting
*No bacterial agent previously found
 
===Developing Countries===
Epidemiological data from developing countries about the importance of norovirus in pediatric diarrhea are limited. Recently, in Nicaragua, it has been observed that norovirus is responsible for 11% of the diarrhea cases occurring in children less than five years of age at community level and 15% of the moderate to severe cases requiring intravenous rehydration.<ref>Bucardo F, Nordgren J, Carlsson B, Paniagua M, Lindgren PE, Espinoza F, Svensson L., "Pediatric norovirus diarrhea in Nicaragua", ''J. Clin. Microbiology'', '''46''': 8 (August 2008), pp. 2573–80.</ref>
 
In the Guangdong province of the People's Republic of China, the Provincial Health Department said on December 17, 2010, that it had confirmed 429 cases of norovirus infection in the November 2010 outbreak in Conghua, Guangzhou, but no one died from it.<ref>[http://english.cntv.cn/20101217/106924.shtml Norovirus infects 429 people in Guangzhou (CNTV reports)]</ref>
 
== References ==
{{Reflist|2}}
{{Reflist|2}}


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[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
 
[[Category:Needs overview]]
[[Category:Needs overview]]
[[Category:Viral diseases]]
[[Category:Viral diseases]]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Norovirus is the leading cause of acute gastroenteritis and foodborne illness in all age groups in the United States. It causes approximately 21 million cases of gastroenteritis yearly. The genogroup II, genotype 4 strain is most commonly involved in large outbreaks of norovirus.

Epidemiology and Demographics

Incidence

Noroviruses causes about 900 deaths, mostly among adults aged 65 and older; 109,000 hospitalizations; 465,000 emergency department visits, mostly in young children; 2,270,000 outpatient clinic visits annually, mostly in young children and 19 to 21 million cases of vomiting and diarrhea illnesses norovirus causes about 21 million cases of acute gastroenteritis yearly. Norovirus accounts for 58% of foodborne illnesses in the United States. Norovirus outbreaks may be observed any time during the year, but it is most common in the winter months. The cost of norovirus illnesses is approximately $60 billion worldwide considering the lost productivity and healthcare costs.[1][2]

Age

  • Norovirus is the leading cause of acute gastroenteritis and foodborne illness in all age groups in the United States.

Gender

  • Norovirus shows no gender predilection.

Race

  • Norovirus is common across all races.

Outbreaks

  • Most noroviruses that infect humans belong to genogroups GI and GII.[3]
  • Noroviruses from Genogroup II, genotype 4 (abbreviated as GII.4) account for the majority of adult outbreaks of gastroenteritis and often sweep across the globe.[4]
  • Recent examples include US95/96-US strain, associated with global outbreaks in the mid- to late-1990s, Farmington Hills virus associated with outbreaks in Europe and the United States in 2002 and in 2004, and Hunter virus was associated with outbreaks in Europe, Japan and Australasia. In 2006, there was another large increase in NoV infection around the globe.[5]
  • Nearly two-thirds of all norovirus outbreaks reported in the United States occur in long-term care facilities. Outbreaks of norovirus illness have also occurred in restaurants, cruise ships, schools, banquet halls, summer camps, and even at family dinners. These are all places where people often eat food handled or prepared by others. In fact, norovirus is the leading cause of illness from contaminated food in the United States. About 50% of all outbreaks of food-related illness are caused by norovirus. Foods that are commonly involved in outbreaks of norovirus illness are:
  • Leafy greens (such as lettuce)
  • Fresh fruits
  • Shellfish (such as oysters)
This graph illustrates outbreaks of acute gastroenteritis in 30 states from January 2007 through April 2010. On average, there were nearly 3 times as many norovirus outbreaks (143 per month) as non-norovirus outbreaks (50 per month) and the number of norovirus outbreaks increased dramatically during the winter months. A new virus strain (GII.4 New Orleans) that first appeared in October 2009 did not lead to more outbreaks.
This graph illustrates the setting of 1,518 confirmed norovirus outbreaks in the U.S. from 2010 to 2011: Long-term Care Facility 59% (889 Outbreaks); Restaurants 8% (123 Outbreaks); Party & Event 7% (99 Outbreaks); Hospital 4% (65 Outbreaks); School 4% (64 Outbreaks); Cruise Ship 4% (55 Outbreaks); Other & Unknown 14% (223 Outbreaks).




Developing Countries

  • Epidemiological data from developing countries about the importance of norovirus in pediatric diarrhea are limited. Recently, in Nicaragua, it has been observed that norovirus is responsible for 11% of the diarrhea cases occurring in children less than five years of age at community level and 15% of the moderate to severe cases requiring intravenous rehydration.[6]
  • In the Guangdong province of the People's Republic of China, the Provincial Health Department said on December 17, 2010, that it had confirmed 429 cases of norovirus infection in the November 2010 outbreak in Conghua, Guangzhou, but no one died from it.[7]

References

  1. ↑ Centers for Disease Control and Prevention (2021). Norovirus: Diagnostic Methods. Accessed on January 28, 2021 http://www.cdc.gov/norovirus/php/illness-outbreaks.html
  2. ↑ https://www.cdc.gov/norovirus/trends-outbreaks/worldwide.html
  3. ↑ Vinjé J, Green J, Lewis DC, Gallimore CI, Brown DW, Koopmans MP (2000). "Genetic polymorphism across regions of the three open reading frames of "Norwalk-like viruses"". Arch. Virol. 145 (2): 223–41. doi:10.1007/s007050050020. PMID 10752550.
  4. ↑ Noel J, Fankhauser RL, Ando T, Monroe SS, Glass RI (2000). "Identification of a distinct common strain of "Norwalk-like viruses" having a global distribution". J. Infect. Dis. 179 (6): 1334–44. doi:10.1086/314783. PMID 10228052.
  5. ↑ Tu ET, Bull RA, Greening GE, Hewitt J, Lyon MJ, Marshall JA, McIver CJ, Rawlinson WD, White PA (2008). "Epidemics of gastroenteritis during 2006 were associated with the spread of norovirus GII.4 variants 2006a and 2006b". Clin. Infect. Dis. 46 (3): 413–20. doi:10.1086/525259. PMID 18177226.
  6. ↑ Bucardo F, Nordgren J, Carlsson B, Paniagua M, Lindgren PE, Espinoza F, Svensson L., "Pediatric norovirus diarrhea in Nicaragua", J. Clin. Microbiology, 46: 8 (August 2008), pp. 2573–80.
  7. ↑ Norovirus infects 429 people in Guangzhou (CNTV reports)


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