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Fua’di MT, Er B, Lee S, Chan PP, Khoo J, Tan D, Li H, Muhammad IR, Raj P, Kurupatham L, Lee V, Tan LK, Chan JSH, Li A, Aung KT. Characteristics of Gastroenteritis Outbreaks Investigated in Singapore: 2018-2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:64. [PMID: 38248529 PMCID: PMC10815581 DOI: 10.3390/ijerph21010064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024]
Abstract
There is a need to study the characteristics of outbreaks via Singapore's outbreak surveillance system to understand and identify the gaps in food safety for targeted policy interventions due to the increasing trend in gastroenteritis outbreaks and consequential increase in foodborne-related deaths and economic burden on public health systems worldwide. A total of 171 gastroenteritis outbreaks were investigated in Singapore from January 2018 to December 2021. This study analyzed the annual trend of investigated gastroenteritis outbreaks, the proportion of outbreaks by implicated sources of food, and the proportion of the type of pathogens identified from human cases, food samples, and environmental swabs collected from outbreak investigations. Among the foodborne gastroenteritis outbreaks (n = 121) investigated in Singapore, approximately 42.1% of the outbreaks had food prepared by caterers, 14.9% by restaurants, and 12.4% had food prepared by in-house kitchens. Clostridium perfringens and Salmonella were the most common causative pathogens in foodborne outbreaks throughout the analysis period. The food samples and environmental swabs collected were mostly detected for Bacillus cereus. Norovirus was the most common causative pathogen in non-foodborne outbreaks and was mainly attributable to preschools. This highlights the importance of monitoring and educating the catering industry and preschools to prevent future outbreaks.
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Affiliation(s)
- Muhd Tarmidzi Fua’di
- National Centre for Food Science, Singapore Food Agency, 7 International Business Park, Techquest, Singapore 609919, Singapore; (M.T.F.); (B.E.); (J.K.); (D.T.); (H.L.); (L.K.T.); (J.S.H.C.); (A.L.)
| | - Benjamin Er
- National Centre for Food Science, Singapore Food Agency, 7 International Business Park, Techquest, Singapore 609919, Singapore; (M.T.F.); (B.E.); (J.K.); (D.T.); (H.L.); (L.K.T.); (J.S.H.C.); (A.L.)
| | - Sylvester Lee
- Communicable Disease Division, Ministry of Health, Singapore 169854, Singapore; (S.L.); (P.P.C.); (I.R.M.); (P.R.); (V.L.)
| | - Pei Pei Chan
- Communicable Disease Division, Ministry of Health, Singapore 169854, Singapore; (S.L.); (P.P.C.); (I.R.M.); (P.R.); (V.L.)
| | - Joanna Khoo
- National Centre for Food Science, Singapore Food Agency, 7 International Business Park, Techquest, Singapore 609919, Singapore; (M.T.F.); (B.E.); (J.K.); (D.T.); (H.L.); (L.K.T.); (J.S.H.C.); (A.L.)
| | - Desmond Tan
- National Centre for Food Science, Singapore Food Agency, 7 International Business Park, Techquest, Singapore 609919, Singapore; (M.T.F.); (B.E.); (J.K.); (D.T.); (H.L.); (L.K.T.); (J.S.H.C.); (A.L.)
| | - Huilin Li
- National Centre for Food Science, Singapore Food Agency, 7 International Business Park, Techquest, Singapore 609919, Singapore; (M.T.F.); (B.E.); (J.K.); (D.T.); (H.L.); (L.K.T.); (J.S.H.C.); (A.L.)
| | - Imran Roshan Muhammad
- Communicable Disease Division, Ministry of Health, Singapore 169854, Singapore; (S.L.); (P.P.C.); (I.R.M.); (P.R.); (V.L.)
| | - Pream Raj
- Communicable Disease Division, Ministry of Health, Singapore 169854, Singapore; (S.L.); (P.P.C.); (I.R.M.); (P.R.); (V.L.)
| | - Lalitha Kurupatham
- Communicable Disease Division, Ministry of Health, Singapore 169854, Singapore; (S.L.); (P.P.C.); (I.R.M.); (P.R.); (V.L.)
| | - Vernon Lee
- Communicable Disease Division, Ministry of Health, Singapore 169854, Singapore; (S.L.); (P.P.C.); (I.R.M.); (P.R.); (V.L.)
| | - Li Kiang Tan
- National Centre for Food Science, Singapore Food Agency, 7 International Business Park, Techquest, Singapore 609919, Singapore; (M.T.F.); (B.E.); (J.K.); (D.T.); (H.L.); (L.K.T.); (J.S.H.C.); (A.L.)
| | - Joanne Sheot Harn Chan
- National Centre for Food Science, Singapore Food Agency, 7 International Business Park, Techquest, Singapore 609919, Singapore; (M.T.F.); (B.E.); (J.K.); (D.T.); (H.L.); (L.K.T.); (J.S.H.C.); (A.L.)
- Department of Food Science and Technology, National University of Singapore, 2 Science Drive 2, Singapore 117543, Singapore
| | - Angela Li
- National Centre for Food Science, Singapore Food Agency, 7 International Business Park, Techquest, Singapore 609919, Singapore; (M.T.F.); (B.E.); (J.K.); (D.T.); (H.L.); (L.K.T.); (J.S.H.C.); (A.L.)
- Department of Food Science and Technology, National University of Singapore, 2 Science Drive 2, Singapore 117543, Singapore
| | - Kyaw Thu Aung
- National Centre for Food Science, Singapore Food Agency, 7 International Business Park, Techquest, Singapore 609919, Singapore; (M.T.F.); (B.E.); (J.K.); (D.T.); (H.L.); (L.K.T.); (J.S.H.C.); (A.L.)
- Department of Food Science and Technology, National University of Singapore, 2 Science Drive 2, Singapore 117543, Singapore
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore 637551, Singapore
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Forero EL, Knoester M, Gard L, Ott A, Brandenburg AH, McCall MBB, Niesters HGM, Van Leer-Buter C. Changes in enterovirus epidemiology after easing of lockdown measures. J Clin Virol 2023; 169:105617. [PMID: 37977075 DOI: 10.1016/j.jcv.2023.105617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/13/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Public health measures aimed at controlling transmission of SARS-CoV-2, otherwise known as "lockdown" measures, had profound effects on circulation of non-SARS viruses, many of which decreased to very low levels. The interrupted transmission of these viruses may have lasting effects. Some of the influenza clades seem to have disappeared during this period, a phenomenon which is described as a "funnel effect". It is currently unknown if the lockdown measures had any effect on the diversity of circulating viruses, other than influenza. Enteroviruses are especially interesting in this context, as the clinical presentation of an infection with a particular enterovirus-type may be clade-dependent. METHODS AND MATERIALS Enteroviruses were detected in clinical materials using a 5'UTR-based detection PCR, and partial VP-1 sequences were obtained, using methods described before. All samples with EV detections from a large part of the Netherlands were included in the study. The samples originated from general practitioners, general hospitals, university hospitals and public health offices. RESULTS Five EV-genotypes circulated in significant numbers before and after the lockdown, EV-D68, E-11, CV-A6, CV-B5 and CV-A2. All five genotypes showed decreased genetic diversity after the lockdown, and four indicate a significant number of sequences clustering together with a very high sequence homology. Moreover, children with E-11 and CV-B5 detections were significantly older after the lockdown than before. CONCLUSIONS The reduced enterovirus transmission in the Netherlands during the pandemic, seems to have led to a decrease in genetic diversity in the five most commonly detected enterovirus serotypes.
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Affiliation(s)
- Erley Lizarazo Forero
- Department of medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Marjolein Knoester
- Department of medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Lilli Gard
- Department of medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Alewijn Ott
- Certe, department of Medical Microbiology Groningen, The Netherlands
| | - Afke H Brandenburg
- Certe, department of Medical Microbiology Friesland|NOP, The Netherlands
| | - Matthew B B McCall
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hubert G M Niesters
- Department of medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Coretta Van Leer-Buter
- Department of medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, The Netherlands.
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van de Berg S, Charles T, Dörre A, Katz K, Böhm S. Epidemiology of common infectious diseases before and during the COVID-19 pandemic in Bavaria, Germany, 2016 to 2021: an analysis of routine surveillance data. Euro Surveill 2023; 28:2300030. [PMID: 37824248 PMCID: PMC10571495 DOI: 10.2807/1560-7917.es.2023.28.41.2300030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/11/2023] [Indexed: 10/14/2023] Open
Abstract
BackgroundUnprecedented non-pharmaceutical interventions to control the COVID-19 pandemic also had an effect on other infectious diseases.AimWe aimed to determine their impact on transmission and diagnosis of notifiable diseases other than COVID-19 in Bavaria, Germany, in 2020 and 2021.MethodsWe compared weekly cases of 15 notifiable infectious diseases recorded in Bavaria between 1 January 2016 and 31 December 2021 in time series analyses, median age and time-to-diagnosis using Wilcoxon rank sum test and hospitalisation rates using univariable logistic regression during three time periods: pre-pandemic (weeks 1 2016-9 2020), pandemic years 1 (weeks 10-52 2020) and 2 (2021).ResultsWeekly case numbers decreased in pandemic year 1 for all diseases assessed except influenza, Lyme disease and tick-borne encephalitis; markedly for norovirus gastroenteritis (IRR = 0.15; 95% CI: 0.12-0.20) and pertussis (IRR = 0.22; 95% CI: 0.18-0.26). In pandemic year 2, influenza (IRR = 0.04; 95% CI: 0.02-0.09) and pertussis (IRR = 0.11; 95% CI: 0.09-0.14) decreased markedly, but also chickenpox, dengue fever, Haemophilus influenzae invasive infection, hepatitis C, legionellosis, noro- and rotavirus gastroenteritis and salmonellosis. For enterohaemorrhagic Escherichia coli infections, median age decreased in pandemic years 1 and 2 (4 years, interquartile range (IQR): 1-32 and 3 years, IQR: 1-18 vs 11 years, IQR: 2-42); hospitalisation proportions increased in pandemic year 1 (OR = 1.60; 95% CI: 1.08-2.34).ConclusionReductions for various infectious diseases and changes in case characteristics in 2020 and 2021 indicate reduced transmission of notifiable diseases other than COVID-19 due to interventions and under-detection.
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Affiliation(s)
- Sarah van de Berg
- Department of Infectious Disease Epidemiology, Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Bavarian Health and Food Safety Authority, Munich, Germany
| | - Tanja Charles
- Department of Infectious Disease Epidemiology, Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Achim Dörre
- Department of Infectious Disease Epidemiology, Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
| | - Katharina Katz
- Bavarian Health and Food Safety Authority, Munich, Germany
| | - Stefanie Böhm
- Bavarian Health and Food Safety Authority, Munich, Germany
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Winder N, Gohar S, Muthana M. Norovirus: An Overview of Virology and Preventative Measures. Viruses 2022; 14:v14122811. [PMID: 36560815 PMCID: PMC9781483 DOI: 10.3390/v14122811] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Norovirus (NoV) is an enteric non-enveloped virus which is the leading cause of gastroenteritis across all age groups. It is responsible for around 200,000 deaths annually and outbreaks are common in small communities such as educational and care facilities. 40% of all NoV outbreaks occur in long-term and acute-care facilities, forming the majority of outbreaks. Nosocomial settings set ideal environments for ease of transmission, especially due to the presence of immunocompromised groups. It is estimated to cost global economies around £48 billion a year, making it a global issue. NoV is transmitted via the faecal-oral route and infection with it results in asymptomatic cases or gastrointestinal disease. It has high mutational rates and this allows for new variants to emerge and be more resistant. The classification system available divides NoV into 10 genogroups and 49 genotypes based on whole amino acid sequencing of VP1 capsid protein and partial sequencing of RdRp, respectively. The most predominant genotypes which cause gastroenteritis in humans include GI.1 and GII.4, where GII.4 is responsible for more extreme clinical implications such as hospitalisation. In addition, GII.4 has been responsible for 6 pandemic strains, the last of which is the GII.4 Sydney (2012) variant. In recent years, the successful cultivation of HuNoV was reported in stem cell-derived human intestinal enteroids (HIEs), which promises to assist in giving a deeper understanding of its underlying mechanisms of infection and the development of more personalized control measures. There are no specific control measures against NoV, therefore common practices are used against it such as hand washing. No vaccine is available, but the HIL-214 candidate passed clinical phase 2b and shows promise.
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Oh KB, Doherty TM, Vetter V, Bonanni P. Lifting non-pharmaceutical interventions following the COVID-19 pandemic - the quiet before the storm? Expert Rev Vaccines 2022; 21:1541-1553. [PMID: 36039786 DOI: 10.1080/14760584.2022.2117693] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In the first months of the novel coronavirus (COVID-19) pandemic that begun in 2020, non-pharmaceutical interventions (NPIs) have been adopted worldwide. However, the effects of NPI implementation go beyond slowing the spread of COVID-19. Here, we review the non-intended effects that may have arisen from prolonged application of NPIs. AREAS COVERED NPIs also affected the epidemiology of other infectious diseases, with unprecedentedly low circulation of several respiratory and gastrointestinal viruses being observed worldwide in 2020. While this was a welcome effect for already strained healthcare systems, prolonged low exposure to pathogens may result in an increased pool of individuals susceptible to certain diseases. Out-of-season or unusually intense outbreaks of non-vaccine preventable diseases have already been documented as NPIs were gradually eased. In the context of widespread and important disruptions in national vaccination programs during the early phase of the pandemic, the risk of vaccine-preventable disease resurgence after NPIs are lifted cannot be excluded either. EXPERT OPINION Awareness must be raised of the risk of vaccine-preventable disease resurgence, and efforts need to be made to mitigate this risk, where possible, by increasing vaccination coverage. Research and regulatory opportunities brought on by the COVID-19 pandemic should be seized.
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Affiliation(s)
| | | | | | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Italy
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Dong L, Jia T, Yu Y, Wang Y. Updating a New Semi-nested PCR Primer Pair for the Specific Detection of GII Norovirus in Oysters. FOOD AND ENVIRONMENTAL VIROLOGY 2022; 14:149-156. [PMID: 35099705 PMCID: PMC8802746 DOI: 10.1007/s12560-022-09511-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
Oysters are major transmission vectors of noroviruses (NoVs) in the environment. Outbreaks of NoVs are often associated with the consumption of NoV-contaminated oysters. Laboratory confirmation of suspected oyster samples is a critical step in the surveillance and control of NoVs. Because of non-specific amplification, false-positive results are frequently obtained by semi-nested RT-PCR with the presently widely used primer set (G2SKF/G2SKR). Here, a novel universal PCR primer set N (NG2OF/NG2OR) specific for genogroup II (GII) NoVs was designed based on all GII NoV sequences available in public databases. Specific products were obtained with the primer set N when the NoV-positive oysters, spiked with each of five representative genotypes of GII NoVs (GII.17, GII.13, GII.4, GII.3, and GII.12), were subjected to analyzing. No products were detected with the primer set N for the NoV-negative oysters, while the primer set C gave various non-specific bands. Twenty-three out of 156 fresh oyster samples were NoV-positive with both the primer set N and the classic primer set, while eight were NoV-positive solely with the primer set N. Compared with the classic primer set, the newly designed primer set N had a higher detection rate and improved specificity for GII NoVs in oyster samples. These results show that the novel PCR primer pair is specific and applicable for the detection of GII NoVs in oysters.
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Affiliation(s)
- Lei Dong
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China
| | - Tianhui Jia
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China
| | - Yongxin Yu
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China.
- Laboratory of Quality and Safety Risk Assessment for Aquatic Products on Storage and Preservation (Shanghai), Ministry of Agriculture and Rural Affairs, Shanghai, China.
| | - Yongjie Wang
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China.
- Laboratory for Marine Biology and Biotechnology, Qingdao National Laboratory for Marine Science and Technology, Qingdao, China.
- Laboratory of Quality and Safety Risk Assessment for Aquatic Products on Storage and Preservation (Shanghai), Ministry of Agriculture and Rural Affairs, Shanghai, China.
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Lu MC, Lin SC, Hsu YH, Chen SY. Epidemiology, Clinical Features, and Unusual Complications of Norovirus Infection in Taiwan: What We Know after Rotavirus Vaccines. Pathogens 2022; 11:pathogens11040451. [PMID: 35456126 PMCID: PMC9026459 DOI: 10.3390/pathogens11040451] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 02/01/2023] Open
Abstract
Noroviruses (NoVs) are one of the emerging and rapidly spreading groups of pathogens threatening human health. A reduction in sporadic NoV infections was noted following the start of the COVID-19 pandemic, but the return of NoV gastroenteritis during the COVID-19 pandemic has been noted recently. Research in recent years has shown that different virus strains are associated with different clinical characteristics; moreover, there is a paucity of research into extraintestinal or unusual complications that may be associated with NoV. The genomic diversity of circulating NoVs is also complex and may vary significantly. Therefore, this short narrative review focuses on sharing the Taiwan experience of NoV infection including epidemiology, clinical features, and complications following suboptimal rotavirus immunization in Taiwan (after October 2006). We also highlight the unusual complications associated with NoV infections and the impacts of NoV infection during the COVID-19 pandemic in the literature for possible future research directions. To conclude, further research is needed to quantify the burden of NoV across the spectrum of disease severity in Taiwan. The evidence of the connection between NoV and the unusual complications is still lacking.
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Affiliation(s)
- Meng-Che Lu
- Division of Allergy, Asthma and Immunology, Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (M.-C.L.); (S.-C.L.)
| | - Sheng-Chieh Lin
- Division of Allergy, Asthma and Immunology, Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (M.-C.L.); (S.-C.L.)
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei city 11031, Taiwan
| | - Yi-Hsiang Hsu
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA;
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Shih-Yen Chen
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei city 11031, Taiwan
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Correspondence:
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Yasmin F, Ali SH, Ullah I. Norovirus outbreak amid COVID-19 in the United Kingdom; priorities for achieving control. J Med Virol 2021; 94:1232-1235. [PMID: 34713915 PMCID: PMC8662166 DOI: 10.1002/jmv.27426] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/23/2021] [Accepted: 10/27/2021] [Indexed: 12/20/2022]
Abstract
Norovirus, an enteric virus primarily responsible for gastroenteritis outbreaks worldwide, is currently causing outbreaks around the United Kingdom during the COVID-19 pandemic. With an already exhausted health care system, the significant burden norovirus can have on the National Health Service, including economic and social burdens, is immense and cannot be tolerated. Primary challenges and priorities to be focused on due to the increase in norovirus outbreaks include a further depletion of health care services, increase cases in schools, nurseries, and care facilities, underreporting of the cases, and no effective vaccine being available. Therefore, it is essential to increase awareness about norovirus and its transmission in public, take necessary precautions, and increase reporting of cases. This article discusses the impact norovirus has during the COVID-19 pandemic, and the challenges, and recommendations to achieve control before it reaches epidemic levels.
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Affiliation(s)
- Farah Yasmin
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Hasan Ali
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Irfan Ullah
- Department of Community Medicine, Kabir Medical College, Gandhara University, Peshawar, Pakistan
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