1
|
Manyam M, Biesheuvel M, Haenen A, van Asten L, van Werkhoven CHH, van de Kassteele J, van Gageldonk-Lafeber R, de Greeff S. Mortality Associated with Infectious Diseases in Dutch Nursing Homes. J Am Med Dir Assoc 2024; 25:105198. [PMID: 39147369 DOI: 10.1016/j.jamda.2024.105198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Although older people in nursing homes have a larger susceptibility to infectious diseases, the extent to which infectious diseases contribute to their mortality is unknown. Therefore, we quantified the associations between seasonal infectious diseases and all-cause mortality in Dutch nursing homes. METHODS We analyzed time series (January 2009 to December 2021) of the weekly sentinel surveillance of infectious diseases in Dutch nursing homes. A generalized linear model with binomial distribution and identity link was used to associate the proportion of all-cause mortality with the incidence of infections: COVID-19 (2020-2021), gastroenteritis (GE), influenza-like illness (ILI), and lower respiratory tract infections (LRTIs) at 0- to 4-week time-lags (mortality incidence at 0 to 4 weeks after infections incidence). RESULTS Over 13 years, 81 nursing homes participated, with 20 to 35 homes each year (mean: 26). A total of 11,555 all-cause deaths occurred over 1,864,667 resident weeks, averaging a mortality incidence of 6.2 per 1000 resident weeks. All 4 tested infectious diseases exhibited a significant association with all-cause mortality in nursing homes (P ≤ .01). Collectively, these infectious diseases were associated with 18.6% (95% CI, 17.8%-19.3%) of all deaths. The association between mortality and ILI was significant in 7 of 12 ILI seasons. Yearly mortality associated with the specific infectious diseases was as follows: LRTI (10.2%; 95% CI, 9.6%-10.8%), ILI (8.2%; 95% CI, 7.5%-8.9%) (over the 7 of 12 significant seasons), COVID-19 (6.5%; 95% CI, 5.4%-7.7%) (over 2019-2021 as there was no previous SARS-CoV-2 circulation), and GE (2.3%; 95% CI, 2.0%-2.5%). CONCLUSION AND IMPLICATIONS In nursing homes, the occurrence of seasonal respiratory and gastrointestinal infections is associated with nearly one-fifth of all-cause deaths. Although infection prevention and surveillance may already be performed in some nursing homes, it is vital to implement, and enhance targeted strategies like (hand) hygiene protocols, environmental cleaning practices, reducing droplet and aerosol transmission, and vaccination to effectively address specific infections.
Collapse
Affiliation(s)
- Meghanadh Manyam
- Centre for Infectious Diseases, Epidemiology and Surveillance, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Mirthe Biesheuvel
- Centre for Infectious Diseases, Epidemiology and Surveillance, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Anja Haenen
- Centre for Infectious Diseases, Epidemiology and Surveillance, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Liselotte van Asten
- Centre for Infectious Diseases, Epidemiology and Surveillance, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - C H Henri van Werkhoven
- Centre for Infectious Diseases, Epidemiology and Surveillance, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan van de Kassteele
- Centre for Infectious Diseases, Epidemiology and Surveillance, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Rianne van Gageldonk-Lafeber
- Centre for Infectious Diseases, Epidemiology and Surveillance, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Sabine de Greeff
- Centre for Infectious Diseases, Epidemiology and Surveillance, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| |
Collapse
|
2
|
Jacobsen S, Faber M, Altmann B, Mas Marques A, Bock CT, Niendorf S. Impact of the COVID-19 pandemic on norovirus circulation in Germany. Int J Med Microbiol 2024; 314:151600. [PMID: 38246091 DOI: 10.1016/j.ijmm.2024.151600] [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: 10/31/2023] [Revised: 12/14/2023] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
Human norovirus is a major cause of viral gastroenteritis in all age groups. The virus is constantly and rapidly changing, allowing mutations and recombination events to create great diversity of circulating viruses. With the start of the COVID-19 pandemic in 2020, a wide range of public health measures were introduced worldwide to control human-to-human transmission of SARS-CoV-2. In Germany, control measures such as distance rules, contact restrictions, personal protection equipment as well as intensive hand hygiene were introduced. To better understand the effect of the measures to control the COVID-19 pandemic on incidence and the molecular epidemiological dynamics of norovirus outbreaks in Germany, we analyzed national notification data between July 2017 and December 2022 and characterized norovirus sequences circulating between January 2018 and December 2022. Compared to a reference period before the pandemic, the incidence of notified norovirus gastroenteritis decreased by 89.7% to 9.6 per 100,000 during the 2020/2021 norovirus season, corresponding to an incidence rate ratio (IRR) of 0.10. Samples from 539 outbreaks were genotyped in two regions of the viral genome from pre-pandemic (January 2018 to February 2020) and samples from 208 outbreaks during pandemic time period (March 2020 to December 2022). As expected, norovirus outbreaks were mainly found in child care facilities and nursing homes. In total, 36 genotypes were detected in the study period. A high proportion of recombinant strains (86%) was found in patients, the proportion of detected recombinant viruses did not vary between the pre-pandemic and pandemic phase. The proportion of the predominant recombinant strain GII.4 Sydney[P16] was unchanged before pandemic and during pandemic at 37.5%. The diversity of most common genotypes in nursing homes and child care facilities showed a different proportion of genotypes causing outbreaks. In nursing homes as well as in child care facilities GII.4 Sydney[P16] was predominant during the whole study period. Compared to the nursing homes, a greater variety of genotypes at the expense of GII.4 Sydney[P16] was detected in child care facilities. Furthermore, the overall proportion of recombinant strain GII.3[P12] increased during the pandemic, due to outbreaks in child care facilities. The COVID-19 pandemic had a high impact on the occurrence of sporadic cases and norovirus outbreaks in Germany, leading to a near suppression of the typical norovirus winter season following the start of the pandemic. The number of norovirus-associated outbreak samples sent to the Consultant Laboratory dropped by 63% during the pandemic. We could not identify a clear influence on circulating norovirus genotypes. The dominance of GII.4 Sydney recombinant strains was independent from the pandemic. Further studies are needed to follow up on the diversity of less predominant genotypes to see if the pandemic could have acted as a bottleneck to the spread of previously minoritized genotypes like GII.3[P12].
Collapse
Affiliation(s)
- Sonja Jacobsen
- Consultant Laboratory for Norovirus, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany
| | - Mirko Faber
- Department of Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany
| | - Britta Altmann
- Department of Infectious Disease, Robert Koch Institute, 13353 Berlin, Germany
| | - Andreas Mas Marques
- Consultant Laboratory for Norovirus, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany
| | - C-Thomas Bock
- Department of Infectious Disease, Robert Koch Institute, 13353 Berlin, Germany
| | - Sandra Niendorf
- Consultant Laboratory for Norovirus, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany.
| |
Collapse
|
3
|
Parrón I, Carol M, Bes N, Izquierdo C, Godoy P, Barrabeig I, Sala MR, Minguell S, Ferras J, Rius C, Martínez AI, Domínguez À. The impact of COVID-19 pandemic on the incidence of acute gastroenteritis outbreaks in Catalonia (Spain). Epidemiol Infect 2023; 152:e10. [PMID: 38073577 PMCID: PMC10804134 DOI: 10.1017/s0950268823001851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/29/2023] [Accepted: 11/16/2023] [Indexed: 01/19/2024] Open
Abstract
We carried out a retrospective study of acute gastroenteritis (AGE) outbreaks reported between 1 January 2015 and 31 December 2021 in Catalonia (Spain) to compare the incidence from 2015 to 2019 with that observed from 2020 to 2021. We observed a higher incidence rate of outbreaks during the prepandemic period (16.89 outbreaks/1,000,000 person-years) than during the pandemic period (6.96 outbreaks/1,000,000 person-years) (rate ratio (RR) 0.41; 95% confidence interval (CI) 0.34 to 0.51). According to the aetiology of the outbreak, those of viral aetiology decreased from 7.82 to 3.38 outbreaks/1,000,000 person-years (RR 2.31; 95% CI 1.72 to 3.12), and those of bacterial aetiology decreased from 5.01 to 2.78 outbreaks/1,000,000 person-years (RR 1.80; 95% CI 1.29 to 2.52). There was a great reduction in AGE outbreaks in Catalonia. This reduction may have been due to the effect of the nonpharmaceutical measures applied to reduce the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the collapse of the healthcare system and epidemiological surveillance services may also have had a strong influence.
Collapse
Affiliation(s)
- Ignasi Parrón
- Agència de Salut Pública de Catalunya, Barcelona, Spain
- Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Mònica Carol
- Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Núria Bes
- Agència de Salut Pública de Catalunya, Barcelona, Spain
| | | | - Pere Godoy
- Facultat de Medicina, Universitat de Lleida, Spain
- Grup d’Epidemiologia Aplicada, Institut de Recerca Biomédica (IRBLleida), Lleida, Spain
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Irene Barrabeig
- Agència de Salut Pública de Catalunya, Barcelona, Spain
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - M. Rosa Sala
- Agència de Salut Pública de Catalunya, Barcelona, Spain
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | | | | | - Cristina Rius
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - Àngela Domínguez
- Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | | |
Collapse
|
4
|
Chen Y, Lopman BA, Hall AJ, Kambhampati AK, Roberts L, Mason J, Vilen K, Salehi E, Fraser A, Adams C. Factors driving norovirus transmission in long-term care facilities: A case-level analysis of 107 outbreaks. Epidemics 2023; 42:100671. [PMID: 36682288 PMCID: PMC11389824 DOI: 10.1016/j.epidem.2023.100671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 11/12/2022] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Norovirus is the most common cause of gastroenteritis outbreaks in long-term care facilities (LTCFs) in the United States, causing a high burden of disease in both residents and staff. Understanding how case symptoms and characteristics contribute to norovirus transmission can lead to more informed outbreak control measures in LTCFs. We examined line lists for 107 norovirus outbreaks that took place in LTCFs in five U.S. states from 2015 to 2019. We estimated the individual effective reproduction number, Ri, to quantify individual case infectiousness and examined the contribution of vomiting, diarrhea, and being a resident (vs. staff) to case infectiousness. The associations between case characteristics and Ri were estimated using a multivariable, log-linear mixed model with inverse variance weighting. We found that cases with vomiting infected 1.28 (95 % CI: 1.11, 1.48) times the number of secondary cases compared to cases without vomiting, and LTCF residents infected 1.31 (95 % CI: 1.15, 1.50) times the number of secondary cases compared to staff. There was no difference in infectiousness between cases with and without diarrhea (1.07; 95 % CI: 0.90, 1.29). This suggests that vomiting, particularly by LTCF residents, was a primary driver of norovirus transmission. These results support control measures that limit exposure to vomitus during norovirus outbreaks in LTCFs.
Collapse
Affiliation(s)
- Yangping Chen
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA.
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
| | - Aron J Hall
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - Anita K Kambhampati
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - Lynn Roberts
- Division of Public Health, Wisconsin Department of Health Services, 1 W Wilson St, Madison, WI 53703, USA
| | - Jordan Mason
- Division of Public Health, Wisconsin Department of Health Services, 1 W Wilson St, Madison, WI 53703, USA
| | - Kelley Vilen
- Foodborne Disease Unit, Minnesota Department of Health, 625 Robert St N, St Paul, MN 55164, USA
| | - Ellen Salehi
- Bureau of Infectious Diseases, Ohio Department of Health, 246 N High St, Columbus, OH 43215, USA
| | - Angela Fraser
- Department of Food, Nutrition and Packaging Science, Clemson University, 105 Sikes Hall, Clemson, SC 29634, USA
| | - Carly Adams
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
| |
Collapse
|
5
|
Hammerschmidt J, Heier L, Ernstmann N. Enablement of nursing home residents in infection prevention during general practitioner visits: A qualitative study. PLoS One 2022; 17:e0266502. [PMID: 35390089 PMCID: PMC8989284 DOI: 10.1371/journal.pone.0266502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/22/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Hand hygiene measures are essential to protect nursing home residents against nosocomial infections. Evidence on the prevention of nosocomial infections for nursing home residents by general practitioners during their medical visits in nursing homes or how they enable nursing home residents to perform hand hygiene measures is lacking. This study aimed to explore hand hygiene behaviors of general practitioners in nursing homes, their attitudes toward infection prevention measures, and the enablement of nursing home residents in performing hand hygiene measures. MATERIALS AND METHODS Semi-structured interviews were conducted with general practitioners and nursing home residents in Germany. Interviews were audio-recorded and transcribed. Data were analyzed using thematic content analysis. RESULTS Overall, 12 general practitioners and 12 nursing home residents participated in the study. The general practitioners expressed the fact that the possibilities for practicing hand hygiene differ in individual nursing homes. For nursing home residents, the availability of hand rub solutions was limited. Instructions for residents on hand disinfection from general practitioners was not described. Due to the lack of enablement, the residents' knowledge on how to correctly perform hand hygiene was low, although some of the nursing home residents have experience with multidrug-resistant organisms. The nursing home residents varied in their needs for active participation and enablement during the general practitioners visit. CONCLUSION Nursing home residents require continuous enablement by their general practitioners to maintain adequate hand hygiene. Therefore, general practitioners should consider the different needs of nursing home residents to ensure adequate individual hand hygiene and safety for the residents. Existing guidelines for infection prevention and control do not adequately cover the nursing home care setting for the enablement of residents to enquire about hand hygiene.
Collapse
Affiliation(s)
| | - Lina Heier
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, Germany
| | - Nicole Ernstmann
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
6
|
Ai J, Zhu Y, Fu J, Cheng X, Zhang X, Ji H, Liu W, Rui J, Xu J, Yang T, Wang Y, Liu X, Yang M, Lin S, Guo X, Bao C, Li Q, Chen T. Study of Risk Factors for Total Attack Rate and Transmission Dynamics of Norovirus Outbreaks, Jiangsu Province, China, From 2012 to 2018. Front Med (Lausanne) 2022; 8:786096. [PMID: 35071268 PMCID: PMC8777030 DOI: 10.3389/fmed.2021.786096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: To describe the epidemiological characteristics of norovirus outbreaks in Jiangsu Province, utilize the total attack rate (TAR) and transmissibility (Runc) as the measurement indicators of the outbreak, and a statistical difference in risk factors associated with TAR and transmissibility was compared. Ultimately, this study aimed to provide scientific suggestions to develop the most appropriate prevention and control measures. Method: We collected epidemiological data from investigation reports of all norovirus outbreaks in Jiangsu Province from 2012 to 2018 and performed epidemiological descriptions, sequenced the genes of the positive specimens collected that were eligible for sequencing, created a database and calculated the TAR, constructed SEIAR and SEIARW transmission dynamic models to calculate Runc, and performed statistical analyses of risk factors associated with the TAR and Runc. Results: We collected a total of 206 reported outbreaks, of which 145 could be used to calculate transmissibility. The mean TAR in was 2.6% and the mean Runc was 12.2. The epidemiological characteristics of norovirus outbreaks showed an overall increasing trend in the number of norovirus outbreaks from 2012 to 2018; more outbreaks in southern Jiangsu than northern Jiangsu; more outbreaks in urban areas than in rural areas; outbreaks occurred mostly in autumn and winter. Most of the sites where outbreaks occurred were schools, especially primary schools. Interpersonal transmission accounted for the majority. Analysis of the genotypes of noroviruses revealed that the major genotypes of the viruses changed every 3 years, with the GII.2 [P16] type of norovirus dominating from 2016 to 2018. Statistical analysis of TAR associated with risk factors found statistical differences in all risk factors, including time (year, month, season), location (geographic location, type of settlement, type of premises), population (total number of susceptible people at the outbreak site), transmission route, and genotype (P < 0.05). Statistical analysis of transmissibility associated with risk factors revealed that only transmissibility was statistically different between sites. Conclusions: The number of norovirus outbreaks in Jiangsu Province continues to increase during the follow-up period. Our findings highlight the impact of different factors on norovirus outbreaks and identify the key points of prevention and control in Jiangsu Province.
Collapse
Affiliation(s)
- Jing Ai
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.,Key Laboratory of Enteric Pathogenic Microbiology, Ministry of Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yuanzhao Zhu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Jianguang Fu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.,Key Laboratory of Enteric Pathogenic Microbiology, Ministry of Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Xiaoqing Cheng
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.,Key Laboratory of Enteric Pathogenic Microbiology, Ministry of Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Xuefeng Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.,Key Laboratory of Enteric Pathogenic Microbiology, Ministry of Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Hong Ji
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.,Key Laboratory of Enteric Pathogenic Microbiology, Ministry of Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Wendong Liu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.,Key Laboratory of Enteric Pathogenic Microbiology, Ministry of Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jia Rui
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Jingwen Xu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Tianlong Yang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Yao Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Xingchun Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Meng Yang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Shengnan Lin
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Xiaohao Guo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Changjun Bao
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.,Key Laboratory of Enteric Pathogenic Microbiology, Ministry of Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Qun Li
- Public Health Emergency Center, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tianmu Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| |
Collapse
|
7
|
Calderwood LE, Wikswo ME, Mattison CP, Kambhampati AK, Balachandran N, Vinjé J, Barclay L, Hall AJ, Parashar U, Mirza SA. Norovirus Outbreaks in Long-term Care Facilities in the United States, 2009-2018: A Decade of Surveillance. Clin Infect Dis 2022; 74:113-119. [PMID: 34523674 PMCID: PMC8978331 DOI: 10.1093/cid/ciab808] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In the United States, norovirus is the leading cause of healthcare-associated gastroenteritis outbreaks. To inform prevention efforts, we describe the epidemiology of norovirus outbreaks in long-term care facilities (LTCFs). METHODS The Centers for Disease Control and Prevention (CDC) collect epidemiologic and laboratory data on norovirus outbreaks from US health departments through the National Outbreak Reporting System (NORS) and CaliciNet. Reports from both systems were merged, and norovirus outbreaks in nursing homes, assisted living, and other LTCFs occurring in 2009-2018 were analyzed. Data from the Centers for Medicare and Medicaid Services and the National Center for Health Statistics were used to estimate state LTCF counts. RESULTS During 2009-2018, 50 states, Washington D.C., and Puerto Rico reported 13 092 norovirus outbreaks and 416 284 outbreak-associated cases in LTCFs. Participation in NORS and CaliciNet increased from 2009 to 2014 and median reporting of LTCF norovirus outbreaks stabilized at 4.1 outbreaks per 100 LTCFs (interquartile range [IQR]: 1.0-7.1) annually since 2014. Most outbreaks were spread via person-to-person transmission (90.4%), and 75% occurred during December-March. Genogroup was reported for 7292 outbreaks with 862 (11.8%) positive for GI and 6370 (87.3%) for GII. Among 4425 GII outbreaks with typing data, 3618 (81.8%) were GII.4. LTCF residents had higher attack rates than staff (median 29.0% vs 10.9%; P < .001). For every 1000 cases, there were 21.6 hospitalizations and 2.3 deaths. CONCLUSIONS LTCFs have a high burden of norovirus outbreaks. Most LTCF norovirus outbreaks occurred during winter months and were spread person-to-person. Outbreak surveillance can inform development of interventions for this vulnerable population, such as vaccines targeting GII.4 norovirus strains.
Collapse
Affiliation(s)
- Laura E. Calderwood
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;,Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Mary E. Wikswo
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Claire P. Mattison
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;,Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Anita K. Kambhampati
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Neha Balachandran
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;,Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Jan Vinjé
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Leslie Barclay
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aron J. Hall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Umesh Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara A. Mirza
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
8
|
Shin IS, Shin JH, Jang DE, Lee J. A Methodological Quality Evaluation of Meta-Analyses on Nursing Home Research: Overview and Suggestions for Future Directions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:505. [PMID: 35010765 PMCID: PMC8744792 DOI: 10.3390/ijerph19010505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/18/2021] [Accepted: 12/23/2021] [Indexed: 02/04/2023]
Abstract
(1) Background: The nursing home (NH) research field lacks quality reporting about meta-analyses (MAs), and most gradings of MA evidence are biased on analyzing the effectiveness of independent variables in randomized control trials. (2) Objectives: This study aimed to perform a critical methodological review of MAs in the NH research field. (3) Methods: We searched the articles from four databases (PubMed, MEDLINE, CINAHL, and PsycINFO) until 15th January 2021. We reviewed a total of 41 published review articles in the NH research field. (4) Results: The studies primarily fell into the following categories: medicine (17/41), nursing (7/41), and psychiatry or psychology (6/41); 36.6% of the reviewed studies did not use any validated MA guidelines. The lowest correctly reported PRISMA 2000 guideline item was protocol and registration (14.6%), and more than 50% of articles did not report risk of bias. Moreover, 78.0% of studies did not describe missing reports of effect size formula. (5) Discussion: NH researchers must follow appropriate and updated guidelines for their MAs in order to provide validated reviews, as well as consider statistical issues such as the complexity of interventions, proper grouping, and scientific effect-size calculations to improve the quality of their study. Future quality review studies should investigate more diverse studies.
Collapse
Affiliation(s)
- In-Soo Shin
- Graduate School of Education, Dongkuk University, Seoul 04620, Korea;
| | - Juh-Hyun Shin
- College of Nursing, Ewha Womans University, Seoul 03760, Korea
| | - Dong-Eun Jang
- School of Nursing, University of Texas at Austin, Austin, TX 78712, USA;
| | - Jiyeon Lee
- College of Nursing, Catholic University of Pusan, Seoul 43241, Korea;
| |
Collapse
|
9
|
Polkowska A, Räsänen S, Nuorti P, Maunula L, Jalava K. Assessment of Food and Waterborne Viral Outbreaks by Using Field Epidemiologic, Modern Laboratory and Statistical Methods-Lessons Learnt from Seven Major Norovirus Outbreaks in Finland. Pathogens 2021; 10:pathogens10121624. [PMID: 34959579 PMCID: PMC8707936 DOI: 10.3390/pathogens10121624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/17/2022] Open
Abstract
Seven major food- and waterborne norovirus outbreaks in Western Finland during 2014–2018 were re-analysed. The aim was to assess the effectiveness of outbreak investigation tools and evaluate the Kaplan criteria. We summarised epidemiological and microbiological findings from seven outbreaks. To evaluate the Kaplan criteria, a one-stage meta-analysis of data from seven cohort studies was performed. The case was defined as a person attending an implicated function with diarrhoea, vomiting or two other symptoms. Altogether, 22% (386/1794) of persons met the case definition. Overall adjusted, 73% of norovirus patients were vomiting, the mean incubation period was 44 h (4 h to 4 days) and the median duration of illness was 46 h. As vomiting was a more common symptom in children (96%, 143/149) and diarrhoea among the elderly (92%, 24/26), symptom and age presentation should drive hypothesis formulation. The Kaplan criteria were useful in initial outbreak assessments prior to faecal results. Rapid food control inspections enabled evidence-based, public-health-driven risk assessments. This led to probability-based vehicle identification and aided in resolving the outbreak event mechanism rather than implementing potentially ineffective, large-scale public health actions such as the withdrawal of extensive food lots. Asymptomatic food handlers should be ideally withdrawn from high-risk work for five days instead of the current two days. Food and environmental samples often remain negative with norovirus, highlighting the importance of research collaborations. Electronic questionnaire and open-source novel statistical programmes provided time and resource savings. The public health approach proved useful within the environmental health area with shoe leather field epidemiology, combined with statistical analysis and mathematical reasoning.
Collapse
Affiliation(s)
- Aleksandra Polkowska
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, 33100 Tampere, Finland; (A.P.); (P.N.)
| | - Sirpa Räsänen
- Pirkanmaa Hospital District, 33520 Tampere, Finland;
| | - Pekka Nuorti
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, 33100 Tampere, Finland; (A.P.); (P.N.)
| | - Leena Maunula
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, 00100 Helsinki, Finland;
| | - Katri Jalava
- Department of Mathematics and Statistics, Faculty of Social Sciences, University of Helsinki, 00100 Helsinki, Finland
- Correspondence: ; Tel.: +44-73-4224-7186
| |
Collapse
|
10
|
Parrón I, Barrabeig I, Alseda M, Rius C, Cornejo-Sánchez T, Jané M, Pérez C, Guix S, Domínguez À. Norovirus outbreaks in long-term care facilities in Catalonia from 2017 to 2018. Sci Rep 2021; 11:23218. [PMID: 34853333 PMCID: PMC8636624 DOI: 10.1038/s41598-021-02348-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022] Open
Abstract
Norovirus is the leading cause of outbreaks of acute viral gastroenteritis. We carried out this study to investigate outbreaks in long-term care facilities reported in 2017 and 2018 in Catalonia (Spain). The characteristics of the centers, exposed persons and the genogroups responsible were analyzed. Viral loads were estimated. The attack rate (AR) of the outbreaks studied, and the rate ratio (RR) and the odds ratio (OR) and their 95% confidence intervals as measures of association were calculated. The mean cycle thresholds were compared using the t-test for independent means. We included 30 outbreaks (4631 exposed people). The global AR was 25.93%. The RR of residents vs. staff was 2.28 (95% CI 2.0–2.6). The RR between AR in residents with total or severe dependence vs. residents with moderate, low or no-dependence was 1.23 (95% CI 1.05–1.45). The AR were higher in smaller centers than in larger ones (38.47% vs. 19.25% and RR 2; 95% CI 1.82–2.2). GII was responsible for 70% of outbreaks. No association was found between the genogroup and presenting symptoms (OR 0.96; 95% CI 0.41–2.26). Viral loads were higher in symptomatic than in asymptomatic patients (p = 0.001).
Collapse
Affiliation(s)
- Ignacio Parrón
- Sub-Direcció Regional a Barcelona del Departament de Salut, Barcelona, Spain. .,Departament de Medicina, Universitat de Barcelona, Barcelona, Spain.
| | - Irene Barrabeig
- Sub-Direcció Regional a Barcelona del Departament de Salut, Barcelona, Spain.,CIBER Epidemiologia y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Miquel Alseda
- Sub-Direcció Regional a Lleida del Departament de Salut, Lleida, Spain
| | - Cristina Rius
- CIBER Epidemiologia y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.,Agència de Salut Pública de Barcelona, Barcelona, Spain
| | | | - Mireia Jané
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiologia y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.,Sub-Direcció General de Vigilància i Resposta a Emergències de Salut Pública, Barcelona, Spain
| | - Cristina Pérez
- Sub-Direcció Regional a Barcelona del Departament de Salut, Barcelona, Spain
| | - Susana Guix
- Departament de Genètica Microbiologia i Estadística, Grup de Virus Entèrics, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca en Nutrició i Seguretat Alimentària (INSA-UB), Universitat de Barcelona, Santa Coloma de Gramenet, Spain
| | - Àngela Domínguez
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiologia y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | | |
Collapse
|
11
|
Boone I, Rosner B, Lachmann R, D'Errico ML, Iannetti L, Van der Stede Y, Boelaert F, Ethelberg S, Eckmanns T, Stark K, Haller S, Wilking H. Healthcare-associated foodborne outbreaks in high-income countries: a literature review and surveillance study, 16 OECD countries, 2001 to 2019. Euro Surveill 2021; 26:2001278. [PMID: 34651575 PMCID: PMC8518306 DOI: 10.2807/1560-7917.es.2021.26.41.2001278] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 03/25/2021] [Indexed: 11/20/2022] Open
Abstract
BackgroundHealthcare-associated foodborne outbreaks (HA-FBO) may have severe consequences, especially in vulnerable groups.AimThe aim was to describe the current state of HA-FBO and propose public health recommendations for prevention.MethodsWe searched PubMed, the Outbreak Database (Charité, University Medicine Berlin), and hand-searched reference lists for HA-FBO with outbreak onset between 2001 and 2018 from Organisation for Economic Co-operation and Development (OECD) countries and HA-FBO (2012-2018) from the German surveillance system. Additionally, data from the European Food Safety Authority were analysed.ResultsThe literature search retrieved 57 HA-FBO from 16 OECD countries, primarily in the US (n = 11), Germany (n = 11) and the United Kingdom (n = 9). In addition, 28 HA-FBO were retrieved from the German surveillance system. Based on the number of outbreaks, the top three pathogens associated with the overall 85 HA-FBO were Salmonella (n = 24), norovirus (n = 22) and Listeria monocytogenes (n = 19). Based on the number of deaths, L. monocytogenes was the main pathogen causing HA-FBO. Frequently reported implicated foods were 'mixed foods' (n = 16), 'vegetables and fruits' (n = 15) and 'meat and meat products' (n = 10). Consumption of high-risk food by vulnerable patients, inadequate time-temperature control, insufficient kitchen hygiene and food hygiene and carriers of pathogens among food handlers were reported as reasons for HA-FBO.ConclusionTo prevent HA-FBO, the supply of high-risk food to vulnerable people should be avoided. Well working outbreak surveillance facilitates early detection and requires close interdisciplinary collaboration and exchange of information between hospitals, food safety and public health authorities.
Collapse
Affiliation(s)
- Idesbald Boone
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Bettina Rosner
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Raskit Lachmann
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Michele Luca D'Errico
- Istituto Superiore di Sanità, Department of Food Safety, Nutrition and Veterinary Public Health, Rome, Italy
| | - Luigi Iannetti
- Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise G. Caporale, National Reference Laboratory for Listeria monocytogenes, Teramo, Italy
| | | | | | - Steen Ethelberg
- Statens Serum Institut, Infectious Disease Epidemiology and Prevention, Copenhagen, Denmark
| | - Tim Eckmanns
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Klaus Stark
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Sebastian Haller
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Hendrik Wilking
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| |
Collapse
|
12
|
Zelner J, Adams C, Havumaki J, Lopman B. Understanding the Importance of Contact Heterogeneity and Variable Infectiousness in the Dynamics of a Large Norovirus Outbreak. Clin Infect Dis 2021; 70:493-500. [PMID: 30901030 DOI: 10.1093/cid/ciz220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/14/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Large norovirus (NoV) outbreaks are explosive in nature and vary widely in final size and duration, suggesting that superspreading combined with heterogeneous contact may explain these dynamics. Modeling tools that can capture heterogeneity in infectiousness and contact are important for NoV outbreak prevention and control, yet they remain limited. METHODS Data from a large NoV outbreak at a Dutch scout jamboree, which resulted in illness among 326 (of 4500 total) individuals from 7 separate camps, were used to examine the contributions of individual variation in infectiousness and clustered contact patterns to the transmission dynamics. A Bayesian hierarchical model of heterogeneous, clustered outbreak transmission was applied to represent (1) between-individual heterogeneity in infectiousness and (2) heterogeneous patterns of contact. RESULTS We found wide heterogeneity in infectiousness across individuals, suggestive of superspreading. Nearly 50% of individual infectiousness was concentrated in the individual's subcamp of residence, with the remainder distributed over other subcamps. This suggests a source-and-sink dynamic in which subcamps with greater average infectiousness fed cases to those with a lower transmission rate. Although the per capita transmission rate within camps was significantly greater than that between camps, the large pool of susceptible individuals across camps enabled similar numbers of secondary cases generated between versus within camps. CONCLUSIONS The consideration of clustered transmission and heterogeneous infectiousness is important for understanding NoV transmission dynamics. Models including these mechanisms may be useful for providing early warning and guiding outbreak response.
Collapse
Affiliation(s)
- Jon Zelner
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Carly Adams
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Joshua Havumaki
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Ben Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| |
Collapse
|
13
|
Jester DJ, Peterson LJ, Dosa DM, Hyer K. Infection Control Citations in Nursing Homes: Compliance and Geographic Variability. J Am Med Dir Assoc 2020; 22:1317-1321.e2. [PMID: 33309701 PMCID: PMC7834329 DOI: 10.1016/j.jamda.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/15/2020] [Accepted: 11/03/2020] [Indexed: 12/17/2022]
Abstract
Objectives To report the initial compliance with new infection control regulations and geographic disparities in nursing homes (NHs) in the United States. Design Retrospective cohort study from November 27, 2017 to November 27, 2019. Setting and Participants In total, 14,894 NHs in the continental United States comprising 26,201 inspections and 176,841 deficiencies. Methods We measured the cumulative incidence of receiving F880: Infection Prevention and Control deficiencies, geographic variability of F880 citations across the United States, and the scope and severity of the infection control deficiencies. Results A total of 6164 NHs (41%) in the continental United States received 1 deficiency for F880, and 2300 NHs (15%) were cited more than once during the 2-year period. Geographic variation was evident for F880 deficiencies, ranging from 20% of NHs in North Carolina to 79% of NHs in West Virginia. Between 0% (Vermont) and 33% (Michigan) of states’ NHs were cited multiple times over 2 years. Facilities receiving 2 or more F880 deficiencies were more reliant on Medicaid, for-profit, and served more acute residents. Infection Prevention and Control deficiencies were of similar severity but of greater scope in NHs that were cited multiple times. Conclusions and Implications As the coronavirus disease 2019 pandemic challenges hospitals with an increased surge of patients from the community, NHs will be asked to accept convalescing patients who were previously infected with the virus. NHs will need to rely on infection control practices to mitigate the effects of the virus in their facilities. Particular attention to NHs that have fared poorly with repeat infection control practices deficiencies might be a good first step to improving care overall and preventing downstream morbidity and mortality among the highest-risk patients.
Collapse
Affiliation(s)
- Dylan J Jester
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA.
| | - Lindsay J Peterson
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - David M Dosa
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA; School of Public Health, Brown University, Providence, RI, USA; Providence VAMC Center of Innovation (COIN), Providence, RI, USA
| | - Kathryn Hyer
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
| |
Collapse
|
14
|
Hooshmand E, Moa A, Trent M, Kunasekaran M, Poulos CJ, Chughtai AA, MacIntyre CR. Epidemiology of 2017 influenza outbreaks in nine Australian Aged care facilities. Influenza Other Respir Viruses 2020; 15:278-283. [PMID: 33026149 PMCID: PMC7902252 DOI: 10.1111/irv.12811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/24/2020] [Accepted: 08/30/2020] [Indexed: 01/07/2023] Open
Abstract
Background The 2017 A/H3N2 influenza season was the most severe season since the 2009 influenza pandemic. There were over 591 influenza outbreaks in institutions across the state of New South Wales (NSW) in Australia. Aim To describe the epidemiology of influenza outbreaks in nine Sydney aged care facilities in 2017. Methods Study data were collected from nine Sydney aged care facilities for 2017 influenza season. Descriptive epidemiological analysis was conducted. Results From the nine sites included, with a total of 716 residents, four sites reported laboratory‐confirmed influenza outbreaks during the study period, with an attack rate in residents ranging from 6% to 29%. The outbreaks resulted in lockdowns in two facilities and hospitalisation of seven residents. No deaths were reported as a result of influenza infection. Influenza A was the most common influenza type reported across the facilities. The duration of outbreak lasted for 1‐4 weeks varied by site. Conclusion The 2017 season was a severe influenza season recorded in Australia. About half of the facilities studied experienced outbreaks of influenza, with a high attack rate among residents. Infection prevention and control measures and outbreak management plans are crucial for aged care facilities, including vaccination of staff and visitors to prevent outbreaks among the vulnerable residents.
Collapse
Affiliation(s)
- Elmira Hooshmand
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Aye Moa
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mallory Trent
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - C Raina MacIntyre
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW The majority of norovirus outbreaks in the United States occur in healthcare facilities. With the growing population of immunocompromised hosts who are in frequent contact with healthcare facilities, norovirus is not only a threat to hospitals and nursing homes but also to these individuals. This review summarizes the impact of norovirus infection on healthcare facilities and immunocompromised hosts. RECENT FINDINGS The natural history of norovirus infection in immunocompromised individuals remains poorly understood. Although host immune responses play a critical role in reducing duration of viral shedding and viral load in norovirus-infected individuals, why some immunocompromised patients spontaneously recover while others develop a chronic and protracted course of illness remains unclear. Norovirus outbreaks occur in healthcare facilities because the virus is highly contagious, resistant to disinfection and efficiently transmitted. The use of real-time metagenomic next-generation sequencing and phylogenetic analyses has provided valuable information on transmission patterns in complex hospital-associated norovirus outbreaks. The development of human intestinal enteroid cultures enables the determination of effectiveness of disinfectants against human noroviruses, circumventing the validity questions with surrogate virus models due to differences in susceptibility to inactivation and disinfectants. SUMMARY Metagenomics next-generation sequencing can enhance our understanding of norovirus transmission and lead to more timely mitigation strategies to curb norovirus outbreaks in healthcare facilities. With new in-vitro cultivation methods for human noroviruses, candidate vaccines and effective antivirals could be available in the near future.
Collapse
|
16
|
Rushton SP, Sanderson RA, Reid WDK, Shirley MDF, Harris JP, Hunter PR, O'Brien SJ. Transmission routes of rare seasonal diseases: the case of norovirus infections. Philos Trans R Soc Lond B Biol Sci 2020; 374:20180267. [PMID: 31104607 DOI: 10.1098/rstb.2018.0267] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Norovirus (NoV) is the most commonly recognized cause of acute gastroenteritis, with over a million cases globally per year. While usually self-limiting, NoV poses a substantial economic burden because it is highly contagious and there are multiple transmission routes. Infection occurs through inhalation of vomitus; faecal-oral spread; and food, water and environmental contamination. While the incidence of the disease is predictably seasonal, much less is known about the relative contribution of the various exposure pathways in causing disease. Additionally, asymptomatic excretion and viral shedding make forecasting disease burden difficult. We develop a novel stochastic dynamic network model to investigate the contributions of different transmission pathways in multiple coupled social networks representing schools, hospitals, care-homes and family households in a community setting. We analyse how the networks impact on transmission. We used ward-level demographic data from Northumberland, UK to create a simulation cohort. We compared the results with extant data on NoV cases from the IID2 study. Connectivity across the simulated cohort was high. Cases of NoV showed marked seasonality, peaking in early winter and declining through the summer. For the first time, we show that fomites and food appear to be the most important exposure routes in determining the population burden of disease. This article is part of the theme issue 'Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control'. This theme issue is linked with the earlier issue 'Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes'.
Collapse
Affiliation(s)
- Stephen P Rushton
- 1 Modelling, Evidence and Policy Research Group, School of Natural and Environmental Science, Newcastle University , Newcastle upon Tyne NE1 7RU , UK
| | - Roy A Sanderson
- 1 Modelling, Evidence and Policy Research Group, School of Natural and Environmental Science, Newcastle University , Newcastle upon Tyne NE1 7RU , UK
| | - William D K Reid
- 2 Ecology Research Group, School of Natural and Environmental Science, Newcastle University , Newcastle upon Tyne NE1 7RU , UK
| | - Mark D F Shirley
- 1 Modelling, Evidence and Policy Research Group, School of Natural and Environmental Science, Newcastle University , Newcastle upon Tyne NE1 7RU , UK
| | - John P Harris
- 3 Public Health and Policy, University of Liverpool , Liverpool L69 3GL , UK.,4 National Institute for Health Research, Health Protection Research Unit in Gastrointestinal Infections , Liverpool L69 3GL , UK
| | - Paul R Hunter
- 4 National Institute for Health Research, Health Protection Research Unit in Gastrointestinal Infections , Liverpool L69 3GL , UK.,5 Norwich Medical School, University of East Anglia , Norwich 33 NR4 7TJ , UK
| | - Sarah J O'Brien
- 1 Modelling, Evidence and Policy Research Group, School of Natural and Environmental Science, Newcastle University , Newcastle upon Tyne NE1 7RU , UK.,2 Ecology Research Group, School of Natural and Environmental Science, Newcastle University , Newcastle upon Tyne NE1 7RU , UK.,4 National Institute for Health Research, Health Protection Research Unit in Gastrointestinal Infections , Liverpool L69 3GL , UK
| |
Collapse
|
17
|
Abstract
On 16 March 2018, a nursing home notified a possible acute gastroenteritis outbreak that affected 11 people. Descriptive and case-control studies and analysis of clinical and environmental samples were carried out to determine the characteristics of the outbreak, its aetiology, the transmission mechanism and the causal food. The extent of the outbreak in and outside the nursing home was determined and the staff factors influencing propagation were studied by multivariate analysis. A turkey dinner on March 14 was associated with the outbreak (OR 4.22, 95% CI 1.11-16.01). Norovirus genogroups I and II were identified in stool samples. The attack rates in residents, staff and household contacts of staff were 23.49%, 46.22% and 22.87%, respectively. Care assistants and cleaning staff were the staff most frequently affected. Cohabitation with an affected care assistant was the most important factor in the occurrence of cases in the home (adjusted OR 6.37, 95% CI 1.13-36.02). Our results show that staff in close contact with residents and their household contacts had a higher risk of infection during the norovirus outbreak.
Collapse
|
18
|
Quantifying the roles of vomiting, diarrhea, and residents vs. staff in norovirus transmission in U.S. nursing home outbreaks. PLoS Comput Biol 2020; 16:e1007271. [PMID: 32210423 PMCID: PMC7135310 DOI: 10.1371/journal.pcbi.1007271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 04/06/2020] [Accepted: 02/21/2020] [Indexed: 12/16/2022] Open
Abstract
The role of individual case characteristics, such as symptoms or demographics, in norovirus transmissibility is poorly understood. Six nursing home norovirus outbreaks occurring in South Carolina, U.S. from 2014 to 2016 were examined. We aimed to quantify the contribution of symptoms and other case characteristics in norovirus transmission using the reproduction number (REi) as an estimate of individual case infectivity and to examine how transmission changes over the course of an outbreak. Individual estimates of REi were calculated using a maximum likelihood procedure to infer the average number of secondary cases generated by each case. The associations between case characteristics and REi were estimated using a weighted multivariate mixed linear model. Outbreaks began with one to three index case(s) with large estimated REi’s (range: 1.48 to 8.70) relative to subsequent cases. Of the 209 cases, 155 (75%) vomited, 164 (79%) had diarrhea, and 158 (76%) were nursing home residents (vs. staff). Cases who vomited infected 2.12 (95% CI: 1.68, 2.68) times the number of individuals as non-vomiters, cases with diarrhea infected 1.39 (95% CI: 1.03, 1.87) times the number of individuals as cases without diarrhea, and resident-cases infected 1.53 (95% CI: 1.15, 2.02) times the number of individuals as staff-cases. Index cases tended to be residents (vs. staff) who vomited and infected considerably more secondary cases compared to non-index cases. Results suggest that individuals, particularly residents, who vomit are more infectious and tend to drive norovirus transmission in U.S. nursing home norovirus outbreaks. While diarrhea also plays a role in norovirus transmission, it is to a lesser degree than vomiting in these settings. Results lend support for prevention and control measures that focus on cases who vomit, particularly if those cases are residents. The majority of all norovirus outbreaks reported to the CDC occur in long-term care facilities (LTCFs), including nursing homes, where older residents are at risk for more severe or prolonged infection. Because there is currently no publicly available norovirus vaccine, sound control measures are key to controlling norovirus outbreaks, but there is little evidence that standard control measures are effective in reducing the size and/or duration of LTCF norovirus outbreaks. Hence, studies leading to a better understanding of disease spread and prevention of additional cases, and thus more effective control measures, are needed. To this end, we aimed to quantify factors associated with norovirus transmission and to examine how transmission changes over the course of an outbreak. We show that vomiting and, to a lesser extent, diarrhea are critical in initiating and sustaining norovirus transmission in U.S. nursing home norovirus outbreaks. We also show that nursing home residents, rather than staff, are the primary drivers of transmission. Results suggest that control measures focusing on cases who vomit, particularly if those cases are residents, would be most effective at curtailing norovirus transmission in these settings.
Collapse
|
19
|
Inns T, Wilson D, Manley P, Harris JP, O'Brien SJ, Vivancos R. What proportion of care home outbreaks are caused by norovirus? An analysis of viral causes of gastroenteritis outbreaks in care homes, North East England, 2016-2018. BMC Infect Dis 2019; 20:2. [PMID: 31892311 PMCID: PMC6938643 DOI: 10.1186/s12879-019-4726-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Outbreaks of infectious gastroenteritis are common in care homes for the elderly. Norovirus can cause these outbreaks, but diagnosis is frequently based solely on clinical characteristics. Our objective in this study was to describe the epidemiology of norovirus and other gastrointestinal pathogens in these settings. METHODS We analysed surveillance data from gastroenteritis outbreaks reported in North East England between 04 July 2016 to 01 July 2018. Stool samples taken during these outbreaks were tested for a range of viral and bacterial pathogens. We described the epidemiology of these outbreaks and explored the characteristics of norovirus outbreaks versus from other viral causes using multivariable logistic regression. RESULTS From the 566 care home gastroenteritis outbreaks in this study, we found that norovirus was the pathogen most frequently isolated. Norovirus was detected in 64% of outbreaks with a pathogen identified. Sapovirus was found in 13%; rotavirus in 11%. We found that norovirus outbreaks were associated with higher attack rates (aOR 1.03, 95% CI 1.01-1.05) and fewer cases sampled (aOR 0.74, 95% CI 0.60-0.91), compared to outbreaks caused by other viral pathogens. CONCLUSIONS These results are important as they quantify the contribution of norovirus to gastroenteritis outbreaks in care homes. Given this evidence, we emphasize the importance of non-specific outbreak interventions that can affect the impact of all such outbreaks. We further recommend that these findings are used to inform the implementation strategies of any norovirus-specific interventions such as a norovirus vaccine.
Collapse
Affiliation(s)
- Thomas Inns
- Field Epidemiology, Field Service, National Infection Service, Public Health England, London, UK. .,Institute of Population Health Sciences, University of Liverpool, Liverpool, UK. .,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.
| | - Deb Wilson
- North East Health Protection Team, Public Health England, Newcastle-upon-Tyne, UK
| | - Petra Manley
- Field Epidemiology, Field Service, National Infection Service, Public Health England, London, UK
| | - John P Harris
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Sarah J O'Brien
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Roberto Vivancos
- Field Epidemiology, Field Service, National Infection Service, Public Health England, London, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| |
Collapse
|
20
|
Gaspard P, Mosnier A, Simon L, Ali-Brandmeyer O, Rabaud C, Larocca S, Heck B, Aho-Glélé S, Pothier P, Ambert-Balay K. Gastroenteritis and respiratory infection outbreaks in French nursing homes from 2007 to 2018: Morbidity and all-cause lethality according to the individual characteristics of residents. PLoS One 2019; 14:e0222321. [PMID: 31550261 PMCID: PMC6759171 DOI: 10.1371/journal.pone.0222321] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 08/27/2019] [Indexed: 01/09/2023] Open
Abstract
Background Gastroenteritis (GE) and respiratory tract infection (RTI) outbreaks are a significant issue in nursing homes. This study aimed to describe GE and RTI outbreaks with infection and all-cause lethality rates according to the individual characteristics of nursing home residents. Methods Clinical and virological surveillance were conducted (2007 to 2018). Virus stratifications for the analysis were: outbreaks with positive norovirus or influenza identifications (respectively NoV+ or Flu+), episodes with no NoV or influenza identification or testing (respectively NoV- or Flu-). Associations between individual variables (sex, age, length of stay (LOS), autonomy status) and infection and lethality rates were tested with univariate and Mantel-Haenszel (MH) methods. Results 61 GE outbreaks and 76 RTI oubreaks (total 137 outbreaks) were recorded involving respectively 4309 and 5862 residents. In univariate analysis, higher infection rates and age were associated in NoV+, NoV-, and Flu+ contexts, and lower infection rates were associated with longer stays (NoV+ and NoV-). In MH stratified analysis (virus, sex (female/male)) adjusted for LOS (<4 or ≥4 years), the odds of being infected remained significant among older residents (≥86 years): NoV+/male (Odds ratio (ORMH): 1.64, 95% confidence interval (CI): 1.16–2.30) and Flu+/female and male (respectively ORMH: 1.50, CI: 1.27–1.79 and 1.73, CI: 1.28–2.33). In univariate analysis, lower autonomy status (NoV+, Flu+ and Flu-) and increased age (Flu+) were associated with higher lethality. In MH adjusted analysis, significant ORage adjusted for autonomy was: Flu+/ ≥86 years compared with <86 years, 1.97 (1.19–3.25) and ORautonomy adjusted for age for the more autonomous group (compared with the less autonomous group) was: Flu+, 0.41 (0.24–0.69); Flu-, 0.42 (0.20, 0.90). Conclusion The residents of nursing homes are increasingly elderly and dependent. The specific infection and lethality risks according to these two factors indicate that surveillance and infection control measures are essential and of high priority.
Collapse
Affiliation(s)
- Philippe Gaspard
- Hospital Hygiene Service, Rouffach Hospital Center, Rouffach, France
- UMR 6249 Chrono-Environnement, University of Franche-Comté, Besançon, France
- * E-mail:
| | | | - Loic Simon
- Coordination Centre for Nosocomial Infection Control, Eastern Regions, Nancy University Hospital, Nancy, France
| | - Olivia Ali-Brandmeyer
- Coordination Centre for Nosocomial Infection Control, Eastern Regions, Nancy University Hospital, Nancy, France
| | - Christian Rabaud
- Coordination Centre for Nosocomial Infection Control, Eastern Regions, Nancy University Hospital, Nancy, France
| | - Sabrina Larocca
- Hospital Hygiene Service, Rouffach Hospital Center, Rouffach, France
| | - Béatrice Heck
- Hospital Hygiene Service, Rouffach Hospital Center, Rouffach, France
| | - Serge Aho-Glélé
- Department of Epidemiology and Infection Control, Dijon University Hospital, Dijon, France
| | - Pierre Pothier
- University Burgundy Franche-Comté, AgroSup Dijon, PAM UMR A 02.102, Dijon, France
- National Reference Center for Gastroenteritis Viruses, Laboratory of Biology and Pathology, University Hospital, Dijon, France
| | - Katia Ambert-Balay
- University Burgundy Franche-Comté, AgroSup Dijon, PAM UMR A 02.102, Dijon, France
- National Reference Center for Gastroenteritis Viruses, Laboratory of Biology and Pathology, University Hospital, Dijon, France
| |
Collapse
|
21
|
Wu QS, Xuan ZL, Liu JY, Zhao XT, Chen YF, Wang CX, Shen XT, Wang YX, Wang L, Hu Y. Norovirus shedding among symptomatic and asymptomatic employees in outbreak settings in Shanghai, China. BMC Infect Dis 2019; 19:592. [PMID: 31286917 PMCID: PMC6613243 DOI: 10.1186/s12879-019-4205-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 06/19/2019] [Indexed: 12/05/2022] Open
Abstract
Background Norovirus (NoV) is recognized as a leading cause of acute gastroenteritis (AGE) outbreaks in settings globally. Studies have shown that employees played an important role in the transmission mode during some NoV outbreaks. This study aimed to investigate the prevalence of NoV infection and duration of NoV shedding among employees during NoV outbreaks, as well as factors affecting shedding duration. Methods Specimens and epidemiological data were collected from employees who were suspected of being involved in the transmission or with AGE symptoms during NoV outbreaks in Xuhui District, Shanghai, from 2015 to 2017. Specimens were detected using real-time RT-PCR to determine whether or not employees had become infected with NoV. Specimens were collected every 3–7 days from NoV-infected employees until specimens became negative for NoV. Results A total of 421 employees were sampled from 49 NoV outbreaks, and nearly 90% of them (377/421) were asymptomatic. Symptomatic employees showed significantly higher prevalence of NoV infection than asymptomatic ones (70.5% vs. 17.0%, P < 0.01). The average duration of NoV shedding was 6.9 days (95% confidence interval: 6.1–7.7 days) among 88 NoV-infected individuals, and was significantly longer in symptomatic individuals than in asymptomatic ones (9.8 days vs. 5.6 days, P < 0.01). In Cox proportional-hazards model, after adjusting age and gender, symptoms was the only factor associated with duration of NoV shedding. Conclusions Compared with asymptomatic employees, symptomatic employees had higher prevalence of NoV infection and longer durations of NoV shedding. Since NoV shedding duration among NoV-infected employees tends to be longer than their isolation time during outbreaks, reinforcement of hygiene practices among these employees is especially necessary to reduce the risk of virus secondary transmissions after their return to work.
Collapse
Affiliation(s)
- Qiang-Song Wu
- Xuhui Center for Disease Control and Prevention, Shanghai, China
| | - Ze-Liang Xuan
- Xuhui Center for Disease Control and Prevention, Shanghai, China
| | - Jing-Yi Liu
- Xuhui Center for Disease Control and Prevention, Shanghai, China
| | - Xue-Tao Zhao
- Xuhui Center for Disease Control and Prevention, Shanghai, China
| | - Yuan-Fang Chen
- Xuhui Center for Disease Control and Prevention, Shanghai, China
| | - Chen-Xi Wang
- Xuhui Center for Disease Control and Prevention, Shanghai, China
| | - Xiao-Ting Shen
- Xuhui Center for Disease Control and Prevention, Shanghai, China
| | - Ya-Xin Wang
- Xuhui Center for Disease Control and Prevention, Shanghai, China
| | - Lan Wang
- Xuhui District Health and Family Planning Commission, Shanghai, China
| | - Yi Hu
- Department of Epidemiology, China and Key Laboratory of Public Health Safety, (Fudan University), School of Public Health, Fudan University, Ministry of Education, No.130 Dongan Road, Xuhui District, Shanghai, 200032, China.
| |
Collapse
|
22
|
Molecular characterization of human enteric viruses in food, water samples, and surface swabs in Sicily. Int J Infect Dis 2019; 80:66-72. [DOI: 10.1016/j.ijid.2018.12.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 01/09/2023] Open
|
23
|
Inns T, Clough HE, Harris JP, Vivancos R, Adams N, O'Brien SJ. Estimating the burden of care home gastroenteritis outbreaks in England, 2014-2016. BMC Infect Dis 2019; 19:12. [PMID: 30611217 PMCID: PMC6321657 DOI: 10.1186/s12879-018-3642-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/20/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Outbreaks of infectious gastroenteritis in care homes are common, with norovirus a frequent cause. In England there is no co-ordinated national surveillance system. We aimed to estimate the burden of these outbreaks. METHODS Using a generalised linear mixed effects regression model we described the relationship between the observed number of care home outbreaks and covariates. Estimated model parameters were used to infer uplift in the number of outbreaks expected if all areas were subjected to enhanced surveillance. From this we then estimated the total burden of care home gastroenteritis outbreaks in this period. RESULTS We estimated a total of 14,146 care home gastroenteritis outbreaks in England during 2014-2016; this is 47% higher than the reported total and a rate of 32.4 outbreaks per 100 care homes per year. The median number of outbreaks from the model estimates was 31 (IQR 20-46) compared to 19 (IQR 12-34) reported from routine surveillance. CONCLUSIONS This estimated care home gastroenteritis burden in England indicates that current surveillance substantially underestimates the number of outbreaks, by almost half. Improving this surveillance could provide better epidemiological knowledge of the burden of norovirus to inform public health policy, particularly with the advent of norovirus vaccines.
Collapse
Affiliation(s)
- Thomas Inns
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK. .,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK. .,National Infection Service, Public Health England, London, UK.
| | - Helen E Clough
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - John P Harris
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,National Infection Service, Public Health England, London, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - Natalie Adams
- National Infection Service, Public Health England, London, UK
| | - Sarah J O'Brien
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| |
Collapse
|
24
|
Nicolay N, Boulet L, Le Bourhis-Zaimi M, Badjadj-Kab L, Henry L, Erouart S, Borgey F. The role of dependency in a norovirus outbreak in a nursing home. Eur Geriatr Med 2018; 9:837-844. [PMID: 34674480 DOI: 10.1007/s41999-018-0120-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/08/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The objectives of the epidemiological investigation were to describe factors associated with prolonged transmission of acute gastroenteritis in a nursing home during a norovirus outbreak. METHODS A retrospective cohort study was conducted among residents (N = 89) and staff members (N = 86) of the nursing home. Outbreak description was performed in both residents and staff members. Among residents, attack rates and relative risks and their 95% confidence interval (95% CI) associated with different identified risk factors including consumption of normal, mixed and choped meal, score of dependency were calculated. A multivariate logistic regression model was fitted to assess the independent association between risk factors and the occurrence of acute gastroenteritis over the entire outbreak duration. Environmental investigations and review of practices were carried out among staff. RESULTS Respectively 49/89 respondent residents (AR 58%) and 9/47 respondent staff members (AR 19%) reported gastrointestinal symptoms between September 17 and October 21, 2016. Norovirus type II was isolated in five stool samples. Residents with dependency score (Gir) below 4 were at higher risk of acute gastroenteritis [RR 2.1 (95% CI 1.1-4.1)] compared to those autonomous. It was the only identified risk factor. In addition, the review of practices in staff identified several breaks in the application of hygiene control standards including misuse of personal protective equipment (gloves were not changed between caring for different patients), inappropriate hand hygiene technique, and disinfection of environmental surfaces with an ineffective product on norovirus. CONCLUSIONS This episode reminds the importance of early recognition of acute gastroenteritis cases and the implementation of rigorous management measures in order to limit the spread of the epidemic in a highly vulnerable dependent population.
Collapse
Affiliation(s)
- Nathalie Nicolay
- The Regional Public Health Agency of Normandy, Public Health France, Rouen, France. .,Cire Normandie, ARS Normandie-"Immeuble Le Mail", 31, Rue Malouet, BP 2061, 76040, Rouen Cedex, France.
| | - Ludivine Boulet
- Departement of Infection Control, Rouen University Hospital, Rouen, France
| | | | - Lynda Badjadj-Kab
- The Regional Public Health Agency of Normandy, Public Health France, Rouen, France
| | - Liliane Henry
- Cire Normandie, ARS Normandie-"Immeuble Le Mail", 31, Rue Malouet, BP 2061, 76040, Rouen Cedex, France
| | - Stéphane Erouart
- Prevention Unit of Healthcare Associated Infections, Normandy, Caen, France
| | - France Borgey
- Cire Normandie, ARS Normandie-"Immeuble Le Mail", 31, Rue Malouet, BP 2061, 76040, Rouen Cedex, France
| |
Collapse
|
25
|
Joseph A, Henriksen K, Malone E. The Architecture Of Safety: An Emerging Priority For Improving Patient Safety. Health Aff (Millwood) 2018; 37:1884-1891. [DOI: 10.1377/hlthaff.2018.0643] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Anjali Joseph
- Anjali Joseph is a professor of architecture and the Spartanburg Regional Healthcare System Endowed Chair in Architecture and Health Design, School of Architecture, Clemson University, in South Carolina
| | - Kerm Henriksen
- Kerm Henriksen is a senior adviser, Human Factors and Patient Safety, at the Agency for Healthcare Research and Quality, in Rockville, Maryland
| | - Eileen Malone
- Eileen Malone is a Realizing Improved Patient Care through Human Centered Design in the Operating Room advisory board member, School of Architecture, Clemson University
| |
Collapse
|
26
|
Sabrià A, Pintó RM, Bosch A, Quer J, Garcia-Cehic D, Gregori J, Dominguez A, Carol M, Sala-Farré MR, Guix S. Characterization of intra- and inter-host norovirus P2 genetic variability in linked individuals by amplicon sequencing. PLoS One 2018; 13:e0201850. [PMID: 30092071 PMCID: PMC6084935 DOI: 10.1371/journal.pone.0201850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 07/22/2018] [Indexed: 11/29/2022] Open
Abstract
Noroviruses are the main cause of epidemics of acute gastroenteritis at a global scale. Although chronically infected immunocompromised individuals are regarded as potential reservoirs for the emergence of new viral variants, viral quasispecies distribution and evolution patterns in acute symptomatic and asymptomatic infections has not been extensively studied. Amplicons of 450 nts from the P2 coding capsid domain were studied using next-generation sequencing (454/GS-Junior) platform. Inter-host diversity between symptomatic and asymptomatic acutely infected individuals linked to the same outbreak as well as their viral intra-host diversity over time were characterized. With an average of 2848 reads per sample and a cutoff frequency of 0.1%, minor variant haplotypes were detected in 5 out of 8 specimens. Transmitted variants could not be confirmed in all infected individuals in one outbreak. The observed initial intra-host viral diversity in asymptomatically infected subjects was higher than in symptomatic ones. Viral quasispecies evolution over time within individuals was host-specific, with an average of 2.8 nt changes per day (0.0062 changes per nucleotide per day) in a given symptomatic case. Nucleotide polymorphisms were detected in 28 out of 450 analyzed nucleotide positions, 32.14% of which were synonymous and 67.86% were non-synonymous. Most observed amino acid changes emerged at or near blockade epitopes A, B, D and E. Our results suggest that acutely infected individuals, even in the absence of symptoms, which go underreported and may enhance transmission, may contribute to norovirus genetic variability and evolution.
Collapse
Affiliation(s)
- Aurora Sabrià
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, University of Barcelona, Barcelona, Spain
- Institute of Nutrition and Food Safety (INSA·UB), University of Barcelona, Barcelona, Spain
| | - Rosa M. Pintó
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, University of Barcelona, Barcelona, Spain
- Institute of Nutrition and Food Safety (INSA·UB), University of Barcelona, Barcelona, Spain
| | - Albert Bosch
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, University of Barcelona, Barcelona, Spain
- Institute of Nutrition and Food Safety (INSA·UB), University of Barcelona, Barcelona, Spain
| | - Josep Quer
- Liver Unit, Internal Medicine, Laboratori de Malalties Hepàtiques, Vall d’Hebron Institut Recerca-Hospital Universitari Vall d’Hebron (VHIR-HUVH), Autonomous University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Damir Garcia-Cehic
- Liver Unit, Internal Medicine, Laboratori de Malalties Hepàtiques, Vall d’Hebron Institut Recerca-Hospital Universitari Vall d’Hebron (VHIR-HUVH), Autonomous University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Gregori
- Liver Unit, Internal Medicine, Laboratori de Malalties Hepàtiques, Vall d’Hebron Institut Recerca-Hospital Universitari Vall d’Hebron (VHIR-HUVH), Autonomous University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Roche Diagnostics S.L., Sant Cugat del Vallès, Spain
| | - Angela Dominguez
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Public Health, University of Barcelona, Barcelona, Spain
| | - Mónica Carol
- Public Health Agency of Catalonia, Generalitat de Catalunya, Barcelona, Spain
| | | | - Susana Guix
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, University of Barcelona, Barcelona, Spain
- Institute of Nutrition and Food Safety (INSA·UB), University of Barcelona, Barcelona, Spain
- * E-mail:
| | | |
Collapse
|
27
|
Petrignani M, Verhoef L, de Graaf M, Richardus JH, Koopmans M. Chronic sequelae and severe complications of norovirus infection: A systematic review of literature. J Clin Virol 2018; 105:1-10. [PMID: 29804008 DOI: 10.1016/j.jcv.2018.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 04/23/2018] [Accepted: 05/11/2018] [Indexed: 11/17/2022]
Abstract
Norovirus causes an estimated 18% of all cases of acute gastroenteritis worldwide and is found to be associated with mortality. To create a first overview of severe complications and chronic sequelae of norovirus infections, a systematic review of literature was performed. Of 3928 individual hits, 176 publications remained for data extraction. Study periods varied between 1974 and 2017, though strongly skewed towards the last decade (n = 122, 70%). Countries of studies were worldwide, though Africa, and Carribean, Central and South America were underrepresented. Strong evidence was found for chronic diarrhea in immunocompromised patients, affecting 9%-100% of investigated cohorts. The duration of chronic diarrhea varied from four weeks up to nine years, leading to either wasting, weight loss or failure to thrive in a third of the reported cases (224). Other complications with significant evidence were necrotizing enterocolitis (NEC) in preterm infants associated with norovirus infection (8 papers), and benign infantile convulsions with gastroenteritis (BICG; 19 papers). Studies on norovirus infection and inflammatory bowel disease (IBD) mostly concluded against this association (5 of 7). The remaining papers mentioned a large variety of possible sequelae or complications. Based on the available literature, chronic norovirus diarrhea is the major sequela of norovirus infection in primary immune deficient, oncologic and transplant patients. Norovirus infection - like other gastrointestinal pathogens - can cause a range of sequelae and complications, and should be considered in the differential diagnosis of these manifestations.
Collapse
Affiliation(s)
- Mariska Petrignani
- Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.
| | - Linda Verhoef
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Miranda de Graaf
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- Public Health Department, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marion Koopmans
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
28
|
Inns T, Keenan A, Huyton R, Harris J, Iturriza-Gomara M, O'Brien SJ, Vivancos R. How timely closure can reduce outbreak duration: gastroenteritis in care homes in North West England, 2012-2016. BMC Public Health 2018; 18:488. [PMID: 29650010 PMCID: PMC5898054 DOI: 10.1186/s12889-018-5413-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 04/05/2018] [Indexed: 01/17/2023] Open
Abstract
Background Data on outbreaks of infectious gastroenteritis in care homes have been collected using an internet-based surveillance system in North West England since 2012. We analysed the burden and characteristics of care home outbreaks to inform future public health decision-making. Methods We described characteristics of care homes and summary measures of the outbreaks such as attack rate, duration and pathogen identified. The primary analysis outcome was duration of closure following an outbreak. We used negative binomial regression to estimate Incidence Rate Ratios (IRR) and confidence intervals (CI) for each explanatory variable. Results We recorded 795 outbreaks from 379 care homes (37.1 outbreaks per 100 care homes per year). In total 11,568 cases, 75 hospitalisations and 29 deaths were reported. Closure within three days of the first case (IRR = 0.442, 95%CI 0.366–0.534) was significantly associated with reduced duration of closure. The total size of the home (IRR = 1.426, 95%CI = 1.275–1.595) and the total attack rate (IRR = 1.434, 95%CI = 1.257–1.595) were significantly associated with increased duration of closure. Conclusions Care homes that closed promptly had outbreaks of shorter duration. Care home providers, and those advising them on infection control, should aim to close homes quickly to prevent lengthy disruption to services.
Collapse
Affiliation(s)
- Thomas Inns
- Field Epidemiology Service, Public Health England, Liverpool, UK. .,Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK. .,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.
| | - Alex Keenan
- Cheshire and Merseyside Health Protection Team, North West Centre, Public Health England, Liverpool, UK.,Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Rita Huyton
- Cheshire and Merseyside Health Protection Team, North West Centre, Public Health England, Liverpool, UK
| | - John Harris
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Miren Iturriza-Gomara
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Sarah J O'Brien
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Roberto Vivancos
- Field Epidemiology Service, Public Health England, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,NIHR Health Protection Research Unit in Emerging & Zoonotic Infections, University of Liverpool, Liverpool, UK
| |
Collapse
|
29
|
Fraenkel CJ, Inghammar M, Söderlund-Strand A, Johansson PJH, Böttiger B. Risk factors for hospital norovirus outbreaks: impact of vomiting, genotype, and multi-occupancy rooms. J Hosp Infect 2018; 98:398-403. [PMID: 29355578 DOI: 10.1016/j.jhin.2018.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 01/12/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Norovirus is frequently introduced to the hospital and is a frequent cause of hospital outbreaks. Recognition of the factors that facilitate or impede norovirus transmission is an important step to effectively prevent hospital outbreaks. AIM To investigate risk factors for norovirus outbreaks in hospital settings. METHODS Clinical data, ward setting, and norovirus genotype were collected from all 65 norovirus-positive index cases in outbreaks and all 186 sporadic norovirus cases at 192 wards in southern Sweden during 2010-2012 in a nested case-control study. Uni- and multivariate statistical analyses were conducted. FINDINGS Outbreak was independently associated with the number of patients sharing a room with the norovirus case (odds ratio (OR): 1.9 per additional patient in the room; P < 0.01), vomiting (OR: 2.6; P = 0.04), age >80 years (OR: 3.2; P < 0.01), comorbidity (OR: 2.3; P = 0.05), and onset of symptoms after admission to the ward (OR: 3.5; P < 0.01) in the multivariate analysis. Infection with genotype GII.4 was found to be strongly associated with outbreak in the univariate analysis (OR: 5.7; P < 0.01). Moreover, associations between GII.4 and vomiting (OR: 2.5; P = 0.01) and old age (OR: 4.3: P < 0.01) were found. CONCLUSION This is the first study to investigate clinical, ward and genotype risk factors for norovirus hospital outbreaks. Recognition of these factors may help direct and prioritize infection control actions based on the outbreak risk. The results also suggest that the outbreak association with GII.4 partly may be explained by an enhanced ability to induce vomiting.
Collapse
Affiliation(s)
- C J Fraenkel
- Department of Infection Control, Region Skåne, Lund, Sweden; Division of Infection Medicine, Department of Clinical Sciences, Lund University, Sweden.
| | - M Inghammar
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Sweden
| | - A Söderlund-Strand
- Department of Clinical Microbiology, University and Regional Laboratories, Region Skåne, Lund, Sweden
| | | | - B Böttiger
- Department of Clinical Microbiology, University and Regional Laboratories, Region Skåne, Lund, Sweden
| |
Collapse
|
30
|
Cui C, Pan L, Wang Y, Xue C, Zhu W, Zhu L, Ye C, Lu X, Song H, Fu Y, Sun Q. An outbreak of acute GII.17 norovirus gastroenteritis in a long-term care facility in China: The role of nursing assistants. J Infect Public Health 2017; 10:725-729. [DOI: 10.1016/j.jiph.2016.10.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/26/2016] [Accepted: 10/01/2016] [Indexed: 11/30/2022] Open
|
31
|
Liu K, Huang S, Miao ZP, Chen B, Jiang T, Cai G, Jiang Z, Chen Y, Wang Z, Gu H, Chai C, Jiang J. Identifying Potential Norovirus Epidemics in China via Internet Surveillance. J Med Internet Res 2017; 19:e282. [PMID: 28790023 PMCID: PMC5566627 DOI: 10.2196/jmir.7855] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/05/2017] [Accepted: 07/10/2017] [Indexed: 12/23/2022] Open
Abstract
Background Norovirus is a common virus that causes acute gastroenteritis worldwide, but a monitoring system for norovirus is unavailable in China. Objective We aimed to identify norovirus epidemics through Internet surveillance and construct an appropriate model to predict potential norovirus infections. Methods The norovirus-related data of a selected outbreak in Jiaxing Municipality, Zhejiang Province of China, in 2014 were collected from immediate epidemiological investigation, and the Internet search volume, as indicated by the Baidu Index, was acquired from the Baidu search engine. All correlated search keywords in relation to norovirus were captured, screened, and composited to establish the composite Baidu Index at different time lags by Spearman rank correlation. The optimal model was chosen and possibly predicted maps in Zhejiang Province were presented by ArcGIS software. Results The combination of two vital keywords at a time lag of 1 day was ultimately identified as optimal (ρ=.924, P<.001). The exponential curve model was constructed to fit the trend of this epidemic, suggesting that a one-unit increase in the mean composite Baidu Index contributed to an increase of norovirus infections by 2.15 times during the outbreak. In addition to Jiaxing Municipality, Hangzhou Municipality might have had some potential epidemics in the study time from the predicted model. Conclusions Although there are limitations with early warning and unavoidable biases, Internet surveillance may be still useful for the monitoring of norovirus epidemics when a monitoring system is unavailable.
Collapse
Affiliation(s)
- Kui Liu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.,Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
| | - Sichao Huang
- School of Medicine, Ningbo University, Ningbo, China
| | - Zi-Ping Miao
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.,Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
| | - Bin Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.,Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
| | - Tao Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Gaofeng Cai
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Zhenggang Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Yongdi Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Zhengting Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Hua Gu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Chengliang Chai
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.,Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
| | - Jianmin Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.,Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
| |
Collapse
|
32
|
Norovirus Disease in Older Adults Living in Long-Term Care Facilities: Strategies for Management. CURRENT GERIATRICS REPORTS 2017; 6:26-33. [PMID: 29204334 DOI: 10.1007/s13670-017-0195-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose of Review Noroviruses are the most common cause of gastroenteritis outbreaks in long-term care facility (LTCFs). This review summarizes the most up-to-date knowledge on norovirus infection in LTCFs with the aim of identifying potential strategies for management. Recent Findings LTCF residents are at greater risk of norovirus infection. Early identification of norovirus infection and prompt initiation of appropriate supportive therapy are required to reduce morbidity and mortality. Measures to prevent outbreaks and reduce the risk of norovirus infection in LTCFs include timely diagnosis and implementation of infection control interventions to limit virus transmission. Summary Current guidelines for prevention and control are based on generic principles of infection control. Real-time reverse transcription-quantitative polymerase chain reaction assays have been the gold standard for the rapid and sensitive detection of noroviruses. With the recent breakthroughs of human norovirus in vitro culture, doors are now opened to evaluate the efficacy of environmental disinfectants and hand hygiene options. Additionally, development of licensed vaccines against noroviruses may provide another important tool for infection prevention among high-risk individuals.
Collapse
|
33
|
Park GW, Chhabra P, Vinjé J. Swab Sampling Method for the Detection of Human Norovirus on Surfaces. J Vis Exp 2017:55205. [PMID: 28287539 PMCID: PMC5409301 DOI: 10.3791/55205] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Human noroviruses are a leading cause of epidemic and sporadic gastroenteritis worldwide. Because most infections are either spread directly via the person-to-person route or indirectly through environmental surfaces or food, contaminated fomites and inanimate surfaces are important vehicles for the spread of the virus during norovirus outbreaks. We developed and evaluated a protocol using macrofoam swabs for the detection and typing of human noroviruses from hard surfaces. Compared with fiber-tipped swabs or antistatic wipes, macrofoam swabs allow virus recovery (range 1.2-33.6%) from toilet seat surfaces of up to 700 cm2. The protocol includes steps for the extraction of the virus from the swabs and further concentration of the viral RNA using spin columns. In total, 127 (58.5%) of 217 swab samples that had been collected from surfaces in cruise ships and long-term care facilities where norovirus gastroenteritis had been reported tested positive for GII norovirus by RT-qPCR. Of these 29 (22.8%) could be successfully genotyped. In conclusion, detection of norovirus on environmental surfaces using the protocol we developed may assist in determining the level of environmental contamination during outbreaks as well as detection of virus when clinical samples are not available; it may also facilitate monitoring of effectiveness of remediation strategies.
Collapse
Affiliation(s)
- Geun Woo Park
- Division of Viral Diseases, Centers for Disease Control and Prevention;
| | - Preeti Chhabra
- Division of Viral Diseases, Centers for Disease Control and Prevention
| | - Jan Vinjé
- Division of Viral Diseases, Centers for Disease Control and Prevention
| |
Collapse
|
34
|
de Graaf M, Villabruna N, Koopmans MP. Capturing norovirus transmission. Curr Opin Virol 2017; 22:64-70. [PMID: 28056379 DOI: 10.1016/j.coviro.2016.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 12/15/2022]
Abstract
Human norovirus is a leading cause of gastroenteritis and is efficiently transmitted between humans and around the globe. The burden of norovirus infections in the global community and in health-care settings warrant the availability of outbreak prevention strategies and control measures that are tailored to the pathogen, outbreak setting and population at risk. A better understanding of viral and host determinants of transmission would aid in developing and fine-tuning such efforts. Here, we describe mechanisms of transmission, available model systems for studying norovirus transmission and their strengths and weaknesses as well as future research strategies.
Collapse
Affiliation(s)
- Miranda de Graaf
- Department of Viroscience, Erasmus Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
| | - Nele Villabruna
- Department of Viroscience, Erasmus Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Marion Pg Koopmans
- Department of Viroscience, Erasmus Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| |
Collapse
|
35
|
Norovirus shedding among food and healthcare workers exposed to the virus in outbreak settings. J Clin Virol 2016; 82:119-125. [PMID: 27479175 DOI: 10.1016/j.jcv.2016.07.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/01/2016] [Accepted: 07/23/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Noroviruses (NoV) are highly contagious and the leading cause of nonbacterial outbreaks of gastroenteritis worldwide. Individuals who are infected asymptomatically may act as reservoirs and facilitate the transmission of NoV, but the likelihood of workers of becoming infected in outbreak settings has not been systematically studied. OBJECTIVES We evaluated the occurrence of norovirus infections among workers exposed to the virus in different outbreak settings. STUDY DESIGN We screened feces from food handlers and healthcare workers related with gastroenteritis outbreaks, and shedding concentrations over time were calculated from serial samples of infected individuals. Sequence analyses of the capsid P2 domain and region C were used to evaluate linkage between asymptomatic employees and outbreak cases. RESULTS Of all employees, 59.1% were positive for NoV, and more than 70% of them were asymptomatic. Asymptomatic infections were significantly more frequent in foodborne compared to person-to-person transmitted outbreaks; and in restaurants and hotels, compared to nursing homes and healthcare institutions. Mean viral loads were similar between symptomatic and asymptomatic individuals, starting at 7.51±1.80 and 6.49±1.93 log10 genome copies/g, respectively, and decreasing to 5.28±0.76 and 4.52±1.45 log10 genome copies/g after 19days. CONCLUSIONS The likelihood of becoming infected when a NoV outbreak occurs at the work place is high and similar between food handlers and healthcare workers, but asymptomatic infections are more frequently identified among food handlers. Since shed amounts of viruses in the absence of symptoms are also high, reinforcement of hygiene practices among workers is especially relevant to reduce the risk of virus secondary transmissions.
Collapse
|
36
|
Currie K, Price L, Curran E, Bunyan D, Knussen C. Acceptability of temporary suspension of visiting during norovirus outbreaks: investigating patient, visitor and public opinion. J Hosp Infect 2016; 93:121-6. [PMID: 26874935 PMCID: PMC4898206 DOI: 10.1016/j.jhin.2015.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/01/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND Noroviruses are a leading cause of outbreaks globally and the most common cause of service disruption due to ward closures. Temporary suspension of visiting (TSV) is increasingly a recommended public health measure to reduce exposure, transmission and impact during norovirus outbreaks; however, preventing patient-visitor contact may contravene the ethos of person-centred care, and public acceptability of this measure is not known. AIM To investigate the acceptability of TSV during norovirus outbreaks from the perspectives of patients, visitors and the wider public. METHODS Cross-sectional survey of patients (N = 153), visitors (N = 175) and the public (N = 224) in three diverse areas in Scotland. Health Belief Model constructs were applied to understand ratings of acceptability of TSV during norovirus outbreaks, and to determine associations between these levels and various predictor variables. FINDINGS The majority (84.6%) of respondents indicated that the possible benefits of TSV are greater than the possible disadvantages. Conversely, the majority (70%) of respondents disagreed that TSV 'is wrong as it ignores people's rights to have contact with family and friends'. The majority (81.6%) of respondents agreed that TSV would be more acceptable if exceptions were made for seriously ill or dying patients. Correlational analysis demonstrated that overall acceptability was positively related to perceived severity (r = 0.65), identified benefits (r = 0.54) and implementing additional communication strategies (r = 0.60); acceptability was negatively related to potential barriers (r = -0.49). CONCLUSIONS There is greater service user and public support for the use of TSV than concerns around impinging upon patients' rights to have visitors. TSV should be considered as an acceptable infection control measure that could be implemented consistently during norovirus outbreaks.
Collapse
Affiliation(s)
- K Currie
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK.
| | - L Price
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - E Curran
- Health Protection Scotland, Glasgow, UK
| | - D Bunyan
- Health Protection Scotland, Glasgow, UK
| | - C Knussen
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| |
Collapse
|
37
|
Kirby AE, Streby A, Moe CL. Vomiting as a Symptom and Transmission Risk in Norovirus Illness: Evidence from Human Challenge Studies. PLoS One 2016; 11:e0143759. [PMID: 27116105 PMCID: PMC4845978 DOI: 10.1371/journal.pone.0143759] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/09/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In the US, noroviruses are estimated to cause 21 million cases annually with economic losses reaching $2 billion. Outbreak investigations frequently implicate vomiting as a major transmission risk. However, little is known about the characteristics of vomiting as a symptom or the amount of virus present in emesis. METHODOLOGY AND PRINCIPAL FINDINGS Emesis samples and symptomology data were obtained from previous norovirus human challenge studies with GI.1 Norwalk virus, GII.2 Snow Mountain virus, and a pilot study with GII.1 Hawaii virus. Viral titers in emesis were determined using strain-specific quantitative RT-PCR. In all four studies, vomiting was common with 40-100% of infected subjects vomiting at least once. However, only 45% of subjects with vomiting also had diarrhea. Most of the emesis samples had detectable virus and the mean viral titers were 8.0 x 105 and 3.9 x 104 genomic equivalent copies (GEC)/ml for GI and GII viruses, respectively (p = 0.02). Sample pH was correlated with GII.2 Snow Mountain virus detection. CONCLUSIONS AND SIGNIFICANCE Half of all subjects with symptomatic infection experienced vomiting and the average subject shed 1.7 x 108 GEC in emesis. Unlike shedding through stool, vomiting is more likely to result in significant environmental contamination, leading to transmission through fomites and airborne droplets. This quantitative data will be critical for risk assessment studies to further understand norovirus transmission and develop effective control measures. The correlation between sample pH and virus detection is consistent with a single site of virus replication in the small intestine and stomach contents becoming contaminated by intestinal reflux. Additionally, the frequency of vomiting without concurrent diarrhea suggests that epidemiology studies that enroll subjects based on the presence of diarrhea may be significantly underestimating the true burden of norovirus disease.
Collapse
Affiliation(s)
- Amy E. Kirby
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Ashleigh Streby
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Christine L. Moe
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| |
Collapse
|
38
|
White MB, Rajagopalan S, Yoshikawa TT. Infectious Diarrhea: Norovirus and Clostridium difficile in Older Adults. Clin Geriatr Med 2016; 32:509-22. [PMID: 27394020 DOI: 10.1016/j.cger.2016.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Norovirus infection usually results in acute gastroenteritis, often with incapacitating nausea, vomiting, and diarrhea. It is highly contagious and resistant to eradication with alcohol-based hand sanitizer. Appropriate preventative and infection control measures can mitigate the morbidity and mortality associated with norovirus infection. Clostridium difficile infection is the leading cause of health care-associated diarrhea in the United States. Antibiotic use is by far the most common risk factor for C difficile colonization and infection. Appropriate preventive measures and judicious use of antibiotics can help mitigate the morbidity and mortality associated with C difficile infection.
Collapse
Affiliation(s)
- Mary B White
- Department of Veterans Affairs, VA Greater Los Angeles Healthcare System, 11300 Wilshire Boulevard, Los Angeles, CA 90073, USA
| | - Shobita Rajagopalan
- County of Los Angeles Department of Public Health, Curtis Tucker Health Center, 123 West Manchester Boulevard, Inglewood CA 90301, USA.
| | - Thomas T Yoshikawa
- Department of Veterans Affairs, VA Greater Los Angeles Healthcare System, 11300 Wilshire Boulevard, Los Angeles, CA 90073, USA
| |
Collapse
|
39
|
Rönnqvist M, Maunula L. Noroviruses on surfaces: detection, persistence, disinfection and role in environmental transmission. Future Virol 2016. [DOI: 10.2217/fvl-2015-0008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Human noroviruses (HuNoVs), the most common cause of infectious nonbacterial gastroenteritis and the cause of numerous foodborne and hospital outbreaks, are easily transmitted from person-to-person. HuNoVs may persist on surfaces for long periods of time and may be transferred via hands, foods, fomites and air. In this review, studies on methods for detecting HuNoVs on environmental surfaces, such as swabbing, are presented. The review also focuses on recent studies on the efficiency of disinfectants for inactivating HuNoV or its surrogates, such as murine norovirus, on environmental surfaces and hands. Although HuNoV is probably more resistant than MuNoV, this study data adds to the understanding of HuNoV transmission routes and selection of tools for the prevention of HuNoV gastroenteritis outbreaks.
Collapse
Affiliation(s)
- Maria Rönnqvist
- Department of Food Hygiene & Environmental Health, Faculty of Veterinary Medicine, P.O. Box 66, 00014, University of Helsinki, Finland
- Finnish Food Safety Authority Evira, Mustialankatu 3, FI-00790 Helsinki, Finland
| | - Leena Maunula
- Department of Food Hygiene & Environmental Health, Faculty of Veterinary Medicine, P.O. Box 66, 00014, University of Helsinki, Finland
| |
Collapse
|
40
|
Temporary suspension of visiting during norovirus outbreaks in NHS Boards and the independent care home sector in Scotland: a cross-sectional survey of practice. J Hosp Infect 2016; 92:253-8. [DOI: 10.1016/j.jhin.2015.10.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/27/2015] [Indexed: 11/19/2022]
|
41
|
Curran ET, Wilson J, Haig CE, McCowan C, Leanord A, Loveday H. The Where is Norovirus Control Lost (WINCL) Study: an enhanced surveillance project to identify norovirus index cases in care settings in the UK and Ireland. J Infect Prev 2016; 17:8-14. [PMID: 28989447 PMCID: PMC5074184 DOI: 10.1177/1757177415613133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/26/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Norovirus outbreaks have a significant impact on all care settings; little is known about the index cases from whom these outbreaks initiate. AIM To identify and categorise norovirus outbreak index cases in care settings. METHODS A mixed-methods, multi-centre, prospective, enhanced surveillance study identified and categorised index cases in acute and non-acute care settings. RESULTS From 54 participating centres, 537 outbreaks were reported (November 2013 to April 2014): 383 (71.3%) in acute care facilities (ACF); 115 (21.4%) in residential or care homes (RCH) and 39 (7.3%) in other care settings (OCS). Index cases were identified in 424 (79%) outbreaks. Of the 245 index cases who were asymptomatic on admission and not transferred within/into the care setting, 123 (50%) had been an inpatient/resident for 4 days. Four themes emerged: missing the diagnosis, care service under pressure, delay in outbreak control measures and patient/resident location and proximity. CONCLUSION The true index case is commonly not identified as the cause of a norovirus outbreak with at least 50% of index cases being misclassified. Unrecognised norovirus cross-transmission occurs frequently suggesting that either Standard Infection Control Precautions (SICPs) are being insufficiently well applied, and or SICPs are themselves are insufficient to prevent outbreaks.
Collapse
Affiliation(s)
| | - Jennie Wilson
- Richard Wells Research Centre, University of West London, UK
| | - Caroline E Haig
- Robertson Centre for Biostatistics, University of Glasgow, UK
| | - Colin McCowan
- Robertson Centre for Biostatistics, University of Glasgow, UK
| | - Alistair Leanord
- Department of Infection, Immunity and Inflammation, University of Glasgow, UK
| | - Heather Loveday
- Richard Wells Research Centre, University of West London, UK
| |
Collapse
|
42
|
Gaspard P, Ambert-Balay K, Mosnier A, Aho-Glélé S, Roth C, Larocca S, Simon L, Talon D, Rabaud C, Pothier P. Burden of gastroenteritis outbreaks: specific epidemiology in a cohort of institutions caring for dependent people. J Hosp Infect 2015; 91:19-27. [DOI: 10.1016/j.jhin.2015.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/28/2015] [Indexed: 02/05/2023]
|