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Neyra J, Kambhampati AK, Calderwood LE, Romero C, Soto G, Campbell WR, Tinoco YO, Hall AJ, Ortega-Sanchez IR, Mirza SA. Household economic costs of norovirus gastroenteritis in two community cohorts in Peru, 2012-2019. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002748. [PMID: 38985718 PMCID: PMC11236139 DOI: 10.1371/journal.pgph.0002748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 06/17/2024] [Indexed: 07/12/2024]
Abstract
While costs of norovirus acute gastroenteritis (AGE) to healthcare systems have been estimated, out-of-pocket and indirect costs incurred by households are not well documented in community settings, particularly in developing countries. We conducted active surveillance for AGE in two communities in Peru: Puerto Maldonado (October 2012-August 2015) and San Jeronimo (April 2015-April 2019). Norovirus AGE events with PCR-positive stool specimens were included. Data collected in follow-up interviews included event-related medical resource utilization, associated out-of-pocket costs, and indirect costs. There were 330 norovirus-associated AGE events among 3,438 participants from 685 households. Approximately 49% of norovirus events occurred among children <5 years of age and total cost to the household per episode was highest in this age group. Norovirus events cost a median of US $2.95 (IQR $1.04-7.85) in out-of-pocket costs and $12.58 (IQR $6.39-25.16) in indirect costs. Medication expenses accounted for 53% of out-of-pocket costs, and productivity losses accounted for 59% of the total financial burden on households. The frequency and associated costs of norovirus events to households in Peruvian communities support the need for prevention strategies including vaccines. Norovirus interventions targeting children <5 years of age and their households may have the greatest economic benefit.
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Affiliation(s)
- Joan Neyra
- U.S. Naval Medical Research Unit SOUTH, Lima, Peru
| | - Anita K Kambhampati
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Laura E Calderwood
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Cherokee Nation Operational Solutions, Tulsa, Oklahoma, United States of America
| | - Candice Romero
- Vysnova Partners, LLC, Greater Landover, Maryland, United States of America
| | - Giselle Soto
- U.S. Naval Medical Research Unit SOUTH, Lima, Peru
| | - Wesley R Campbell
- Division of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | | | - Aron J Hall
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ismael R Ortega-Sanchez
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sara A Mirza
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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2
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Amexo JX, Negoro M, Kuurdor EDM, Lartey BL, Sokejima S, Sugata K, Tonto PB, Taniguchi K. Molecular Epidemiology of Norovirus (NoV) Infection in Mie Prefecture: The Kinetics of Norovirus Antigenemia in Pediatric Patients. Viruses 2022; 14:v14020173. [PMID: 35215766 PMCID: PMC8880472 DOI: 10.3390/v14020173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/10/2022] Open
Abstract
Few studies have shown the presence of norovirus (NoV) RNA in blood circulation but there is no data on norovirus antigenemia. We examined both antigenemia and RNAemia from the sera of children with NoV infections and studied whether norovirus antigenemia is correlated with the levels of norovirus-specific antibodies and clinical severity of gastroenteritis. Both stool and serum samples were collected from 63 children admitted to Mie National Hospital with acute NoV gastroenteritis. Norovirus antigen and RNA were detected in sera by ELISA and real-time RT-PCR, respectively. NoV antigenemia was found in 54.8% (34/62) and RNAemia in 14.3% (9/63) of sera samples. Antigenemia was more common in the younger age group (0–2 years) than in the older age groups, and most patients were male. There was no correlation between stool viral load and norovirus antigen (NoV-Ag) levels (rs = −0.063; Cl −0.3150 to 0.1967; p = 0.6251). Higher levels of acute norovirus-specific IgG serum antibodies resulted in a lower antigenemia OD value (n = 61; r = −0.4258; CI −0.62 to −0.19; p = 0.0006). Norovirus antigenemia occurred more commonly in children under 2 years of age with NoV-associated acute gastroenteritis. The occurrence of antigenemia was not correlated with stool viral load or disease severity.
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Affiliation(s)
- Jennifer X. Amexo
- Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-shi 514-8507, Japan; (E.D.-M.K.); (S.S.)
- Department of Clinical Research, National Hospital Organization, Mie National Hospital, Tsu-shi 514-0125, Japan; (M.N.); (K.S.); (P.B.T.)
- Correspondence: (J.X.A.); (K.T.)
| | - Manami Negoro
- Department of Clinical Research, National Hospital Organization, Mie National Hospital, Tsu-shi 514-0125, Japan; (M.N.); (K.S.); (P.B.T.)
| | - Elijah Deku-Mwin Kuurdor
- Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-shi 514-8507, Japan; (E.D.-M.K.); (S.S.)
| | - Belinda L. Lartey
- Department of Electron Microscopy and Histopathology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra 00233, Ghana;
| | - Shigeru Sokejima
- Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-shi 514-8507, Japan; (E.D.-M.K.); (S.S.)
- Epidemiology Centre for Disease Control and Prevention, Mie University Hospital, Tsu-shi 514-8507, Japan
| | - Ken Sugata
- Department of Clinical Research, National Hospital Organization, Mie National Hospital, Tsu-shi 514-0125, Japan; (M.N.); (K.S.); (P.B.T.)
| | - Prince Baffour Tonto
- Department of Clinical Research, National Hospital Organization, Mie National Hospital, Tsu-shi 514-0125, Japan; (M.N.); (K.S.); (P.B.T.)
| | - Kiyosu Taniguchi
- Department of Clinical Research, National Hospital Organization, Mie National Hospital, Tsu-shi 514-0125, Japan; (M.N.); (K.S.); (P.B.T.)
- Correspondence: (J.X.A.); (K.T.)
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3
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Noroviruses-The State of the Art, Nearly Fifty Years after Their Initial Discovery. Viruses 2021; 13:v13081541. [PMID: 34452406 PMCID: PMC8402810 DOI: 10.3390/v13081541] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/06/2021] [Accepted: 07/31/2021] [Indexed: 12/11/2022] Open
Abstract
Human noroviruses are recognised as the major global cause of viral gastroenteritis. Here, we provide an overview of notable advances in norovirus research and provide a short recap of the novel model systems to which much of the recent progress is owed. Significant advances include an updated classification system, the description of alternative virus-like protein morphologies and capsid dynamics, and the further elucidation of the functions and roles of various viral proteins. Important milestones include new insights into cell tropism, host and microbial attachment factors and receptors, interactions with the cellular translational apparatus, and viral egress from cells. Noroviruses have been detected in previously unrecognised hosts and detection itself is facilitated by improved analytical techniques. New potential transmission routes and/or viral reservoirs have been proposed. Recent in vivo and in vitro findings have added to the understanding of host immunity in response to norovirus infection, and vaccine development has progressed to preclinical and even clinical trial testing. Ongoing development of therapeutics includes promising direct-acting small molecules and host-factor drugs.
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Burgess C, Nelis L, Huang C. Modeling the Potential Impact of Norovirus Vaccination Among DoD Forces. Mil Med 2021; 186:91-99. [PMID: 33499503 DOI: 10.1093/milmed/usaa381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/04/2020] [Accepted: 09/21/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Norovirus, a contagious disease that spreads rapidly in close-quartered communities, has a debilitating effect in military settings, affecting troops' health, productivity, and mission-readiness. This research presents a model of norovirus transmission, testing the vaccination's effectiveness in military training centers. METHODS Transmission was modeled using structured ordinary differential equations, including symptomatic and asymptomatic infection, genetic resistance, vaccination, and herd-immunity effects, within a hypothetical cohort of trainees and support staff. The modeled vaccine had an efficacy of 72%, 4 weeks after a single dose in phase 2 clinical trials. The transmission model was calibrated against data from a norovirus outbreak in a university setting. Sensitivity and uncertainty analyses were performed on 22 parameters. RESULTS The greatest reduction in norovirus cases resulted from prophylactic environmental decontamination and vaccination of trainee and staff populations. These combined interventions prevented more than 6,800 cases of norovirus over the 10-year simulated period-a 15% reduction over the baseline scenario of no interventions. Implementing vaccination and environmental decontamination with an outbreak response threshold of 0.1%, prevented more than 5,300 infections; raising the threshold to 0.2% to 0.5% significantly reduced effectiveness. Environmental decontamination and contact reduction alone had little impact on overall norovirus cases. CONCLUSIONS Given vaccine characteristics, the model predicted that up to 15% of norovirus cases occurring in training settings over a 10-year period could be prevented by vaccinating all trainees and staff members immediately upon arrival on-base combined with continuous environmental decontamination. There was an impact on morbidity from implementing vaccination of trainees, alone and in combination with staff members. However, vaccinating staff alone prevented few cases over the simulation period, indicating the importance of trainees in norovirus transmission. Likewise, the negligible impact of environmental decontamination or contact reduction alone highlights the importance of addressing both person-to-person and environmental transmission together to minimize illnesses and training downtime.
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Affiliation(s)
- Colleen Burgess
- Ramboll US Corporation, Amherst, MA 01002.,MathEcology LLC, Phoenix, AZ 85086
| | - Lis Nelis
- Ramboll US Corporation, Seattle, Washington 98164
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5
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Razafimahefa RM, Ludwig-Begall LF, Le Guyader FS, Farnir F, Mauroy A, Thiry E. Optimisation of a PMAxx™-RT-qPCR Assay and the Preceding Extraction Method to Selectively Detect Infectious Murine Norovirus Particles in Mussels. FOOD AND ENVIRONMENTAL VIROLOGY 2021; 13:93-106. [PMID: 33389671 DOI: 10.1007/s12560-020-09454-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
Human noroviruses are a major cause for gastroenteritis outbreaks. Filter-feeding bivalve molluscs, which accumulate noroviruses in their digestive tissues, are a typical vector for human infection. RT-qPCR, the established method for human norovirus detection in food, does not allow discrimination between infectious and non-infectious viruses and can overestimate potentially infectious viral loads. To develop a more accurate method of infectious norovirus load estimation, we combined intercalating agent propidium monoazide (PMAxx™)-pre-treatment with RT-qPCR assay using in vitro-cultivable murine norovirus. Three primer sets targeting different genome regions and diverse amplicon sizes were used to compare one-step amplification of a short genome fragment to three two-step long-range RT-qPCRs (7 kbp, 3.6 kbp and 2.3 kbp amplicons). Following initial assays performed on untreated infectious, heat-, or ultraviolet-inactivated murine noroviruses in PBS suspension, PMAxx™ RT-qPCRs were implemented to detect murine noroviruses subsequent to their extraction from mussel digestive tissues; virus extraction via anionic polymer-coated magnetic beads was compared with the proteinase K-dependent ISO norm. The long-range RT-qPCR process detecting fragments of more than 2.3 kbp allowed accurate estimation of the infectivity of UV-damaged murine noroviruses. While proteinase K extraction limited later estimation of PMAxx™ pre-treatment effects and was found to be unsuited to the assay, magnetic bead-captured murine noroviruses retained their infectivity. Genome copies of heat-inactivated murine noroviruses differed by 2.3 log10 between RT-qPCR and PMAxx™-RT-qPCR analysis in bivalve molluscs, the PMAxx™ pre-treatment allowing a closer approximation of infectious titres. The combination of bead-based virus extraction and PMAxx™ RT-qPCR thus provides a more accurate model for the estimation of noroviral bivalve mollusc contamination than the conjunction of proteinase K extraction and RT-qPCR and has the potential (once validated utilising infectious human norovirus) to provide an added measure of security to food safety authorities in the hazard assessment of potential bivalve mollusc contamination.
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Affiliation(s)
- Ravo M Razafimahefa
- Veterinary Virology and Animal Viral Diseases, Department of Infectious and Parasitic Diseases, FARAH Research Centre, Faculty of Veterinary Medicine, Liège University, B43b, Quartier Vallée 2, Avenue de Cureghem, 10, 4000, Liège, Belgium
| | - Louisa F Ludwig-Begall
- Veterinary Virology and Animal Viral Diseases, Department of Infectious and Parasitic Diseases, FARAH Research Centre, Faculty of Veterinary Medicine, Liège University, B43b, Quartier Vallée 2, Avenue de Cureghem, 10, 4000, Liège, Belgium
| | | | - Frédéric Farnir
- Biostatistics and Bioinformatics Applied To Veterinary Science, FARAH Research Centre, Faculty of Veterinary Medicine, University of Liège, 4000, Liège, Belgium
| | - Axel Mauroy
- Staff Direction for Risk Assessment, Control Policy, Federal Agency for the Safety of the Food Chain, Bld du Jardin Botanique 55, 1000, Brussels, Belgium
| | - Etienne Thiry
- Veterinary Virology and Animal Viral Diseases, Department of Infectious and Parasitic Diseases, FARAH Research Centre, Faculty of Veterinary Medicine, Liège University, B43b, Quartier Vallée 2, Avenue de Cureghem, 10, 4000, Liège, Belgium.
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6
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Grytdal S, Browne H, Collins N, Vargas B, Rodriguez-Barradas MC, Rimland D, Beenhouwer DO, Brown ST, Goetz MB, Lucero-Obusan C, Holodniy M, Kambhampati A, Parashar U, Vinjé J, Lopman B, Hall AJ, Cardemil CV. Trends in Incidence of Norovirus-associated Acute Gastroenteritis in 4 Veterans Affairs Medical Center Populations in the United States, 2011-2015. Clin Infect Dis 2021; 70:40-48. [PMID: 30901024 DOI: 10.1093/cid/ciz165] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/25/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Norovirus is an important cause of epidemic acute gastroenteritis (AGE), yet the burden of endemic disease in adults has not been well documented. We estimated the prevalence and incidence of outpatient and community-acquired inpatient norovirus AGE at 4 Veterans Affairs Medical Centers (VAMC) (Atlanta, Georgia; Bronx, New York; Houston, Texas; and Los Angeles, California) and examined trends over 4 surveillance years. METHODS From November 2011 to September 2015, stool specimens collected within 7 days of AGE symptom onset for clinician-requested diagnostic testing were tested for norovirus, and positive samples were genotyped. Incidence was calculated by multiplying norovirus prevalence among tested specimens by AGE-coded outpatient encounters and inpatient discharges, and dividing by the number of unique patients served. RESULTS Of 1603 stool specimens, 6% tested were positive for norovirus; GII.4 viruses (GII.4 New Orleans [17%] and GII.4 Sydney [47%]) were the most common genotypes. Overall prevalence and outpatient and inpatient community-acquired incidence followed a seasonal pattern, with higher median rates during November-April (9.2%, 376/100 000, and 45/100 000, respectively) compared to May-October (3.0%, 131/100 000, and 13/100 000, respectively). An alternate-year pattern was also detected, with highest peak prevalence and outpatient and inpatient community-acquired norovirus incidence rates in the first and third years of surveillance (14%-25%, 349-613/100 000, and 43-46/100 000, respectively). CONCLUSIONS This multiyear analysis of laboratory-confirmed AGE surveillance from 4 VAMCs demonstrates dynamic intra- and interannual variability in prevalence and incidence of outpatient and inpatient community-acquired norovirus in US Veterans, highlighting the burden of norovirus disease in this adult population.
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Affiliation(s)
- Scott Grytdal
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hannah Browne
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Tennessee
| | - Nikail Collins
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Blanca Vargas
- Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center.,Infectious Diseases Section, Baylor College of Medicine, Houston, Texas
| | | | - David O Beenhouwer
- Veterans Affairs Greater Los Angeles Healthcare System, California.,David Geffen School of Medicine, University of California, Los Angeles
| | - Sheldon T Brown
- James J. Peters Veterans Affairs Medical Center.,Mount Sinai School of Medicine, Bronx, New York
| | - Matthew Bidwell Goetz
- Veterans Affairs Greater Los Angeles Healthcare System, California.,David Geffen School of Medicine, University of California, Los Angeles
| | - Cynthia Lucero-Obusan
- Public Health Surveillance and Research, Department of Veterans Affairs, Palo Alto, California
| | - Mark Holodniy
- Public Health Surveillance and Research, Department of Veterans Affairs, Palo Alto, California
| | - Anita Kambhampati
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.,IHRC, Inc
| | - Umesh Parashar
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jan Vinjé
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ben Lopman
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.,Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Aron J Hall
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cristina V Cardemil
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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7
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Pindyck T, Hall AJ, Tate JE, Cardemil CV, Kambhampati AK, Wikswo ME, Payne DC, Grytdal S, Boom JA, Englund JA, Klein EJ, Halasa N, Selvarangan R, Staat MA, Weinberg GA, Beenhouwer DO, Brown ST, Holodniy M, Lucero-Obusan C, Marconi VC, Rodriguez-Barradas MC, Parashar U. Validation of Acute Gastroenteritis-related International Classification of Diseases, Clinical Modification Codes in Pediatric and Adult US Populations. Clin Infect Dis 2020; 70:2423-2427. [PMID: 31626687 PMCID: PMC7390357 DOI: 10.1093/cid/ciz846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/22/2019] [Indexed: 11/14/2022] Open
Abstract
International Classification of Diseases diagnostic codes are used to estimate acute gastroenteritis (AGE) disease burden. We validated AGE-related codes in pediatric and adult populations using 2 multiregional active surveillance platforms. The sensitivity of AGE codes was similar (54% and 58%) in both populations and increased with addition of vomiting-specific codes.
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Affiliation(s)
- Talia Pindyck
- Epidemic Intelligence Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- 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
| | - Jacqueline E Tate
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cristina V Cardemil
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anita K Kambhampati
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- IHRC, Inc, Atlanta, Georgia, USA
| | - Mary E Wikswo
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel C Payne
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott Grytdal
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Natasha Halasa
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Mary Allen Staat
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Geoffrey A Weinberg
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - David O Beenhouwer
- Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Sheldon T Brown
- James J. Peters VA Medical Center, Bronx, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mark Holodniy
- Public Health Surveillance and Research, Department of Veterans Affairs, Palo Alto, California, USA
| | - Cynthia Lucero-Obusan
- Public Health Surveillance and Research, Department of Veterans Affairs, Palo Alto, California, USA
| | - Vince C Marconi
- Atlanta VA Medical Center, Decatur, Georgia, USA
- Rollins School of Public Health at Emory University, Atlanta, Georgia, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Infectious Diseases Section, Baylor College of Medicine, Houston, Texas, USA
| | - Umesh Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Razafimahefa RM, Ludwig-Begall LF, Thiry E. Cockles and mussels, alive, alive, oh-The role of bivalve molluscs as transmission vehicles for human norovirus infections. Transbound Emerg Dis 2019; 67 Suppl 2:9-25. [PMID: 31232515 DOI: 10.1111/tbed.13165] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/04/2019] [Accepted: 03/01/2019] [Indexed: 12/13/2022]
Abstract
Human noroviruses are recognized as the leading worldwide cause of sporadic and epidemic viral gastroenteritis, causing morbidity and mortality in impoverished developing countries and engendering enormous economic losses in developed countries. Transmitted faecal-orally, either via person-to-person contact, or by consumption of contaminated foods or water, norovirus outbreaks are often reported in institutional settings or in the context of communal dining. Bivalve molluscs, which accumulate noroviruses via filter feeding and are often eaten raw or insufficiently cooked, are a common food vehicle implicated in gastroenteritis outbreaks. The involvement of bivalve molluscs in norovirus outbreaks and epidemiology over the past two decades are reviewed. The authors describe how their physiology of filter feeding can render them concentrated vehicles of norovirus contamination in polluted environments and how high viral loads persist in molluscs even after application of depuration practices and typical food preparation steps. The global prevalence of noroviruses in bivalve molluscs as detected by different monitoring efforts is determined and the various methods currently utilized for norovirus extraction and detection from bivalve matrices described. An overview of gastroenteritis outbreaks affirmatively associated with norovirus-contaminated bivalve molluscs as reported in the past 18 years is also provided. Strategies for risk reduction in shellfish contamination and subsequent human infection are discussed.
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Affiliation(s)
- Ravo M Razafimahefa
- Veterinary Virology and Animal Viral Diseases, Department of Infectious and Parasitic Diseases, FARAH Research Centre, Faculty of Veterinary Medicine, Liège University, Liège, Belgium
| | - Louisa F Ludwig-Begall
- Veterinary Virology and Animal Viral Diseases, Department of Infectious and Parasitic Diseases, FARAH Research Centre, Faculty of Veterinary Medicine, Liège University, Liège, Belgium
| | - Etienne Thiry
- Veterinary Virology and Animal Viral Diseases, Department of Infectious and Parasitic Diseases, FARAH Research Centre, Faculty of Veterinary Medicine, Liège University, Liège, Belgium
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9
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Kambhampati AK, Vargas B, Mushtaq M, Browne H, Grytdal S, Atmar RL, Vinjé J, Parashar UD, Lopman B, Hall AJ, Rodriguez-Barradas MC, Cardemil CV. Active Surveillance for Norovirus in a US Veterans Affairs Patient Population, Houston, Texas, 2015-2016. Open Forum Infect Dis 2019; 6:ofz115. [PMID: 30949545 PMCID: PMC6441783 DOI: 10.1093/ofid/ofz115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/01/2019] [Indexed: 01/12/2023] Open
Abstract
Background Norovirus is a leading cause of acute gastroenteritis (AGE); however, few data exist on endemic norovirus disease burden among adults. Candidate norovirus vaccines are currently in development for all ages, and robust estimates of norovirus incidence among adults are needed to provide baseline data. Methods We conducted active surveillance for AGE among inpatients at a Veterans Affairs (VA) hospital in Houston, Texas. Patients with AGE (≥3 loose stools, ≥2 vomiting episodes, or ≥1 episode of both loose stool and vomiting, within 24 hours) within 10 days of enrollment and non-AGE control patients were enrolled. Demographic data and clinical characteristics were collected. Stool samples were tested using the FilmArray gastrointestinal panel; virus-positives were confirmed by real-time reverse transcription polymerase chain reaction and genotyped by sequencing. Results From November 2, 2015 through November 30, 2016, 147 case patients and 19 control patients were enrolled and provided a stool specimen. Among case patients, 139 (95%) were male and 70 (48%) were aged ≥65 years. Norovirus was the leading viral pathogen detected (in 16 of 20 virus-positive case patients) and accounted for 11% of all AGE cases. No viral pathogens were detected among control patients. Incidence of norovirus-associated hospitalization was 20.3 cases/100 000 person-years and was similar among those aged <65 and ≥65 years. Conclusions This active surveillance platform employed screening and enrollment of hospitalized VA patients meeting a standardized AGE case definition, as well as non-AGE control patients. Data from this study highlight the burden of norovirus in a VA inpatient population and will be useful in policy considerations of a norovirus vaccine.
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Affiliation(s)
- Anita K Kambhampati
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.,IHRC, Inc., Atlanta, Georgia
| | - Blanca Vargas
- Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.,Infectious Diseases Section, Baylor College of Medicine, Houston, Texas
| | - Mahwish Mushtaq
- Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.,Infectious Diseases Section, Baylor College of Medicine, Houston, Texas
| | - Hannah Browne
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Scott Grytdal
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert L Atmar
- Infectious Diseases Section, Baylor College of Medicine, Houston, Texas
| | - Jan Vinjé
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Umesh D Parashar
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin Lopman
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.,Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Aron J Hall
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.,Infectious Diseases Section, Baylor College of Medicine, Houston, Texas
| | - Cristina V Cardemil
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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The incidence of medically-attended norovirus gastro-enteritis in Japan: Modelling using a medical care insurance claims database. PLoS One 2018; 13:e0195164. [PMID: 29601600 PMCID: PMC5877878 DOI: 10.1371/journal.pone.0195164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/16/2018] [Indexed: 12/20/2022] Open
Abstract
Background The burden of medically-attended acute gastro-enteritis (MA-AGE) that can be attributed to norovirus is not well established in Japan. Using a nationwide database of medical care insurance claims, we estimated the incidence of medically-attended norovirus-attributable gastroenteritis (MA-NGE) in Japan. Methods The incidences of MA-NGE outpatient consultations or hospitalization in Japan were modelled on seasonal patterns of MA-AGE for unspecified causes derived from the Japan Medical Data Center (JMDC) database for the period July 2007 to June 2015. Results Mean age-adjusted annual incidence rates (per 10,000 person-years) of MA-NGE associated with outpatient care or hospitalization were 389 (95% CI 269–558) and 13 (95% CI 9–20), respectively. Highest rates were in children under 5 years of age: 1,569 (95% CI 1,325–1,792) for outpatient consultations and 48 (95% CI 39–56) for hospitalizations. Of all gastroenteritis episodes associated with outpatient care or hospitalization, 29% and 31% were attributed to norovirus, respectively. Norovirus was estimated to be responsible for 4,964,000 outpatient visits (95% CI 3,435,000–7,123,000) and 171,000 hospitalizations (95% CI 110,000–251,000) per year across Japan. Conclusions Incidence rates of MA-AGE are high in Japan, and norovirus-attributable disease is at least as high as in some other developed countries.
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Watson AP, Armstrong AQ, White GH, Thran BH. Health-based ingestion exposure guidelines for Vibrio cholerae: Technical basis for water reuse applications. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 613-614:379-387. [PMID: 28917176 DOI: 10.1016/j.scitotenv.2017.08.297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 06/07/2023]
Abstract
U.S. military and allied contingency operations are increasingly occurring in locations with limited, unstable or compromised fresh water supplies. Non-potable graywater reuse is currently under assessment as a viable means to increase mission sustainability while significantly reducing the resources, logistics and attack vulnerabilities posed by transport of fresh water. Development of health-based (non-potable) exposure guidelines for the potential microbial components of graywater would provide a logical and consistent human-health basis for water reuse strategies. Such health-based strategies will support not only improved water security for contingency operations, but also sustainable military operations. Dose-response assessment of Vibrio cholerae based on adult human oral exposure data were coupled with operational water exposure scenario parameters common to numerous military activities, and then used to derive health risk-based water concentrations. The microbial risk assessment approach utilized oral human exposure V. cholerae dose studies in open literature. Selected studies focused on gastrointestinal illness associated with experimental infection by specific V. cholerae serogroups most often associated with epidemics and pandemics (O1 and O139). Nonlinear dose-response model analyses estimated V. cholerae effective doses (EDs) aligned with gastrointestinal illness severity categories characterized by diarrheal purge volume. The EDs and water exposure assumptions were used to derive Risk-Based Water Concentrations (CFU/100mL) for mission-critical illness severity levels over a range of water use activities common to military operations. Human dose-response studies, data and analyses indicate that ingestion exposures at the estimated ED1 (50CFU) are unlikely to be associated with diarrheal illness while ingestion exposures at the lower limit (200CFU) of the estimated ED10 are not expected to result in a level of diarrheal illness associated with degraded individual capability. The current analysis indicates that the estimated ED20 (approximately 1000CFU) represents initiation of a more advanced stage of diarrheal illness associated with clinical care.
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Affiliation(s)
- Annetta P Watson
- Environmental Sciences Division, Oak Ridge National Laboratory, P.O. Box 2008, Bldg 1507, MS 6407, Oak Ridge, TN 37831-6407, United States
| | - Anthony Q Armstrong
- Environmental Sciences Division, Oak Ridge National Laboratory, P.O. Box 2008, Bldg 1507, MS 6407, Oak Ridge, TN 37831-6407, United States.
| | - George H White
- U.S. Army Public Health Center, 5158 Blackhawk Road, Aberdeen Proving Ground, MD 21010-5403, United States
| | - Brandolyn H Thran
- U.S. Army Public Health Center, 5158 Blackhawk Road, Aberdeen Proving Ground, MD 21010-5403, United States
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Abstract
Norovirus is the leading cause of acute gastroenteritis in the USA. Although secondary household transmission of norovirus is frequently reported in outbreaks, little is known about specific risk factors for susceptibility and infectiousness in the household. Three norovirus outbreaks were investigated and data were collected on individuals exposed in the primary outbreak setting and their household members. Potential individual- and household-level risk factors for susceptibility and infectiousness were assessed using univariate and multivariate generalised linear mixed models. In the univariate models, the secondary attack rate (SAR) was significantly higher when living in a household with two or more primary cases (incidence rate ratio (IRR) = 2·1; 95% confidence interval (CI) 1·37-3·29), more than one primary case with vomiting (IRR = 1·9; CI 1·11-3·37), and at least one primary case with diarrhoea (IRR = 3·0; CI 1·46-6·01). After controlling for other risk factors in the multivariate models, the SAR was significantly higher among those living in a household with two or more primary cases (adjusted IRR = 2·0; CI 1·17-3·47) and at least one primary case with diarrhoea (adjusted IRR = 2·8; CI 1·35-5·93). These findings underscore the importance of maintaining proper hygiene and isolating ill household members to prevent norovirus transmission in the household.
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Riddle MS. Big Data Meet Precision Public Health: The Modeling of Acute Gastroenteritis, Norovirus and Its Present and Future Utility. J Infect Dis 2017; 216:929-931. [DOI: 10.1093/infdis/jix412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/09/2017] [Indexed: 11/13/2022] Open
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Lopman BA, Steele D, Kirkwood CD, Parashar UD. The Vast and Varied Global Burden of Norovirus: Prospects for Prevention and Control. PLoS Med 2016; 13:e1001999. [PMID: 27115709 PMCID: PMC4846155 DOI: 10.1371/journal.pmed.1001999] [Citation(s) in RCA: 270] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Globally, norovirus is associated with approximately one-fifth of all diarrhea cases, with similar prevalence in both children and adults, and is estimated to cause over 200,000 deaths annually in developing countries. Norovirus is an important pathogen in a number of high-priority domains: it is the most common cause of diarrheal episodes globally, the principal cause of foodborne disease outbreaks in the United States, a key health care-acquired infection, a common cause of travel-associated diarrhea, and a bane for deployed military troops. Partly as a result of this ubiquity and burden across a range of different populations, identifying target groups and strategies for intervention has been challenging. And, on top of the breadth of this public health problem, there remain important gaps in scientific knowledge regarding norovirus, especially with respect to disease in low-income settings. Many pathogens can cause acute gastroenteritis. Historically, rotavirus was the most common cause of severe disease in young children globally. Now, vaccines are available for rotavirus and are universally recommended by the World Health Organization. In countries with effective rotavirus vaccination programs, disease due to that pathogen has decreased markedly, but norovirus persists and is now the most common cause of pediatric gastroenteritis requiring medical attention. However, the data supporting the precise role of norovirus in low- and middle-income settings are sparse. With vaccines in the pipeline, addressing these and other important knowledge gaps is increasingly pressing. We assembled an expert group to assess the evidence for the global burden of norovirus and to consider the prospects for norovirus vaccine development. The group assessed the evidence in the areas of burden of disease, epidemiology, diagnostics, disease attribution, acquired immunity, and innate susceptibility, and the group considered how to bring norovirus vaccines from their current state of development to a viable product that will benefit global health.
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Affiliation(s)
- Benjamin A. Lopman
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Duncan Steele
- Enteric & Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Carl D. Kirkwood
- Enteric & Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Umesh D. Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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