Norovirus infection epidemiology and demographics

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

Overview

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

Epidemiology and Demographics

Incidence

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

Age

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

Gender

  • Norovirus shows no gender predilection.

Race

  • Norovirus is common across all races.

Outbreaks

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




Developing Countries

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

References

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


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