Emergence of New Norovirus Variants on Spring Cruise Ships and Prediction of Winter Epidemics

Verhoef, Linda; Depoortere, Evelyn; Boxman, Ingeborg L.A.; Duizer, Erwin; Duynhoven, Yvonne van; Harris, John P.; Johnsen, Christina K.; Kroneman, Annelies; Guyader, Soizick Le; Lim, Wilina; Maunula, Leena; Meldal, H; Ratcliff, Rodney Μ.; Reuter, Gábor; Schreier, E.; Siebenga, J. Joukje; Vainio, Kirsti; Varela, Carmen; Vennema, Harry; Koopmans, Marion

doi:10.3201/eid1402.061567

Cited by 104 publications

(68 citation statements)

References 23 publications

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“…Then a new variant termed Hunter (9) became the most common circulating strain worldwide in 2004, displacing the Farmington Hills variant (18). Lately two new variants, 2006a and 2006b, have been described as the global predominant strains (7,13,15,19,34,35,36,37,39). Our results show the presence of the 2004 variant Hunter from the very start of our study, in January 2003, as confirmed by the sequencing of the complete ORF2 of two samples collected in that month.…”

Section: Discussionsupporting

confidence: 60%

Molecular Epidemiology of Norovirus Gastroenteritis Investigated Using Samples Collected from Children in Tunisia during a Four-Year Period: Detection of the Norovirus Variant GGII.4 Hunter as Early as January 2003

Sdiri-Loulizi

Ambert-Balay²,

Gharbi-Khélifi

et al. 2009

J Clin Microbiol

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Section: Discussionsupporting

confidence: 60%

Molecular Epidemiology of Norovirus Gastroenteritis Investigated Using Samples Collected from Children in Tunisia during a Four-Year Period: Detection of the Norovirus Variant GGII.4 Hunter as Early as January 2003

Sdiri-Loulizi

Ambert-Balay²,

Gharbi-Khélifi

et al. 2009

J Clin Microbiol

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“…In fact, all the targeted viruses were found to be more prevalent in young children than in adults (Table 4). Like norovirus GI/GII (45,46), both astrovirus (47,48) and sapovirus (49) are thought to be more prevalent during winter months. Interestingly, both viruses were detected during this study during the spring and summer months.…”

Section: Discussionmentioning

confidence: 99%

Multicenter Evaluation of the BioFire FilmArray Gastrointestinal Panel for Etiologic Diagnosis of Infectious Gastroenteritis

et al. 2015

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fThe appropriate treatment and control of infectious gastroenteritis depend on the ability to rapidly detect the wide range of etiologic agents associated with the disease. Clinical laboratories currently utilize an array of different methodologies to test for bacterial, parasitic, and viral causes of gastroenteritis, a strategy that suffers from poor sensitivity, potentially long turnaround times, and complicated ordering practices and workflows. Additionally, there are limited or no testing methods routinely available for most diarrheagenic Escherichia coli strains, astroviruses, and sapoviruses. This study assessed the performance of the FilmArray Gastrointestinal (GI) Panel for the simultaneous detection of 22 different enteric pathogens directly from stool specimens: Campylobacter spp., Clostridium difficile (toxin A/B), Plesiomonas shigelloides, Salmonella spp., Vibrio spp., Vibrio cholerae, Yersinia enterocolitica, enteroaggregative E. coli, enteropathogenic E. coli, enterotoxigenic E. coli, Shiga-like toxin-producing E. coli (stx 1 and stx 2 ) (including specific detection of E. coli O157), Shigella spp./enteroinvasive E. coli, Cryptosporidium spp., Cyclospora cayetanensis, Entamoeba histolytica, Giardia lamblia, adenovirus F 40/41, astrovirus, norovirus GI/GII, rotavirus A, and sapovirus. Prospectively collected stool specimens (n ‫؍‬ 1,556) were evaluated using the BioFire FilmArray GI Panel and tested with conventional stool culture and molecular methods for comparison. The FilmArray GI Panel sensitivity was 100% for 12/22 targets and >94.5% for an additional 7/22 targets. For the remaining three targets, sensitivity could not be calculated due to the low prevalences in this study. The FilmArray GI Panel specificity was >97.1% for all panel targets. The FilmArray GI Panel provides a comprehensive, rapid, and streamlined alternative to conventional methods for the etiologic diagnosis of infectious gastroenteritis in the laboratory setting. The potential advantages include improved performance parameters, a more extensive menu of pathogens, and a turnaround time of as short as 1 h. Infectious gastroenteritis (IGE) is a leading cause of global morbidity and mortality. It is estimated that IGE contributes to the death of 2,195 children each day (1). IGE also contributes to serious morbidities, such as malnutrition, stunting, and impaired cognitive function (2, 3). Diarrheal disease disproportionately affects developing nations, but IGE remains a significant problem in industrialized countries as well. For example, it is estimated that each year, approximately 178.8 million cases of gastrointestinal illness occur in the United States, resulting in 474,000 hospitalizations and 5,000 deaths (4). Although the etiologic agents responsible for about 80% of these illnesses are unidentified or otherwise unspecified (4), norovirus and Salmonella spp. are currently the most commonly identified pathogens associated with food-borne disease in the United States and account for 5.5 and 1.0 million cases each year, resp...

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“…Early studies suggested that norovirus outbreaks could be contained by rapid implementation of enhanced hygiene measures, such as washing hands, thoroughly cleaning contaminated surfaces, avoiding contact between sick and healthy persons, and requesting caretakers and cleaning staff to wear gloves and aprons (13)(14)(15)(16). However, in nursing homes or on cruise ships, norovirus can cause consecutive outbreaks, even after implementation of strict hygiene protocols (9,17,18). No quantitative estimates exist of the results of such enhanced hygiene measures on reducing further transmission of norovirus.…”

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confidence: 99%

Enhanced Hygiene Measures and Norovirus Transmission during an Outbreak

Heijne¹,

Teunis²,

Morroy³

et al. 2009

Emerg. Infect. Dis.

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Control of norovirus outbreaks relies on enhanced hygiene measures, such as handwashing, surface cleaning, using disposable paper towels, and using separate toilets for sick and well persons. However, little is known about their effectiveness in limiting further spread of norovirus infections. We analyzed norovirus outbreaks in 7 camps at an international scouting jamboree in the Netherlands during 2004. Implementation of hygiene measures coincided with an 84.8% (95% predictive interval 81.2%-86.6%) reduction in reproduction number. This reduction was unexpectedly large but still below the reduction needed to contain a norovirus outbreak. Even more stringent control measures are required to break the chain of transmission of norovirus. G astroenteritis is one of the most common causes of illness (1). Recent fi ndings indicate norovirus is the most common cause of gastroenteritis (2,3). Of all gastroenteritis outbreaks reported in the Netherlands during 2002, 54% were caused by norovirus (4). Norovirus is predominantly transmitted through the fecal-oral route, either indirectly through contaminated food or surfaces or directly from person to person (5). It can be transmitted through small infectious droplets (aerosols) after a vomiting episode (6,7) and can survive for a very long time in the environment (5,8). Most norovirus outbreaks are seen in settings where clusters of vulnerable, susceptible persons live closely together, such as nursing homes, hospitals, and daycare centers (4), and in settings in which turnover of susceptible persons is high, such as hotels and cruise ships (9,10).Norovirus infection can cause serious medical complications, such as dehydration, in persons with underlying illness (11). No antiviral treatment exists for norovirus infection, and although norovirus vaccines are in development (12), none are available yet. Early studies suggested that norovirus outbreaks could be contained by rapid implementation of enhanced hygiene measures, such as washing hands, thoroughly cleaning contaminated surfaces, avoiding contact between sick and healthy persons, and requesting caretakers and cleaning staff to wear gloves and aprons (13-16). However, in nursing homes or on cruise ships, norovirus can cause consecutive outbreaks, even after implementation of strict hygiene protocols (9,17,18). No quantitative estimates exist of the results of such enhanced hygiene measures on reducing further transmission of norovirus. To our knowledge, the effect of enhanced hygiene measures has not been investigated in randomized controlled trials or in statistical analyses of outbreaks.We investigated the effect of enhanced hygiene measures on reducing norovirus transmission during an outbreak. We measured the effectiveness of enhanced hygiene measures as the relative reduction in the reproduction number-defi ned as the average number of secondary cases caused by 1 typical case-in the absence of and after enhanced hygiene measures. The value of this reproduction number provides crucial information about transmissi...

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Emergence of New Norovirus Variants on Spring Cruise Ships and Prediction of Winter Epidemics

Abstract: A reporting system could provide early warning.

Cited by 104 publications

References 23 publications

Molecular Epidemiology of Norovirus Gastroenteritis Investigated Using Samples Collected from Children in Tunisia during a Four-Year Period: Detection of the Norovirus Variant GGII.4 Hunter as Early as January 2003

Molecular Epidemiology of Norovirus Gastroenteritis Investigated Using Samples Collected from Children in Tunisia during a Four-Year Period: Detection of the Norovirus Variant GGII.4 Hunter as Early as January 2003

Multicenter Evaluation of the BioFire FilmArray Gastrointestinal Panel for Etiologic Diagnosis of Infectious Gastroenteritis

Enhanced Hygiene Measures and Norovirus Transmission during an Outbreak

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