Skip to main content
×
Home
    • Aa
    • Aa

Epidemiology of norovirus gastroenteritis in Germany 2001–2009: eight seasons of routine surveillance

  • H. BERNARD (a1), M. HÖHNE (a2), S. NIENDORF (a2), D. ALTMANN (a1) and K. STARK (a1)...
Abstract
SUMMARY

We analysed data on laboratory or epidemiologically confirmed cases (n = 856 539) and on outbreaks (n = 31 644) notified during week 31 (2001) to week 30 (2009), and performed molecular typing of specimens from 665 outbreaks. We aimed at identifying demographic and molecular characteristics to inform on potential additional approaches to prevent disease spread in the population. The mean incidence by norovirus season (week 31 in one year to week 30 in the following year) was 130 (range 19–300) cases/100 000 population and was highest in persons aged <5 years (430/100 000) and ⩾75 years (593/100 000). The proportion hospitalized in community-acquired cases was 8–19% per season. The mean norovirus-associated mortality was 0·05/100 000 per season and 0·5/100 000 in the ⩾75 years age group. Most outbreaks with known setting (75%) occurred in hospitals (32%), nursing homes (28%), households (24%) and childcare facilities (10%). GII strains dominated in the outbreak specimens. GII.4 strains were found in 82% of nursing home outbreaks, 85% of hospital outbreaks, and 33% of childcare facility and school outbreaks. Cases in younger individuals were notified earlier during the season than adult cases, and outbreaks in childcare facilities and schools preceded those in nursing/residential homes, hospitals and private households. We suggest future studies to investigate more closely potential transmission patterns between children and adults.

Copyright
Corresponding author
*Author for correspondence: Dr H. Bernard, Robert Koch Institute, Department of Infectious Disease Epidemiology, Gastrointestinal Infections, Zoonoses and Tropical Infections Unit, DGZ-Ring 1, 13086 Berlin, Germany. (Email: BernardH@rki.de)
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. RI Glass , UD Parashar , MK Estes . Norovirus gastroenteritis. New England Journal of Medicine 2009; 361: 17761785.

2. MM Patel , Systematic literature review of role of noroviruses in sporadic gastroenteritis. Emerging Infectious Diseases 2008; 14: 1224–31.

3. JP Harris , Deaths from norovirus among the elderly, England and Wales. Emerging Infectious Diseases 2008; 14: 15461552.

6. DP Zheng , Norovirus classification and proposed strain nomenclature. Virology 2006; 346: 312–23.

7. JJ Siebenga , Norovirus illness is a global problem: emergence and spread of norovirus GII.4 variants, 2001–2007. Journal of Infectious Diseases 2009; 200: 802812.

8. K Bok , Evolutionary dynamics of GII.4 noroviruses over a 34-year period. Journal of Virology 2009; 83: 11890–901.

10. J Vinje , RA Hamidjaja , MD Sobsey . Development and application of a capsid VP1 (region D) based reverse transcription PCR assay for genotyping of genogroup I and II noroviruses. Journal of Virological Methods 2004; 116: 109117.

11. M Hoehne , E Schreier . Detection of Norovirus genogroup I and II by multiplex real-time RT-PCR using a 3′-minor groove binder-DNA probe. BMC Infectious Diseases 2006; 6: 69.

12. DY Oh , G Gaedicke , E Schreier . Viral agents of acute gastroenteritis in German children: prevalence and molecular diversity. Journal of Medical Virology 2003; 71: 8293.

14. JJ Siebenga , Gastroenteritis caused by norovirus GGII.4, The Netherlands, 1994–2005. Emerging Infectious Diseases 2007; 13: 144146.

17. G Phillips , Community incidence of norovirus-associated infectious intestinal disease in England: improved estimates using viral load for norovirus diagnosis. American Journal of Epidemiology 2010; 171: 10141022.

18. CC Tam , Longitudinal study of infectious intestinal disease in the UK (IID2 study): incidence in the community and presenting to general practice. Gut 2012; 61: 6977.

22. MD Kirk , Surveillance for outbreaks of gastroenteritis in long-term care facilities, Australia, 2002–2008. Clinical Infectious Diseases 2010; 51: 907914.

23. AJ Hall , The roles of Clostridium difficile and norovirus among gastroenteritis-associated deaths in the United States, 1999–2007. Clinical Infectious Diseases 2012; 55: 216223.

26. B Lopman , Increase in viral gastroenteritis outbreaks in Europe and epidemic spread of new norovirus variant. Lancet 2004; 363: 682688.

27. L Huhti , Norovirus GII-4 causes a more severe gastroenteritis than other noroviruses in young children. Journal of Infectious Diseases 2011; 203: 14421444.

28. MC Chan , Fecal viral load and norovirus-associated gastroenteritis. Emerging Infectious Diseases 2006; 12: 12781280.

30. B Rockx , Natural history of human calicivirus infection: a prospective cohort study. Clinical Infectious Diseases 2002; 35: 246253.

31. C Arias , Epidemiological and clinical features of norovirus gastroenteritis in outbreaks: a population-based study. Clinical Microbiology and Infection 2010; 16: 3944.

32. FH Sukhrie , Nosocomial transmission of norovirus is mainly caused by symptomatic cases. Clinical Infectious Diseases 2012; 54: 931937.

33. F Bon , Molecular epidemiology of caliciviruses detected in sporadic and outbreak cases of gastroenteritis in France from December 1998 to February 2004. Journal of Clinical Microbiology 2005; 43: 46594664.

34. BA Lopman , Two epidemiologic patterns of norovirus outbreaks: surveillance in England and wales, 1992–2000. Emerging Infectious Diseases 2003; 9: 7177.

35. LH Blanton , Molecular and epidemiologic trends of caliciviruses associated with outbreaks of acute gastroenteritis in the United States, 2000–2004. Journal of Infectious Diseases 2006; 193: 413421.

36. AM Hauri , Electronic outbreak surveillance in Germany: a first evaluation for nosocomial norovirus outbreaks. PLoS One 2011; 6: e17341.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 3
Total number of PDF views: 15 *
Loading metrics...

Abstract views

Total abstract views: 92 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd March 2017. This data will be updated every 24 hours.