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Norovirus disease associated with excess mortality and use of statins: a retrospective cohort study of an outbreak following a pilgrimage to Lourdes

  • M. RONDY (a1) (a2), M. KOOPMANS (a3) (a4), C. ROTSAERT (a5), T. VAN LOON (a5), B. BELJAARS (a6), G. VAN DIJK (a6), J. SIEBENGA (a3) (a4), S. SVRAKA (a3) (a4), J. W. A. ROSSEN (a7), P. TEUNIS (a1) (a8), W. VAN PELT (a1) and L. VERHOEF (a3)
  • DOI:
  • Published online: 24 May 2010

Although norovirus infection is generally known to be a mild disease, there is some evidence for severe outcome. An outbreak in a Dutch psychiatric institution, originating from pilgrims returning from Lourdes (France), provided an opportunity for performing a retrospective cohort study in order to identify risk factors for norovirus disease and excess mortality. Relative risks (RR) including 95% confidence intervals (CI) showed that attending the pilgrimage (RR 2·0, 95% CI 1·4–3·0) and age >70 (RR 1·7, 95% CI 1·2–2·2) were risk factors for symptomatic infection. In a subset of patients, for whom more detailed information was available, the use of statins was associated with norovirus disease when adjusted for underlying condition (adjusted odds ratio 3·9, 95% CI 1·2–13·0). Mortality was higher in cases infected during the pilgrimage compared to other residents (RR 20·9, 95% CI 4·7–93·8). Norovirus disease can lead to severe outcome. The newly identified risk of statins for contracting norovirus disease may have considerable consequences for the Western world and needs prospective confirmation.

Corresponding author
*Author for correspondence: M. Rondy, National Institute for Public Health and the Environment (RIVM), Postbak 75, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands. (Email:
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