Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 15
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Herrera, Juan José Rodríguez 2016. Food Hygiene and Toxicology in Ready to Eat Foods.

    Huang, Runze Ye, Mu Li, Xinhui Ji, Lin Karwe, Mukund and Chen, Haiqiang 2016. Evaluation of high hydrostatic pressure inactivation of human norovirus on strawberries, blueberries, raspberries and in their purees. International Journal of Food Microbiology, Vol. 223, p. 17.

    Wobus, C.E. Cunha, J.B. Elftman, M.D. and Kolawole, A.O. 2016. Viral Gastroenteritis.

    BRAEYE, T. DE SCHRIJVER, K. WOLLANTS, E. van RANST, M. and VERHAEGEN, J. 2015. A large community outbreak of gastroenteritis associated with consumption of drinking water contaminated by river water, Belgium, 2010. Epidemiology and Infection, Vol. 143, Issue. 04, p. 711.

    Chau, Man Ling Hartantyo, Sri Harminda Pahm Yap, Min Kang, Joanne Su Lin Aung, Kyaw Thu Gutiérrez, Ramona Alikiiteaga Ng, Lee Ching Tam, Clarence C. and Barkham, Timothy 2015. Diarrheagenic pathogens in adults attending a hospital in Singapore. BMC Infectious Diseases, Vol. 16, Issue. 1,

    Hennechart-Collette, Catherine Martin-Latil, Sandra Guillier, Laurent and Perelle, Sylvie 2015. Determination of which virus to use as a process control when testing for the presence of hepatitis A virus and norovirus in food and water. International Journal of Food Microbiology, Vol. 202, p. 57.

    Ho, Zheng Jie Marc Vithia, Gunalan Ng, Ching Ging Maurer-Stroh, Sebastian Tan, Clive M. Loh, Jimmy Lin, Tzer Pin Raymond and Lee, Jian Ming Vernon 2015. Emergence of norovirus GI.2 outbreaks in military camps in Singapore. International Journal of Infectious Diseases, Vol. 31, p. 23.

    Karst, Stephanie M. and Wobus, Christiane E. 2015. Viruses in Rodent Colonies: Lessons Learned from Murine Noroviruses. Annual Review of Virology, Vol. 2, Issue. 1, p. 525.

    Petrignani, M. van Beek, J. Borsboom, G. Richardus, J.H. and Koopmans, M. 2015. Norovirus introduction routes into nursing homes and risk factors for spread: a systematic review and meta-analysis of observational studies. Journal of Hospital Infection, Vol. 89, Issue. 3, p. 163.

    Pringle, Kimberly Lopman, Benjamin Vega, Everardo Vinje, Jan Parashar, Umesh D and Hall, Aron J 2015. Noroviruses: epidemiology, immunity and prospects for prevention. Future Microbiology, Vol. 10, Issue. 1, p. 53.

    Barclay, L. Park, G.W. Vega, E. Hall, A. Parashar, U. Vinjé, J. and Lopman, B. 2014. Infection control for norovirus. Clinical Microbiology and Infection, Vol. 20, Issue. 8, p. 731.

    Belliot, G. Lopman, B.A. Ambert-Balay, K. and Pothier, P. 2014. The burden of norovirus gastroenteritis: an important foodborne and healthcare-related infection. Clinical Microbiology and Infection, Vol. 20, Issue. 8, p. 724.

    Fajardo, Paula Atanassova, Miroslava Garrido-Maestu, Alejandro Wortner-Smith, Tim Cotterill, Jane and Cabado, Ana G. 2014. Bacteria isolated from shellfish digestive gland with antipathogenic activity as candidates to increase the efficiency of shellfish depuration process. Food Control, Vol. 46, p. 272.

    Khamrin, P. Thongprachum, A. Okitsu, S. Maneekarn, N. Hayakawa, S. and Ushijima, H. 2014. Comparison of Three Rapid Tests for Detection of Norovirus in Stool Samples of Acute Gastroenteritis Pediatric Patients. Journal of Tropical Pediatrics, Vol. 60, Issue. 6, p. 481.

    Yu, Yongxin Yan, Shuling Li, Bailin Pan, Yingjie and Wang, Yongjie 2014. Genetic Diversity and Distribution of Human Norovirus in China (1999–2011). BioMed Research International, Vol. 2014, p. 1.


Norovirus outbreaks: a systematic review of commonly implicated transmission routes and vehicles

  • E. J. BITLER (a1), J. E. MATTHEWS (a1), B. W. DICKEY (a1), J. N. S. EISENBERG (a2) and J. S. LEON (a1)
  • DOI:
  • Published online: 22 February 2013

Causal mechanisms of norovirus outbreaks are often not revealed. Understanding the transmission route (e.g. foodborne, waterborne, or environmental) and vehicle (e.g. shellfish or recreational water) of a norovirus outbreak, however, is of great public health importance; this information can facilitate interventions for an ongoing outbreak and regulatory action to limit future outbreaks. Towards this goal, we conducted a systematic review to examine whether published outbreak information was associated with the implicated transmission route or vehicle. Genogroup distribution was associated with transmission route and food vehicle, but attack rate and the presence of GII.4 strain were not associated with transmission route, food vehicle, or water vehicle. Attack rate, genogroup distribution, and GII.4 strain distribution also varied by other outbreak characteristics (e.g. setting, season, hemisphere). These relationships suggest that different genogroups exploit different environmental conditions and thereby can be used to predict the likelihood of various transmission routes or vehicles.

Corresponding author
*Author for correspondence: Dr J. S. Leon, Emory University, Hubert Department of Global Health, Mailstop 1518-002-7BB, 1518 Clifton Road NE, Atlanta, GA 30322, USA. (Email:
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.RL Fankhauser , Epidemiologic and molecular trends of ‘Norwalk-like viruses’ associated with outbreaks of gastroenteritis in the United States. Journal of Infectious Diseases 2002; 186: 17.

2.R Goodgame . Norovirus gastroenteritis. Current Gastroenterology Reports 2006; 8: 401408.

3.M Koopmans . Progress in understanding norovirus epidemiology. Current Opinion in Infectious Diseases 2008; 21: 544552.

4.JL Adler , R Zickl . Winter vomiting disease. Journal of Infectious Diseases 1969; 119: 668673.

5.AC Thornton , KS Jennings-Conklin , MI McCormick . Noroviruses: agents in outbreaks of acute gastroenteritis. Disaster Managemnet & Response 2004; 2: 49.

8.J Leon , C Moe , M Potter . Role of viruses in foodborne disease. In: M Potter . Food Consumption and Disease Risk: Consumer–Pathogen Interactions. Baltimore: Woodhead Publishing in Food Science, Technology and Nutrition, 2006, pp. 309342.

9.K Mattison . Norovirus as a foodborne disease hazard. Advances in Food & Nutrition Research 2011; 62: 139.

10.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.

12.IH Friesema , Differences in clinical presentation between norovirus genotypes in nursing homes. Journal of Clinical Virology 2009; 46: 341344.

14.J Xerry , Tracking the transmission routes of genogroup II noroviruses in suspected food-borne or environmental outbreaks of gastroenteritis through sequence analysis of the P2 domain. Journal of Medical Virology 2009; 81: 1298–304.

15.JE Kaplan , Epidemiology of Norwalk gastroenteritis and the role of Norwalk virus in outbreaks of acute nonbacterial gastroenteritis. Annals of Internal Medicine 1982; 96: 756761.

16.DP Zheng , Norovirus classification and proposed strain nomenclature. Virology 2006; 346: 312323.

17.RA Bull , Emergence of a new norovirus genotype II.4 variant associated with global outbreaks of gastroenteritis. Journal of Clinical Microbiology 2006; 44: 327333.

18.M Lysen , Genetic diversity among food-borne and waterborne norovirus strains causing outbreaks in Sweden. Journal of Clinical Microbiology 2009; 47: 24112418.

19.L Maunula , IT Miettinen , CH Von Bonsdorff . Norovirus outbreaks from drinking water. Emerging Infectious Diseases 2005; 11: 17161721.

21.HL ter Waarbeek , Waterborne gastroenteritis outbreak at a scouting camp caused by two norovirus genogroups: GI and GII. Journal of Clinical Virology 2010; 47: 268272.

23.JP Harris , BA Lopman , SJ O'Brien . Infection control measures for norovirus: a systematic review of outbreaks in semi-enclosed settings. Journal of Hospital Infection 2010; 74: 19.

24.L Bruggink , J Marshall . The relationship between health care and nonhealth care norovirus outbreak settings and norovirus genotype in Victoria, Australia, 2002–2005. Journal of Microbiology, Immunology, and Infection 2011; 44: 241246.

25.MA Widdowson , Outbreaks of acute gastroenteritis on cruise ships and on land: identification of a predominant circulating strain of norovirus – United States, 2002. Journal of Infectious Diseases 2004; 190: 2736.

26.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.

27.N Iritani , Molecular epidemiology of noroviruses detected in seasonal outbreaks of acute nonbacterial gastroenteritis in Osaka City, Japan, from 1996–1997 to 2008–2009. Journal of Medical Virology 2010; 82: 20972105.

28.L Verhoef , Emergence of new norovirus variants on spring cruise ships and prediction of winter epidemics. Emerging Infectious Diseases 2008; 14: 238243.

29.JA Marshall , A Dimitriadis , PJ Wright . Molecular and epidemiological features of norovirus-associated gastroenteritis outbreaks in Victoria, Australia in 2001. Journal of Medical Virology 2005; 75: 321331.

30.JA Marshall , Incidence and characteristics of endemic Norwalk-like virus-associated gastroenteritis. Journal of Medical Virology 2003; 69: 568578.

31.L Verhoef , Use of norovirus genotype profiles to differentiate origins of foodborne outbreaks. Emerging Infectious Diseases 2010; 16: 617624.

32.LP Verhoef , Selection tool for foodborne norovirus outbreaks. Emerging Infectious Diseases 2009; 15: 3138.

35.DG Kleinbaum , M Klein . Logistic Regression: A Self Learning Text, 3 edn. New York: Springer‚ Inc; 1994.

36.G Heinze , M Schemper . A solution to the problem of separation in logistic regression. Statistics in medicine 2002; 21: 24092419.

37.CI Gallimore , Multiple norovirus genotypes characterised from an oyster-associated outbreak of gastroenteritis. International Journal of Food Microbiology 2005; 103: 323330.

38.DP Zheng , Molecular epidemiology of genogroup II-genotype 4 noroviruses in the United States between 1994 and 2006. Journal of Clinical Microbiology 2010; 48: 168177.

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

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? *