A decade of norovirus disease risk among older adults in upper-middle and high income countries: a systematic review

Abstract

BackgroundNoroviruses (NoVs) are the most common cause of acute gastroenteritis (AGE) causing both sporadic and outbreak-associated illness. Norovirus (NoV) infections occur across all ages but certain sub-groups are considered at increased risk due to heightened transmission and/or symptom severity. Older adults are potentially at high risk of NoV-associated illness due to frequent outbreaks in long-term care facilities (LTCFs) and severe health outcomes following infection. Elucidation of NoV risk among older adults will support prevention, treatment and control efforts.MethodsWe conducted a systematic literature review to summarize the published risk estimates of NoV-associated illness, hospitalization and death among individuals aged 65 years and older. A structured search using defined NoV and gastroenteritis (GE) terms was performed in the PubMed and EMBASE databases of human studies published between January 1, 2003 and May 16, 2013.ResultsWe identified 39 studies from high income (HI) and upper-middle income (UMI) countries. Thirty-six percent of publications provided risk estimates based on laboratory-confirmed or epidemiologically-linked population-based surveillance data using molecular diagnostic methods. Over the study period, estimated annual NoV rates and extrapolated number of cases among older adults in HI and UMI countries were: 29-120/10,000 or 1.2–4.8 million NoV-associated illnesses; 18–54/10,000 or 723,000–2.2 million NoV-associated outpatient visits; 1–19/10,000 or 40,00–763,000 NoV-associated inpatient visits; 0.04–0.32/10,000 or 2000–13,000 NoV-associated deaths. NoV was responsible for approximately 10–20 % of GE hospitalizations and 10–15 % of all-cause GE deaths among older adults. Older adults experienced a heightened risk of nosocomial infections. Those in LTCFs experience frequent NoV outbreaks and the range in attack rates was 3–45 %, case hospitalization rates 0.5–6 % and case fatality rates 0.3–1.6 %.ConclusionsOlder adults are at increased risk of severe NoV-associated health outcomes. NoV-associated hospitalization rates were higher, more severe, resulted in longer stays and incurred greater costs than for younger patients. NoV-associated mortality rates were approximately 200 % higher among individuals 65 years and older compared to <5 years. The burden of NoV among older adults is expected to rise along with societal aging and increased need for institutionalized care. NoV prevention in older adults, including potential vaccination, may significantly impact risk of severe illness.

Norovirus Disease in Older Adults Living in Long-Term Care Facilities: Strategies for Management

“…Lindasay et al reviewed 39 studies on risk estimates of norovirus infection and found a high burden of the infection in all ages with the highest rates of hospitalization and death among the elderly [3]. Older people are at higher risk of norovirus-associated hospitalization, resulting in excess hospital stays and greater costs compared to young adults [3].…”

“…Lindasay et al reviewed 39 studies on risk estimates of norovirus infection and found a high burden of the infection in all ages with the highest rates of hospitalization and death among the elderly [3]. Older people are at higher risk of norovirus-associated hospitalization, resulting in excess hospital stays and greater costs compared to young adults [3]. The overall estimates of disease burden suggest that noroviruses are responsible for approximately 10–20% of gastroenteritis hospitalizations, 10–15% of gastroenteritis deaths, and ≥0.2% of all-cause mortality among older adults in upper-middle-income and high-income countries [9, 10, 11•, 12,13].…”

“…Long-term care facilities (LTCFs) are common settings for outbreaks of norovirus infection, where they are responsible for 30–80% of acute gastroenteritis outbreaks [3, 4, 5, 6•]. While noroviruses can cause both sporadic infections and outbreaks in all age groups, older people are at higher risks of hospitalization and death [3], owing to intrinsic factors, such as age-related immunosenescence or the presence of comorbid conditions, which result in more extended symptoms [7].…”

“…While noroviruses can cause both sporadic infections and outbreaks in all age groups, older people are at higher risks of hospitalization and death [3], owing to intrinsic factors, such as age-related immunosenescence or the presence of comorbid conditions, which result in more extended symptoms [7]. Additionally, elderly residents of LTCFs are at elevated risks of infection as a result of institutionalized confinement that promotes transmission by sharing rooms and touching common surfaces [8].…”

Navigating Microbiological Food Safety in the Era of Whole-Genome Sequencing

“…NoV is a highly infectious and rapidly evolving RNA virus that is responsible for the majority of acute gastroenteritis cases around the world (160)(161)(162). There is no vaccine or therapeutic intervention available to prevent or control NoV infections.…”