Burden of norovirus in healthcare facilities and strategies for outbreak control

Abstract

SUMMARY Norovirus is the most frequently occurring cause of community-acquired acute gastroenteritis in people of all ages. It is also one of the most frequent causes of outbreaks in healthcare settings, affecting both long-term care facilities and acute care hospitals. Whereas norovirus gastroenteritis is typically mild and resolves without medical attention, healthcare-associated infections often affect vulnerable populations, resulting in severe infections and disruption of healthcare services. Globally, most norovirus outbreaks in hospitals and residential care institutions are associated with genogroup II type 4 (GII.4) strains. Recent data demonstrate that excess mortality occurs during outbreak periods in healthcare facilities. Nosocomial outbreaks can result in large economic and societal costs. Current control measures for norovirus are largely based on general infection control principles, and treatment is mainly supportive and non-specific. While neither vaccines nor antiviral agents are currently available, both are being developed with encouraging results.

Transcriptomic analysis of human norovirus NS1-2 protein highlights a multifunctional role in murine monocytes

“…In the US, norovirus mortality rates are higher in individuals aged over 65 years, whereas hospitalization is more common in children under 5 years of age [2]. The majority of outbreaks in healthcare institutes are caused by the genogroup II.4 strains [3]. The current pandemic strain is Sydney 2012, which arose as a recombination event between New Orleans 2009, Apeldoorn 2008 and Osaka 2007 viruses [4].…”

Rotavirus and Norovirus in Pediatric Healthcare-Associated Gastroenteritis

“…In the postvaccine era, healthcare-associated rotavirus decreased by 60%–74% [3, 4]. Norovirus is a common cause of gastroenteritis due to its low infectious dose, extended shedding (especially in immunocompromised hosts), sustained environmental persistence, emergence of pandemic strains every 2–3 years, and poor cross-protection between genotypes [5]. Norovirus is the most common cause of healthcare-related outbreaks in adults [5], and limited data suggest it is implicated in 5%–16% of pediatric healthcare-associated gastroenteritis [6, 7].…”

Tropical and travel-associated norovirus

“…Apart from young children and military service members from high-income countries deployed to tropical regions, other tropical and travel-associated populations that might benefit from norovirus vaccination include the elderly [114■], hospitalized patients [114■], individuals with immune compromise, school-aged children, developing country military personnel [10■■], healthcare workers [114■], food handlers, food processing facility workers, farm workers, and travel industry workers [1]. The key challenge of evaluating norovirus vaccine cost-effectiveness in these populations is the lack of norovirus disease burden data, in addition to uncertainty about the price, dosing, and effectiveness of candidate vaccines.…”