Concurrent Outbreak of Norovirus Genotype I and Enterotoxigenic Escherichia coli on a U.S. Navy Ship following a Visit to Lima, Peru

Gonzaga, Victor; Ramos, Mariana; Maves, Ryan C; Freeman, Randal; Montgomery, Joel M.

doi:10.1371/journal.pone.0020822

Cited by 21 publications

(13 citation statements)

References 11 publications

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“…coli , as well as norovirus. [ 2 , 25 , 26 ] Culture-independent methods are being used increasingly to understand the etiology of acute GI infections across a variety of populations and settings. [ 27 – 30 ] Culture-independent/molecular methods provide a more expedient and simplified means of identifying pathogens in clinical samples as compared to conventional diagnostic approaches that often include bacterial culture (requiring a variety of different culture media and growth conditions), microscopy with and without stains, immunofluorescence, and stool antigen tests for detection of protozoa.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Etiology and Risk Factors for Travelers’ Diarrhea during a Hospital Ship-Based Military Humanitarian Mission: Continuing Promise 2011

et al. 2016

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Travelers’ diarrhea (TD) is the most common ailment affecting travelers, including deployed U.S. military. Continuing Promise 2011 was a 5-month humanitarian assistance/disaster response (HA/DR) military and non-governmental organization training mission aboard the hospital ship USNS Comfort, which deployed to Central and South America and the Caribbean between April and September 2011. Enhanced TD surveillance was undertaken during this mission for public health purposes. Passive surveillance (clinic visits), active surveillance (self-reported questionnaires), and stool samples were collected weekly from shipboard personnel. Descriptive statistics and multivariate-logistic regression methods were used to estimate disease burden and risk factor identification. Two polymerase chain reaction methods on frozen stool were used for microbiological identification. TD was the primary complaint for all clinic visits (20%) and the leading cause of lost duties days due to bed rest confinement (62%), though underreported, as the active self-reported incidence was 3.5 times higher than the passive clinic-reported incidence. Vomiting (p = 0.002), feeling lightheaded or weak (p = 0.005), and being a food handler (p = 0.017) were associated with increased odds of lost duty days. Thirty-eight percent of self-reported cases reported some amount of performance impact. Based on the epidemiological curve, country of exercise and liberty appeared to be temporally associated with increased risk. From the weekly self-reported questionnaire risk factor analysis, eating off ship in the prior week was strongly associated (adjusted odds ratio [OR] 2.4, p<0.001). Consumption of seafood increased risk (aOR 1.7, p = 0.03), though consumption of ice appeared protective (aOR 0.3, p = 0.01). Etiology was bacterial (48%), with enterotoxigenic Escherichia coli as the predominant pathogen (35%). Norovirus was identified as a sole pathogen in 12%, though found as a copathogen in an additional 6%. Despite employment of current and targeted preventive interventions, ship-board HA/DR missions may experience a significant risk for TD among deployed US military personnel and potentially impact mission success.

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Section: Discussionmentioning

confidence: 99%

Incidence, Etiology and Risk Factors for Travelers’ Diarrhea during a Hospital Ship-Based Military Humanitarian Mission: Continuing Promise 2011

et al. 2016

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“…Due to their low infectious dose and high environmental stability, HuNoVs are highly transmissible, rendering the personto-person transmission route the most efficient, especially in (semi)-closed communities [13]. Sharing the same contaminated environment can obviously facilitate the transmission of this virus as exemplified by an AGE outbreaks with highly efficient personto-person transmission reported in Peru [33], in Argentina [34] and in Brazil [35,36]. Furthermore, the person-to-person transmission route facilitates geographical extension of outbreaks caused by contaminated food as observed in Antofagasta, Chile [21], and in outbreaks involving Latin American travelers [33,[37][38][39].…”

Section: Transmissionmentioning

confidence: 99%

“…Sharing the same contaminated environment can obviously facilitate the transmission of this virus as exemplified by an AGE outbreaks with highly efficient personto-person transmission reported in Peru [33], in Argentina [34] and in Brazil [35,36]. Furthermore, the person-to-person transmission route facilitates geographical extension of outbreaks caused by contaminated food as observed in Antofagasta, Chile [21], and in outbreaks involving Latin American travelers [33,[37][38][39]. In Chile, a prevalence of 12.3% for HuNoVs in AGE outbreaks has been found, with positive detection in samples from wastewater treatment plants but negative results in potable water samples collected from households [21].…”

Section: Transmissionmentioning

confidence: 99%

Human norovirus infection in Latin America

Poló

Peiró

Mendes

et al. 2016

Journal of Clinical Virology

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Noroviruses are important enteric pathogens involved in non-bacterial gastroenteritis outbreaks worldwide. Noroviruses mainly occur from person to person via the fecal-oral route but also through contaminated food or water; indirect contamination is also possible due to the resistance of the virus in the environment. Latin American countries as a whole cover a vast North-to-South range, which is highly heterogeneous in terms of climate, ecosystem, human population distribution (urban areas with high human densities versus closed communities), economic development and genetic backgrounds resulting from each particular historical context. This review aims to present epidemiological and clinical patterns of human norovirus infections in Latin American countries. Divergent prevalences were observed depending on the country and the surveyed population. In particular, a shift in rotavirus/norovirus ratio in the etiologies of gastroenteritis was detected in some countries and could be attributed partly to rotavirus vaccine coverage in their infant population. While GII.4 noroviruses were seen to constitute the most common genotype, differences in genotype distribution were observed both in the environment (via sewage sampling proxy) and between genotypes circulating in healthy and diarrheic patients. Due to high climatic discrepancies, different patterns of seasonality were observed. Accordingly, this continent may condense the different particular epidemiological features encountered for HuNoV infections worldwide.

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“…The co-occurrence and co-infection with multiple enteric pathogens is common in gastroenteritis outbreaks especially when associated with massive contamination of water supplies (Charles et al, 2014;Ethelberg et al, 2010;Gonzaga et al, 2011;Qadri et al, 2005aQadri et al, , 2005b, as was the case in the Antofagasta region.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Characterization of enterotoxigenic Escherichia coli strains isolated from the massive multi-pathogen gastroenteritis outbreak in the Antofagasta region following the Chilean earthquake, 2010

Montero

Vidal

Pardo

et al. 2017

Infection, Genetics and Evolution

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Concurrent Outbreak of Norovirus Genotype I and Enterotoxigenic Escherichia coli on a U.S. Navy Ship following a Visit to Lima, Peru

Cited by 21 publications

References 11 publications

Incidence, Etiology and Risk Factors for Travelers’ Diarrhea during a Hospital Ship-Based Military Humanitarian Mission: Continuing Promise 2011

Incidence, Etiology and Risk Factors for Travelers’ Diarrhea during a Hospital Ship-Based Military Humanitarian Mission: Continuing Promise 2011

Human norovirus infection in Latin America

Characterization of enterotoxigenic Escherichia coli strains isolated from the massive multi-pathogen gastroenteritis outbreak in the Antofagasta region following the Chilean earthquake, 2010

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