Sensor, a Population-based Cohort Study on Gastroenteritis in the Netherlands: Incidence and Etiology

Abstract

A prospective population-based cohort study with a nested case-control study was conducted to estimate the incidence of gastroenteritis and the associated pathogens in the general Dutch population. Follow-up of two consecutive cohorts was performed by weekly reporting cards from December 1998 to December 1999. Cases and controls in the case-control study supplied a questionnaire and stool samples. The standardized gastroenteritis incidence was 283 per 1,000 person-years. The incidence rose with increasing level of education and was higher for persons with a history of diarrhea and for young children. Bacterial pathogens accounted for 5% of cases, bacterial toxins for 9%, parasites for 6%, and viral pathogens for 21%, with Norwalk-like virus (NLV) as the leading pathogen in 11% of cases. The gastroenteritis incidence was higher than that reported for England, but lower than for the United States. In community cases, viral pathogens are the leading cause of gastroenteritis, with NLV being the number one cause of illness in all age groups but one. In many countries, preventive measures are implemented to decrease bacterial infections. However, additional prevention of viral infections, especially NLV, might significantly decrease the number of gastroenteritis cases in the community.

The estimated disease burden of norovirus in The Netherlands

“…in The Netherlands [29] which, in contrast to norovirus, is well known as an enteric pathogen with a high burden. The population-based age-adjusted estimates of all norovirus cases in The Netherlands slightly increased from almost 3170 cases/100 000 in 1999 on the basis of the Sensor study [6] and 3100/100 000 in 2004 [7] to 3800 cases/100 000 in 2009 using a trend correction of 125 %. However, the evidence for correction may be weak due to its indirect link to norovirus infections as a consequence of the absence of a case-based reporting system in The Netherlands.…”

“…Nevertheless, an actual increase is likely as a result of the emergence of new variants, as described by Siebenga et al [13]. The updated number of 1285 estimated discounted DALYs is higher compared to y500 in 1999 [6] and 2004 [7]. This difference is mainly attributed to the use of a new estimate of 0 .…”

“…Several prospective population-based studies were performed, e.g. in the UK and The Netherlands, resulting in estimates of norovirus gastroenteritis incidence of 1/80 to 1/64 of the population per annum in the UK between 1993 and 1996 [4] and 1/18 to 1/26 in 2008-2009 [5], and 1/31 inhabitants in The Netherlands in 1999 (Sensor) [6]. The annual burden of norovirus in The Netherlands was estimated to be 450 disability-adjusted life-years (DALYs) with an incidence of 2900/100 000 (470 000 cases/year), costing Dutch society 25 million euros in 2004 [7].…”

Prevalence and characteristics of asymptomatic norovirus infection in the community in England

“…Further work is needed to validate the use of a cycle threshold value cutoff for use in studies without a control group. Asymptomatic norovirus infection is very common (1,16,21,(33)(34)(35). Therefore, this quantitative approach provides the most rigorous estimate of norovirus disease burden.…”

“…Norovirus is the most common cause of infectious intestinal disease (IID) in the community in high-income countries (1)(2)(3)(4), and a substantial prevalence of norovirus infection has been reported among IID cases seeking medical care (5). Existing estimates of norovirus-associated IID incidence in the community and among individuals presenting to their general practitioner in England are based on electron microscopy, which has poor diagnostic sensitivity for identifying norovirus-associated IID (6)(7)(8); it is very likely that these estimates underrepresent the burden of norovirus disease.…”