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Norovirus disease associated with excess mortality and use of statins: a retrospective cohort study of an outbreak following a pilgrimage to Lourdes

  • M. RONDY (a1) (a2), M. KOOPMANS (a3) (a4), C. ROTSAERT (a5), T. VAN LOON (a5), B. BELJAARS (a6), G. VAN DIJK (a6), J. SIEBENGA (a3) (a4), S. SVRAKA (a3) (a4), J. W. A. ROSSEN (a7), P. TEUNIS (a1) (a8), W. VAN PELT (a1) and L. VERHOEF (a3)...

Summary

Although norovirus infection is generally known to be a mild disease, there is some evidence for severe outcome. An outbreak in a Dutch psychiatric institution, originating from pilgrims returning from Lourdes (France), provided an opportunity for performing a retrospective cohort study in order to identify risk factors for norovirus disease and excess mortality. Relative risks (RR) including 95% confidence intervals (CI) showed that attending the pilgrimage (RR 2·0, 95% CI 1·4–3·0) and age >70 (RR 1·7, 95% CI 1·2–2·2) were risk factors for symptomatic infection. In a subset of patients, for whom more detailed information was available, the use of statins was associated with norovirus disease when adjusted for underlying condition (adjusted odds ratio 3·9, 95% CI 1·2–13·0). Mortality was higher in cases infected during the pilgrimage compared to other residents (RR 20·9, 95% CI 4·7–93·8). Norovirus disease can lead to severe outcome. The newly identified risk of statins for contracting norovirus disease may have considerable consequences for the Western world and needs prospective confirmation.

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Copyright

Corresponding author

*Author for correspondence: M. Rondy, National Institute for Public Health and the Environment (RIVM), Postbak 75, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands. (Email: marc.rondy@rivm.nl)

References

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1.Kirk, MD, Roberts, L, Horvath, J. Understanding gastroenteritis in elderly residents of aged-care facilities. Medical Journal of Australia 2008; 189: 476477.
2.Koopmans, M. Progress in understanding norovirus epidemiology. Current Opinion in Infectious Diseases 2008; 21: 544552.
3.de Wit, MA, et al. Sensor, a population-based cohort study on gastroenteritis in the Netherlands: incidence and etiology. American Journal of Epidemiology 2001; 154: 666674.
4.Musher, DM, Musher, BL. Contagious acute gastrointestinal infections. New England Journal of Medicine 2004; 351: 24172427.
5.Verhoef, L, et al. Emergence of new norovirus variants on spring cruise ships and prediction of winter epidemics. Emerging Infectious Diseases 2008; 14: 238243.
6.van Duynhoven, YT, et al. A one-year intensified study of outbreaks of gastroenteritis in The Netherlands. Epidemiology and Infection 2005; 133: 9–21.
7.Lopman, B, et al. Increase in viral gastroenteritis outbreaks in Europe and epidemic spread of new norovirus variant. Lancet 2004; 363: 682688.
8.Widdowson, MA, et al. 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.
9.Dolin, R. Noroviruses – challenges to control. New England Journal of Medicine 2007; 357: 10721073.
10.Ludwig, A, et al. Quantitative detection of norovirus excretion in pediatric patients with cancer and prolonged gastroenteritis and shedding of norovirus. Journal of Medical Virology 2008; 80: 14611467.
11.Teunis, PF, et al. Norwalk virus: how infectious is it? Journal of Medical Virology 2008; 80: 14681476.
12.Lopman, BA, et al. Clinical manifestation of norovirus gastroenteritis in health care settings. Clinical Infectious Diseases 2004; 39: 318324.
13.Mattner, F, et al. Risk groups for clinical complications of norovirus infections: an outbreak investigation. Clinical Microbiology and Infection 2006; 12: 6974.
14.Siebenga, JJ, et al. High prevalence of prolonged norovirus shedding and illness among hospitalized patients: a model for in vivo molecular evolution. Journal of Infectious Diseases 2008; 198: 994–1001.
15.Wu, HM, et al. A norovirus outbreak at a long-term-care facility: the role of environmental surface contamination. Infection Control and Hospital Epidemiology 2005; 26: 802810.
16.Okada, M, et al. Genetic analysis of noroviruses associated with fatalities in healthcare facilities. Archives of Virology 2006; 151: 16351641.
17.Calderon-Margalit, R, et al. A large-scale gastroenteritis outbreak associated with Norovirus in nursing homes. Epidemiology and Infection 2005; 133: 3540.
18.Frenzen, PD. Mortality due to gastroenteritis of unknown etiology in the United States. J Infect Dis 2003; 187: 441452.
19.Harris, JP, et al. Deaths from norovirus among the elderly, England and Wales. Emerging Infectious Diseases 2008; 14: 1546–52.
20.Verhoef, L, et al. Import of norovirus infections in the Netherlands and Ireland following pilgrimages to Lourdes, 2008 – preliminary report. Eurosurveillance 2008; 13: pii: 19025.
21.Malorny, B, et al. Diagnostic real-time PCR for detection of Salmonella in food. Applied and Environmental Microbiology 2004; 70: 70467052.
22.Best, EL, et al. Applicability of a rapid duplex real-time PCR assay for speciation of Campylobacter jejuni and Campylobacter coli directly from culture plates. FEMS Microbiology Letters 2003; 229: 237241.
23.Vu, DT, et al. Detection of Shigella by a PCR assay targeting the ipaH gene suggests increased prevalence of shigellosis in Nha Trang, Vietnam. Journal of Clinical Microbiology 2004; 42: 20312035.
24.Svraka, S, et al. Etiological role of viruses in outbreaks of acute gastroenteritis in The Netherlands from 1994 through 2005. Journal of Clinical Microbiology 2007; 45: 13891394.
25.van den Berg, RJ, et al. Rapid diagnosis of toxinogenic Clostridium difficile in faecal samples with internally controlled real-time PCR. Clinical Microbiology and Infection 2006; 12: 184186.
26.Siebenga, JJ, et al. Epochal evolution of GGII.4 norovirus capsid proteins from 1995 to 2006. Journal of Virology 2007; 81: 99329941.
27.Charlson, M, et al. Validation of a combined comorbidity index. Journal of Clinical Epidemiology 1994; 47: 12451251.
28.Mahoney, FI, Barthel, DW. Functional evaluation: the Barthel Index. Maryland State Medical Journal 1965; 14: 6165.
29.Wolfram Research. Mathematica, version 6; Champaign, IL, USA. (http://www.wolfram.com).
30.Duizer, E, et al. Probabilities in norovirus outbreak diagnosis. Journal of Clinical Virology 2007; 40: 3842.
31.Marks, PJ, et al. Evidence for airborne transmission of Norwalk-like virus (NLV) in a hotel restaurant. Epidemiology and Infection 2000; 124: 481487.
32.High, KP. Infection in an ageing world. Lancet Infectious Diseases 2002; 2: 655.
33.Friesema, IH, et al. Norovirus outbreaks in nursing homes: the evaluation of infection control measures. Epidemiology and Infection 2009; 137: 17221733.
34.Ferry, M. Strategies for ensuring good hydration in the elderly. Nutrition Reviews 2005; 63: S22–29.
35.Chang, KO. Role of cholesterol pathways in norovirus replication. Journal of Virology 2009; 83: 85878595.
36.Mitka, M. Expanding statin use to help more at-risk patients is causing financial heartburn. Journal of the American Medical Association 2003; 290: 22432245.
37.Van Asten, L, et al. Greater pathogenicity of norovirus strains in 2003? A syndromic approach. Advances in Disease Surveillance 2007; 2: 175.
38.McIntosh, I. Elderly travellers, individuals with disabilities and fitness to travel. In: Lockie, C et al. , eds. Travel Medicine and Migrant Health. UK: Churchill Livingstone, 2000, pp. 106108.
39.Teunis, P, et al. A reconsideration of the Campylobacter dose-response relation. Epidemiology and Infection 2005; 133: 583592.
40.Gallimore, CI, et al. Asymptomatic and symptomatic excretion of noroviruses during a hospital outbreak of gastroenteritis. Journal of Clinical Microbiology 2004; 42: 22712274.

Keywords

Norovirus disease associated with excess mortality and use of statins: a retrospective cohort study of an outbreak following a pilgrimage to Lourdes

  • M. RONDY (a1) (a2), M. KOOPMANS (a3) (a4), C. ROTSAERT (a5), T. VAN LOON (a5), B. BELJAARS (a6), G. VAN DIJK (a6), J. SIEBENGA (a3) (a4), S. SVRAKA (a3) (a4), J. W. A. ROSSEN (a7), P. TEUNIS (a1) (a8), W. VAN PELT (a1) and L. VERHOEF (a3)...

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