Skip to main content Accessibility help
×
Home

Risk factors for symptomatic and asymptomatic norovirus infection in the community

  • G. PHILLIPS (a1), C. C. TAM (a1), L. C. RODRIGUES (a1) and B. LOPMAN (a1)

Summary

The objective of this study was to investigate risk factors for norovirus-associated infectious intestinal disease (IID) and asymptomatic norovirus infection. Individuals with IID and healthy controls were recruited in a community-based study in England (1993–1996). This is the first risk-factor study to use viral load measurements, generated by real-time RT–PCR, to identify cases of norovirus-associated IID and asymptomatic infections. Using multivariable logistic regression the main risk factor identified for norovirus-associated IID was contact with a person with IID symptoms. Infectious contacts accounted for 54% of norovirus cases in young children and 39% of norovirus cases in older children and adults. For young children, contacts outside the household presented the highest risk; for older children and adults, the highest risk was associated with child contacts inside the household. Foreign travel and consumption of shellfish increased the risk of norovirus-associated IID. Lifestyle and dietary factors were associated with a decreased risk of both norovirus-associated IID and asymptomatic infection. No risk factors were identified for asymptomatic norovirus infection.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Risk factors for symptomatic and asymptomatic norovirus infection in the community
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Risk factors for symptomatic and asymptomatic norovirus infection in the community
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Risk factors for symptomatic and asymptomatic norovirus infection in the community
      Available formats
      ×

Copyright

Corresponding author

*Author for correspondence: Dr G. Phillips, Institute for Health and Human Development, University of East London, Water Lane, London E15 4LZ, UK. (Email: g.phillips@uel.ac.uk)

References

Hide All
1.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.
2.Hellard, ME, et al. A randomized, blinded, controlled trial investigating the gastrointestinal health effects of drinking water quality. Environmental Health Perspectives 2001; 109: 773778.
3.Marshall, JA, et al. Incidence and characteristics of endemic Norwalk-like virus-associated gastroenteritis. Journal of Medical Virology 2003; 69: 568578.
4.Phillips, G, et al. Community incidence of norovirus-associated infectious intestinal disease in England: improved estimates using viral load for norovirus diagnosis. American Journal of Epidemiology 2010; 171: 10141022.
5.Phillips, G, et al. Prevalence and characteristics of asymptomatic norovirus infection in the community in England. Epidemiology and Infection 2010; 138: 14541458.
6.Karsten, C, et al. Incidence and risk factors for community-acquired acute gastroenteritis in north-west Germany in 2004. European Journal of Clinical Microbiology & Infectious Diseases 2009.
7.Marshall, JA, et al. Failure to detect norovirus in a large group of asymptomatic individuals. Public Health 2004; 118: 230233.
8.Atmar, RL, et al. Norwalk virus shedding after experimental human infection. Emerging Infectious Diseases 2008; 14: 15531557.
9.Lindesmith, L, et al. Human susceptibility and resistance to Norwalk virus infection. Nature Medicine 2003; 9: 548553.
10.de Wit, MA, Koopmans, MP, Van Duynhoven, YT. Risk factors for norovirus, Sapporo-like virus, and group A rotavirus gastroenteritis. Emerging Infectious Diseases 2003; 9: 15631570.
11.Fretz, R, et al. Risk factors for infections with Norovirus gastrointestinal illness in Switzerland. European Journal of Clinical Microbiology & Infectious Diseases 2005; 24: 256261.
12.Food Standards Agency. A report of the study of infectious intestinal disease in England. London: HMSO, 2000.
13.Amar, CF, et al. Detection by PCR of eight groups of enteric pathogens in 4,627 faecal samples: re-examination of the English case-control Infectious Intestinal Disease Study (1993–1996). European Journal of Clinical Microbiology & Infectious Diseases 2007; 26: 311323.
14.Phillips, G, et al. Diagnosing norovirus-associated infectious intestinal disease using viral load. BMC Infectious Diseases 2009; 9: 63.
15.Tompkins, DS, et al. A study of infectious intestinal disease in England: microbiological findings in cases and controls. Communicable Disease and Public Health 1999; 2: 108113.
16.Sethi, D, et al. A study of infectious intestinal disease in England: plan and methods of data collection. Communicable Disease and Public Health 1999; 2: 101107.
17.Haruki, K, et al. Pattern of shedding of small, round-structured virus particles in stools of patients of outbreaks of food-poisoning from raw oysters. Microbiology and Immunology 1991; 35: 8386.
18.Thornhill, TS, et al. Pattern of shedding of the Norwalk particle in stools during experimentally induced gastroenteritis in volunteers as determined by immune electron microscopy. Journal of Infectious Diseases 1975; 132: 2834.
19.Victora, CG, et al. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. International Journal of Epidemiology 1997; 26: 224227.
20.Bland, JM, Altman, DG. Matching. British Medical Journal 1994; 309: 1128.
21.Royston, P. Multiple imputation of missing values: update of ice. Stata Journal 2005; 5: 527536.
22.StataCorp.Stata Statistical Software, release 10 [computer program]. College Station, TX: Stata Corporation LP; 2007.
23.Brady, T. Adjusted population attributable fractions from logistic regression. Stata Technical Bulletin 2009; 42: 812.
24.Dedman, D, et al. Surveillance of small round structured virus (SRSV) infection in England and Wales, 1990–5. Epidemiology and Infection 1998; 121: 139149.
25.Fretz, R, et al. Outbreaks of gastroenteritis due to infections with Norovirus in Switzerland, 2001–2003. Epidemiology and Infection 2005; 133: 429437.
26.Kroneman, A, et al. Analysis of integrated virological and epidemiological reports of norovirus outbreaks collected within the foodborne viruses in Europe Network from 1 July 2001 to 30 June 2006. Journal of Clinical Microbiology 2008; 46: 29592965.
27.Gotz, H, et al. Clinical spectrum and transmission characteristics of infection with Norwalk-like virus: findings from a large community outbreak in Sweden. Clinical Infectious Diseases 2001; 33: 622628.
28.Makita, K, et al. First detection of IgA against norovirus in breast milk. Clinical Laboratory 2007; 53: 125128.
29.Hale, AD, et al. Homotypic and heterotypic IgG and IgM antibody responses in adults infected with small round structured viruses. Journal of Medical Virology 1998; 54: 305312.
30.Lindesmith, LC, et al. Heterotypic humoral and cellular immune responses following Norwalk virus infection. Journal of Virology 2009.
31.Cukor, G, Nowak, NA, Blacklow, NR. Immunoglobulin M responses to the Norwalk virus of gastroenteritis. Infection and Immunity 1982; 37: 463468.
32.Parrino, TA, et al. Clinical immunity in acute gastroenteritis caused by Norwalk agent. New England Journal of Medicine 1977; 297: 8689.
33.Chapin, AR, et al. Prevalence of norovirus among visitors from the United States to Mexico and Guatemala who experience traveler's diarrhea. Journal of Clinical Microbiology 2005; 43: 11121117.
34.Tam, CC, Rodrigues, LC, O'Brien, SJ. The study of infectious intestinal disease in England: what risk factors for presentation to general practice tell us about potential for selection bias in case-control studies of reported cases of diarrhoea. International Journal of Epidemiology 2003; 32: 99105.
35.Barker, J, Vipond, IB, Bloomfield, SF. Effects of cleaning and disinfection in reducing the spread of Norovirus contamination via environmental surfaces. Journal of Hospital Infection 2004; 58: 4249.
36.Ejemot, RI, et al. Hand washing for preventing diarrhoea. Cochrane Database of Systematic Reviews 2008; Issue No. 1. Art No. CD004265.
37.Surgeoner, BV, Chapman, BJ, Powell, DA. University students' hand hygiene practice during a gastrointestinal outbreak in residence: what they say they do and what they actually do. Journal of Environmental Health 2009; 72: 2428.
38.Baert, L, et al. Reported foodborne outbreaks due to noroviruses in Belgium: the link between food and patient investigations in an international context. Epidemiology & Infection 2009; 137: 316325.
39.Korsager, B, et al. Two outbreaks of norovirus infections associated with the consumption of imported frozen raspberries, Denmark, May–June 2005. Eurosurveillance 2005; 10: E050623.
40.Kingsley, DH, Meade, GK, Richards, GP. Detection of both hepatitis A virus and Norwalk-like virus in imported clams associated with food-borne illness. Applied and Environmental Microbiology 2002; 68: 39143918.
41.Maunula, L, Miettinen, IT, von Bonsdorff, CH. Norovirus outbreaks from drinking water. Emerging Infectious Diseases 2005; 11: 17161721.
42.Yoder, J, et al. Surveillance for waterborne disease and outbreaks associated with drinking water and water not intended for drinking – United States, 2005–2006. Morbidity and Mortality Weekly Reports. Surveillance Summaries 2008; 57: 3962.
43.Maunula, L, et al. Wading pool water contaminated with both noroviruses and astroviruses as the source of a gastroenteritis outbreak. Epidemiology and Infection 2004; 132: 737743.
44.Podewils, LJ, et al. Outbreak of norovirus illness associated with a swimming pool. Epidemiology and Infection 2006; 135: 827833.
45.Cheng, PK, et al. Norovirus contamination found in oysters worldwide. Journal of Medical Virology 2005; 76: 593597.
46.Rockx, B, et al. Natural history of human calicivirus infection: a prospective cohort study. Clinical Infectious Diseases 2002; 35: 246253.
47.Huang, P, et al. Norovirus and histo-blood group antigens: demonstration of a wide spectrum of strain specificities and classification of two major binding groups among multiple binding patterns. Journal of Virology 2005; 79: 67146722.
48.Chimonas, MA, et al. Passenger behaviors associated with norovirus infection on board a cruise ship – Alaska, May to June 2004. Journal of Travel Medicine 2008; 15: 177183.
49.Magulski, T, et al. Inactivation of murine norovirus by chemical biocides on stainless steel. BMC Infectious Diseases 2009; 9: 107.
50.Teunis, PF, et al. Norwalk virus: how infectious is it? Journal of Medical Virology 008; 80: 14681476.
51.Thomas, R, Elias, P. Development of the standard occupational classification. Population Trends 1989; 55: 1621.

Keywords

Type Description Title
WORD
Supplementary materials

Phillips Supplementary Material
File_01.doc

 Word (38 KB)
38 KB
WORD
Supplementary materials

Phillips Supplementary Material
File_02.doc

 Word (41 KB)
41 KB
WORD
Supplementary materials

Phillips Supplementary Material
File_03.doc

 Word (137 KB)
137 KB
WORD
Supplementary materials

Phillips Supplementary Material
File_04.doc

 Word (27 KB)
27 KB
WORD
Supplementary materials

Phillips Supplementary Material
File_05.doc

 Word (125 KB)
125 KB
WORD
Supplementary materials

Phillips Supplementary Material
File_06.doc

 Word (116 KB)
116 KB

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed