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Volume 17, Number 8–August 2011
Incidence of Acute Gastroenteritis and Role of Norovirus, Georgia, USA, 2004–2005
Aron J. Hall, Comments to Author Mariana Rosenthal, Nicole Gregoricus, Sharon A. Greene, Jeana Ferguson, Olga L. Henao, Jan Vinjé, Ben A. Lopman, Umesh D. Parashar, and Marc-Alain Widdowson
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (A.J. Hall, M. Rosenthal, N. Gregoricus, S.A. Greene, O.L. Henao, J. Vinjé, B.A. Lopman, U.D. Parashar, M.-A. Widdowson); University of Michigan, Ann Arbor, Michigan, USA (M. Rosenthal); and Kaiser Permanente, Atlanta (J. Ferguson)
Suggested citation for this article
Approximately 179 million cases of acute gastroenteritis (AGE) occur annually in the United States. However, lack of routine clinical testing for viruses limits understanding of their role among persons seeking medical care. Fecal specimens submitted for routine bacterial culture through a health maintenance organization in Georgia, USA, were tested with molecular diagnostic assays for norovirus, rotavirus, astrovirus, sapovirus, and adenovirus. Incidence was estimated by using national health care utilization rates. Routine clinical diagnostics identified a pathogen in 42 (7.3%) of 572 specimens; inclusion of molecular viral testing increased pathogen detection to 15.7%. Community AGE incidence was 41,000 cases/100,000 person-years and outpatient incidence was 5,400/100,000 person-years. Norovirus was the most common pathogen, accounting for 6,500 (16%) and 640 (12%) per 100,000 person-years of community and outpatient AGE episodes, respectively. This study demonstrates that noroviruses are leading causes of AGE among persons seeking medical care.
Acute gastroenteritis (AGE), defined as diarrheal disease of rapid onset potentially accompanied by nausea, vomiting, fever, or abdominal pain, is a major cause of illness in the United States. Approximately 179 million episodes of AGE occur each year and result in ≈600,000 hospitalizations and 5,000 deaths (1,2). A specific etiology is attributed to only ≈20% of AGE cases, although viruses are recognized as the most common of the known agents (1,3). Noroviruses, in particular, have been estimated to cause ≈21 million cases of AGE annually, including >56,000 hospitalizations and 570 deaths (3). However, these estimates are based on US estimates of AGE and extrapolation of etiologic fractions from studies in other industrialized countries because few laboratory-based data are available on the role of noroviruses in sporadic AGE in the United States.
Development of more precise disease incidence estimates for noroviruses and other viral causes of AGE have been hampered, in part, by the lack of diagnostic assays available in clinical settings. With the exception of an enzyme immunoassay (EIA) for rotavirus, diagnosis of viral AGE in the United States is made largely on the basis of clinical signs and symptoms. Molecular techniques used for definitive diagnosis, specifically PCR, are available mostly in public health laboratories and research settings. Commercial EIA kits for norovirus have been developed but are not widely available in the United States and are not cleared by the US Food and Drug Administration for diagnosis of sporadic AGE cases. Evaluation of viral AGE incidence is further limited by the fact that most AGE patients do not seek medical care, and, of those who do, <20% submit fecal specimens for diagnostics (2). Lastly, general perception is that norovirus gastroenteritis is a self-limiting mild illness that rarely requires medical attention, despite several reports of serious illness and death in various settings (3–7).
Better understanding of the relative role of specific viral causes of AGE among persons seeking medical care is needed to help guide clinical management and ultimately to develop more appropriate AGE prevention strategies. We sought to determine the prevalence of viral pathogens among AGE patients who sought medical care and identify their trends in seasonality and molecular epidemiology. Using a similar strategy as that used for common bacterial and parasitic causes of AGE (3), we further sought to estimate incidence of viral agents of AGE in community and outpatient settings.
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Suggested Citation for this Article
Hall AJ, Rosenthal M, Gregoricus N, Greene SA, Ferguson J, Henao OL, et al. Incidence of acute gastroenteritis and role of norovirus, Georgia, USA, 2004–2005. Emerg Infect Dis [serial on the Internet]. 2011 Aug [date cited]. http://www.cdc.gov/EID/content/17/8/101533.htm
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