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Volume 17, Number 8–August 2011
Specimen Collection and Confirmation of Norovirus Outbreaks1
Melissa S. Plantenga, Beletshachew Shiferaw, William E. Keene, Christianne Biggs, James M. Terry, LaDonna Grenz, and Paul R. Cieslak Comments to Author
Author affiliation: Oregon Department of Human Services, Portland, Oregon, USA
Suggested citation for this article
We evaluated data from gastroenteritis outbreaks in Oregon to assess sensitivity of stool testing for norovirus and determine number of specimens needed to confirm norovirus as the cause. Norovirus can be readily confirmed if 3–6 specimens are collected any time <7 days after onset of diarrhea and for almost that long after symptoms resolve.
One goal of any outbreak investigation is to identify the causative pathogen (1). In a recent analysis of foodborne disease outbreaks in the United States during 2006, only 49% had a confirmed causative pathogen (2). A review of foodborne disease outbreaks investigated in the 10-site Foodborne Disease Active Surveillance Network during 1998–1999 found that an etiologic agent was identified for only 29% (3). The major limitation in identifying etiologic agents was a lack of specimens; no stool specimens were collected in two thirds of the unconfirmed outbreaks.
In Oregon, outbreaks of illness are reportable to public health authorities, who investigate to determine the causative pathogen and means of transmission and to implement control measures accordingly. Obtaining stool specimens within 3 days of onset has been recommended (4), but carrying out this recommendation is frequently not feasible.
Since 1999, specimens from case-patients in outbreaks of acute gastroenteritis have been tested for norovirus at the Oregon State Public Health Laboratory. Noroviruses are a group of related, nonenveloped, single-stranded RNA viruses that cause acute gastroenteritis in humans. We reviewed Oregon data to assess the sensitivity of stool testing for norovirus at different times after illness onset and to determine the number of specimens needed to ensure a high probability of confirming a norovirus outbreak.
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Suggested Citation for this Article
Plantenga MS, Shiferaw B, Keene WE, Biggs C, Terry JM, Grenz L. Speciman collection and confirmation of norovirus outbreaks. Emerg Infect Dis [serial on the Internet]. 2011 Aug [date cited]. http://www.cdc.gov/EID/content/17/8/101815.htm
1Preliminary report presented at the 2004 International Conference on Emerging Infectious Diseases, February 29–March 3, 2004, Atlanta, Georgia, USA (abstract no. 244).
Comments to the Authors
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Paul R. Cieslak, Acute and Communicable Disease Prevention, 800 NE Oregon St, Suite 772, Portland, OR 97232, USA; email: firstname.lastname@example.org