Ahead of Print -Norovirus Epidemiology in Community and Health Care Settings and Association with Patient Age, Denmark - Volume 20, Number 7—July 2014 - Emerging Infectious Disease journal - CDC

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Ahead of Print -Norovirus Epidemiology in Community and Health Care Settings and Association with Patient Age, Denmark - Volume 20, Number 7—July 2014 - Emerging Infectious Disease journal - CDC

Volume 20, Number 7—July 2014

Research

Norovirus Epidemiology in Community and Health Care Settings and Association with Patient Age, Denmark 
Norovirus Epidemiology in Community and Health Care Settings and Association with Patient Age, Denmark

Article Contents

• Materials and Methods
• Results
• Discussion
• Acknowledgments
• References
• Figure 1
• Figure 2
• Figure 3
• Table 1
• Table 2
• Technical Appendix - 13 KB 
• Suggested Citation

Kristina T. Franck , Jannik Fonager, Annette K. Ersbøll, and Blenda Böttiger

Author affiliations: Statens Serum Institut, Copenhagen, Denmark (K. T. Franck, J. Fonager, B. Böttiger); University of Southern Denmark, Odense, Denmark (K. T. Franck); University of Southern Denmark, Copenhagen (A. K. Ersbøll); Lund University, Malmö, Sweden (B. Böttiger)

Suggested citation for this article

Abstract

Norovirus (NoV) is a major cause of gastroenteritis. NoV genotype II.4 (GII.4) is the predominant genotype in health care settings but the reason for this finding is unknown. Stool samples containing isolates with a known NoV genotype from 2,109 patients in Denmark (patients consulting a general practitioner or outpatient clinic, inpatients, and patients from foodborne outbreaks) were used to determine genotype distribution in relation to age and setting. NoV GII.4 was more prevalent among inpatients than among patients in community settings or patients who became infected during foodborne outbreaks. In community and health care settings, we found an association between infection with GII.4 and increasing age. Norovirus GII.4 predominated in patients ≥60 years of age and in health care settings. A larger proportion of children than adults were infected with NoV GII.3 or GII.P21. Susceptibility to NoV infection might depend on patient age and infecting NoV genotype. Cohort studies are warranted to test this hypothesis.

Norovirus (NoV) is a major cause of viral gastroenteritis (1) and a common cause of outbreaks of acute gastroenteritis in institutional settings, such as hospitals, nursing homes, and schools. Foodborne outbreaks of NoV infection are also common (2,3).

NoVs are positive-sense, single-stranded, non-enveloped RNA viruses (4). On the basis of amino acid or nucleotide sequencing of the polymerase and capsid regions, NoV can be divided into 6 genogroups (GI–GVI) and several genotypes. GI, GII, and GIV are human pathogens (5–7). Recombination events within a genogroup are common (8). Thus, genotyping of NoV should ideally be based on sequencing of the capsid and polymerase regions of the viral genome (9).

NoV sequences reported to the Foodborne Viruses in Europe Network come from mainly foodborne outbreaks or outbreaks in health care settings (2). Outbreaks in health care settings are most often caused by NoV genogroup II genotype 4 (GII.4) (10–13). The proportion of outbreaks caused by GII.4 is lower in non–health care settings (2,3,12,14). Elderly persons seem to be more susceptible to NoV infection (15,16). This susceptibility has been suggested to be genotype dependent (3).

The purpose of this study was to describe the distribution of NoV genotypes among infections in patients consulting a general practitioner (GP) or outpatient clinic, patients in health care settings, and patients in foodborne outbreaks. The association between NoV GII.4 and age of the patients in community and health care settings was also determined.

Dr Franck is a physician at Statens Serum Institut, Copenhagen, Denmark, and a doctoral student at the University of Southern Denmark, Odense, Denmark. Her research interest is norovirus infections in hospital and community settings and in foodborne outbreaks.

Acknowledgments

We thank Brita Bruun for comments on the manuscript and Lasse Lundby Franck for assistance with data management.

This study was supported in part by the Helene E.B. Marckwardts Foundation and the European Commission, Project no. 502571 (Enteric Virus Emergence, New Tools).

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Figures

• Figure 1. Distribution of norovirus genotypes of isolates from stool samples of A) patients in community settings (n = 781 samples), B) patients in health care settings (n = 785 samples),...
• Figure 2. Distribution of norovirus genotypes by patient age and setting for 1,566 patients positive for norovirus, Denmark, 2006–2010Only 1 patient from each general practice or outpatient clinic (n = 781...
• Figure 3. Proportions of norovirus genogroups GII.4 or GII.P4 with respect to mean age of patients with an assigned genotype in each hospital ward (A) (n = 212 wards, 1,070 patients)...

Tables

• Table 1. Age and setting for 3,848 patients with stool samples positive for norovirus, Denmark, 2006–2010
• Table 2. Association between age and infection with norovirus GII.4, Denmark, 2006–2010

Technical Appendix

• Technical Appendix.  13 KB 

Suggested citation for this article: Franck KT, Fonager J, Kjær Ersbøll A, Böttiger B. Norovirus epidemiology in community and health care settings and association with patient age, Denmark. Emerg Infect Dis [Internet]. 2014 Jul [date cited]. http://dx.doi.org/10.3201/eid2007.130781

DOI: 10.3201/eid2007.130781