National Center for Immunizations and Respiratory Disease, Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Public Health Rep. 2011 Mar-Apr;126(2):251-8. doi: 10.1177/003335491112600216.
The role of noroviruses in both foodborne and person-to-person outbreaks of acute gastroenteritis (AGE) has been difficult to determine in the U.S. because of lack of routine norovirus testing and of national reporting of person-to-person outbreaks. We conducted a prospective study in one state in which enhanced testing for noroviruses was performed to better understand the relative contribution of all gastroenteric pathogens.
During the two-year period, 2000-2001, we took all fecal specimens from AGE outbreaks reported in Georgia that were negative for bacteria and tested these for norovirus.
We investigated 78 AGE outbreaks, from which suitable fecal samples were collected from 57 of them. Norovirus was identified in 25 (44%) outbreaks, bacteria in 20 (35%) outbreaks, and parasites in one (2%) outbreak. Forty-three (75%) of the outbreaks tested were foodborne, of which 17 (40%) were attributable to norovirus and 18 (42%) were attributable to bacteria. Adjusting for incomplete testing, we estimated that 53% of all AGE outbreaks were attributable to norovirus. A total of 2,674 people were reported ill in the 57 outbreaks, and norovirus infections accounted for 1,735 (65%) of these cases. Norovirus outbreaks tended to be larger than bacterial outbreaks, with a median number of 30 vs. 16 cases per outbreak, respectively (p = 0.057).
This study provides further evidence that noroviruses are, overall, the most common cause of AGE outbreaks in the U.S. Improved specimen collection, reporting person-to-person outbreaks, and access to molecular assays are needed to further understand the role of these viruses and methods for their prevention.
在美国，由于缺乏常规诺如病毒检测和人际传播暴发的国家报告，因此难以确定诺如病毒在食源性和人际传播急性胃肠炎（AGE）暴发中的作用。我们在一个州进行了一项前瞻性研究，该州对诺如病毒进行了强化检测，以更好地了解所有肠道病原体的相对贡献。
在 2000-2001 年的两年期间，我们采集了佐治亚州报告的所有 AGE 暴发中粪便样本，这些样本均为细菌阴性，并对这些样本进行了诺如病毒检测。
我们调查了 78 起 AGE 暴发，其中 57 起暴发采集了合适的粪便样本。在 25 起（44%）暴发中鉴定出了诺如病毒，在 20 起（35%）暴发中鉴定出了细菌，在 1 起（2%）暴发中鉴定出了寄生虫。43 起（75%）暴发为食源性，其中 17 起（40%）归因于诺如病毒，18 起（42%）归因于细菌。经不完全检测校正后，我们估计所有 AGE 暴发中有 53%归因于诺如病毒。在 57 起暴发中共有 2674 人患病，其中诺如病毒感染占 1735 例（65%）。诺如病毒暴发的规模往往大于细菌暴发，中位数分别为 30 例和 16 例（p = 0.057）。
本研究进一步证明，诺如病毒总体上是美国 AGE 暴发的最常见原因。需要改进标本采集、报告人际传播暴发以及获得分子检测方法，以进一步了解这些病毒的作用及其预防方法。
