National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
Emerg Infect Dis. 2011 Mar;17(3):412-8. doi: 10.3201/eid1703.100979.
International foodborne norovirus outbreaks can be difficult to recognize when using standard outbreak investigation methods. In a novel approach, we provide step-wise selection criteria to identify clusters of outbreaks that may involve an internationally distributed common foodborne source. After computerized linking of epidemiologic data to aligned sequences, we retrospectively identified 100 individually reported outbreaks that potentially represented 14 international common source events in Europe during 1999-2008. Analysis of capsid sequences of outbreak strains (n = 1,456), showed that ≈7% of outbreaks reported to the Foodborne Viruses in Europe database were part of an international event (range 2%-9%), compared with 0.4% identified through standard epidemiologic investigations. Our findings point to a critical gap in surveillance and suggest that international collaboration could have increased the number of recognized international foodborne outbreaks. Real-time exchange of combined epidemiologic and molecular data is needed to validate our findings through timely trace-backs of clustered outbreaks.
当使用标准的暴发调查方法时，国际食源性诺如病毒暴发可能很难被识别。在一种新方法中，我们提供了逐步选择标准，以确定可能涉及国际分布的共同食源性来源的暴发集群。在将流行病学数据与对齐的序列进行计算机化链接后，我们回顾性地确定了 1999-2008 年期间在欧洲发生的 100 起单独报告的暴发，这些暴发可能代表了 14 起国际共同源事件。对暴发菌株衣壳序列的分析（n = 1456）表明，报告给欧洲食源性病毒数据库的暴发中，约有 7%（范围为 2%-9%）是国际事件的一部分，而通过标准流行病学调查确定的比例为 0.4%。我们的研究结果表明监测存在一个关键的差距，并表明国际合作本可以增加已识别的国际食源性暴发的数量。需要实时交换综合流行病学和分子数据，以通过及时回溯聚类暴发来验证我们的发现。
