Lopman Benjamin A, Steele Duncan, Kirkwood Carl D, Parashar Umesh D
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Enteric & Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America.
PLoS Med. 2016 Apr 26;13(4):e1001999. doi: 10.1371/journal.pmed.1001999. eCollection 2016 Apr.
Globally, norovirus is associated with approximately one-fifth of all diarrhea cases, with similar prevalence in both children and adults, and is estimated to cause over 200,000 deaths annually in developing countries. Norovirus is an important pathogen in a number of high-priority domains: it is the most common cause of diarrheal episodes globally, the principal cause of foodborne disease outbreaks in the United States, a key health care-acquired infection, a common cause of travel-associated diarrhea, and a bane for deployed military troops. Partly as a result of this ubiquity and burden across a range of different populations, identifying target groups and strategies for intervention has been challenging. And, on top of the breadth of this public health problem, there remain important gaps in scientific knowledge regarding norovirus, especially with respect to disease in low-income settings. Many pathogens can cause acute gastroenteritis. Historically, rotavirus was the most common cause of severe disease in young children globally. Now, vaccines are available for rotavirus and are universally recommended by the World Health Organization. In countries with effective rotavirus vaccination programs, disease due to that pathogen has decreased markedly, but norovirus persists and is now the most common cause of pediatric gastroenteritis requiring medical attention. However, the data supporting the precise role of norovirus in low- and middle-income settings are sparse. With vaccines in the pipeline, addressing these and other important knowledge gaps is increasingly pressing. We assembled an expert group to assess the evidence for the global burden of norovirus and to consider the prospects for norovirus vaccine development. The group assessed the evidence in the areas of burden of disease, epidemiology, diagnostics, disease attribution, acquired immunity, and innate susceptibility, and the group considered how to bring norovirus vaccines from their current state of development to a viable product that will benefit global health.
在全球范围内，诺如病毒约占所有腹泻病例的五分之一，在儿童和成人中的患病率相似，据估计在发展中国家每年导致超过20万人死亡。诺如病毒是多个高度优先领域中的重要病原体：它是全球腹泻发作的最常见原因，是美国食源性疾病暴发的主要原因，是一种关键的医疗保健相关感染，是旅行相关腹泻的常见原因，也是部署军队的一大难题。部分由于其在一系列不同人群中的普遍存在和负担，确定目标群体和干预策略一直具有挑战性。而且，除了这个公共卫生问题的广度之外，关于诺如病毒的科学知识仍存在重要差距，特别是在低收入环境中的疾病方面。许多病原体可引起急性胃肠炎。历史上，轮状病毒是全球幼儿严重疾病的最常见原因。现在，有针对轮状病毒的疫苗，世界卫生组织普遍推荐使用。在实施有效轮状病毒疫苗接种计划的国家，由该病原体引起的疾病已显著减少，但诺如病毒仍然存在，现在是需要医疗护理的小儿胃肠炎的最常见原因。然而，支持诺如病毒在低收入和中等收入环境中确切作用的数据很少。随着疫苗即将问世，解决这些以及其他重要的知识差距变得越来越紧迫。我们组建了一个专家组，以评估诺如病毒全球负担的证据，并考虑诺如病毒疫苗开发的前景。该小组评估了疾病负担、流行病学、诊断、疾病归因、获得性免疫和先天易感性等领域的证据，并考虑如何将诺如病毒疫苗从目前的开发状态转变为一种将造福全球健康的可行产品。
