Kambhampati Anita K, Vargas Blanca, Mushtaq Mahwish, Browne Hannah, Grytdal Scott, Atmar Robert L, Vinjé Jan, Parashar Umesh D, Lopman Benjamin, Hall Aron J, Rodriguez-Barradas Maria C, Cardemil Cristina V
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
IHRC, Inc., Atlanta, Georgia.
Open Forum Infect Dis. 2019 Mar 6;6(4):ofz115. doi: 10.1093/ofid/ofz115. eCollection 2019 Apr.
Norovirus is a leading cause of acute gastroenteritis (AGE); however, few data exist on endemic norovirus disease burden among adults. Candidate norovirus vaccines are currently in development for all ages, and robust estimates of norovirus incidence among adults are needed to provide baseline data.
We conducted active surveillance for AGE among inpatients at a Veterans Affairs (VA) hospital in Houston, Texas. Patients with AGE (≥3 loose stools, ≥2 vomiting episodes, or ≥1 episode of both loose stool and vomiting, within 24 hours) within 10 days of enrollment and non-AGE control patients were enrolled. Demographic data and clinical characteristics were collected. Stool samples were tested using the FilmArray gastrointestinal panel; virus-positives were confirmed by real-time reverse transcription polymerase chain reaction and genotyped by sequencing.
From November 2, 2015 through November 30, 2016, 147 case patients and 19 control patients were enrolled and provided a stool specimen. Among case patients, 139 (95%) were male and 70 (48%) were aged ≥65 years. Norovirus was the leading viral pathogen detected (in 16 of 20 virus-positive case patients) and accounted for 11% of all AGE cases. No viral pathogens were detected among control patients. Incidence of norovirus-associated hospitalization was 20.3 cases/100 000 person-years and was similar among those aged <65 and ≥65 years.
This active surveillance platform employed screening and enrollment of hospitalized VA patients meeting a standardized AGE case definition, as well as non-AGE control patients. Data from this study highlight the burden of norovirus in a VA inpatient population and will be useful in policy considerations of a norovirus vaccine.
诺如病毒是急性胃肠炎（AGE）的主要病因；然而，关于成人中地方性诺如病毒疾病负担的数据很少。目前正在为所有年龄段开发候选诺如病毒疫苗，需要对成人中的诺如病毒发病率进行可靠估计以提供基线数据。
我们在得克萨斯州休斯顿的一家退伍军人事务（VA）医院对住院患者中的急性胃肠炎进行了主动监测。纳入了入院10天内出现急性胃肠炎（24小时内≥3次稀便、≥2次呕吐发作或≥1次稀便和呕吐发作）的患者以及非急性胃肠炎对照患者。收集了人口统计学数据和临床特征。使用FilmArray胃肠道检测板对粪便样本进行检测；病毒阳性通过实时逆转录聚合酶链反应确认，并通过测序进行基因分型。
从2015年11月2日至2016年11月30日，共纳入147例病例患者和19例对照患者并提供了粪便标本。病例患者中，139例（95%）为男性，70例（48%）年龄≥65岁。诺如病毒是检测到的主要病毒病原体（20例病毒阳性病例患者中有16例），占所有急性胃肠炎病例的11%。对照患者中未检测到病毒病原体。诺如病毒相关住院发病率为20.3例/10万人年，在年龄＜65岁和≥65岁的人群中相似。
这个主动监测平台采用了对符合标准化急性胃肠炎病例定义的住院退伍军人患者以及非急性胃肠炎对照患者进行筛查和纳入的方法。本研究的数据突出了诺如病毒在退伍军人住院患者群体中的负担，将有助于诺如病毒疫苗的政策考量。
