Hofmann Felix Martin, Michaelis Martina, Stößel Ulrich, Hofmann Friedrich
FFAS, Freiburger Forschungsstelle Arbeits- und Sozialmedizin, Freiburg im Breisgau.
Gesundheitswesen. 2021 May;83(5):357-362. doi: 10.1055/a-1076-8128. Epub 2020 Jan 21.
Only laboratory-confirmed norovirus (NoV) cases have to be notified to the Robert Koch Institute (RKI) since 2011, but not other, e. g. clinical-epidemiological cases. It can be assumed that the extent of underreporting of NoV cases in Germany has significantly increased since then.
To discuss the extent of underreporting, we wanted to find out how many laboratory tests were carried out during gastroenteritis outbreaks. Furthermore, the significance of NoV outbreaks in occupational health is discussed.
Of all pseudonymized gastroenteritis outbreak data reported to 2 local health authorities between 2011 and 2015, the proportion of NoV outbreaks and reported cases of infection among employees in hospitals and community facilities (nursing homes for the elderly, day-care centers, schools) confirmed by laboratory tests was calculated retrospectively.
Only a few gastroenteritis outbreaks in day-care centers were etiologically diagnosed, so that only 6% and less could be classified as NoV outbreaks. In nursing homes for the elderly, about half of the outbreaks were classified as NoV, in hospitals almost all of them. Employees accounted for up to 23% of those affected in NoV outbreaks.
The low level of laboratory diagnostics carried out during gastroenteritis outbreaks in day-care centers suggests a considerable number of hidden NoV cases. The significant proportion of staff relative to the total number of infected persons during the outbreaks highlights the importance of the burden of NoV outbreaks as a topic in occupational health. Further, large-scale prospective studies are needed to empirically substantiate these initial findings.
自2011年起，仅实验室确诊的诺如病毒（NoV）病例需通报给罗伯特·科赫研究所（RKI），其他病例，如临床流行病学病例则无需通报。可以推测，自那时起德国诺如病毒病例的漏报程度显著增加。
为探讨漏报程度，我们想了解在胃肠炎暴发期间进行了多少次实验室检测。此外，还讨论了诺如病毒暴发在职业健康中的重要性。
回顾性计算2011年至2015年间报告给2个地方卫生当局的所有匿名胃肠炎暴发数据中，诺如病毒暴发的比例以及医院和社区设施（老年护理院、日托中心、学校）员工中经实验室检测确诊的感染病例数。
日托中心仅有少数胃肠炎暴发得到病因诊断，因此只有6%及以下可归类为诺如病毒暴发。在老年护理院中，约一半的暴发归类为诺如病毒暴发，在医院中几乎所有暴发都归类为此类。在诺如病毒暴发中，员工占受影响者的比例高达23%。
日托中心胃肠炎暴发期间实验室诊断水平较低，表明存在大量隐匿的诺如病毒病例。暴发期间员工在总感染人数中所占的显著比例凸显了诺如病毒暴发负担作为职业健康话题的重要性。此外，需要大规模的前瞻性研究来实证证实这些初步发现。
