Community Incidence of Norovirus-associated Infectious Intestinal Disease in England: Improved Estimates Using Viral Load for Norovirus Diagnosis

Gemma Phillips*, Clarence C. Tam, Stefano Conti, Laura C. Rodrigues, David Brown, Miren Iturriza-Gomara, Jim Gray, Ben Lopman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Existing estimates of the incidence of infectious intestinal disease (IID) caused by norovirus are based on electron microscopy or reverse transcription-polymerase chain reaction (RT-PCR). Neither method accurately represents norovirus disease burden: Electron microscopy has poor diagnostic sensitivity, and RT-PCR has poor diagnostic specificity. In this study, viral load measurements were used to identify cases of norovirus-associated IID and to produce new incidence estimates for England. IID cases were ascertained in the Study of Infectious Intestinal Disease in England (1993-1996), and stool specimens were tested by semiquantitative real-time RT-PCR for norovirus. The age-adjusted community incidence of norovirus-associated IID was 4.5/100 person-years (95% credibility interval: 3.8, 5.2), equating to 2 million episodes/year. Among children aged less than 5 years, the community incidence was 21.4/100 person-years (95% credibility interval: 15.9, 27.7), and the incidence of consultations to general practitioners for norovirus-associated IID was 3.2/100 person-years (95% credibility interval: 2.6, 3.8), with 100,000 children visiting their general practitioner for norovirus-associated IID each year. Norovirus is the most common cause of IID in the community in England and is responsible for a similar number of pediatric primary care consultations as rotavirus.

Original languageEnglish
Pages (from-to)1014-1022
Number of pages9
JournalAmerican Journal of Epidemiology
Volume171
Issue number9
DOIs
Publication statusPublished - 1 May 2010

Keywords

  • England
  • gastroenteritis
  • incidence
  • Monte Carlo method
  • Norovirus
  • primary health care
  • reverse transcriptase polymerase chain reaction
  • VIRUS-LIKE PARTICLES
  • MOLECULAR EPIDEMIOLOGY
  • GASTROENTERITIS
  • OUTBREAKS
  • SURVEILLANCE
  • VOLUNTEERS
  • DIVERSITY
  • EMERGENCE
  • PATTERN
  • VARIANT

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