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. 2019 Dec 31;20(1):2.
doi: 10.1186/s12879-019-4726-4.

What proportion of care home outbreaks are caused by norovirus? An analysis of viral causes of gastroenteritis outbreaks in care homes, North East England, 2016-2018

Thomas Inns  1   2   3 , Deb Wilson  4 , Petra Manley  5 , John P Harris  6   7 , Sarah J O'Brien  6   7 , Roberto Vivancos  5   7   8
Affiliations

What proportion of care home outbreaks are caused by norovirus? An analysis of viral causes of gastroenteritis outbreaks in care homes, North East England, 2016-2018

Thomas Inns et al. BMC Infect Dis. .

Abstract

Background: Outbreaks of infectious gastroenteritis are common in care homes for the elderly. Norovirus can cause these outbreaks, but diagnosis is frequently based solely on clinical characteristics. Our objective in this study was to describe the epidemiology of norovirus and other gastrointestinal pathogens in these settings.

Methods: We analysed surveillance data from gastroenteritis outbreaks reported in North East England between 04 July 2016 to 01 July 2018. Stool samples taken during these outbreaks were tested for a range of viral and bacterial pathogens. We described the epidemiology of these outbreaks and explored the characteristics of norovirus outbreaks versus from other viral causes using multivariable logistic regression.

Results: From the 566 care home gastroenteritis outbreaks in this study, we found that norovirus was the pathogen most frequently isolated. Norovirus was detected in 64% of outbreaks with a pathogen identified. Sapovirus was found in 13%; rotavirus in 11%. We found that norovirus outbreaks were associated with higher attack rates (aOR 1.03, 95% CI 1.01-1.05) and fewer cases sampled (aOR 0.74, 95% CI 0.60-0.91), compared to outbreaks caused by other viral pathogens.

Conclusions: These results are important as they quantify the contribution of norovirus to gastroenteritis outbreaks in care homes. Given this evidence, we emphasize the importance of non-specific outbreak interventions that can affect the impact of all such outbreaks. We further recommend that these findings are used to inform the implementation strategies of any norovirus-specific interventions such as a norovirus vaccine.

Keywords: Gastroenteritis; Norovirus; Outbreaks; Surveillance.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Care home gastroenteritis outbreaks by month and year, North East England, 2016–2018. a Total number of outbreaks. b Percentage of outbreaks with a faecal sample submitted, with loess regression smoothed line (blue line) and 95% Confidence Interval (grey). c Percentage of outbreaks with a positive norovirus sample, with loess regression smoothed line (blue line) and 95% Confidence Interval (grey)
Fig. 2
Fig. 2
Boxplot showing the distribution of attack rates in residents during care home gastroenteritis outbreaks of astrovirus, norovirus, rotavirus and sapovirus (n = 256*), North East England, 2016–2018. *excluding one adenovirus outbreak
See this image and copyright information in PMC

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