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-Go'Mara, James Gray, Ben Lopman

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    130 Citations (Scopus)

    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 - May 2010

    Keywords

    • England
    • Monte Carlo method
    • Norovirus
    • gastroenteritis
    • incidence
    • primary health care
    • reverse transcriptase polymerase chain reaction

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