Emergence of new norovirus variants on spring cruise ships and prediction of winter epidemics

Linda Verhoef*, Evelyn Depoortere, Ingeborg Boxman, Erwin Duizer, Yvonne Van Duynhoven, John Harris, Christina Johnsen, Annelies Kroneman, Soizick Le Guyader, Wilina Lim, Leena Maunula, Hege Meldal, Rod Ratcliff, Gábor Reuter, Eckart Schreier, Joukje Siebenga, Kirsti Vainio, Carmen Varela, Harry Vennema, Marion Koopmans

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    94 Citations (Scopus)


    In June 2006, reported outbreaks of norovirus on cruise ships suddenly increased; 43 outbreaks occurred on 13 vessels. All outbreaks investigated manifested person-to-person transmission. Detection of a point source was impossible because of limited investigation of initial outbreaks and data sharing. The most probable explanation for these outbreaks is increased norovirus activity in the community, which coincided with the emergence of 2 new GGII.4 variant strains in Europe and the Pacific. As in 2002, a new GGII.4 variant detected in the spring and summer corresponded with high norovirus activity in the subsequent winter. Because outbreaks on cruise ships are likely to occur when new variants circulate, an active reporting system could function as an early warning system. Internationally accepted guidelines are needed for reporting, investigating, and controlling norovirus illness on cruise ships in Europe.

    Original languageEnglish
    Pages (from-to)238-243
    Number of pages6
    JournalEmerging Infectious Diseases
    Issue number2
    Publication statusPublished - Feb 2008


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