Increase in viral gastroenteritis outbreaks in Europe and epidemic spread of new norovirus variant

Ben Lopman, Harry Vennema, Evelyne Kohli, Pierre Pothier, Alicia Sanchez, Anabel Negredo, Javier Buesa, Eckart Schreier, Mark Reacher, David Brown, Jim Gray, Miren Iturriza, Chris Gallimore, Blenda Bottiger, Kjell Olof Hedlund, Maria Torvén, Carl Henrik Von Bonsdorff, Leena Maunula, Mateja Poljsak-Prijatelj, Janet ZimsekGábor Reuter, György Szücs, Béla Melegh, Lennart Svennson, Yvonne Van Duijnhoven, Marion Koopmans*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

454 Citations (Scopus)


Background Highly publicised outbreaks of norovirus gastroenteritis in hospitals in the UK and Ireland and cruise ships in the USA sparked speculation about whether this reported activity was unusual. Methods We analysed data collected through a collaborative research and surveillance network of viral gastroenteritis in ten European countries (England and Wales were analysed as one region). We compiled data on total number of outbreaks by month, and compared genetic sequences from the isolated viruses. Data were compared with historic data from a systematic retrospective review of surveillance systems and with a central database of viral sequences. Findings Three regions (England and Wales, Germany, and the Netherlands) had sustained epidemiological and viral characterisation data from 1995 to 2002. In all three, we noted a striking increase in norovirus outbreaks in 2002 that coincided with the detection and emergence of a new predominant norovirus variant of genogroup II4, which had a consistent mutation in the polymerase gene. Eight of nine regions had an annual peak in 2002 and the new genogroup II4 variant was detected in nine countries. Also, the detection of the new variant preceded an atypical spring and summer peak of outbreaks in three countries. Interpretation Our data from ten European countries show a striking increase and unusual seasonal pattern of norovirus gastroenteritis in 2002 that occurred concurrently with the emergence of a novel genetic variant. In addition to showing the added value of an international network for viral gastroenteritis outbreaks, these observations raise questions about the biological properties of the variant and the mechanisms for its rapid dissemination.

Original languageEnglish
Pages (from-to)682-688
Number of pages7
JournalThe Lancet
Issue number9410
Publication statusPublished - 28 Feb 2004

Bibliographical note

Funding Information:
This work was supported by the European Commission, Quality of Life Program, 5th Framework (QLK1-CT-1999-00594).


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