Understanding norovirus reporting patterns in England: a mixed model approach

N. Ondrikova; H. E. Clough; N. A. Cunliffe; M. Iturriza-Gomara; R. Vivancos; J. P. Harris

doi:10.1186/s12889-021-11317-3

Understanding norovirus reporting patterns in England: a mixed model approach

N. Ondrikova^*, H. E. Clough, N. A. Cunliffe, M. Iturriza-Gomara, R. Vivancos, J. P. Harris

^*Corresponding author for this work

Field Epidemiology (North West)

Research output: Contribution to journal › Article › peer-review

8 Citations (Scopus)

18 Downloads (Pure)

Abstract

Background: Norovirus has a higher level of under-reporting in England compared to other intestinal infectious agents such as Campylobacter or Salmonella, despite being recognised as the most common cause of gastroenteritis globally. In England, this under-reporting is a consequence of the frequently mild/self-limiting nature of the disease, combined with the passive surveillance system for infectious diseases reporting. We investigated heterogeneity in passive surveillance system in order to improve understanding of differences in reporting and laboratory testing practices of norovirus in England.

Methods: The reporting patterns of norovirus relating to age and geographical region of England were investigated using a multivariate negative binomial model. Multiple model formulations were compared, and the best performing model was determined by proper scoring rules based on one-week-ahead predictions. The reporting patterns are represented by epidemic and endemic random intercepts; values close to one and less than one imply a lower number of reports than expected in the given region and age-group.

Results: The best performing model highlighted atypically large and small amounts of reporting by comparison with the average in England. Endemic random intercept varied from the lowest in East Midlands in those in the under 5 year age-group (0.36, CI 0.18–0.72) to the highest in the same age group in South West (3.00, CI 1.68–5.35) and Yorkshire & the Humber (2.93, CI 1.74–4.94). Reporting by age groups showed the highest variability in young children.

Conclusion: We identified substantial variability in reporting patterns of norovirus by age and by region of England. Our findings highlight the importance of considering uncertainty in the design of forecasting tools for norovirus, and to inform the development of more targeted risk management approaches for norovirus disease.

Original language	English
Article number	1245
Number of pages	9
Journal	BMC Public Health
Volume	21
Issue number	1
Early online date	28 Jun 2021
DOIs	https://doi.org/10.1186/s12889-021-11317-3
Publication status	Published - 28 Jun 2021

Bibliographical note

Funding Information: Nikola Ondrikova would like to acknowledge the gracious support of this work through the EPSRC and ESRC Centre for Doctoral Training on Quantification and Management of Risk Uncertainty in Complex Systems & Environments Grant No. (EP/L015927/1). Also, without surveillance data from Public Health England, none of this work would be possible.
EPSRC and ESRC Centre for Doctoral Training on Quantification and
Management of Risk Uncertainty in Complex Systems & Environments Grant
No. (EP/L015927/1). The funder had no role in the design of the study, data
analysis, interpretation of the results and in writing the manuscript.

Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Publisher Copyright: © 2021, The Author(s).

Citation: Ondrikova, N., Clough, H.E., Cunliffe, N.A. et al. Understanding norovirus reporting patterns in England: a mixed model approach. BMC Public Health 21, 1245 (2021).

DOI: https://doi.org/10.1186/s12889-021-11317-3

Keywords

HHH4
Mixed-effects
Negative binomial
Norovirus
Public health surveillance
Underestimation
DISEASE
SURVEILLANCE
GASTROENTERITIS

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Ondrikova2021UnderstandingNorovirusReportingPatternsBMCPublicHealthFinal published version, 2.5 MBLicence: CC BY

Cite this

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title = "Understanding norovirus reporting patterns in England: a mixed model approach",

abstract = "Background: Norovirus has a higher level of under-reporting in England compared to other intestinal infectious agents such as Campylobacter or Salmonella, despite being recognised as the most common cause of gastroenteritis globally. In England, this under-reporting is a consequence of the frequently mild/self-limiting nature of the disease, combined with the passive surveillance system for infectious diseases reporting. We investigated heterogeneity in passive surveillance system in order to improve understanding of differences in reporting and laboratory testing practices of norovirus in England. Methods: The reporting patterns of norovirus relating to age and geographical region of England were investigated using a multivariate negative binomial model. Multiple model formulations were compared, and the best performing model was determined by proper scoring rules based on one-week-ahead predictions. The reporting patterns are represented by epidemic and endemic random intercepts; values close to one and less than one imply a lower number of reports than expected in the given region and age-group. Results: The best performing model highlighted atypically large and small amounts of reporting by comparison with the average in England. Endemic random intercept varied from the lowest in East Midlands in those in the under 5 year age-group (0.36, CI 0.18–0.72) to the highest in the same age group in South West (3.00, CI 1.68–5.35) and Yorkshire \& the Humber (2.93, CI 1.74–4.94). Reporting by age groups showed the highest variability in young children. Conclusion: We identified substantial variability in reporting patterns of norovirus by age and by region of England. Our findings highlight the importance of considering uncertainty in the design of forecasting tools for norovirus, and to inform the development of more targeted risk management approaches for norovirus disease.",

keywords = "HHH4, Mixed-effects, Negative binomial, Norovirus, Public health surveillance, Underestimation, DISEASE, SURVEILLANCE, GASTROENTERITIS",

author = "N. Ondrikova and Clough, \{H. E.\} and Cunliffe, \{N. A.\} and M. Iturriza-Gomara and R. Vivancos and Harris, \{J. P.\}",

note = "Funding Information: Nikola Ondrikova would like to acknowledge the gracious support of this work through the EPSRC and ESRC Centre for Doctoral Training on Quantification and Management of Risk Uncertainty in Complex Systems \& Environments Grant No. (EP/L015927/1). Also, without surveillance data from Public Health England, none of this work would be possible. EPSRC and ESRC Centre for Doctoral Training on Quantification and Management of Risk Uncertainty in Complex Systems \& Environments Grant No. (EP/L015927/1). The funder had no role in the design of the study, data analysis, interpretation of the results and in writing the manuscript. Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Publisher Copyright: {\textcopyright} 2021, The Author(s). Citation: Ondrikova, N., Clough, H.E., Cunliffe, N.A. et al. Understanding norovirus reporting patterns in England: a mixed model approach. BMC Public Health 21, 1245 (2021). DOI: https://doi.org/10.1186/s12889-021-11317-3",

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AU - Cunliffe, N. A.

AU - Iturriza-Gomara, M.

AU - Vivancos, R.

AU - Harris, J. P.

N1 - Funding Information: Nikola Ondrikova would like to acknowledge the gracious support of this work through the EPSRC and ESRC Centre for Doctoral Training on Quantification and Management of Risk Uncertainty in Complex Systems & Environments Grant No. (EP/L015927/1). Also, without surveillance data from Public Health England, none of this work would be possible. EPSRC and ESRC Centre for Doctoral Training on Quantification and Management of Risk Uncertainty in Complex Systems & Environments Grant No. (EP/L015927/1). The funder had no role in the design of the study, data analysis, interpretation of the results and in writing the manuscript. Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Publisher Copyright: © 2021, The Author(s). Citation: Ondrikova, N., Clough, H.E., Cunliffe, N.A. et al. Understanding norovirus reporting patterns in England: a mixed model approach. BMC Public Health 21, 1245 (2021). DOI: https://doi.org/10.1186/s12889-021-11317-3

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N2 - Background: Norovirus has a higher level of under-reporting in England compared to other intestinal infectious agents such as Campylobacter or Salmonella, despite being recognised as the most common cause of gastroenteritis globally. In England, this under-reporting is a consequence of the frequently mild/self-limiting nature of the disease, combined with the passive surveillance system for infectious diseases reporting. We investigated heterogeneity in passive surveillance system in order to improve understanding of differences in reporting and laboratory testing practices of norovirus in England. Methods: The reporting patterns of norovirus relating to age and geographical region of England were investigated using a multivariate negative binomial model. Multiple model formulations were compared, and the best performing model was determined by proper scoring rules based on one-week-ahead predictions. The reporting patterns are represented by epidemic and endemic random intercepts; values close to one and less than one imply a lower number of reports than expected in the given region and age-group. Results: The best performing model highlighted atypically large and small amounts of reporting by comparison with the average in England. Endemic random intercept varied from the lowest in East Midlands in those in the under 5 year age-group (0.36, CI 0.18–0.72) to the highest in the same age group in South West (3.00, CI 1.68–5.35) and Yorkshire & the Humber (2.93, CI 1.74–4.94). Reporting by age groups showed the highest variability in young children. Conclusion: We identified substantial variability in reporting patterns of norovirus by age and by region of England. Our findings highlight the importance of considering uncertainty in the design of forecasting tools for norovirus, and to inform the development of more targeted risk management approaches for norovirus disease.

AB - Background: Norovirus has a higher level of under-reporting in England compared to other intestinal infectious agents such as Campylobacter or Salmonella, despite being recognised as the most common cause of gastroenteritis globally. In England, this under-reporting is a consequence of the frequently mild/self-limiting nature of the disease, combined with the passive surveillance system for infectious diseases reporting. We investigated heterogeneity in passive surveillance system in order to improve understanding of differences in reporting and laboratory testing practices of norovirus in England. Methods: The reporting patterns of norovirus relating to age and geographical region of England were investigated using a multivariate negative binomial model. Multiple model formulations were compared, and the best performing model was determined by proper scoring rules based on one-week-ahead predictions. The reporting patterns are represented by epidemic and endemic random intercepts; values close to one and less than one imply a lower number of reports than expected in the given region and age-group. Results: The best performing model highlighted atypically large and small amounts of reporting by comparison with the average in England. Endemic random intercept varied from the lowest in East Midlands in those in the under 5 year age-group (0.36, CI 0.18–0.72) to the highest in the same age group in South West (3.00, CI 1.68–5.35) and Yorkshire & the Humber (2.93, CI 1.74–4.94). Reporting by age groups showed the highest variability in young children. Conclusion: We identified substantial variability in reporting patterns of norovirus by age and by region of England. Our findings highlight the importance of considering uncertainty in the design of forecasting tools for norovirus, and to inform the development of more targeted risk management approaches for norovirus disease.

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Understanding norovirus reporting patterns in England: a mixed model approach

Abstract

Bibliographical note

Keywords

UN SDGs

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