Risk Factors for Norovirus, Sapporo-like Virus, and Group A Rotavirus Gastroenteritis

Matty A.S. de Wit; Marion P.G. Koopmans; Yvonne T.H.P. van Duynhoven


Emerging Infectious Diseases. 2003;9(12) 

In This Article

Abstract and Introduction

Viral pathogens are the most common causes of gastroenteritis in the community. To identify modes of transmission and opportunities for prevention, a case-control study was conducted and risk factors for gastroenteritis attributable to norovirus (NV), Sapporo-like virus (SLV), and rotavirus were studied. For NV gastroenteritis, having a household member with gastroenteritis, contact with a person with gastroenteritis outside the household, and poor food-handling hygiene were associated with illness (population attributable risk fractions [PAR] of 17%, 56%, and 47%, respectively). For SLV gastroenteritis, contact with a person with gastroenteritis outside the household was associated with a higher risk (PAR 60%). For rotavirus gastroenteritis, contact with a person with gastroenteritis outside the household and food-handling hygiene were associated with a higher risk (PAR 86% and 46%, respectively). Transmission of these viral pathogens occurs primarily from person to person. However, for NV gastroenteritis, foodborne transmission seems to play an important role.

Recent studies in the Netherlands and other countries have shown that viral infections, especially noroviruses (NV), are the most frequent cause of gastroenteritis in the community, both outbreak-related and endemic.[1–8] The overall incidence of gastroenteritis in the Netherlands was estimated at 283 per 1,000 persons per year in a community-based study in 1999.[3] NV was detected in 11% of cases, Sapporo-like viruses (SLV) in 2%, and rotavirus group A in 4%. The incidence at the general-practice level from 1996 to 1999 was estimated at 14 per 1,000 person-years; 5% was attributed to NV, 2% to SLV, and 5% to rotavirus.[2,9] For rotavirus, preventive measures currently focus on developing vaccines to reduce hospitalizations in cases where the illness is complicated by dehydration. For caliciviruses, in spite of their high incidence, little effort has gone into prevention, and little is known about preventable routes of infection. Although possible transmission routes, such as food products or water supplies,[10,11] were identified in outbreaks, sources in endemic cases are difficult to detect. Therefore, we conducted a case-control study to identify risk factors that could provide leads for preventing endemic cases of viral gastroenteritis attributable to caliciviruses and rotavirus.


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