Materiały źródłowe

• #1 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9622243/

  Knowledge of the epidemiology of sporadic acute gastroenteritis (AGE) in the United States is limited. During September 2016September 2017, we surveyed Kaiser Permanente Northwest members in Oregon and Washington, USA, to collect data on the 30-day prevalence of dually defined AGE and diarrhea disease and related health-seeking behavior; from a subset of participants, we obtained a stool specimen. We estimated a 30-day prevalence of 10.4% for AGE and 7.6% for diarrhea only; annual rates were 1.27 cases/person/year for AGE and 0.92 cases/person/year for diarrhea only. Of those with AGE, 19% sought medical care. Almost one quarter (22.4%) of stool specimens from those reporting AGE tested positive for 1 viral pathogen, compared with 8.2% from those without AGE. […] In the United States, the incidence of acute gastroenteritis (AGE) is high. AGE is estimated to cause 179 million illnesses annually. Precise data are limited on the occurrence and characteristics of sporadic AGE, particularly because the illnesses are generally mild and usually do not require medical care; may not have had diagnostic testing even if care was sought; and, depending on the pathogen, may not be reportable through public health surveillance systems. Previous US publications, using data from the US Foodborne Diseases Active Surveillance Network (FoodNet), have reported AGE prevalence ranging from 7.7 to 11%, equivalent to roughly 0.71.4 illnesses/person/year, depending on the recall period (i.e., 7 or 28 days) and symptom profile (i.e., diarrheal illness alone or with the presence of additional symptoms).

• #2 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States – Volume 28, Number 11—November 2022 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/28/11/22-0247_article

  Knowledge of the epidemiology of sporadic acute gastroenteritis (AGE) in the United States is limited. During September 2016September 2017, we surveyed Kaiser Permanente Northwest members in Oregon and Washington, USA, to collect data on the 30-day prevalence of dually defined AGE and diarrhea disease and related health-seeking behavior; from a subset of participants, we obtained a stool specimen. We estimated a 30-day prevalence of 10.4% for AGE and 7.6% for diarrhea only; annual rates were 1.27 cases/person/year for AGE and 0.92 cases/person/year for diarrhea only. Of those with AGE, 19% sought medical care. Almost one quarter (22.4%) of stool specimens from those reporting AGE tested positive for 1 viral pathogen, compared with 8.2% from those without AGE. […] In the United States, the incidence of acute gastroenteritis (AGE) is high. AGE is estimated to cause 179 million illnesses annually. Precise data are limited on the occurrence and characteristics of sporadic AGE, particularly because the illnesses are generally mild and usually do not require medical care; may not have had diagnostic testing even if care was sought; and, depending on the pathogen, may not be reportable through public health surveillance systems. Previous US publications, using data from the US Foodborne Diseases Active Surveillance Network (FoodNet), have reported AGE prevalence ranging from 7.7 to 11%, equivalent to roughly 0.71.4 illnesses/person/year, depending on the recall period (i.e., 7 or 28 days) and symptom profile (i.e., diarrheal illness alone or with the presence of additional symptoms). These studies have been essential in establishing estimates of AGE incidence in the community and highlighting the substantial burden of disease.

• #3 Gastroenteritis – Wikipedia

  https://en.wikipedia.org/wiki/Gastroenteritis

  It is estimated that there were two billion cases of gastroenteritis that resulted in 1.3 million deaths globally in 2015. […] Children and those in the developing world are most commonly affected. […] As of 2011, in those younger than five, there were about 1.7 billion cases resulting in 0.7 million deaths, with most of these occurring in the world’s poorest nations. […] More than 450,000 of these fatalities are due to rotavirus in children under five years of age. […] Cholera causes about three to five million cases of disease and kills approximately 100,000 people yearly. […] In the developing world, children less than two years of age frequently get six or more infections a year that result in significant gastroenteritis. […] It is less common in adults, partly due to the development of acquired immunity.

• #4

  https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease

  Diarrhoeal disease is the third leading cause of death in children under 5 years old and is responsible for killing around 443 832 children every year. […] Diarrhoeal disease is a leading cause of child mortality and morbidity in the world, and mostly results from contaminated food and water sources. […] Diarrhoea due to infection is widespread throughout developing countries. […] Diarrhoea is a leading cause of malnutrition in children under 5 years old. […] Diarrhoea is a symptom of infections caused by a host of bacterial, viral and parasitic organisms, most of which are spread by faeces-contaminated water. […] Infection is more common when there is a shortage of adequate sanitation and hygiene and safe water for drinking, cooking and cleaning. […] Diarrhoeal disease can also spread from person-to-person, aggravated by poor personal hygiene.

• #5 Diarrhea: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/928598-overview

  In the United States, one estimate before the introduction of specific antirotavirus immunization in 2006 assumed a cumulative incidence of 1 hospitalization for diarrhea per 23-27 children by age 5 years, with more than 50,000 hospitalizations. By these estimates, rotavirus was associated with 4-5% of all childhood hospitalizations and a cost of nearly $ 1 billion. Furthermore, acute diarrhea is responsible for 20% of physician referrals in children younger than 2 years and for 10% in children younger than 3 years. […] The impact of vaccination on rotavirus morbidity has been remarkable, with significant reduction of diarrhea-associated hospitalizations and visits to emergency departments in children in the years 2007-2008 compared with the prevaccine period. […] In developing countries, an average of 3 episodes per child per year in children younger than 5 years is reported; however, some areas report 6-8 episodes per year per child. In these settings, malnutrition is an important additional risk factor for diarrhea, and recurrent episodes of diarrhea lead to growth faltering and substantially increased mortality.

• #6 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States – Volume 28, Number 11—November 2022 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/28/11/22-0247_article

  Knowledge of the epidemiology of sporadic acute gastroenteritis (AGE) in the United States is limited. During September 2016September 2017, we surveyed Kaiser Permanente Northwest members in Oregon and Washington, USA, to collect data on the 30-day prevalence of dually defined AGE and diarrhea disease and related health-seeking behavior; from a subset of participants, we obtained a stool specimen. We estimated a 30-day prevalence of 10.4% for AGE and 7.6% for diarrhea only; annual rates were 1.27 cases/person/year for AGE and 0.92 cases/person/year for diarrhea only. Of those with AGE, 19% sought medical care. Almost one quarter (22.4%) of stool specimens from those reporting AGE tested positive for 1 viral pathogen, compared with 8.2% from those without AGE. […] In the United States, the incidence of acute gastroenteritis (AGE) is high. AGE is estimated to cause 179 million illnesses annually. Precise data are limited on the occurrence and characteristics of sporadic AGE, particularly because the illnesses are generally mild and usually do not require medical care; may not have had diagnostic testing even if care was sought; and, depending on the pathogen, may not be reportable through public health surveillance systems. Previous US publications, using data from the US Foodborne Diseases Active Surveillance Network (FoodNet), have reported AGE prevalence ranging from 7.7 to 11%, equivalent to roughly 0.71.4 illnesses/person/year, depending on the recall period (i.e., 7 or 28 days) and symptom profile (i.e., diarrheal illness alone or with the presence of additional symptoms). These studies have been essential in establishing estimates of AGE incidence in the community and highlighting the substantial burden of disease.

• #7 Pediatric Gastroenteritis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/964131-overview

  Children in the United States experience, on average, 1.3-2.3 episodes of diarrhea each year. Overall, acute gastroenteritis accounts for than 1.5 million outpatient visits, 220,000 hospitalizations, and direct costs of more than $2 billion each year in the United States alone. […] Worldwide, children younger than 5 years have an estimated 1.7 billion episodes of diarrhea each year, leading to 124 million clinic visits, 9 million hospitalizations, and 1.34 million deaths, with more than 98% of these deaths occurring in the developing world. […] Although the prevalence of acute gastroenteritis in children has changed little over the past 4 decades, mortality has declined sharply, from 4.6 million in the 1970s to 3 million in the 1980s and 2.5 million in the 1990s. One of the most important reasons for this decline has been the increasing international support for the use of oral rehydration solution (ORS) as the treatment of choice for acute diarrhea, with the proportion of diarrheal episodes treated with ORS rising from 15% in 1984 to 40% in 1993.

• #8 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9622243/

  Among persons with AGE, 12%20% have reported visiting a healthcare provider to manage their symptoms, and AGE has been estimated to contribute to 23 million ambulatory visits and 900,000 hospitalizations per year in the United States. However, these data have relied on samples of persons within a geographic area who may differentially seek care depending on if they have medical insurance or access to an affordable care source. As a result, these studies may not accurately estimate the true potential burden on a healthcare system. […] Overall, 395 participants met our primary AGE case definition, resulting in a 30-day AGE age-weighted prevalence of 10.4%, equivalent to a rate of 1.27 cases/person/year. Among those participants, 23% reported both diarrhea and vomiting, 50% reported only diarrhea, and 27% reported only vomiting. A total of 289 participants reported having acute diarrhea, resulting in a 30-day diarrheal prevalence of 7.6%, equivalent to a rate of 0.92 cases/person/year.

• #9 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States – Volume 28, Number 11—November 2022 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/28/11/22-0247_article

  To better characterize the incidence of AGE in the community, the associated healthcare utilization, and the prevalence of viral enteropathogens among both symptomatic and asymptomatic persons, we conducted the Community Acute Gastroenteritis (CAGE) Study among the membership population of a large, integrated healthcare system. The aims of the CAGE Study were to generate 30-day prevalence and annualized incidence estimates of AGE occurrence across the age spectrum, describe the proportion of symptomatic persons seeking healthcare, and calculate the prevalence of enteric viral pathogens among those who did and did not report AGE. […] Overall, 395 participants met our primary AGE case definition, resulting in a 30-day AGE age-weighted prevalence of 10.4%, equivalent to a rate of 1.27 cases/person/year. Among those participants, 23% reported both diarrhea and vomiting, 50% reported only diarrhea, and 27% reported only vomiting. A total of 289 participants reported having acute diarrhea, resulting in a 30-day diarrheal prevalence of 7.6%, equivalent to a rate of 0.92 cases/person/year.

• #10 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States – Volume 28, Number 11—November 2022 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/28/11/22-0247_article

  To better characterize the incidence of AGE in the community, the associated healthcare utilization, and the prevalence of viral enteropathogens among both symptomatic and asymptomatic persons, we conducted the Community Acute Gastroenteritis (CAGE) Study among the membership population of a large, integrated healthcare system. The aims of the CAGE Study were to generate 30-day prevalence and annualized incidence estimates of AGE occurrence across the age spectrum, describe the proportion of symptomatic persons seeking healthcare, and calculate the prevalence of enteric viral pathogens among those who did and did not report AGE. […] Overall, 395 participants met our primary AGE case definition, resulting in a 30-day AGE age-weighted prevalence of 10.4%, equivalent to a rate of 1.27 cases/person/year. Among those participants, 23% reported both diarrhea and vomiting, 50% reported only diarrhea, and 27% reported only vomiting. A total of 289 participants reported having acute diarrhea, resulting in a 30-day diarrheal prevalence of 7.6%, equivalent to a rate of 0.92 cases/person/year.

• #11 Pulsenotes | Gastroenteritis

  https://app.pulsenotes.com/medicine/infectious-diseases/notes/gastroenteritis

  Gastroenteritis is estimated to affect 1 in 5 people in the UK each year. […] Gastroenteritis is one of the leading causes of death in children under 5 years old in resource-limited countries. Here, it is estimated to account for up to 2 million deaths annually. […] An estimated 20% of the UK population develop symptoms of gastroenteritis each year, but only 1 in 30 present to healthcare services.

• #12 Epidemiology, aetiology and seasonality of infectious diarrhoea in adult outpatients through active surveillance in Shanghai, China, 2012–2016: a cross-sectional study | BMJ Open

  https://bmjopen.bmj.com/content/8/9/e019699

  This study also demonstrated the seasonality of adult infectious diarrhoea and relevant contribution of different enteric pathogens in seasonal trend. A seasonal distribution of adult infectious diarrhoea was observed with a large peak in winter and a small peak in summer. Winter peak was mainly due to norovirus and rotavirus, which was in line with previous study. Summer peak was smaller, due to low proportion of bacterial infections. What should be noted was that there was a peak around March due to norovirus in 2014-2016, even higher than the summer peak in 2015-2016 season cycle. This emerging spring peak was possibly because of the increased activity of a novel norovirus GII.17. […] Our findings highlight the necessity for conducting an active, comprehensive surveillance for both bacterial and viral enteric pathogens in adults, to monitor the changing dynamics in the epidemiology and aetiology of infectious diarrhoea. These findings help us to understand adult infectious diarrhoea better and to develop targeted prevention strategies.

• #13 Norovirus | Mass.gov

  https://www.mass.gov/info-details/norovirus

  Norovirus is the leading cause of acute gastroenteritis among people of all ages in the United States. It is possible to get sick at any time of the year, but illnesses are most common between November and April. […] Noroviruses are very contagious and can be found in the stool or vomit of infected people. People get sick by accidentally getting tiny particles of stool or vomit in their mouth from a person infected with norovirus. […] Anyone can get infected with norovirus. Children younger than 5 years old, older adults, and people with weakened immune systems are more likely to develop severe infections. […] People with norovirus infection are most contagious when they have symptoms, especially vomiting, and during the first few days after feeling better. Studies have shown that you can still spread norovirus for two weeks or more after you feel better.

• #14

  https://www.gov.uk/government/collections/gastrointestinal-infections-guidance-data-and-analysis

  Infectious intestinal diseases affect 1 in 5 people in the UK each year and symptoms are not confined to diarrhoea and vomiting. […] Gastrointestinal infections cause an estimated 17 million cases in the UK each year. Bacterial gastroenteritis is particularly common in summer months and outbreaks of zoonotic infections, such as campylobacteriosis, salmonellosis and Shiga toxin-producing E. coli (STEC) occur every year. […] During the coronavirus (COVID-19) pandemic, the UK Government advice to stay at home and social distancing strategies have changed patterns of shopping, cooking and food consumption in the population. It is therefore important to be highly vigilant of complicated cases of gastroenteritis in the coming months. […] Foodborne and non-foodborne gastrointestinal outbreaks surveillance.

• #15 Epidemiology, aetiology and seasonality of infectious diarrhoea in adult outpatients through active surveillance in Shanghai, China, 2012–2016: a cross-sectional study | BMJ Open

  https://bmjopen.bmj.com/content/8/9/e019699

  This study is the first study in Shanghai to identify the aetiology and epidemiology of adult infectious diarrhoea in sporadic outpatients from a continuous active diarrhoea surveillance enhanced with comprehensive laboratory testing for common enteric bacteria and virus. It also adds to the limited number of studies investigating adult cases of infectious diarrhoea in China. The Shanghai diarrhoea comprehensive surveillance system used PPS sampling method and was conducted among 22 sentinel hospitals in all 16 districts of Shanghai continuously since May 2012, data from which are more representative and more feasible to be extrapolated to the city’s population by avoiding the influence of clusters and season-specific cases. […] Aetiology of adult infectious diarrhoea in Shanghai was detailed in this study. At least one enteric pathogen was found in 47.96% of adult diarrhoea patients stools. Viral infections are predominant and bacteria were isolated from many cases. These findings were consistent with those of Wang’s research in Beijing. We found that norovirus was the most common enteric pathogen, accounting for over 40% of all cases, followed by rotavirus, V. parahaemolyticus, DEC and Salmonella spp. The proportion of norovirus was higher than the sum proportion of rotavirus, V. parahaemolyticus, DEC and Salmonella spp. This result confirmed norovirus’s leading role in adult infectious diarrhoea in China, and was similar to the research finding in sporadic gastroenteritis in both low/middle-income and developed countries.

• #16 Norovirus | Norovirus | CDC

  https://www.cdc.gov/norovirus/index.html

  Norovirus is the leading cause of vomiting and diarrhea, and foodborne illness in the United States. […] Identify surveillance and reporting systems for norovirus and different roles in reporting. […] Compare differences across the CDC systems used for reporting norovirus outbreaks.

• #17 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States – Volume 28, Number 11—November 2022 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/28/11/22-0247_article

  Knowledge of the epidemiology of sporadic acute gastroenteritis (AGE) in the United States is limited. During September 2016September 2017, we surveyed Kaiser Permanente Northwest members in Oregon and Washington, USA, to collect data on the 30-day prevalence of dually defined AGE and diarrhea disease and related health-seeking behavior; from a subset of participants, we obtained a stool specimen. We estimated a 30-day prevalence of 10.4% for AGE and 7.6% for diarrhea only; annual rates were 1.27 cases/person/year for AGE and 0.92 cases/person/year for diarrhea only. Of those with AGE, 19% sought medical care. Almost one quarter (22.4%) of stool specimens from those reporting AGE tested positive for 1 viral pathogen, compared with 8.2% from those without AGE. […] In the United States, the incidence of acute gastroenteritis (AGE) is high. AGE is estimated to cause 179 million illnesses annually. Precise data are limited on the occurrence and characteristics of sporadic AGE, particularly because the illnesses are generally mild and usually do not require medical care; may not have had diagnostic testing even if care was sought; and, depending on the pathogen, may not be reportable through public health surveillance systems. Previous US publications, using data from the US Foodborne Diseases Active Surveillance Network (FoodNet), have reported AGE prevalence ranging from 7.7 to 11%, equivalent to roughly 0.71.4 illnesses/person/year, depending on the recall period (i.e., 7 or 28 days) and symptom profile (i.e., diarrheal illness alone or with the presence of additional symptoms). These studies have been essential in establishing estimates of AGE incidence in the community and highlighting the substantial burden of disease.

• #18 Sentinel Diarrhoeal Disease Surveillance: South Africa 2022 Insights

  https://www.phbsa.ac.za/diarrhoeal-disease-surveillance-2022/

  Diarrhoeal diseases refer to a group of illnesses that involve the passage of loose or watery stools, often accompanied by an increased frequency of bowel movements. […] Diarrhoeal diseases can range in severity from mild and self-limiting to severe and life-threatening. […] The Diarrhoeal Diseases Syndromic Surveillance (DDSS) is a system that was set up in April 2009 to keep an eye on severe cases of diarrhoea, especially in children under 5 years old, after the introduction of the rotavirus vaccine. […] This surveillance system aims to understand and monitor the impact of the vaccine on reducing severe diarrhoea. […] Diarrhoeal diseases are still a significant health issue in South Africa, and not everyone who gets sick with diarrhoea has their stool tested. […] Overall, it helps in understanding and managing the impact of diarrhoeal diseases in the population.

• #19 Epidemiology, aetiology and seasonality of infectious diarrhoea in adult outpatients through active surveillance in Shanghai, China, 2012–2016: a cross-sectional study | BMJ Open

  https://bmjopen.bmj.com/content/8/9/e019699

  This study is the first study in Shanghai to identify the aetiology and epidemiology of adult infectious diarrhoea in sporadic outpatients from a continuous active diarrhoea surveillance enhanced with comprehensive laboratory testing for common enteric bacteria and virus. It also adds to the limited number of studies investigating adult cases of infectious diarrhoea in China. The Shanghai diarrhoea comprehensive surveillance system used PPS sampling method and was conducted among 22 sentinel hospitals in all 16 districts of Shanghai continuously since May 2012, data from which are more representative and more feasible to be extrapolated to the city’s population by avoiding the influence of clusters and season-specific cases. […] Aetiology of adult infectious diarrhoea in Shanghai was detailed in this study. At least one enteric pathogen was found in 47.96% of adult diarrhoea patients stools. Viral infections are predominant and bacteria were isolated from many cases. These findings were consistent with those of Wang’s research in Beijing. We found that norovirus was the most common enteric pathogen, accounting for over 40% of all cases, followed by rotavirus, V. parahaemolyticus, DEC and Salmonella spp. The proportion of norovirus was higher than the sum proportion of rotavirus, V. parahaemolyticus, DEC and Salmonella spp. This result confirmed norovirus’s leading role in adult infectious diarrhoea in China, and was similar to the research finding in sporadic gastroenteritis in both low/middle-income and developed countries.

• #20 Epidemiology of norovirus and viral gastroenteritis in Ontario, Canada, 2009–2014 – Canada.ca

  https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2021-47/issue-10-october-2021/epidemiology-norovirus-viral-gastroenteritis-ontario-canada-2009-2014.html

  Norovirus is the most common cause of acute gastroenteritis in Canada. The objective of this article is to describe the epidemiology of norovirus in the province of Ontario, Canada from 2009 to 2014. To assess activity of norovirus and viral gastroenteritis (VGE) in Ontario, three datasets were acquired from the provincial government: two traditional surveillance datasets (outbreak and laboratory) and syndromic surveillance data (telehealth), all spanning 2009-2014. Between 2009 and 2014, 41.5% of VGE outbreaks, 63.4% of VGE laboratory submissions and 36.6% of all acute gastroenteritis-related telehealth calls were attributed to norovirus and norovirus-like illness in Ontario. Norovirus and norovirus-like illnesses were the leading cause of VGE in Ontario between 2009 and 2014. This study describes the epidemiology of VGE and, specifically, norovirus in the province of Ontario, Canada between 2009 and 2014. Our study demonstrates that norovirus is a highly prevalent illness and the most dominant cause of VGE in the province.

• #21 Epidemiology of norovirus and viral gastroenteritis in Ontario, Canada, 2009–2014 – Canada.ca

  https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2021-47/issue-10-october-2021/epidemiology-norovirus-viral-gastroenteritis-ontario-canada-2009-2014.html

  Norovirus is the most common cause of acute gastroenteritis in Canada. The objective of this article is to describe the epidemiology of norovirus in the province of Ontario, Canada from 2009 to 2014. To assess activity of norovirus and viral gastroenteritis (VGE) in Ontario, three datasets were acquired from the provincial government: two traditional surveillance datasets (outbreak and laboratory) and syndromic surveillance data (telehealth), all spanning 2009-2014. Between 2009 and 2014, 41.5% of VGE outbreaks, 63.4% of VGE laboratory submissions and 36.6% of all acute gastroenteritis-related telehealth calls were attributed to norovirus and norovirus-like illness in Ontario. Norovirus and norovirus-like illnesses were the leading cause of VGE in Ontario between 2009 and 2014. This study describes the epidemiology of VGE and, specifically, norovirus in the province of Ontario, Canada between 2009 and 2014. Our study demonstrates that norovirus is a highly prevalent illness and the most dominant cause of VGE in the province.

• #22 Norovirus | Health & Human Services

  https://hhs.iowa.gov/center-acute-disease-epidemiology/epi-manual/information-other-diseases-and-conditions-fact-sheets/norovirus

  Iowa Administrative Code 641-1.3(139) stipulates that the laboratory and the healthcare provider must immediately report suspected or confirmed outbreaks. […] Disease reporting regulations require that suspected or confirmed outbreaks, including norovirus, be reported to local public health agencies by the most rapid means available within 24 hours.

• #23

  https://portal.ct.gov/dph/epidemiology-and-emerging-infections/ctepi/volumes/42/no-2/a1

  On May 12, 2021, the Connecticut Department of Public Health (DPH) was notified by a local health department (LHD) of a possible foodborne outbreak among patrons of a food service establishment (FSE) in Tolland County. […] A case was defined as an individual experiencing vomiting and/or diarrhea (3 loose stools in 24 hours) who ate from the FSE between May 8, 2021 May 16, 2021. […] Reported symptoms included nausea (n=105 [95%]), vomiting (n=102 [93%]) and diarrhea (n=102 [93%]). […] Norovirus is the most common cause of foodborne outbreaks in the United States, accounting for about 50% of outbreaks (1). […] The epidemiologic, environmental, and laboratory investigation indicate that an outbreak of Norovirus occurred among patrons of FSE in Tolland County. […] To help prevent Norovirus outbreaks, it is important to avoid preparing foods while ill, wash hands carefully for at least 20 seconds with warm water and soap, and report suspected illness from consuming food to the state or local health department (2).

• #24

  http://space.gov.bm/print/html/node/226896

  Ministry reports increase in diarrhoea and vomiting illness in the community. The Epidemiology and Surveillance Unit (ESU) of the Ministry of Health would like to inform the public of an increase in diarrhoea and vomiting illness (gastroenteritis) in the community. An increase in reported cases over the last four weeks has caused the Ministry to issue a medium alert. […] Further updates will be given if the alert level rises or if a specific cause of the diarrhoea and vomiting is identified.

• #25 Causes of acute infectious diarrhea and other foodborne illnesses in resource-abundant settings – UpToDate

  https://www.uptodate.com/contents/causes-of-acute-infectious-diarrhea-and-other-foodborne-illnesses-in-resource-abundant-settings

  Most cases of acute diarrhea in adults are of infectious etiology and are self-limited. In resource-abundant settings, many diarrheal pathogens are transmitted through contaminated food or water, sometimes resulting in outbreaks. […] The infectious etiologies of acute diarrhea and other foodborne illnesses in resource-abundant countries will be reviewed here. […] The approach to evaluation and management of acute diarrhea in adults and children in resource-abundant settings is discussed elsewhere. […] For most patients with acute diarrhea or other foodborne illness, the precise causative pathogen cannot be reliably distinguished based on clinical presentation alone. However, there are certain features that raise the probability of certain pathogens over others.

• #26 Gastroenteritis in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0201/p159.html

  Acute gastroenteritis is defined as a diarrheal disease of rapid onset, with or without nausea, vomiting, fever, or abdominal pain. In the United States, acute gastroenteritis accounts for 1.5 million office visits, 200,000 hospitalizations, and 300 deaths in children each year. […] Worldwide, 68% of diarrheal disease occurs in young children. Diarrheal disease is the fifth leading cause of death in children worldwide, accounting for about 2.5 million deaths. In the United States, acute gastroenteritis is not a major cause of death but leads to significant morbidity, especially in children younger than five years, accounting for 1.5 million office visits, 200,000 hospitalizations, and 300 deaths in children each year. […] This review focuses on acute gastroenteritis in children in industrialized nations, where viruses account for 75% to 90% of childhood acute infectious gastroenteritis. Approximately 20% of cases are due to bacteria. Diarrhea persisting for at least 14 days is more commonly caused by parasitic infections, which account for less than 5% of acute gastroenteritis cases. […] Handwashing, breastfeeding, and rotavirus vaccination reduce the incidence of acute gastroenteritis in young children.

• #27 Gastroenteritis in Adults and Older Children | Doctor

  https://patient.info/doctor/gastroenteritis-in-adults-and-older-children

  Gastroenteritis is caused by a variety of viral (for example, norovirus, rotavirus and adenovirus), bacterial (for example, Campylobacter spp., Escherichia coli O157, Salmonella spp., Shigella spp., or toxins from Staphylococcus aureus, Bacillus cereus or Clostridium perfringens) and parasitic pathogens (for example, Cryptosporidium spp., Entamoeba histolytica (amoebiasis) or Giardia lamblia). […] Gastrointestinal infections cause an estimated 17 million cases in the UK each year. Bacterial gastroenteritis is particularly common in summer months and outbreaks of zoonotic infections, such as campylobacteriosis, salmonellosis and Shiga toxin-producing E. coli (STEC) occur every year. […] Viral infections cause 30-40% of gastroenteritis cases in industrialised countries. The figure is higher for children. Norovirus is the most common cause of viral infectious gastroenteritis in adults in England and Wales.

• #28 Norovirus – UpToDate

  https://www.uptodate.com/contents/norovirus

  Norovirus is one of the leading causes of acute gastroenteritis (AGE) outbreaks and a main cause of childhood-endemic AGE worldwide. The epidemiology, virology, clinical manifestations, diagnosis, pathogenesis, and prevention of norovirus will be reviewed here. […] EPIDEMIOLOGY […] Burden of disease — Norovirus is the most common viral cause of epidemic gastroenteritis worldwide; it is also a common cause of endemic diarrhea in community settings. The highest frequency of norovirus infection occurs among infants less than 12 months of age. […] Each year in the United States, norovirus causes 19 to 21 million illnesses, including 900 deaths, 103,000 hospitalizations, 460,000 emergency department visits, and 2.6 million outpatient visits. In one surveillance study between 2014 to 2016 in the United States, the estimated incidence of medically attended episodes was 5.5 per 1000 person-years; the incidence was highest among children <5 years (20.4 per 1000 person-years) followed by adults ≥65 years (4.5 per 1000 person-years).

• #29 Gastroenteritis in Adults and Older Children | Doctor

  https://patient.info/doctor/gastroenteritis-in-adults-and-older-children

  Gastroenteritis is caused by a variety of viral (for example, norovirus, rotavirus and adenovirus), bacterial (for example, Campylobacter spp., Escherichia coli O157, Salmonella spp., Shigella spp., or toxins from Staphylococcus aureus, Bacillus cereus or Clostridium perfringens) and parasitic pathogens (for example, Cryptosporidium spp., Entamoeba histolytica (amoebiasis) or Giardia lamblia). […] Gastrointestinal infections cause an estimated 17 million cases in the UK each year. Bacterial gastroenteritis is particularly common in summer months and outbreaks of zoonotic infections, such as campylobacteriosis, salmonellosis and Shiga toxin-producing E. coli (STEC) occur every year. […] Viral infections cause 30-40% of gastroenteritis cases in industrialised countries. The figure is higher for children. Norovirus is the most common cause of viral infectious gastroenteritis in adults in England and Wales.

• #30 Norovirus – UpToDate

  https://www.uptodate.com/contents/norovirus

  Norovirus is one of the leading causes of acute gastroenteritis (AGE) outbreaks and a main cause of childhood-endemic AGE worldwide. The epidemiology, virology, clinical manifestations, diagnosis, pathogenesis, and prevention of norovirus will be reviewed here. […] EPIDEMIOLOGY […] Burden of disease — Norovirus is the most common viral cause of epidemic gastroenteritis worldwide; it is also a common cause of endemic diarrhea in community settings. The highest frequency of norovirus infection occurs among infants less than 12 months of age. […] Each year in the United States, norovirus causes 19 to 21 million illnesses, including 900 deaths, 103,000 hospitalizations, 460,000 emergency department visits, and 2.6 million outpatient visits. In one surveillance study between 2014 to 2016 in the United States, the estimated incidence of medically attended episodes was 5.5 per 1000 person-years; the incidence was highest among children <5 years (20.4 per 1000 person-years) followed by adults ≥65 years (4.5 per 1000 person-years).

• #31 Stomach Flu & Diarrhea: Causes, Symptoms, and Treatments | IMODIUM®

  https://www.imodium.com/what-causes-diarrhea/stomach-flu

  It is estimated that 179 million incidents of acute gastroenteritis occur annually in the United States, which can result in diarrhea. […] Norovirus is estimated to cause around 19 to 21 million cases of gastroenteritis in the U.S. annually with most outbreaks happening from November to April. There are about 2,500 norovirus outbreaks reported annually in the U.S. […] Rotavirus is a contagious stomach virus that causes severe diarrhea in infants and young children. Before a vaccine was introduced in 2006, almost all U.S. children were infected with rotavirus before their 5th birthday. Each year, the vaccine prevents an estimated 40,000 to 50,000 hospitalizations among infants and young children in the United States. […] Some adults may have a higher risk of getting rotavirus, including those who are older, those who care for children with rotavirus, or those with compromised immune systems. […] Healthy people are likely to recover from stomach flu or gastroenteritis without complications. However, some cases may warrant a call or trip to the doctor.

• #32 Diarrhea: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/928598-overview

  In the United States, one estimate before the introduction of specific antirotavirus immunization in 2006 assumed a cumulative incidence of 1 hospitalization for diarrhea per 23-27 children by age 5 years, with more than 50,000 hospitalizations. By these estimates, rotavirus was associated with 4-5% of all childhood hospitalizations and a cost of nearly $ 1 billion. Furthermore, acute diarrhea is responsible for 20% of physician referrals in children younger than 2 years and for 10% in children younger than 3 years. […] The impact of vaccination on rotavirus morbidity has been remarkable, with significant reduction of diarrhea-associated hospitalizations and visits to emergency departments in children in the years 2007-2008 compared with the prevaccine period. […] In developing countries, an average of 3 episodes per child per year in children younger than 5 years is reported; however, some areas report 6-8 episodes per year per child. In these settings, malnutrition is an important additional risk factor for diarrhea, and recurrent episodes of diarrhea lead to growth faltering and substantially increased mortality.

• #33 Gastroenteritis in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0201/p159.html

  Acute gastroenteritis is defined as a diarrheal disease of rapid onset, with or without nausea, vomiting, fever, or abdominal pain. In the United States, acute gastroenteritis accounts for 1.5 million office visits, 200,000 hospitalizations, and 300 deaths in children each year. […] Worldwide, 68% of diarrheal disease occurs in young children. Diarrheal disease is the fifth leading cause of death in children worldwide, accounting for about 2.5 million deaths. In the United States, acute gastroenteritis is not a major cause of death but leads to significant morbidity, especially in children younger than five years, accounting for 1.5 million office visits, 200,000 hospitalizations, and 300 deaths in children each year. […] This review focuses on acute gastroenteritis in children in industrialized nations, where viruses account for 75% to 90% of childhood acute infectious gastroenteritis. Approximately 20% of cases are due to bacteria. Diarrhea persisting for at least 14 days is more commonly caused by parasitic infections, which account for less than 5% of acute gastroenteritis cases. […] Handwashing, breastfeeding, and rotavirus vaccination reduce the incidence of acute gastroenteritis in young children.

• #34 Gastroenteritis in Adults and Older Children | Doctor

  https://patient.info/doctor/gastroenteritis-in-adults-and-older-children

  Gastroenteritis is caused by a variety of viral (for example, norovirus, rotavirus and adenovirus), bacterial (for example, Campylobacter spp., Escherichia coli O157, Salmonella spp., Shigella spp., or toxins from Staphylococcus aureus, Bacillus cereus or Clostridium perfringens) and parasitic pathogens (for example, Cryptosporidium spp., Entamoeba histolytica (amoebiasis) or Giardia lamblia). […] Gastrointestinal infections cause an estimated 17 million cases in the UK each year. Bacterial gastroenteritis is particularly common in summer months and outbreaks of zoonotic infections, such as campylobacteriosis, salmonellosis and Shiga toxin-producing E. coli (STEC) occur every year. […] Viral infections cause 30-40% of gastroenteritis cases in industrialised countries. The figure is higher for children. Norovirus is the most common cause of viral infectious gastroenteritis in adults in England and Wales.

• #35 Comparative study on epidemiological and etiological characteristics of patients with acute diarrhea with febrile or non-febrile symptoms in China | Infectious Diseases of Poverty | Full Text

  https://idpjournal.biomedcentral.com/articles/10.1186/s40249-023-01108-w

  Acute diarrhea with fever can potentially represent a more severe form of the disease compared to non-febrile diarrhea. This study was to investigate the epidemiological characteristics and enteric pathogen composition of febrile-diarrheal patients, and to explore factors including pathogens associated with fever by age group. […] A nationwide surveillance study of acute diarrheal patients of all ages was conducted in 217 sentinel hospitals from 31 provinces (autonomous regions or municipalities) in China between 2011 and 2020. […] A total of 146,296 patients with acute diarrhea (18.6% with fever) were tested. […] The febrile-diarrheal patients were associated with a significantly higher prevalence of bacterial pathogens than afebrile-diarrheal patients (all P<0.01). [...] There are significant discrepancy of the infected enteric pathogens in patients with acute diarrhea with fever between age groups, and it is valuable for priority detection of NTS and rotavirus A in patients with children 5 years old and NTS and DEC in adult patients.

• #36 Epidemiology, aetiology and seasonality of infectious diarrhoea in adult outpatients through active surveillance in Shanghai, China, 2012–2016: a cross-sectional study | BMJ Open

  https://bmjopen.bmj.com/content/8/9/e019699

  Diarrhoea is generally characterised by the frequent passage of loose or liquid stools. It is usually a symptom of gastrointestinal infections caused by bacterial, viral or parasitic pathogens, which spread through contaminated food or drinking water or from person to person. According to WHO, rotavirus and diarrhoeagenic Escherichia coli (DEC) are the two most common aetiological agents of diarrhoea in low/middle-income countries. However, norovirus was found the most prevalent pathogen of infectious diarrhoea in adults in Chinese Center For Disease Control And Prevention research, and Vibrio parahaemolyticus was the most common enteric pathogen in acute bacterial gastroenteritis. The aetiology of infectious diarrhoea differs among regions depending on economic development, local climate and geography.

• #37 Gastroenteritis in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0201/p159.html

  Acute gastroenteritis is defined as a diarrheal disease of rapid onset, with or without nausea, vomiting, fever, or abdominal pain. In the United States, acute gastroenteritis accounts for 1.5 million office visits, 200,000 hospitalizations, and 300 deaths in children each year. […] Worldwide, 68% of diarrheal disease occurs in young children. Diarrheal disease is the fifth leading cause of death in children worldwide, accounting for about 2.5 million deaths. In the United States, acute gastroenteritis is not a major cause of death but leads to significant morbidity, especially in children younger than five years, accounting for 1.5 million office visits, 200,000 hospitalizations, and 300 deaths in children each year. […] This review focuses on acute gastroenteritis in children in industrialized nations, where viruses account for 75% to 90% of childhood acute infectious gastroenteritis. Approximately 20% of cases are due to bacteria. Diarrhea persisting for at least 14 days is more commonly caused by parasitic infections, which account for less than 5% of acute gastroenteritis cases. […] Handwashing, breastfeeding, and rotavirus vaccination reduce the incidence of acute gastroenteritis in young children.

• #38 Gastroenteritis in Adults and Older Children | Doctor

  https://patient.info/doctor/gastroenteritis-in-adults-and-older-children

  Gastroenteritis is caused by a variety of viral (for example, norovirus, rotavirus and adenovirus), bacterial (for example, Campylobacter spp., Escherichia coli O157, Salmonella spp., Shigella spp., or toxins from Staphylococcus aureus, Bacillus cereus or Clostridium perfringens) and parasitic pathogens (for example, Cryptosporidium spp., Entamoeba histolytica (amoebiasis) or Giardia lamblia). […] Gastrointestinal infections cause an estimated 17 million cases in the UK each year. Bacterial gastroenteritis is particularly common in summer months and outbreaks of zoonotic infections, such as campylobacteriosis, salmonellosis and Shiga toxin-producing E. coli (STEC) occur every year. […] Viral infections cause 30-40% of gastroenteritis cases in industrialised countries. The figure is higher for children. Norovirus is the most common cause of viral infectious gastroenteritis in adults in England and Wales.

• #39

  https://bpac.org.nz/BT/2014/February/rural-infections.aspx

  Campylobacter, Salmonella, Cryptosporidium and Giardia cause diarrhoeal illnesses in thousands of people annually in New Zealand. The incidence of these infections is significantly higher in New Zealand compared to most other developed nations. […] From July to September, 2013 (the most recent surveillance period*), these four pathogens caused a total of 50 outbreaks and approximately 2880 confirmed illnesses. […] Approximately 10% of the notified cases in the reporting period were traced to an environmental, animal or waterborne source. […] Any illness caused by these four organisms is notifiable to the Medical Officer of Health. […] Campylobacter, Giardia, Salmonella and Cryptosporidium are all Section A infectious illnesses. Laboratory testing is required to confirm the illness for notification. Both culture or antigen testing are sufficiently accurate for notification purposes. […] Notification and surveillance are key components of managing and preventing communicable illnesses in New Zealand. The data gathered from these activities guides the direction and scope of local and national public health efforts and campaigns.

• #40

  https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease

  Key measures to prevent diarrhoea include access to safe drinking-water, use of improved sanitation, hand washing with soap, and health education about how infections spread. […] WHO works with Member States and other partners to promote national policies and investments that support case management of diarrhoea and its complications as well as increasing access to safe drinking-water and sanitation in developing countries.

• #41 Norovirus – Disease Surveillance Epidemiology Program – MeCDC; DHHS Maine

  https://www.maine.gov/dhhs/norovirus

  Norovirus is a very contagious virus that causes vomiting and diarrhea. Norovirus causes what is known as the „stomach flu.” People with norovirus can shed billions of norovirus particles, and it only takes a few virus particles to make others sick. This virus can spread rapidly through daycares, long term care facilities, and other congregate facilities. […] The most common symptoms of norovirus are: Diarrhea, Vomiting, Nausea, Stomach Pain. […] Norovirus spreads through contaminated food. Norovirus can easily contaminate food because it only takes a very small amount of virus particles to make you sick. […] Norovirus spreads through contaminated water. Recreational or drinking water can get contaminated with norovirus and make you sick or contaminate your food. […] Norovirus spreads through sick people and contaminated surfaces. Surfaces can get contaminated with norovirus in many ways, including when: An infected person touches the surface with their bare hands that have feces or vomit particles on them. […] How to prevent person-to-person transmission of norovirus: Wash your hands often and thoroughly, Handle and prepare food safely, When you are sick, do not prepare food or care for others, Clean and disinfect surfaces after someone vomits or has diarrhea, Wash laundry thoroughly.

• #42 Norovirus | Mass.gov

  https://www.mass.gov/info-details/norovirus

  Norovirus is the leading cause of acute gastroenteritis among people of all ages in the United States. It is possible to get sick at any time of the year, but illnesses are most common between November and April. […] Noroviruses are very contagious and can be found in the stool or vomit of infected people. People get sick by accidentally getting tiny particles of stool or vomit in their mouth from a person infected with norovirus. […] Anyone can get infected with norovirus. Children younger than 5 years old, older adults, and people with weakened immune systems are more likely to develop severe infections. […] People with norovirus infection are most contagious when they have symptoms, especially vomiting, and during the first few days after feeling better. Studies have shown that you can still spread norovirus for two weeks or more after you feel better.

• #43 Viral gastroenteritis (not rotavirus)

  https://www.health.vic.gov.au/infectious-diseases/viral-gastroenteritis-not-rotavirus

  Viral gastroenteritis is not notifiable, but cases should be excluded from schools or childcare centres until 48 hours after symptoms have stopped. […] Norovirus is recognised as the major cause of outbreaks of non-bacterial infectious gastroenteritis. […] The endemic burden of viral gastroenteritis is not known; however, approximately 80 per cent of gastroenteritis outbreaks investigated each year in Victoria are attributed to viral pathogens. […] High secondary attack rates result in outbreaks that are often prolonged and difficult to contain. […] An outbreak is defined as two or more related cases of gastroenteritis. […] The primary aim is to prevent further disease by identifying the source, cleaning contaminated environments and isolating cases. […] Viral gastroenteritis is predominantly spread via the faecal-oral route.

• #44 Norovirus – Disease Surveillance Epidemiology Program – MeCDC; DHHS Maine

  https://www.maine.gov/dhhs/norovirus

  Norovirus is a very contagious virus that causes vomiting and diarrhea. Norovirus causes what is known as the „stomach flu.” People with norovirus can shed billions of norovirus particles, and it only takes a few virus particles to make others sick. This virus can spread rapidly through daycares, long term care facilities, and other congregate facilities. […] The most common symptoms of norovirus are: Diarrhea, Vomiting, Nausea, Stomach Pain. […] Norovirus spreads through contaminated food. Norovirus can easily contaminate food because it only takes a very small amount of virus particles to make you sick. […] Norovirus spreads through contaminated water. Recreational or drinking water can get contaminated with norovirus and make you sick or contaminate your food. […] Norovirus spreads through sick people and contaminated surfaces. Surfaces can get contaminated with norovirus in many ways, including when: An infected person touches the surface with their bare hands that have feces or vomit particles on them. […] How to prevent person-to-person transmission of norovirus: Wash your hands often and thoroughly, Handle and prepare food safely, When you are sick, do not prepare food or care for others, Clean and disinfect surfaces after someone vomits or has diarrhea, Wash laundry thoroughly.

• #45 Norovirus | Health & Human Services

  https://hhs.iowa.gov/center-acute-disease-epidemiology/epi-manual/information-other-diseases-and-conditions-fact-sheets/norovirus

  Norovirus is common worldwide, and is mostly associated with sporadic outbreaks. […] Norovirus is the most common cause of acute gastroenteritis in the United States. Each year, it causes 19-21 million illnesses and contributes to 56,000-71,000 hospitalizations and 570-800 deaths. Norovirus is also the most common cause of foodborne-disease outbreaks in the United States. […] In Iowa, noroviruses cause the majority of foodborne illness outbreaks. […] Most outbreaks are due to person-to-person spread, but many are foodborne. […] There have also been outbreaks associated with people vomiting and aerosolizing virus in public settings. […] Diapered children playing in kiddie pools filled with tap water (pools that have not been chlorinated) have also been associated with norovirus outbreaks.

• #46 Norovirus | Mass.gov

  https://www.mass.gov/info-details/norovirus

  Norovirus is the leading cause of acute gastroenteritis among people of all ages in the United States. It is possible to get sick at any time of the year, but illnesses are most common between November and April. […] Noroviruses are very contagious and can be found in the stool or vomit of infected people. People get sick by accidentally getting tiny particles of stool or vomit in their mouth from a person infected with norovirus. […] Anyone can get infected with norovirus. Children younger than 5 years old, older adults, and people with weakened immune systems are more likely to develop severe infections. […] People with norovirus infection are most contagious when they have symptoms, especially vomiting, and during the first few days after feeling better. Studies have shown that you can still spread norovirus for two weeks or more after you feel better.

• #47 Norovirus | Mass.gov

  https://www.mass.gov/info-details/norovirus

  Norovirus is the leading cause of acute gastroenteritis among people of all ages in the United States. It is possible to get sick at any time of the year, but illnesses are most common between November and April. […] Noroviruses are very contagious and can be found in the stool or vomit of infected people. People get sick by accidentally getting tiny particles of stool or vomit in their mouth from a person infected with norovirus. […] Anyone can get infected with norovirus. Children younger than 5 years old, older adults, and people with weakened immune systems are more likely to develop severe infections. […] People with norovirus infection are most contagious when they have symptoms, especially vomiting, and during the first few days after feeling better. Studies have shown that you can still spread norovirus for two weeks or more after you feel better.

• #48 Norovirus | Mass.gov

  https://www.mass.gov/info-details/norovirus

  Norovirus is the leading cause of acute gastroenteritis among people of all ages in the United States. It is possible to get sick at any time of the year, but illnesses are most common between November and April. […] Noroviruses are very contagious and can be found in the stool or vomit of infected people. People get sick by accidentally getting tiny particles of stool or vomit in their mouth from a person infected with norovirus. […] Anyone can get infected with norovirus. Children younger than 5 years old, older adults, and people with weakened immune systems are more likely to develop severe infections. […] People with norovirus infection are most contagious when they have symptoms, especially vomiting, and during the first few days after feeling better. Studies have shown that you can still spread norovirus for two weeks or more after you feel better.

• #49 A narrative review of norovirus epidemiology, biology, and challenges to vaccine development | npj Vaccines

  https://www.nature.com/articles/s41541-024-00884-2

  The most commonly reported setting for norovirus outbreaks in the US and other industrialized countries is healthcare settings. […] Guidelines to help control outbreaks in healthcare settings include enhanced hand hygiene and environmental cleaning, restriction of patient movements, and exclusion of ill staff from work. […] Outbreaks in long-term care facilities (LTCFs) are of particular concern, as individuals receiving care in these settings are more likely to be elderly or have underlying medical conditions. […] Norovirus AGE attack rates during outbreaks in LTCFs can be up to 45% and are associated with hospitalization rates of ~4% and mortality rates of ~2%, making LTCFs an important target for surveillance and control of norovirus. […] An analysis of norovirus outbreaks reported to the Centers for Disease Control and Prevention (CDC) CaliciNet in the US between 2009 and 2013 reported the most common settings as long-term care facilities (62.5% of outbreaks), restaurants (9.8%), schools and communities (5.7%), parties or events (5.4%), and hospitals (3.6%).

• #50 A narrative review of norovirus epidemiology, biology, and challenges to vaccine development | npj Vaccines

  https://www.nature.com/articles/s41541-024-00884-2

  The most commonly reported setting for norovirus outbreaks in the US and other industrialized countries is healthcare settings. […] Guidelines to help control outbreaks in healthcare settings include enhanced hand hygiene and environmental cleaning, restriction of patient movements, and exclusion of ill staff from work. […] Outbreaks in long-term care facilities (LTCFs) are of particular concern, as individuals receiving care in these settings are more likely to be elderly or have underlying medical conditions. […] Norovirus AGE attack rates during outbreaks in LTCFs can be up to 45% and are associated with hospitalization rates of ~4% and mortality rates of ~2%, making LTCFs an important target for surveillance and control of norovirus. […] An analysis of norovirus outbreaks reported to the Centers for Disease Control and Prevention (CDC) CaliciNet in the US between 2009 and 2013 reported the most common settings as long-term care facilities (62.5% of outbreaks), restaurants (9.8%), schools and communities (5.7%), parties or events (5.4%), and hospitals (3.6%).

• #51 A narrative review of norovirus epidemiology, biology, and challenges to vaccine development | npj Vaccines

  https://www.nature.com/articles/s41541-024-00884-2

  The most commonly reported setting for norovirus outbreaks in the US and other industrialized countries is healthcare settings. […] Guidelines to help control outbreaks in healthcare settings include enhanced hand hygiene and environmental cleaning, restriction of patient movements, and exclusion of ill staff from work. […] Outbreaks in long-term care facilities (LTCFs) are of particular concern, as individuals receiving care in these settings are more likely to be elderly or have underlying medical conditions. […] Norovirus AGE attack rates during outbreaks in LTCFs can be up to 45% and are associated with hospitalization rates of ~4% and mortality rates of ~2%, making LTCFs an important target for surveillance and control of norovirus. […] An analysis of norovirus outbreaks reported to the Centers for Disease Control and Prevention (CDC) CaliciNet in the US between 2009 and 2013 reported the most common settings as long-term care facilities (62.5% of outbreaks), restaurants (9.8%), schools and communities (5.7%), parties or events (5.4%), and hospitals (3.6%).

• #52 A narrative review of norovirus epidemiology, biology, and challenges to vaccine development | npj Vaccines

  https://www.nature.com/articles/s41541-024-00884-2

  The most commonly reported setting for norovirus outbreaks in the US and other industrialized countries is healthcare settings. […] Guidelines to help control outbreaks in healthcare settings include enhanced hand hygiene and environmental cleaning, restriction of patient movements, and exclusion of ill staff from work. […] Outbreaks in long-term care facilities (LTCFs) are of particular concern, as individuals receiving care in these settings are more likely to be elderly or have underlying medical conditions. […] Norovirus AGE attack rates during outbreaks in LTCFs can be up to 45% and are associated with hospitalization rates of ~4% and mortality rates of ~2%, making LTCFs an important target for surveillance and control of norovirus. […] An analysis of norovirus outbreaks reported to the Centers for Disease Control and Prevention (CDC) CaliciNet in the US between 2009 and 2013 reported the most common settings as long-term care facilities (62.5% of outbreaks), restaurants (9.8%), schools and communities (5.7%), parties or events (5.4%), and hospitals (3.6%).

• #53 A narrative review of norovirus epidemiology, biology, and challenges to vaccine development | npj Vaccines

  https://www.nature.com/articles/s41541-024-00884-2

  The most commonly reported setting for norovirus outbreaks in the US and other industrialized countries is healthcare settings. […] Guidelines to help control outbreaks in healthcare settings include enhanced hand hygiene and environmental cleaning, restriction of patient movements, and exclusion of ill staff from work. […] Outbreaks in long-term care facilities (LTCFs) are of particular concern, as individuals receiving care in these settings are more likely to be elderly or have underlying medical conditions. […] Norovirus AGE attack rates during outbreaks in LTCFs can be up to 45% and are associated with hospitalization rates of ~4% and mortality rates of ~2%, making LTCFs an important target for surveillance and control of norovirus. […] An analysis of norovirus outbreaks reported to the Centers for Disease Control and Prevention (CDC) CaliciNet in the US between 2009 and 2013 reported the most common settings as long-term care facilities (62.5% of outbreaks), restaurants (9.8%), schools and communities (5.7%), parties or events (5.4%), and hospitals (3.6%).

• #54 A narrative review of norovirus epidemiology, biology, and challenges to vaccine development | npj Vaccines

  https://www.nature.com/articles/s41541-024-00884-2

  The most commonly reported setting for norovirus outbreaks in the US and other industrialized countries is healthcare settings. […] Guidelines to help control outbreaks in healthcare settings include enhanced hand hygiene and environmental cleaning, restriction of patient movements, and exclusion of ill staff from work. […] Outbreaks in long-term care facilities (LTCFs) are of particular concern, as individuals receiving care in these settings are more likely to be elderly or have underlying medical conditions. […] Norovirus AGE attack rates during outbreaks in LTCFs can be up to 45% and are associated with hospitalization rates of ~4% and mortality rates of ~2%, making LTCFs an important target for surveillance and control of norovirus. […] An analysis of norovirus outbreaks reported to the Centers for Disease Control and Prevention (CDC) CaliciNet in the US between 2009 and 2013 reported the most common settings as long-term care facilities (62.5% of outbreaks), restaurants (9.8%), schools and communities (5.7%), parties or events (5.4%), and hospitals (3.6%).

• #55 A narrative review of norovirus epidemiology, biology, and challenges to vaccine development | npj Vaccines

  https://www.nature.com/articles/s41541-024-00884-2

  The most commonly reported setting for norovirus outbreaks in the US and other industrialized countries is healthcare settings. […] Guidelines to help control outbreaks in healthcare settings include enhanced hand hygiene and environmental cleaning, restriction of patient movements, and exclusion of ill staff from work. […] Outbreaks in long-term care facilities (LTCFs) are of particular concern, as individuals receiving care in these settings are more likely to be elderly or have underlying medical conditions. […] Norovirus AGE attack rates during outbreaks in LTCFs can be up to 45% and are associated with hospitalization rates of ~4% and mortality rates of ~2%, making LTCFs an important target for surveillance and control of norovirus. […] An analysis of norovirus outbreaks reported to the Centers for Disease Control and Prevention (CDC) CaliciNet in the US between 2009 and 2013 reported the most common settings as long-term care facilities (62.5% of outbreaks), restaurants (9.8%), schools and communities (5.7%), parties or events (5.4%), and hospitals (3.6%).

• #56 A narrative review of norovirus epidemiology, biology, and challenges to vaccine development | npj Vaccines

  https://www.nature.com/articles/s41541-024-00884-2

  Norovirus AGE causes substantial economic and clinical burden, with direct healthcare costs and lost productivity from personal illness or time spent caring for an ill child estimated to cost $60 billion globally each year. […] Observational studies have attempted to quantify incidence rates in smaller, defined populations, but wider, routine population-based surveillance is needed to fully appreciate the societal impact of norovirus AGE.

• #57 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9622243/

  Overall, 80 (19%) persons with AGE had 1 AGE-related healthcare encounters within KPNW. Most of those (63 [79%]) had an in-person encounter, 37 (46%) of whom also had a remote encounter; 17 (19%) had only a remote encounter. The percentage of participants seeking AGE-related medical care was slightly lower among persons reporting only acute diarrhea; 17% had 1 encounter overall, of which 77% had an in-person visit and 23% had a remote encounter only. […] We observed an overall pathogen positivity of roughly 10% from among all submitted stool specimens; differences observed in pathogen positivity between those who did and did not have AGE were not statistically significant. This finding is likely because of the small numbers within our SS cohort and the potential time lag between occurrence of symptoms and collection of stool sample, as well as the high rate of rotavirus detection by qRT-PCR.

• #58 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States – Volume 28, Number 11—November 2022 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/28/11/22-0247_article

  Overall, 80 (19%) persons with AGE had 1 AGE-related healthcare encounters within KPNW. Most of those (63 [79%]) had an in-person encounter, 37 (46%) of whom also had a remote encounter; 17 (19%) had only a remote encounter. The percentage of participants seeking AGE-related medical care was slightly lower among persons reporting only acute diarrhea; 17% had 1 encounter overall, of which 77% had an in-person visit and 23% had a remote encounter only. […] We observed an overall pathogen positivity of roughly 10% from among all submitted stool specimens; differences observed in pathogen positivity between those who did and did not have AGE were not statistically significant. This finding is likely because of the small numbers within our SS cohort and the potential time lag between occurrence of symptoms and collection of stool sample, as well as the high rate of rotavirus detection by qRT-PCR.

• #59 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9622243/

  Overall, 80 (19%) persons with AGE had 1 AGE-related healthcare encounters within KPNW. Most of those (63 [79%]) had an in-person encounter, 37 (46%) of whom also had a remote encounter; 17 (19%) had only a remote encounter. The percentage of participants seeking AGE-related medical care was slightly lower among persons reporting only acute diarrhea; 17% had 1 encounter overall, of which 77% had an in-person visit and 23% had a remote encounter only. […] We observed an overall pathogen positivity of roughly 10% from among all submitted stool specimens; differences observed in pathogen positivity between those who did and did not have AGE were not statistically significant. This finding is likely because of the small numbers within our SS cohort and the potential time lag between occurrence of symptoms and collection of stool sample, as well as the high rate of rotavirus detection by qRT-PCR.

• #60 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States – Volume 28, Number 11—November 2022 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/28/11/22-0247_article

  Overall, 80 (19%) persons with AGE had 1 AGE-related healthcare encounters within KPNW. Most of those (63 [79%]) had an in-person encounter, 37 (46%) of whom also had a remote encounter; 17 (19%) had only a remote encounter. The percentage of participants seeking AGE-related medical care was slightly lower among persons reporting only acute diarrhea; 17% had 1 encounter overall, of which 77% had an in-person visit and 23% had a remote encounter only. […] We observed an overall pathogen positivity of roughly 10% from among all submitted stool specimens; differences observed in pathogen positivity between those who did and did not have AGE were not statistically significant. This finding is likely because of the small numbers within our SS cohort and the potential time lag between occurrence of symptoms and collection of stool sample, as well as the high rate of rotavirus detection by qRT-PCR.

• #61 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9622243/

  Overall, 80 (19%) persons with AGE had 1 AGE-related healthcare encounters within KPNW. Most of those (63 [79%]) had an in-person encounter, 37 (46%) of whom also had a remote encounter; 17 (19%) had only a remote encounter. The percentage of participants seeking AGE-related medical care was slightly lower among persons reporting only acute diarrhea; 17% had 1 encounter overall, of which 77% had an in-person visit and 23% had a remote encounter only. […] We observed an overall pathogen positivity of roughly 10% from among all submitted stool specimens; differences observed in pathogen positivity between those who did and did not have AGE were not statistically significant. This finding is likely because of the small numbers within our SS cohort and the potential time lag between occurrence of symptoms and collection of stool sample, as well as the high rate of rotavirus detection by qRT-PCR.

• #62 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States – Volume 28, Number 11—November 2022 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/28/11/22-0247_article

  Overall, 80 (19%) persons with AGE had 1 AGE-related healthcare encounters within KPNW. Most of those (63 [79%]) had an in-person encounter, 37 (46%) of whom also had a remote encounter; 17 (19%) had only a remote encounter. The percentage of participants seeking AGE-related medical care was slightly lower among persons reporting only acute diarrhea; 17% had 1 encounter overall, of which 77% had an in-person visit and 23% had a remote encounter only. […] We observed an overall pathogen positivity of roughly 10% from among all submitted stool specimens; differences observed in pathogen positivity between those who did and did not have AGE were not statistically significant. This finding is likely because of the small numbers within our SS cohort and the potential time lag between occurrence of symptoms and collection of stool sample, as well as the high rate of rotavirus detection by qRT-PCR.

• #63 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9622243/

  Among persons with AGE, 12%20% have reported visiting a healthcare provider to manage their symptoms, and AGE has been estimated to contribute to 23 million ambulatory visits and 900,000 hospitalizations per year in the United States. However, these data have relied on samples of persons within a geographic area who may differentially seek care depending on if they have medical insurance or access to an affordable care source. As a result, these studies may not accurately estimate the true potential burden on a healthcare system. […] Overall, 395 participants met our primary AGE case definition, resulting in a 30-day AGE age-weighted prevalence of 10.4%, equivalent to a rate of 1.27 cases/person/year. Among those participants, 23% reported both diarrhea and vomiting, 50% reported only diarrhea, and 27% reported only vomiting. A total of 289 participants reported having acute diarrhea, resulting in a 30-day diarrheal prevalence of 7.6%, equivalent to a rate of 0.92 cases/person/year.

• #64 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States – Volume 28, Number 11—November 2022 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/28/11/22-0247_article

  However, differences in AGE case definitions have complicated efforts to compare findings across studies and time periods, and robust estimates of occurrence across the age spectrum remain limited. Consequently, there is a need to obtain all-age, population-based estimates of AGE within the United States. […] Even assuming the lowest reported AGE prevalence of 7.7%, there is potential for substantial disease burden on the local healthcare systems and on society, such as through lost productivity. Among persons with AGE, 12%20% have reported visiting a healthcare provider to manage their symptoms, and AGE has been estimated to contribute to 23 million ambulatory visits and 900,000 hospitalizations per year in the United States. […] Clarifying the etiology of AGE illness within communities and healthcare systems can help to effectively target prevention efforts. Sporadic cases of AGE are largely attributable to viral pathogens; norovirus is the most common cause of AGE across the age spectrum.

• #65 A narrative review of norovirus epidemiology, biology, and challenges to vaccine development | npj Vaccines

  https://www.nature.com/articles/s41541-024-00884-2

  Norovirus AGE causes substantial economic and clinical burden, with direct healthcare costs and lost productivity from personal illness or time spent caring for an ill child estimated to cost $60 billion globally each year. […] Observational studies have attempted to quantify incidence rates in smaller, defined populations, but wider, routine population-based surveillance is needed to fully appreciate the societal impact of norovirus AGE.

• #66 Pediatric Gastroenteritis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/964131-overview

  Children in the United States experience, on average, 1.3-2.3 episodes of diarrhea each year. Overall, acute gastroenteritis accounts for than 1.5 million outpatient visits, 220,000 hospitalizations, and direct costs of more than $2 billion each year in the United States alone. […] Worldwide, children younger than 5 years have an estimated 1.7 billion episodes of diarrhea each year, leading to 124 million clinic visits, 9 million hospitalizations, and 1.34 million deaths, with more than 98% of these deaths occurring in the developing world. […] Although the prevalence of acute gastroenteritis in children has changed little over the past 4 decades, mortality has declined sharply, from 4.6 million in the 1970s to 3 million in the 1980s and 2.5 million in the 1990s. One of the most important reasons for this decline has been the increasing international support for the use of oral rehydration solution (ORS) as the treatment of choice for acute diarrhea, with the proportion of diarrheal episodes treated with ORS rising from 15% in 1984 to 40% in 1993.

• #67 Understanding Diarrhoea & Vomiting — REAL First Aid

  https://www.realfirstaid.co.uk/diarrhoea-vomiting

  Diarrhoea and vomiting (DV) is as common a feature of foreign travel as airport delays and a regrettable tattoo. Diarrhoea is defined as three or more unformed stools in a 24 hour period, often accompanied by at least one of the following: fever, nausea, vomiting, cramps, or bloody stools (dysentery). It is the most common health problem of overseas travellers affecting an estimated 20 to 60 percent of those who travel to high risk destinations of the world. Approximately 20% of travellers are confined to bed for one or two days, 40% have to change their itinerary, and 1% are admitted to hospital. Vomiting is uncommon, and dysentery is infrequent. DV typically occurs during the first week of arrival and is often self-limiting, lasting three to four days. Most episodes will last between one and seven days, with approximately 10% lasting for longer than one week, 5% lasting more than two weeks, and 1% lasting more than 30 days.

• #68 Understanding Diarrhoea & Vomiting — REAL First Aid

  https://www.realfirstaid.co.uk/diarrhoea-vomiting

  Diarrhoea and vomiting (DV) is as common a feature of foreign travel as airport delays and a regrettable tattoo. Diarrhoea is defined as three or more unformed stools in a 24 hour period, often accompanied by at least one of the following: fever, nausea, vomiting, cramps, or bloody stools (dysentery). It is the most common health problem of overseas travellers affecting an estimated 20 to 60 percent of those who travel to high risk destinations of the world. Approximately 20% of travellers are confined to bed for one or two days, 40% have to change their itinerary, and 1% are admitted to hospital. Vomiting is uncommon, and dysentery is infrequent. DV typically occurs during the first week of arrival and is often self-limiting, lasting three to four days. Most episodes will last between one and seven days, with approximately 10% lasting for longer than one week, 5% lasting more than two weeks, and 1% lasting more than 30 days.

• #69 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9622243/

  AGE continues to exert a substantial burden of disease within the population, as well as upon healthcare delivery systems. This effect is particularly notable when vomiting is considered as part of the AGE case definition; prevalence estimates were nearly 50% higher when including this symptom. General interventions designed to reduce the transmission of AGE-related viral pathogens (e.g., hand hygiene) continue to be crucial as a means to reduce the extent of AGE in the population, even among persons without symptomatic disease. However, the high number of AGE cases in the community, particularly when including vomiting-only symptoms, leads to a heavy burden on the healthcare system. Additional targeted interventions, such as vaccines, could help reduce AGE in the community and, thus, reduce strain on healthcare systems.

• #70 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States – Volume 28, Number 11—November 2022 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/28/11/22-0247_article

  In conclusion, AGE continues to exert a substantial burden of disease within the population, as well as upon healthcare delivery systems. This effect is particularly notable when vomiting is considered as part of the AGE case definition; prevalence estimates were nearly 50% higher when including this symptom. General interventions designed to reduce the transmission of AGE-related viral pathogens (e.g., hand hygiene) continue to be crucial as a means to reduce the extent of AGE in the population, even among persons without symptomatic disease. However, the high number of AGE cases in the community, particularly when including vomiting-only symptoms, leads to a heavy burden on the healthcare system. Additional targeted interventions, such as vaccines, could help reduce AGE in the community and, thus, reduce strain on healthcare systems.

• #71

  https://www.kflaph.ca/en/health-topics/vomiting-and-diarrhea-gastroenteritis.aspx

  Gastroenteritis is a common condition caused by irritation and inflammation of the stomach and intestines. This results in vomiting and diarrhea. Bacteria, viruses, and parasites can all cause gastroenteritis. […] Labs and health care providers must report all possible illness caused by contaminated food or water to public health. KFLA Public Health looks into all cases to investigate the source of illness and to provide education. […] Gastroenteritis spreads very quickly and easily. This can happen if you: Eat food or drink liquids that are contaminated. […] The following actions will prevent the spread of gastroenteritis: Wash your hands thoroughly after using the toilet, after contact with animals, before preparing or eating food, and after changing a diaper. […] Take precautions with food and water when traveling. Learn more about how to eat and drink safely abroad by visiting the Government of Canada website.

• #72

  https://portal.ct.gov/dph/epidemiology-and-emerging-infections/ctepi/volumes/42/no-2/a1

  On May 12, 2021, the Connecticut Department of Public Health (DPH) was notified by a local health department (LHD) of a possible foodborne outbreak among patrons of a food service establishment (FSE) in Tolland County. […] A case was defined as an individual experiencing vomiting and/or diarrhea (3 loose stools in 24 hours) who ate from the FSE between May 8, 2021 May 16, 2021. […] Reported symptoms included nausea (n=105 [95%]), vomiting (n=102 [93%]) and diarrhea (n=102 [93%]). […] Norovirus is the most common cause of foodborne outbreaks in the United States, accounting for about 50% of outbreaks (1). […] The epidemiologic, environmental, and laboratory investigation indicate that an outbreak of Norovirus occurred among patrons of FSE in Tolland County. […] To help prevent Norovirus outbreaks, it is important to avoid preparing foods while ill, wash hands carefully for at least 20 seconds with warm water and soap, and report suspected illness from consuming food to the state or local health department (2).

• #73 Norovirus

  https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_epidemiology/dc/dc_norovirus.html

  Norovirus is a very contagious virus that causes vomiting and diarrhea. It is sometimes called the „stomach flu” or the „stomach bug.” […] In the United States, Norovirus is the most common infectious cause of vomiting and diarrhea. It is also the leading cause of foodborne illness. […] A person can get norovirus by accidentally getting tiny particles of poop or vomit in their mouth from a person infected with norovirus. Norovirus spreads very easily and quickly in different ways, including: […] People with norovirus should stay home until they no longer experience vomiting or diarrhea. They should not prepare food, or provide care for others, while they are ill and for at least 2 days after symptoms stop to avoid getting others sick. […] Most common symptoms: Diarrhea, vomiting, nausea, and stomach pain. […] Norovirus Outbreaks Reported to the Epidemiology Unit, County of San Diego as of 4/1/2025. […] Norovirus spreads easily and causes vomiting and diarrhea. Protect yourself and your loved ones by washing your hands with soap and water, keeping things clean, and handling and preparing food safely.

• #74 A narrative review of norovirus epidemiology, biology, and challenges to vaccine development | npj Vaccines

  https://www.nature.com/articles/s41541-024-00884-2

  The most commonly reported setting for norovirus outbreaks in the US and other industrialized countries is healthcare settings. […] Guidelines to help control outbreaks in healthcare settings include enhanced hand hygiene and environmental cleaning, restriction of patient movements, and exclusion of ill staff from work. […] Outbreaks in long-term care facilities (LTCFs) are of particular concern, as individuals receiving care in these settings are more likely to be elderly or have underlying medical conditions. […] Norovirus AGE attack rates during outbreaks in LTCFs can be up to 45% and are associated with hospitalization rates of ~4% and mortality rates of ~2%, making LTCFs an important target for surveillance and control of norovirus. […] An analysis of norovirus outbreaks reported to the Centers for Disease Control and Prevention (CDC) CaliciNet in the US between 2009 and 2013 reported the most common settings as long-term care facilities (62.5% of outbreaks), restaurants (9.8%), schools and communities (5.7%), parties or events (5.4%), and hospitals (3.6%).

• #75 A narrative review of norovirus epidemiology, biology, and challenges to vaccine development | npj Vaccines

  https://www.nature.com/articles/s41541-024-00884-2

  The most commonly reported setting for norovirus outbreaks in the US and other industrialized countries is healthcare settings. […] Guidelines to help control outbreaks in healthcare settings include enhanced hand hygiene and environmental cleaning, restriction of patient movements, and exclusion of ill staff from work. […] Outbreaks in long-term care facilities (LTCFs) are of particular concern, as individuals receiving care in these settings are more likely to be elderly or have underlying medical conditions. […] Norovirus AGE attack rates during outbreaks in LTCFs can be up to 45% and are associated with hospitalization rates of ~4% and mortality rates of ~2%, making LTCFs an important target for surveillance and control of norovirus. […] An analysis of norovirus outbreaks reported to the Centers for Disease Control and Prevention (CDC) CaliciNet in the US between 2009 and 2013 reported the most common settings as long-term care facilities (62.5% of outbreaks), restaurants (9.8%), schools and communities (5.7%), parties or events (5.4%), and hospitals (3.6%).

• #76 A narrative review of norovirus epidemiology, biology, and challenges to vaccine development | npj Vaccines

  https://www.nature.com/articles/s41541-024-00884-2

  The most commonly reported setting for norovirus outbreaks in the US and other industrialized countries is healthcare settings. […] Guidelines to help control outbreaks in healthcare settings include enhanced hand hygiene and environmental cleaning, restriction of patient movements, and exclusion of ill staff from work. […] Outbreaks in long-term care facilities (LTCFs) are of particular concern, as individuals receiving care in these settings are more likely to be elderly or have underlying medical conditions. […] Norovirus AGE attack rates during outbreaks in LTCFs can be up to 45% and are associated with hospitalization rates of ~4% and mortality rates of ~2%, making LTCFs an important target for surveillance and control of norovirus. […] An analysis of norovirus outbreaks reported to the Centers for Disease Control and Prevention (CDC) CaliciNet in the US between 2009 and 2013 reported the most common settings as long-term care facilities (62.5% of outbreaks), restaurants (9.8%), schools and communities (5.7%), parties or events (5.4%), and hospitals (3.6%).

• #77 Original ArticleInvestigation of an Outbreak of Diarrhea and Vomiting among Residents and Staff at One Care Center for the Severely Handicapped in Taipei City – Taiwan Centers for Disease Control

  https://www.cdc.gov.tw/En/EpidemicTheme/Detail/hQ4XhaZAzUmNe2ksY4tjMA?archiveId=oCZ7Xagr7gQPparRF24GvQ

  Since 22 out of the entire 48 residents exhibited symptoms that met the case definition, the attack rate was estimated at 45.8%. […] After ruling out some point-source exposure possibilities, such as sharing drinking water or food, transmission from one particular person as a common source, and through a common household utensil, we have to conclude that the transmission was likely to have occurred in the person-to-person mode. […] As to the countermeasures implemented in this case, the care center started on September 28 to quarantine the sick residents, restrict the movement of its workers while performing their routine duties, and conduct a blanket sterilization program of the living quarters as well as all facilities on the premises. The outcome appeared to be a success as no more individuals have fallen sick since October 1.

• #78 Stomach Flu & Diarrhea: Causes, Symptoms, and Treatments | IMODIUM®

  https://www.imodium.com/what-causes-diarrhea/stomach-flu

  It is estimated that 179 million incidents of acute gastroenteritis occur annually in the United States, which can result in diarrhea. […] Norovirus is estimated to cause around 19 to 21 million cases of gastroenteritis in the U.S. annually with most outbreaks happening from November to April. There are about 2,500 norovirus outbreaks reported annually in the U.S. […] Rotavirus is a contagious stomach virus that causes severe diarrhea in infants and young children. Before a vaccine was introduced in 2006, almost all U.S. children were infected with rotavirus before their 5th birthday. Each year, the vaccine prevents an estimated 40,000 to 50,000 hospitalizations among infants and young children in the United States. […] Some adults may have a higher risk of getting rotavirus, including those who are older, those who care for children with rotavirus, or those with compromised immune systems. […] Healthy people are likely to recover from stomach flu or gastroenteritis without complications. However, some cases may warrant a call or trip to the doctor.

• #79 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9622243/

  AGE continues to exert a substantial burden of disease within the population, as well as upon healthcare delivery systems. This effect is particularly notable when vomiting is considered as part of the AGE case definition; prevalence estimates were nearly 50% higher when including this symptom. General interventions designed to reduce the transmission of AGE-related viral pathogens (e.g., hand hygiene) continue to be crucial as a means to reduce the extent of AGE in the population, even among persons without symptomatic disease. However, the high number of AGE cases in the community, particularly when including vomiting-only symptoms, leads to a heavy burden on the healthcare system. Additional targeted interventions, such as vaccines, could help reduce AGE in the community and, thus, reduce strain on healthcare systems.

• #80 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States – Volume 28, Number 11—November 2022 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/28/11/22-0247_article

  In conclusion, AGE continues to exert a substantial burden of disease within the population, as well as upon healthcare delivery systems. This effect is particularly notable when vomiting is considered as part of the AGE case definition; prevalence estimates were nearly 50% higher when including this symptom. General interventions designed to reduce the transmission of AGE-related viral pathogens (e.g., hand hygiene) continue to be crucial as a means to reduce the extent of AGE in the population, even among persons without symptomatic disease. However, the high number of AGE cases in the community, particularly when including vomiting-only symptoms, leads to a heavy burden on the healthcare system. Additional targeted interventions, such as vaccines, could help reduce AGE in the community and, thus, reduce strain on healthcare systems.

• #81

  https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease

  Key measures to prevent diarrhoea include access to safe drinking-water, use of improved sanitation, hand washing with soap, and health education about how infections spread. […] WHO works with Member States and other partners to promote national policies and investments that support case management of diarrhoea and its complications as well as increasing access to safe drinking-water and sanitation in developing countries.

• #82

  https://portal.ct.gov/dph/epidemiology-and-emerging-infections/ctepi/volumes/42/no-2/a1

  On May 12, 2021, the Connecticut Department of Public Health (DPH) was notified by a local health department (LHD) of a possible foodborne outbreak among patrons of a food service establishment (FSE) in Tolland County. […] A case was defined as an individual experiencing vomiting and/or diarrhea (3 loose stools in 24 hours) who ate from the FSE between May 8, 2021 May 16, 2021. […] Reported symptoms included nausea (n=105 [95%]), vomiting (n=102 [93%]) and diarrhea (n=102 [93%]). […] Norovirus is the most common cause of foodborne outbreaks in the United States, accounting for about 50% of outbreaks (1). […] The epidemiologic, environmental, and laboratory investigation indicate that an outbreak of Norovirus occurred among patrons of FSE in Tolland County. […] To help prevent Norovirus outbreaks, it is important to avoid preparing foods while ill, wash hands carefully for at least 20 seconds with warm water and soap, and report suspected illness from consuming food to the state or local health department (2).

• #83

  https://www.kflaph.ca/en/health-topics/vomiting-and-diarrhea-gastroenteritis.aspx

  Gastroenteritis is a common condition caused by irritation and inflammation of the stomach and intestines. This results in vomiting and diarrhea. Bacteria, viruses, and parasites can all cause gastroenteritis. […] Labs and health care providers must report all possible illness caused by contaminated food or water to public health. KFLA Public Health looks into all cases to investigate the source of illness and to provide education. […] Gastroenteritis spreads very quickly and easily. This can happen if you: Eat food or drink liquids that are contaminated. […] The following actions will prevent the spread of gastroenteritis: Wash your hands thoroughly after using the toilet, after contact with animals, before preparing or eating food, and after changing a diaper. […] Take precautions with food and water when traveling. Learn more about how to eat and drink safely abroad by visiting the Government of Canada website.

• #84 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9622243/

  AGE continues to exert a substantial burden of disease within the population, as well as upon healthcare delivery systems. This effect is particularly notable when vomiting is considered as part of the AGE case definition; prevalence estimates were nearly 50% higher when including this symptom. General interventions designed to reduce the transmission of AGE-related viral pathogens (e.g., hand hygiene) continue to be crucial as a means to reduce the extent of AGE in the population, even among persons without symptomatic disease. However, the high number of AGE cases in the community, particularly when including vomiting-only symptoms, leads to a heavy burden on the healthcare system. Additional targeted interventions, such as vaccines, could help reduce AGE in the community and, thus, reduce strain on healthcare systems.

• #85 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States – Volume 28, Number 11—November 2022 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/28/11/22-0247_article

  In conclusion, AGE continues to exert a substantial burden of disease within the population, as well as upon healthcare delivery systems. This effect is particularly notable when vomiting is considered as part of the AGE case definition; prevalence estimates were nearly 50% higher when including this symptom. General interventions designed to reduce the transmission of AGE-related viral pathogens (e.g., hand hygiene) continue to be crucial as a means to reduce the extent of AGE in the population, even among persons without symptomatic disease. However, the high number of AGE cases in the community, particularly when including vomiting-only symptoms, leads to a heavy burden on the healthcare system. Additional targeted interventions, such as vaccines, could help reduce AGE in the community and, thus, reduce strain on healthcare systems.

• #86 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9622243/

  AGE continues to exert a substantial burden of disease within the population, as well as upon healthcare delivery systems. This effect is particularly notable when vomiting is considered as part of the AGE case definition; prevalence estimates were nearly 50% higher when including this symptom. General interventions designed to reduce the transmission of AGE-related viral pathogens (e.g., hand hygiene) continue to be crucial as a means to reduce the extent of AGE in the population, even among persons without symptomatic disease. However, the high number of AGE cases in the community, particularly when including vomiting-only symptoms, leads to a heavy burden on the healthcare system. Additional targeted interventions, such as vaccines, could help reduce AGE in the community and, thus, reduce strain on healthcare systems.

• #87 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States – Volume 28, Number 11—November 2022 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/28/11/22-0247_article

  In conclusion, AGE continues to exert a substantial burden of disease within the population, as well as upon healthcare delivery systems. This effect is particularly notable when vomiting is considered as part of the AGE case definition; prevalence estimates were nearly 50% higher when including this symptom. General interventions designed to reduce the transmission of AGE-related viral pathogens (e.g., hand hygiene) continue to be crucial as a means to reduce the extent of AGE in the population, even among persons without symptomatic disease. However, the high number of AGE cases in the community, particularly when including vomiting-only symptoms, leads to a heavy burden on the healthcare system. Additional targeted interventions, such as vaccines, could help reduce AGE in the community and, thus, reduce strain on healthcare systems.

• #88 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9622243/

  AGE continues to exert a substantial burden of disease within the population, as well as upon healthcare delivery systems. This effect is particularly notable when vomiting is considered as part of the AGE case definition; prevalence estimates were nearly 50% higher when including this symptom. General interventions designed to reduce the transmission of AGE-related viral pathogens (e.g., hand hygiene) continue to be crucial as a means to reduce the extent of AGE in the population, even among persons without symptomatic disease. However, the high number of AGE cases in the community, particularly when including vomiting-only symptoms, leads to a heavy burden on the healthcare system. Additional targeted interventions, such as vaccines, could help reduce AGE in the community and, thus, reduce strain on healthcare systems.

• #89 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States – Volume 28, Number 11—November 2022 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/28/11/22-0247_article

  In conclusion, AGE continues to exert a substantial burden of disease within the population, as well as upon healthcare delivery systems. This effect is particularly notable when vomiting is considered as part of the AGE case definition; prevalence estimates were nearly 50% higher when including this symptom. General interventions designed to reduce the transmission of AGE-related viral pathogens (e.g., hand hygiene) continue to be crucial as a means to reduce the extent of AGE in the population, even among persons without symptomatic disease. However, the high number of AGE cases in the community, particularly when including vomiting-only symptoms, leads to a heavy burden on the healthcare system. Additional targeted interventions, such as vaccines, could help reduce AGE in the community and, thus, reduce strain on healthcare systems.

• #90 A narrative review of norovirus epidemiology, biology, and challenges to vaccine development | npj Vaccines

  https://www.nature.com/articles/s41541-024-00884-2

  Norovirus AGE causes substantial economic and clinical burden, with direct healthcare costs and lost productivity from personal illness or time spent caring for an ill child estimated to cost $60 billion globally each year. […] Observational studies have attempted to quantify incidence rates in smaller, defined populations, but wider, routine population-based surveillance is needed to fully appreciate the societal impact of norovirus AGE.

• #91 Quantifying the roles of vomiting, diarrhea, and residents vs. staff in norovirus transmission in U.S. nursing home outbreaks | PLOS Computational Biology

  https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1007271

  The role of individual case characteristics, such as symptoms or demographics, in norovirus transmissibility is poorly understood. […] We aimed to quantify the contribution of symptoms and other case characteristics in norovirus transmission using the reproduction number (REi) as an estimate of individual case infectivity and to examine how transmission changes over the course of an outbreak. […] Of the 209 cases, 155 (75%) vomited, 164 (79%) had diarrhea, and 158 (76%) were nursing home residents (vs. staff). […] Results suggest that individuals, particularly residents, who vomit are more infectious and tend to drive norovirus transmission in U.S. nursing home norovirus outbreaks. […] While diarrhea also plays a role in norovirus transmission, it is to a lesser degree than vomiting in these settings.

• #92 Quantifying the roles of vomiting, diarrhea, and residents vs. staff in norovirus transmission in U.S. nursing home outbreaks | PLOS Computational Biology

  https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1007271

  We show that vomiting and, to a lesser extent, diarrhea are critical in initiating and sustaining norovirus transmission in U.S. nursing home norovirus outbreaks. […] We also show that nursing home residents, rather than staff, are the primary drivers of transmission. […] Results suggest that control measures focusing on cases who vomit, particularly if those cases are residents, would be most effective at curtailing norovirus transmission in these settings. […] Vomiting, particularly by residents, drives norovirus transmission in U.S. nursing home outbreaks. This has implications for prevention and control measure recommendations for outbreaks in these settings.

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