Shedding of norovirus in symptomatic and asymptomatic infections.

Abstract:

:Norovirus is the most frequent cause of acute infectious gastroenteritis and it is difficult to control in crowded environments like hospitals and nursing homes. Transmission depends on oral intake of virus deposited in the environment by infectious subjects. Data from volunteer studies indicate that virus concentrations in stool are highly variable, but systematic studies of the time-course of shedding and its individual variation are lacking. This paper quantifies norovirus shedding in a large population of 102 subjects, including asymptomatic shedders, and uses a longitudinal model to generalize shedding patterns. Enhanced surveillance for studies of transmission of norovirus in hospital outbreaks has yielded a considerable number of faecal samples from symptomatic and asymptomatic shedders, both from patients and staff. Norovirus concentrations were determined by real-time PCR. A quantitative dynamic model was fitted to the shedding data, in a multilevel Bayesian framework, to study the time-course of shedding and its variation. The results indicate that shedding in asymptomatic subjects is similar to that in symptomatic infections, both showing considerable variation in peak levels (average 105-109 /g faeces) as well as duration of virus shedding (average 8-60 days). Patients appear to shed higher numbers of virus than staff, for slightly longer durations, but the differences are too small to be significant. Given equal shedding, the greater contribution of symptomatic cases to transmission must be caused by their higher efficiency in spreading these viruses. The results of this study will be helpful for risk studies that need to quantify the deposition of virus in the environment.

journal_name

Epidemiol Infect

authors

Teunis PF,Sukhrie FH,Vennema H,Bogerman J,Beersma MF,Koopmans MP

doi

10.1017/S095026881400274X

subject

Has Abstract

pub_date

2015-06-01 00:00:00

pages

1710-7

issue

8

eissn

0950-2688

issn

1469-4409

pii

S095026881400274X

journal_volume

143

pub_type

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