title: Analysis of integrated virological and epidemiological reports of norovirus outbreaks collected within the Foodborne Viruses in Europe network from 1 July 2001 to 30 June 2006.
abstract: The Foodborne Viruses in Europe network has developed integrated epidemiological and virological outbreak reporting with aggregation and sharing of data through a joint database. We analyzed data from reported outbreaks of norovirus (NoV)-caused gastroenteritis from 13 European countries (July 2001 to July 2006) for trends in time and indications of different epidemiology of genotypes and variants. Of the 13 countries participating in this surveillance network, 11 were capable of collecting integrated epidemiological and virological surveillance data and 10 countries reported outbreaks throughout the entire period. Large differences in the numbers and rates of reported outbreaks per country were observed, reflecting the differences in the focus and coverage of national surveillance systems. GII.4 strains predominated throughout the 5-year surveillance period, but the proportion of outbreaks associated with GII.4 rose remarkably during years in which NoV activity was particularly high. Spring and summer peaks indicated the emergence of genetically distinct variants within GII.4 across Europe and were followed by increased NoV activity during the 2002-2003 and 2004-2005 winter seasons. GII.4 viruses predominated in health care settings and in person-to-person transmission. The consecutive emergence of new GII.4 variants is highly indicative of immune-driven selection. Their predominance in health care settings suggests properties that facilitate transmission in settings with a high concentration of people such as higher virus loads in excreta or a higher incidence of vomiting. Understanding the mechanisms driving the changes in epidemiology and clinical impact of these rapidly evolving RNA viruses is essential to design effective intervention and prevention measures.
authors.affiliation: National Institute for Public Health and the Environment, Laboratory for Infectious Diseases and Screening, Center for Infectious Disease Control, Bilthoven, The Netherlands. annelies.kroneman@rivm.nl
authors.forename: A
authors.initials: A
authors.lastname: Kroneman
authors.forename: L
authors.initials: L
authors.lastname: Verhoef
authors.forename: J
authors.initials: J
authors.lastname: Harris
authors.forename: H
authors.initials: H
authors.lastname: Vennema
authors.forename: E
authors.initials: E
authors.lastname: Duizer
authors.forename: Y
authors.initials: Y
authors.lastname: van Duynhoven
authors.forename: J
authors.initials: J
authors.lastname: Gray
authors.forename: M
authors.initials: M
authors.lastname: Iturriza
authors.forename: B
authors.initials: B
authors.lastname: Böttiger
authors.forename: G
authors.initials: G
authors.lastname: Falkenhorst
authors.forename: C
authors.initials: C
authors.lastname: Johnsen
authors.forename: C-H
authors.initials: CH
authors.lastname: von Bonsdorff
authors.forename: L
authors.initials: L
authors.lastname: Maunula
authors.forename: M
authors.initials: M
authors.lastname: Kuusi
authors.forename: P
authors.initials: P
authors.lastname: Pothier
authors.forename: A
authors.initials: A
authors.lastname: Gallay
authors.forename: E
authors.initials: E
authors.lastname: Schreier
authors.forename: M
authors.initials: M
authors.lastname: Höhne
authors.forename: J
authors.initials: J
authors.lastname: Koch
authors.forename: G
authors.initials: G
authors.lastname: Szücs
authors.forename: G
authors.initials: G
authors.lastname: Reuter
authors.forename: K
authors.initials: K
authors.lastname: Krisztalovics
authors.forename: M
authors.initials: M
authors.lastname: Lynch
authors.forename: P
authors.initials: P
authors.lastname: McKeown
authors.forename: B
authors.initials: B
authors.lastname: Foley
authors.forename: S
authors.initials: S
authors.lastname: Coughlan
authors.forename: F M
authors.initials: FM
authors.lastname: Ruggeri
authors.forename: I
authors.initials: I
authors.lastname: Di Bartolo
authors.forename: K
authors.initials: K
authors.lastname: Vainio
authors.forename: E
authors.initials: E
authors.lastname: Isakbaeva
authors.forename: M
authors.initials: M
authors.lastname: Poljsak-Prijatelj
authors.forename: A Hocevar
authors.initials: AH
authors.lastname: Grom
authors.forename: J Zimsek
authors.initials: JZ
authors.lastname: Mijovski
authors.forename: A
authors.initials: A
authors.lastname: Bosch
authors.forename: J
authors.initials: J
authors.lastname: Buesa
authors.forename: A Sanchez
authors.initials: AS
authors.lastname: Fauquier
authors.forename: G
authors.initials: G
authors.lastname: Hernandéz-Pezzi
authors.forename: K-O
authors.initials: KO
authors.lastname: Hedlund
authors.forename: M
authors.initials: M
authors.lastname: Koopmans
mesh_terms: D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D018563:Disease Notification; D004196:Disease Outbreaks; D005060:Europe / Q000453:epidemiology; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000821:virology; D005759:Gastroenteritis / Q000453:epidemiology* / Q000821:virology; D005838:Genotype; D006801:Humans; D015999:Multivariate Analysis; D029322:Norovirus / Q000235:genetics