title: Norovirus disease associated with excess mortality and use of statins: a retrospective cohort study of an outbreak following a pilgrimage to Lourdes.
abstract: Although norovirus infection is generally known to be a mild disease, there is some evidence for severe outcome. An outbreak in a Dutch psychiatric institution, originating from pilgrims returning from Lourdes (France), provided an opportunity for performing a retrospective cohort study in order to identify risk factors for norovirus disease and excess mortality. Relative risks (RR) including 95% confidence intervals (CI) showed that attending the pilgrimage (RR 2·0, 95% CI 1·4-3·0) and age >70 (RR 1·7, 95% CI 1·2-2·2) were risk factors for symptomatic infection. In a subset of patients, for whom more detailed information was available, the use of statins was associated with norovirus disease when adjusted for underlying condition (adjusted odds ratio 3·9, 95% CI 1·2-13·0). Mortality was higher in cases infected during the pilgrimage compared to other residents (RR 20·9, 95% CI 4·7-93·8). Norovirus disease can lead to severe outcome. The newly identified risk of statins for contracting norovirus disease may have considerable consequences for the Western world and needs prospective confirmation.
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Center for Infectious Diseases Control, Epidemiology and Surveillance Unit, Bilthoven, The Netherlands. marc.rondy@rivm.nl
authors.forename: M
authors.initials: M
authors.lastname: Rondy
authors.forename: M
authors.initials: M
authors.lastname: Koopmans
authors.forename: C
authors.initials: C
authors.lastname: Rotsaert
authors.forename: T
authors.initials: T
authors.lastname: Van Loon
authors.forename: B
authors.initials: B
authors.lastname: Beljaars
authors.forename: G
authors.initials: G
authors.lastname: Van Dijk
authors.forename: J
authors.initials: J
authors.lastname: Siebenga
authors.forename: S
authors.initials: S
authors.lastname: Svraka
authors.forename: J W A
authors.initials: JW
authors.lastname: Rossen
authors.forename: P
authors.initials: P
authors.lastname: Teunis
authors.forename: W
authors.initials: W
authors.lastname: Van Pelt
authors.forename: L
authors.initials: L
authors.lastname: Verhoef
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000401:mortality*; D015331:Cohort Studies; D004196:Disease Outbreaks; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005602:France; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D009426:Netherlands; D029322:Norovirus / Q000302:isolation & purification*; D012189:Retrospective Studies; D012307:Risk Factors; D014195:Travel
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors