title: Emergency department visit data for rapid detection and monitoring of norovirus activity, United States.
abstract: Noroviruses are the leading cause of gastroenteritis in the United States, but timely measures of disease are lacking. BioSense, a national-level electronic surveillance system, assigns data on chief complaints (patient symptoms) collected during emergency department (ED) visits to 78 subsyndromes in near real-time. In a series of linear regression models, BioSense visits mapped by chief complaints of diarrhea and nausea/vomiting subsyndromes as a monthly proportion of all visits correlated strongly with reported norovirus outbreaks from 6 states during 2007-2010. Higher correlations were seen for diarrhea (R = 0.828-0.926) than for nausea/vomiting (R = 0.729-0.866) across multiple age groups. Diarrhea ED visit proportions exhibited winter seasonality attributable to norovirus; rotavirus contributed substantially for children <5 years of age. Diarrhea ED visit data estimated the onset, peak, and end of norovirus season within 4 weeks of observed dates and could be reliable, timely indicators of norovirus activity.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. wif8@cdc.gov
authors.forename: Brian
authors.initials: B
authors.lastname: Rha
authors.forename: Sherry
authors.initials: S
authors.lastname: Burrer
authors.forename: Soyoun
authors.initials: S
authors.lastname: Park
authors.forename: Tarak
authors.initials: T
authors.lastname: Trivedi
authors.forename: Umesh D
authors.initials: UD
authors.lastname: Parashar
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Lopman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017250:Caliciviridae Infections / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology* / Q000821:virology; D004196:Disease Outbreaks; D057286:Electronic Health Records; D004636:Emergency Service, Hospital; D062665:Epidemiological Monitoring; D005759:Gastroenteritis / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D007223:Infant; D016014:Linear Models; D008875:Middle Aged; D029322:Norovirus; D012400:Rotavirus Infections / Q000453:epidemiology; D012621:Seasons; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: United States; biosurveillance; chief complaint; detection; emergency department; enteric infections; gastroenteritis; norovirus; outbreaks; rotavirus; surveillance; tracking; viruses