Epidemiology of Acute Gastroenteritis Outbreaks Caused by Human Calicivirus (Norovirus and Sapovirus) in Catalonia: A Two Year Prospective Study, 2010-2011

<div><p>Background</p><p>The epidemiology of cases of acute gastroenteritis (AGE) of viral etiology is a relevant public health issue. Due to underreporting, the study of outbreaks is an accepted approach to investigate their epidemiology. The objective of this study was to investigate the epidemiological characteristics of AGE outbreaks due to norovirus (NoV) and sapovirus (SV) in Catalonia.</p><p>Material and Methods</p><p>Prospective study of AGE outbreaks of possible viral etiology notified during two years in Catalonia. NoV and SV were detected by real time reverse transcription polymerase (RT-PCR).</p><p>Results</p><p>A total of 101 outbreaks were registered affecting a total of 2756 persons and 12 hospitalizations (hospitalization rate: 0.8x1,000,000 persons-year); 49.5% of outbreaks were foodborne, 45.5% person to person and 5% waterborne. The distribution of outbreaks according to the setting showed a predominance of catering services (39.6%), nursing homes and long term care facilities (26.8%) and schools (11.9%). The median number of cases per outbreak was 17 (range 2–191). The total Incidence rate (IR) was 18.3 per 100,000 persons-years (95%CI: 17.6–19.0). The highest IR was in persons aged ≥65 years (43.6x100,000 (95% CI: 41.0–46.2)) (p<0.001). A total of 1065 samples were analyzed with a positivity rate of 60.8%. 98% of positive samples were NoV (GII 56.3%; GI 4.2%; GII+GI 4.2%; non- typable 33.0%). SV was identified in two person-to-person transmission outbreaks in children.</p><p>Conclusions</p><p>These results confirm the relevance of viral AGE outbreaks, both foodborne and person-to-person, especially in institutionalized persons. SV should be taken into account when investigating viral AGE outbreaks.</p></div

Distribution of acute gastroenteritis outbreaks by month of occurrence and transmission mode.

<p>Catalonia 2010 and 2011.* Cold months (November to April) significantly higher incidence than warm months (May to October) for both transmission modes (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0152503#pone.0152503.t003" target="_blank">Table 3</a>).</p

Incidence rates and risk ratio of infection, hospitalization rates, medical consultation and absenteeism according to age groups and gender.

<p>Catalonia 2010–2011.</p

Distribution of outbreaks according to setting of occurrence and mode transmission.

<p>Catalonia 2010–2011.</p

Distribution of percentage of outbreaks by season of the year and transmission mode.

<p>Catalonia 2010–2011.</p

Flowchart of healthcare workers’ questionnaires assessed in the study.

<p>Flowchart of healthcare workers’ questionnaires assessed in the study.</p

Manhattan plots of a general population sample vs.

<p>(A) severe influenza cases; (B) mild influenza cases and (C) all influenza cases. Only p-values < 0.05 are shown. (D): Venn diagram of SNPs with significant associations with p<5×10⁻⁸ when comparing severe influenza cases, mild influenza cases or all influenza cases to a general population sample.</p

Manhattan plot of severe vs. mild influenza cases. Only p-values < 0.05 are shown. The thick horizontal line denotes p = 5×10⁻⁸.

<p>Manhattan plot of severe vs. mild influenza cases. Only p-values < 0.05 are shown. The thick horizontal line denotes p = 5×10⁻⁸.</p

Multidimensional scaling based on identity by state distances among severe influenza cases, mild influenza cases, and a general population sample.

<p>Multidimensional scaling based on identity by state distances among severe influenza cases, mild influenza cases, and a general population sample.</p

Main sociodemographic features of hospitalized and non-hospitalized patients with confirmed infection by influenza A(H1N1) 2009 virus in Spain 2009–2010.

<p>Crude and adjusted odds-ratios, from bivariate and multivariate (logistic regression) analyses respectively, are shown. Only variables used in the adjusted analyses are reported.</p><p>OR = Odds ratio; CI = Confidence interval.</p