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Journal of Clinical Microbiology, September 2008, p. 2959-2965, Vol. 46, No. 9
0095-1137/08/$08.00+0     doi:10.1128/JCM.00499-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

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

National Institute for Public Health and the Environment, Center for Infectious Disease Control, Bilthoven, The Netherlands,¹ Health Protection Agency, Centre for Infections, London, England,² Statens Serum Institut, Copenhagen, Denmark,³ University of Helsinki, Helsinki, Finland,⁴ National Public Health Institute, Helsinki, Finland,⁵ University of Dijon, Dijon, France,⁶ Institut de Veille Sanitaire, St. Maurice, France,⁷ Robert Koch Institut, Berlin, Germany,⁸ Regional Institute of State Public Health Service, Pécs, Hungary,⁹ National Center for Epidemiology, Budapest, Hungary,¹⁰ Mater Misericordiae Hospital, Dublin, Ireland,¹¹ Health Protection Surveillance Centre, Dublin, Ireland,¹² National Virus Reference Laboratory, Dublin, Ireland,¹³ Instituto Superiore di Sanita, Rome, Italy,¹⁴ Norwegian Institute of Public Health, Oslo, Norway,¹⁵ University of Ljubljana, Ljubljana, Slovenia,¹⁶ Institute of Public Health of the Republic of Slovenia, Ljubljana, Slovenia,¹⁷ University of Barcelona, Barcelona, Spain,¹⁸ University of Valencia, Valencia, Spain,¹⁹ Instituto de Salud Carlos III, Madrid, Spain,²⁰ Swedish Institute for Infectious Disease Control, Solna, Sweden,²¹

Received 13 March 2008/ Returned for modification 29 May 2008/ Accepted 11 July 2008

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.

Published ahead of print on 23 July 2008.