Abstract
Norovirus outbreaks severely disrupt healthcare systems. We evaluated whether Websök, an internet-based surveillance system using search engine data, improved norovirus surveillance and response in Sweden. We compared Websök users' characteristics with the general population, cross-correlated weekly Websök searches with laboratory notifications between 2006 and 2013, compared the time Websök and laboratory data crossed the epidemic threshold and surveyed infection control teams about their perception and use of Websök. Users of Websök were not representative of the general population. Websök correlated with laboratory data (b = 0.88-0.89) and gave an earlier signal to the onset of the norovirus season compared with laboratory-based surveillance. 17/21 (81%) infection control teams answered the survey, of which 11 (65%) believed Websök could help with infection control plans. Websök is a low-resource, easily replicable system that detects the norovirus season as reliably as laboratory data, but earlier. Using Websök in routine surveillance can help infection control teams prepare for the yearly norovirus season.
Highlights
Norovirus is a leading cause of gastroenteritis [1], responsible for sporadic cases as well as outbreaks [2]
Infection with norovirus is characterized by acute onset of nausea, vomiting, abdominal cramps, myalgia, and non-bloody diarrhea
Almost 90% of individuals with norovirus illness do not seek healthcare [10] and estimations suggest that national surveillance systems only capture 1 in 1,500 community cases [11]
Summary
Norovirus is a leading cause of gastroenteritis [1], responsible for sporadic cases as well as outbreaks [2]. Norovirus outbreaks peak during winter months in temperate climates [3] and are referred to as ‘winter vomiting disease’ Other pathogens, such as rotavirus, contribute to acute gastrointestinal illness in the winter months and can lead to several peaks of gastrointestinal illness during that season [4]. Healthcare associated outbreaks affect patients and disrupt hospital functioning because of containment procedures (e.g., closure of wards, postponement of surgery) and staff absenteeism [2,5,12]. They are costly: a 2011 study estimated that each nosocomial norovirus infection case cost $6 237 [13]. Implementation of prevention measures including hand hygiene, staff exclusion and disinfection shorten norovirus outbreaks [14] and reduce hospital costs [13]
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