Abstract
BackgroundNorovirus is an important cause of acute gastroenteritis globally. However, norovirus is rarely laboratory confirmed or recorded explicitly as a cause of hospitalization. In recent years, there has been an interest in using medical databases and indirect modelling methods to estimate the incidence of norovirus gastroenteritis. The objective of this study was to estimate the incidence of hospitalizations for norovirus gastroenteritis in Europe (2004–2015) using nationwide in-patient discharge records from different European countries.MethodsNational hospital discharge registers in all 28 European Union countries (at that time) and all 4 European Free Trade Association countries were contacted and invited to participate in the study. Discharges with ICD9/ICD10 codes for acute gastroenteritis (AGE) as first-listed (principal) diagnosis were extracted to assess hospitalization rates for AGE and norovirus gastroenteritis (NGE), overall, by age group, country, month, and seasonal year. The number of cause-unspecified episodes was regressed against pathogen-specific AGE episodes: Rotavirus, Clostridium difficile, Other Bacterial, Other Viral and Parasitic separately. NGE hospital discharges were estimated for each month by calculating the difference between observed cause-unspecified and model-predicted counts, assuming that any remaining seasonality not otherwise captured in the model was due to norovirus, and adding those to the coded NGE episodes to get the total number of norovirus-associated episodes.ResultsData were available from 15 countries, representing 68% of the total population in Europe. Only 24.4% of all AGE discharges were coded as cause-specified. We estimated that between 2004 and 2015, the overall rate of NGE hospital discharges in Europe was 3.9 per 10,000 person-years, ranging from 1.2 (Portugal) to 10.7 (Lithuania). Norovirus was predicted to be responsible for 17% of all AGE hospital discharges in Europe in this period. Norovirus affects individuals of all ages, but NGE discharge rates were highest in children < 5 years (24.8 per 10,000 person-years), and adults aged ≥80 years (10.7 per 10,000 person-years).ConclusionWe estimated that 1 in 400 hospitalizations in Europe can be attributed to Norovirus. In the absence of routine norovirus testing and recording in hospital settings, modelling methods are useful resources to estimate the incidence of norovirus gastroenteritis.
Highlights
Norovirus is an important cause of acute gastroenteritis (AGE) globally across all age groups [1,2,3]
No data were obtained from other EU & European Free Trade Association (EFTA) countries for reasons explained in Supplemental Table 3
In an earlier study we performed on the incidence of norovirus gastroenteritis (NGE) in England, using a similar modeling method and using data from the Clinical Practice Research Datalink (CPRD) linked to the Hospital Episode Statistics (HES) database, we found a rate of 7.1 NGE hospital discharges per 10,000 personyears [6], compared with 1.8 per 10,000 using only the HES database in the current study
Summary
Norovirus is an important cause of acute gastroenteritis (AGE) globally across all age groups [1,2,3]. From July 2007 through June 2013 90% of all gastroenteritis hospital discharges in England were of undetermined etiology [6] To overcome these issues, in recent years there has been an increasing interest and use of medical databases and mathematical models to indirectly estimate the incidence of norovirus-associated disease [7,8,9,10,11]. In-patient datasets are usually recorded as mandatory national health registers in most European countries. These registers contain information on hospital discharges by diagnostic codes commonly using the International Classification of Diseases, Ninth/tenth Revision (ICD-9/10). The objective of this study was to estimate the incidence of hospitalizations for norovirus gastroenteritis in Europe (2004–2015) using nationwide in-patient discharge records from different European countries
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