Norovirus outbreaks in long-term care facilities in Catalonia from 2017 to 2018

Ignasi Parrón ,Mireia Jané,Montse Cunillé,Núria Torner,Sara Sabaté,Esteve Camprubí,Thais Cornejo-Sánchez,Efrén Razquín,Maria Sabaté,Núria Soldevila,Rosa Bartolomé,M Lluïsa Forns,Cristina Pérez,Antonio Moreno-Martínez,Miquel Alsedà,Sofía Minguell ,Irene Barrabeig,Susana Guix,Ángela Domı́nguez ,Rosa Maria Vileu,Pere Godoy,Anna De Andrés ,Conchita Izquierdo,Ariadna Rovira,Cristina Rius,Lorena Coronas,Javier De Benito,Michaela Simon ,Jaime Álvarez ,Anna Isabel Belver,M Sala ,A Martínez ,Neus Camps,Mònica Carol

doi:10.1038/s41598-021-02348-2

Abstract

Norovirus is the leading cause of outbreaks of acute viral gastroenteritis. We carried out this study to investigate outbreaks in long-term care facilities reported in 2017 and 2018 in Catalonia (Spain). The characteristics of the centers, exposed persons and the genogroups responsible were analyzed. Viral loads were estimated. The attack rate (AR) of the outbreaks studied, and the rate ratio (RR) and the odds ratio (OR) and their 95% confidence intervals as measures of association were calculated. The mean cycle thresholds were compared using the t-test for independent means. We included 30 outbreaks (4631 exposed people). The global AR was 25.93%. The RR of residents vs. staff was 2.28 (95% CI 2.0–2.6). The RR between AR in residents with total or severe dependence vs. residents with moderate, low or no-dependence was 1.23 (95% CI 1.05–1.45). The AR were higher in smaller centers than in larger ones (38.47% vs. 19.25% and RR 2; 95% CI 1.82–2.2). GII was responsible for 70% of outbreaks. No association was found between the genogroup and presenting symptoms (OR 0.96; 95% CI 0.41–2.26). Viral loads were higher in symptomatic than in asymptomatic patients (p = 0.001).

Highlights

Norovirus is the leading cause of outbreaks of acute viral gastroenteritis
Of the more than 1000 outbreaks of acute gastroenteritis (AGE) reported annually in 2009 and 2010 in the United States, norovirus was confirmed as the etiological agent in 86%, and 90% of norovirus-associated deaths occurred in people aged ≥ 65 years[7]
Agency of Catalonia; 40 (18.78%) occurred in long-term care facilities (LTCF) and norovirus was identified as the causal agent in 75% (30/40)

Summary

Introduction

Norovirus is the leading cause of outbreaks of acute viral gastroenteritis. Norovirus is estimated to be responsible for 20% of cases of all-cause diarrhea w orldwide[3] and may cause up to 90% of outbreaks of acute gastroenteritis (AGE) of viral e tiology[4]. Kreidieh et al.[6] in a similar study in the Middle East and North Africa between 2000 and 2015 found that between 0.82% and 36.84% of AGE outbreaks in children aged < 5 years treated in hospital emergency rooms were caused by norovirus. Of the more than 1000 outbreaks of AGE reported annually in 2009 and 2010 in the United States, norovirus was confirmed as the etiological agent in 86%, and 90% of norovirus-associated deaths occurred in people aged ≥ 65 years[7]

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