Significance of norovirus in occupational health: a review of published norovirus outbreaks in Central and Northern Europe

Felix Martin Hofmann,Martina Michaelis,Edward Olawumi,Ulrich Stößel,Friedrich Hofmann

doi:10.1007/s00420-020-01543-4

Abstract

ObjectivesGlobally, norovirus (NoV) is the leading cause of gastroenteritis infection among all ages. The development of prevention strategies in the field of occupational health requires a detailed knowledge about the impact of the disease on employees. This review article aims not only at evaluating the burden of NoV outbreaks on staff but also at discussing implications for future prevention strategies.MethodsPublished NoV outbreaks in Central and Northern Europe were identified via a systematic literature search. Additionally, published NoV outbreaks in Germany were detected via a manual literature search. Key epidemiological data, as the number of symptomatic staff, was then extracted. The proportion of affected employees was calculated for each dataset (single NoV outbreaks or aggregated data of multiple outbreaks).ResultsOverall, 116 datasets were extracted from 72 relevant articles. 144,852 persons were affected by NoV gastroenteritis, 25,408 out of them (17.5%) were employees. 23,874 (94.0%) of them fell sick during outbreaks in hospitals and related settings. NoV cases among personnel in food establishments were reported only sporadically (mean ratio: 0.01).ConclusionsEmployees in hospitals and community facilities seem quantitatively to be most vulnerable towards NoV epidemics. Therefore, high quality of prevention measures in these settings, respective compliance with prevention strategies should have the highest priority. The disease can be considered as an occupational disease, even regularly without long-term consequences. Following work safety rules, a vaccination for vulnerable groups should be recommended if the vaccine development turns out to be successful.

Highlights

Norovirus (NoV) infection is the leading cause of sporadic disease and outbreaks of acute gastroenteritis worldwide (Glass et al 2009; Lopman et al 2015)
To be able to assess the significance of NoV in occupational health and to discuss implications for future prevention strategies, this study aims at synthesising published epidemiological data from either single NoV outbreaks or aggregated register data
More than 50% of the NoV cases during 13 out of 43 outbreaks in health care facilities were employees and those staff members accounted for 34.9% of the NoV cases during community facility outbreaks, it is fair to conclude that NoV should be regarded, from a quantitative perspective, as an important occupational disease in these settings

Summary

Introduction

Norovirus (NoV) infection is the leading cause of sporadic disease and outbreaks of acute gastroenteritis worldwide (Glass et al 2009; Lopman et al 2015). The prevalence of NoV is highest in developing countries (Lanata et al 2013). The extremely contagious virus affects individuals of all ages, but young children and the elderly remain the most vulnerable groups (Glass et al 2009). An annual incidence rate in England as high as 34 consultations/1000 personyears in children younger than five years has been reported, thereby confirming the unequivocal vulnerability of this group to NoV infections (Verstraeten et al 2017)

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