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Norovirusinfektionen in Deutschland

Norovirus infections in Germany

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Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Noroviren verursachen einen Großteil der weltweit auftretenden akuten viralen Gastroenteritiden. Sie verbreiten sich über kontaminierte Lebensmittel und Wasser, als Schmierinfektion oder über Aerosole, die beim Erbrechen entstehen. Aufgrund der hohen Viruskonzentration im Stuhl oder Erbrochenen, ihrer hohen Umweltstabilität, der niedrigen infektiösen Dosis sowie dem Fehlen einer längerfristigen Immunität führen Noroviruserkrankungen neben sporadischen Einzelerkrankungen überwiegend in Gemeinschaftseinrichtungen wie Krankenhäusern und Altenheimen zu Ausbrüchen von beachtlichem Ausmaß. Die Bewältigung dieser Krankheitsgeschehen erfordert ein striktes Hygienemanagement. Kinder und alte Menschen sind von der Erkrankung, die durch plötzlich einsetzendes häufig schwallartiges Erbrechen gekennzeichnet ist, besonders betroffen. Kennzeichnend für Noroviren ist die extreme Genomvariabilität, durch die fortlaufend neue Virusvarianten mit einem unterschiedlich stark ausgeprägten pathogenen Potenzial entstehen. Abhängig von der zirkulierenden Virusvariante differiert dadurch vor allem der Wintergipfel der saisonal verlaufenden Erkrankung deutlich. Für die Diagnostik stehen neben dem elektronenmikroskopischen Nachweis insbesondere der virale RNA-Nachweis in der PCR bzw. des viralen Antigens im Antigen-Enzymimmunoassay (EIA) zur Verfügung. Die Genomsequenzierung liefert wertvolle Informationen zur Identifikation der Virusvariante und zur Aufklärung von Infektionsketten. Erst nach Umsetzung des Infektionsschutzgesetzes (IfSG) im Januar 2001 mit Einführung der Meldepflicht von Norovirusinfektionen ist es möglich, einen detaillierten Überblick zur bundesweiten Epidemiologie dieser Erkrankung in Deutschland zu erhalten.

Abstract

Noroviruses are responsible for the majority of acute viral gastroenteritis infections worldwide. Transmission may be faecal-oral or through contaminated food and water or airborne by virus-containing aerosols. Characteristics of noroviruses that facilitate their spread are their high concentration in stool and vomitus, their extreme environmental stability, their low infectious dose as well as the lack of long-lasting immunity. The majority of norovirus infections occur in large outbreaks among persons living in institutional settings, such as hospitals and nursing homes, although sporadic cases also occur. Children and elderly persons are most often affected. Illness is characterized by acute onset of projectile vomiting. For prevention and control of norovirus outbreaks strict control management is necessary. Based on the high genomic variability new variant noroviruses with different pathogenic factors can arise. Depending on the circulating variant the extent of the usual winter peak can vary enormously. Available diagnostic methods include RT-PCR assays for detection of viral RNA, electron microscopy and enzyme immunoassays (EIA) for detection of viral antigens. The implicated virus can be subtyped through nucleotide sequencing and linked to a specific outbreak. With the enactment of the Protection against Infection Act in January 2001 a mandatory reporting system of norovirus infections was established. Analysis of surveillance data from this system permits a detailed overview of the nationwide epidemiology of this disease in Germany.

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Authors and Affiliations

  1. Robert Koch-Institut, Berlin

    J. Koch, K. Stark & E. Schreier

  2. Charité, Berlin

    T. Schneider

  3. Abteilung für Infektionsepidemiologie, Robert Koch-Institut, 650261, 13302 , Berlin

    J. Koch

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  1. J. Koch
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  2. T. Schneider
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  4. E. Schreier
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Correspondence to J. Koch.

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Koch, J., Schneider, T., Stark, K. et al. Norovirusinfektionen in Deutschland. Bundesgesundheitsbl - Gesundheitsforsch - Gesundheitsschutz 49, 296–309 (2006). https://doi.org/10.1007/s00103-006-1231-x

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  • DOI: https://doi.org/10.1007/s00103-006-1231-x

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