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Global Burden of Norovirus

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Norovirus

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Abstract

Noroviruses are small, non-enveloped, positive-stranded RNA viruses belonging to the family Caliciviridae, and are ubiquitous worldwide. Though GII.4 strains have historically dominated, recent surveillance suggests that other strains may replace GII.4 in some geographies. However, there are several challenges to quantifying overall norovirus disease burden, including low rates of care-seeking, limited use of norovirus diagnostics in clinical practice, and non-negligible asymptomatic shedding and vomiting-only presentations. Nonetheless, various methods exist to estimate incidence, and can be characterized by three general steps: (1) Estimate the global incidence of all-cause diarrheal disease; (2) Attribute a proportion of total diarrheal disease to noroviruses; (3) Adjust the norovirus diarrhea estimate for vomiting-only cases of norovirus. In a 2015 analysis, the overall disease burden of norovirus was estimated to encompass 685 million (95% Uncertainty Interval [UI]: 491–1123 million) cases and 212,489 (95% UI: 160,595–278,420) deaths annually. Although norovirus occurs across the age spectrum, young children and elderly persons are most affected, with the elderly most likely to suffer the most severe outcomes. Critical knowledge gaps include a need for population-based studies across the age spectrum, with particular focus on developing countries, as well as increased understanding of asymptomatic shedding and its impact on norovirus disease estimates. Scientific understanding of norovirus has previously been challenged by an inability to culture the virus in vitro; however, recent advances in this area will enable new lines of research. Further areas of exciting research include vaccine development, which will likely complement increased surveillance activities.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention (CDC).

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Authors and Affiliations

  1. Viral Gastroenteritis Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Rachel M. Burke & Aron J. Hall

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  1. Rachel M. Burke
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  1. Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon

    Nada M. Melhem

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Burke, R.M., Hall, A.J. (2019). Global Burden of Norovirus. In: Melhem, N. (eds) Norovirus. Springer, Cham. https://doi.org/10.1007/978-3-030-27209-8_1

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