Gastroenteritis outbreaks
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Norovirus and Rotavirus as Leading Causes of Gastroenteritis Outbreaks
Norovirus is the most common cause of gastroenteritis outbreaks worldwide, affecting all age groups and settings, including healthcare facilities, schools, and residential institutions L’Etoile2025Svraka2007Hall2013. In recent years, norovirus has surpassed rotavirus as the primary cause of healthcare-associated gastroenteritis outbreaks in regions such as North America, Europe, and Australia, largely due to the introduction of rotavirus vaccines . Rotavirus, while still significant, now accounts for a smaller proportion of outbreaks, particularly in pediatric and long-term care settings Svraka2007Mattison2021.
Emerging Norovirus Genotypes and Global Trends
Historically, the GII.4 genotype of norovirus has been the most prevalent in outbreaks. However, new genotypes such as GII.17 and recombinant strains like GII.P16-GII.2 have emerged and caused significant outbreaks in various regions Lu2015Gomes2025Fu2017+1 MORE. For example, in Guangdong, China, during the winter of 2014–2015, 82% of norovirus outbreaks were caused by the GII.17 variant . Similarly, a multi-province outbreak in Argentina in 2024 was linked to a novel lineage of GII.17, highlighting the importance of ongoing genomic surveillance to detect and respond to emerging strains . In Jiangsu, China, a re-emerging GII.P16-GII.2 variant was responsible for the majority of outbreaks in early 2017, demonstrating the dynamic nature of norovirus evolution and its impact on public health .
Transmission Pathways and Outbreak Settings
Person-to-person transmission is the most common mode of spread in gastroenteritis outbreaks, especially in long-term care facilities, daycares, schools, and residential institutions Svraka2007Mattison2021Hall2013. Foodborne transmission also plays a significant role, particularly in outbreaks associated with contaminated food items such as salads, cheese omelets, raw oysters, and catered meals Alsedà2023Inouye2000. In Japan, over 60% of nonbacterial gastroenteritis outbreaks were linked to contaminated food, with large outbreaks often traced to school lunches and catered events .
Infection Prevention and Control Measures
Effective infection prevention (IP) strategies are critical in controlling gastroenteritis outbreaks, especially in healthcare and institutional settings L’Etoile2025Alsedà2023. Key measures include excluding symptomatic food handlers from work, ensuring proper hand hygiene, and thorough cleaning of surfaces to prevent further spread . Surveillance systems, such as the National Outbreak Reporting System in the United States, play a vital role in tracking outbreaks, identifying transmission pathways, and informing targeted prevention efforts .
Other Viral Causes of Gastroenteritis Outbreaks
While norovirus and rotavirus are the leading causes, other viruses such as sapovirus, astrovirus, and adenovirus also contribute to gastroenteritis outbreaks, particularly in settings with close person-to-person contact Svraka2007Mattison2021. These viruses are less common but should be considered in outbreak investigations, especially when norovirus is not detected .
Conclusion
Gastroenteritis outbreaks remain a significant public health concern, with norovirus as the predominant cause globally. The emergence of new norovirus genotypes and recombinant strains underscores the need for continuous surveillance and rapid response. Effective infection prevention, prompt exclusion of symptomatic individuals, and attention to food safety are essential strategies to mitigate the impact of these outbreaks across diverse settings Lu2015L’Etoile2025Svraka2007+7 MORE.
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Most relevant research papers on this topic
Healthcare-Associated Gastroenteritis: Outbreak Report and Systematic Review of the Literature.
Norovirus has become the most common cause of healthcare-associated gastroenteritis outbreaks in North America, Europe, and Australia/New Zealand, since the introduction of rotavirus vaccines.
Two successive outbreaks of acute gastroenteritis due to norovirus GII.6 in a holiday camp house
Two consecutive outbreaks of norovirus GII.6 in a holiday camp house in Lleida, Spain, highlight the importance of excluding food handlers with gastroenteritis, proper handwashing, and surface cleaning.
Non-Norovirus Viral Gastroenteritis Outbreaks Reported to the National Outbreak Reporting System, USA, 2009–2018
Non-norovirus viral gastroenteritis outbreaks in the US between 2009 and 2018 included adenovirus, astrovirus, rotavirus, and sapovirus, with most occurring in long-term care facilities, daycares, and schools.
Acute Gastroenteritis Surveillance through the National Outbreak Reporting System, United States
The National Outbreak Reporting System identifies norovirus as the predominant cause of acute gastroenteritis in the United States, aiding prevention efforts.
An acute gastroenteritis outbreak caused by GII.17 norovirus in Jiangsu Province, China.
GII.17 norovirus caused an acute gastroenteritis outbreak in a senior high school in Wuxi, Jiangsu Province, China, with exposure to patients and sharing a communal water cooler as contributing factors.
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