Faculty, Staff and Student Publications
Publication Date
10-19-2024
Journal
Journal of Travel Medicine
Abstract
BACKGROUND: Acute gastroenteritis (AGE) is a major medical condition for travellers worldwide, particularly travellers to low- and middle-income countries. Norovirus (NoV) is the most common cause of viral AGE in older children and adults, but data on prevalence and impact amongst travellers is limited.
METHODS: Prospective, multi-site, observational cohort study conducted 2015-2017, amongst adult international travellers from the US and Europe to areas of moderate to high risk of travel-acquired AGE. Participants provided self-collected pre-travel stool samples and self-reported AGE symptoms whilst travelling. Post-travel stool samples were requested from symptomatic subjects and a sample of asymptomatic travellers within 14 days of return. Samples were tested for NoV by RT-qPCR, genotyped if positive and tested for other common enteric pathogens by Luminex xTAG GPP.
RESULTS: Of the 1109 participants included, 437 (39.4%) developed AGE symptoms resulting in an overall AGE incidence of 24.7 per 100 person-weeks [95% confidence interval (CI): 22.4; 27.1]. In total, 20 NoV-positive AGE cases (5.2% of those tested) were identified at an incidence of 1.1 per 100 person-weeks (95% CI: 0.7; 1.7). NoV-positive samples belonged mostly to genogroup GII (18, 85.7%); None of the 13 samples sequenced belonged to genotype GII.4. Clinical severity of AGE was higher for NoV-positive than for NoV-negative cases (mean modified Vesikari Score 6.8 vs 4.9) with more cases classified as severe or moderate (25% vs 6.8%). In total, 80% of NoV-positive participants (vs 38.9% in NoV-negative) reported at least moderate impact on travel plans.
CONCLUSIONS: AGE is a prevalent disease amongst travellers with a small proportion associated with NoV. Post-travel stool sample collection timing might have influenced the low number of NoV cases detected; however, NoV infections resulted in high clinical severity and impact on travel plans. These results may contribute to targeted vaccine development and the design of future studies on NoV epidemiology.
Keywords
Humans, Prospective Studies, Gastroenteritis, Norovirus, Caliciviridae Infections, Male, Female, Europe, Adult, Diarrhea, Travel, United States, Middle Aged, Feces, Incidence, Young Adult, Risk Factors, Prevalence, Cohort Studies, Acute Disease, Epidemiology, viral gastroenteritis, incidence, genotype, symptoms, impact, travel plans, vomiting
DOI
10.1093/jtm/taad051
PMID
37074164
PMCID
PMC11500662
PubMedCentral® Posted Date
4-19-2023
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Comments
This article has been corrected. See J Travel Med. 2023 Jun 3;30(6):taad076.