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. 2021 Jul 1;73(1):e1-e8.
doi: 10.1093/cid/ciaa438.

Burden of Norovirus in the United States, as Estimated Based on Administrative Data: Updates for Medically Attended Illness and Mortality, 2001-2015

Rachel M Burke  1 , Claire P Mattison  1   2 , Talia Pindyck  1   3 , Rebecca M Dahl  4 , Jessica Rudd  4 , Daoling Bi  1 , Aaron T Curns  1 , Umesh Parashar  1 , Aron J Hall  1
Affiliations

Burden of Norovirus in the United States, as Estimated Based on Administrative Data: Updates for Medically Attended Illness and Mortality, 2001-2015

Rachel M Burke et al. Clin Infect Dis. .

Abstract

Background: Up-to-date estimates of the burden of norovirus, a leading cause of acute gastroenteritis (AGE) in the United States, are needed to assess the potential value of norovirus vaccines in development. We aimed to estimate the rates, annual counts, and healthcare charges of norovirus-associated ambulatory clinic encounters, emergency department (ED) visits, hospitalizations, and deaths in the United States.

Methods: We analyzed administrative data on AGE outcomes from 1 July 2001 through 30 June 2015. Data were sourced from IBM MarketScan Commercial and Medicare Supplemental Databases (ambulatory clinic and ED visits), the Healthcare Utilization Project National Inpatient Sample (hospitalizations), and the National Center for Health Statistics multiple-cause-of-mortality data (deaths). Outcome data (ambulatory clinic and ED visits, hospitalizations, or deaths) were summarized by month, age group, and setting. Healthcare charges were estimated based on insurance claims. Monthly counts of cause-unspecified gastroenteritis-associated outcomes were modeled as functions of cause-specified outcomes, and model residuals were analyzed to estimate norovirus-associated outcomes. Healthcare charges were estimated by applying average charges per cause-unspecified gastroenteritis encounter to the estimated number of norovirus encounters.

Results: We estimate 900 deaths (95% confidence interval [CI], 650-1100), 109 000 hospitalizations (95% CI, 80 000-145 000), 465 000 ED visits (95% CI, 348 000-610 000), and 2.3 million ambulatory clinic encounters (95% CI, 1.7-2.9 million) annually due to norovirus, with an associated $430-$740 million in healthcare charges.

Conclusions: Norovirus causes a substantial health burden in the United States each year, and an effective vaccine could have important public health impact.

Keywords: United States; gastroenteritis; norovirus; norovirus incidence.

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Figures

Figure 1:
Figure 1:. Estimated Rates of Norovirus Encounters by Seasonal Year—United States, 2001/2002 – 2014/2015.
Estimated annual rates of norovirus-related encounters varied by seasonal year as well as outcome.
Figure 2:
Figure 2:. The disease burden of norovirus in the United States.
Ranges of total annual deaths, hospitalizations, emergency department visits, and ambulatory clinic encounters are presented within the pyramid and the corresponding estimated lifetime risk is noted with arrows.
See this image and copyright information in PMC

References

    1. Vinjé J Advances in Laboratory Methods for Detection and Typing of Norovirus. Journal of Clinical Microbiology 2015; 53(2): 373–81. - PMC - PubMed
    1. Chhabra P, de Graaf M, Parra GI, et al. Updated classification of norovirus genogroups and genotypes. J Gen Virol 2019; 100(10): 1393–406. - PMC - PubMed
    1. Kirk MD, Pires SM, Black RE, et al. World Health Organization Estimates of the Global and Regional Disease Burden of 22 Foodborne Bacterial, Protozoal, and Viral Diseases, 2010: A Data Synthesis. PLoS Med 2015; 12(12): e1001921. - PMC - PubMed
    1. Hall AJ, Lopman BA, Payne DC, et al. Norovirus disease in the United States. Emerg Infect Dis 2013; 19(8): 1198–205. - PMC - PubMed
    1. Lopman BA, Steele D, Kirkwood CD, Parashar UD. The Vast and Varied Global Burden of Norovirus: Prospects for Prevention and Control. PLoS Med 2016; 13(4): e1001999. - PMC - PubMed