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Abstract
Widdowson MA, Cramer EH, Hadley L, Bresee JS, Beard RS, Bulens SN,
Charles M, Chege W, Isakbaeva E, Wright JG, Mintz E, Forney D, Massey
J, Glass RI, Monroe SS. "Outbreaks of acute gastroenteritis on cruise
ships and on land: identification of a predominant circulating strain
of norovirus--United States, 2002," Journal
of Infectious Disease,
2004, 190:1 (July 1), 27-36.
In 2002, a sharp increase in outbreaks of
norovirus-associated illness, both on cruise ships and on land,
encouraged us to examine the molecular epidemiology of detected
noroviruses, to identify a common strain or source. Of 14
laboratory-confirmed outbreaks on cruise ships, 12 (86%) were
attributed to caliciviruses; among these 12, outbreak characteristics
included continuation on successive cruises in 6 (50%), multiple modes
of transmission in 7 (58%), and high (>10%) attack rates in 7 (58%).
Eleven of the 12 calicivirus outbreaks were attributed to noroviruses,
7 (64%) of which were attributed to a previously unreported lineage,
provisionally named "the Farmington Hills strain." From May 2002 to
December 2002, 10 (45%) of 22 land-based outbreaks also were attributed
to this strain. Nucleotide-sequence analysis provided insights into
norovirus transmission, by documenting links among outbreaks, the
introduction of strains onto ships, and viral persistence on board
(despite cleaning). Control measures for outbreaks should address all
routes of transmission. Better outbreak surveillance and collection of
data on sequences will help to monitor norovirus strains and to
identify common sources.
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