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Differences in clinical presentation between norovirus genotypes in nursing homes

I H M Friesema1, H Vennema, J C M Heijne

  • 1National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands. ingrid.friesema@rivm.nl

Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology
|October 3, 2009
PubMed
Abstract

Insights

Norovirus (NoV) genotype II.4 (GII.4) outbreaks in nursing homes are linked to more severe symptoms, including increased vomiting and higher resident attack rates. Understanding these genotype-symptom links is crucial for infection control.

Area of Science:

  • Infectious Diseases
  • Virology
  • Epidemiology

Background:

  • Norovirus (NoV) outbreaks in healthcare settings are frequently caused by genotype II.4 (GII.4) strains.
  • Emerging GII.4 variants periodically lead to increased outbreak incidence.

Purpose of the Study:

  • To investigate the association between norovirus (NoV) genotype and clinical symptoms in nursing home residents and staff.
  • To compare symptom profiles and attack rates between GII.4 and non-GII.4 norovirus outbreaks.

Main Methods:

  • Retrospective analysis of data from 28 norovirus outbreaks in 49 nursing homes during the 2005/2006 and 2006/2007 winter seasons.
  • Symptom and illness duration data were collected for 465 residents and 174 staff members.
  • Genotyping identified norovirus strains, with GII.4 being predominant.

Main Results:

  • Genotype GII.4 caused 21 of 28 outbreaks and was associated with higher resident attack rates.
  • Residents in GII.4 outbreaks experienced more frequent vomiting, nausea, abdominal cramps, fever, and mucus in stool compared to other genotypes.
  • Specific GII.4 variants (2004 vs. 2006a) showed variations in symptom prevalence, but illness duration did not differ significantly. Staff symptoms showed no clear genotype-specific differences.

Conclusions:

  • Norovirus genotype GII.4 is associated with more severe symptomatic illness in nursing home residents.
  • Higher attack rates and increased vomiting are key indicators of GII.4 outbreaks.
  • Findings highlight the clinical impact of specific norovirus genotypes in institutional settings.

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