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Incidence of Hospital Norovirus Outbreaks and Infections Using 2 Surveillance Methods in Sweden

Published online by Cambridge University Press:  14 November 2016

Carl-Johan Fraenkel ,
Malin Inghammar ,
P. J. Hugo Johansson  and
Blenda Böttiger
Carl-Johan Fraenkel*
Affiliation:
Department of Infection Control, Region Skåne, Lund, Sweden Department of Clinical Sciences, Section for Infection Medicine, Lund University, Lund, Sweden
Malin Inghammar
Affiliation:
Department of Clinical Sciences, Section for Infection Medicine, Lund University, Lund, Sweden
P. J. Hugo Johansson
Affiliation:
Department of Infection Control, Region Skåne, Lund, Sweden
Blenda Böttiger
Affiliation:
Clinical Microbiology, University and Regional Laboratories, Region Skåne, Lund, Sweden
*
Address correspondence to Carl-Johan Fraenkel, MD, Klinikgatan 3, S-22185 Lund, Sweden ([email protected]).
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Abstract

OBJECTIVE

To evaluate 2 different methods of surveillance and to estimate the incidence of norovirus (NoV) outbreaks in hospitals.

DESIGN

Prospective observational study.

SETTING

All 194 hospital wards in southern Sweden during 2 winter seasons (2010–2012).

METHODS

Clinical surveillance based on outbreak reports of 2 or more clinical cases, with symptom onset within 5 days, was compared with laboratory surveillance based on positive NoV results among inpatients. At least 2 NoV positive patients sampled within 5 days at a ward defined a cluster. Outbreak reports including at least 1 NoV positive case and clusters including at least 1 NoV positive patient with 5 or more days from ward admission to sampling were defined as NoV outbreaks.

RESULTS

During the study periods 135 NoV outbreaks were identified; 74 were identified by both clinical and laboratory surveillance, 18 were identified only by outbreak reports, and 43 were identified only by laboratory surveillance. The outbreak incidence was 1.0 (95% CI, 0.8–1.2) and 0.5 (95% CI, 0.3–0.6) per 1,000 admissions for the 2 different seasons, respectively. To correctly identify NoV outbreaks, the sensitivity and positive predictive value of the clinical surveillance were 68% and 88% and of the laboratory surveillance were 86% and 81%, respectively.

CONCLUSION

The addition of laboratory surveillance significantly improves outbreak surveillance and provides a more complete estimate of NoV outbreaks in hospitals. Laboratory surveillance can be recommended for evaluation of clinical surveillance.

Infect Control Hosp Epidemiol 2016;1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 1 , January 2017 , pp. 96 - 102
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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