Attribution of pediatric acute gastroenteritis episodes and emergency department visits to norovirus genogroups i and II

Gillian A.M. Tarr, Xiao Li Pang, Ran Zhuo, Bonita E. Lee, Linda Chui, Samina Ali, Otto G. Vanderkooi, Christine Michaels-Igbokwe, Phillip I. Tarr, Shannon E. Macdonald, Gillian Currie, Judy Macdonald, Kelly Kim, Stephen B. Freedman

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Norovirus is a leading cause of acute gastroenteritis. With vaccines in development, population-based estimates of norovirus burden are needed to identify target populations, quantify potential benefits, and understand disease dynamics. Methods: We estimated the attributable fraction (AF) for norovirus infections in children, defined as the proportion of children testing positive for norovirus whose gastroenteritis was attributable to norovirus. We calculated the standardized incidence and emergency department (ED) visit rates attributable to norovirus using provincial gastroenteritis visit administrative data. Results: From 3731 gastroenteritis case patients and 2135 controls we determined that the AFs were 67.0% (95% confidence interval [CI], 31.5%-100%) and 91.6% (88.8%-94.4%) for norovirus genogroups I (GI) and II (GII), respectively. Norovirus GII AF varied by season but not age. We attributed 116 episodes (95% CI, 103-129) and 59 (51-67) ED visits per 10000 child-years to norovirus GII across all ages, accounting for 20% and 18% of all medically attended gastroenteritis episodes and ED visits, respectively. Conclusions: In children, a large proportion of norovirus GII detections reflect causation, demonstrating significant potential for norovirus GII vaccines. Seasonal variation in the norovirus GII AF may have implications for understanding the role asymptomatic carriage plays in disease dynamics.

Original languageEnglish (US)
Pages (from-to)452-461
Number of pages10
JournalJournal of Infectious Diseases
Issue number3
StatePublished - Jul 2 2020

Bibliographical note

Publisher Copyright:
© 2020 The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].


  • epidemiology
  • gastroenteritis
  • norovirus
  • pediatric emergency medicine


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