Author/Editor		Verhoef, Linda; Kouyos, Roger D; Vennema, Harry; Kroneman, Annelies; Siebenga, Joukje; van Pelt, Wilfrid; Koopmans, Marion; Poljšak-Prijatelj, M; Barlič-Maganja, D; Hočevar-Grom, A
Title		An integrated approach to identifying international foodborne norovirus outbreaks
Type		članek
Source		Emerg Infect Dis
Vol. and No.		Letnik 17, št. 3
Publication year		2011
Volume		str. 412-8
Language		eng
Abstract		International foodborne norovirus outbreaks can be difficult to recognize when using standard outbreak investigation methods. In a novel approach, we provide step-wise selection criteria to identify clusters of outbreaks that may involve an internationally distributed common foodborne source. After computerized linking of epidemiologic data to aligned sequences, we retrospectively identified 100 individually reported outbreaks that potentially represented 14 international common source events in Europe during 1999-2008. Analysis of capsid sequences of outbreak strains (n = 1,456), showed that aprox. 7% of outbreaks reported to the Foodborne Viruses in Europe database were part of an international event (range 2%-9%), compared with 0.4% identified through standard epidemiologic investigations. Our findings point to a critical gap in surveillance and suggest that international collaboration could have increased the number of recognized international foodborne outbreaks. Real-time exchange of combined epidemiologic and molecular data is needed to validate our findings through timely trace-backs of clustered outbreaks.
Descriptors		GASTROENTERITIS FOOD CONTAMINATION VIRUS DISEASES GENOTYPE DISEASE OUTBREAKS CLUSTER ANALYSIS EUROPE