Characterizing Norovirus Transmission from Outbreak Data, United States

Emerg Infect Dis. 2020 Aug;26(8):1818-1825. doi: 10.3201/eid2608.191537.


Norovirus is the leading cause of acute gastroenteritis outbreaks in the United States. We estimated the basic (R0) and effective (Re) reproduction numbers for 7,094 norovirus outbreaks reported to the National Outbreak Reporting System (NORS) during 2009-2017 and used regression models to assess whether transmission varied by outbreak setting. The median R0 was 2.75 (interquartile range [IQR] 2.38-3.65), and median Re was 1.29 (IQR 1.12-1.74). Long-term care and assisted living facilities had an R0 of 3.35 (95% CI 3.26-3.45), but R0 did not differ substantially for outbreaks in other settings, except for outbreaks in schools, colleges, and universities, which had an R0 of 2.92 (95% CI 2.82-3.03). Seasonally, R0 was lowest (3.11 [95% CI 2.97-3.25]) in summer and peaked in fall and winter. Overall, we saw little variability in transmission across different outbreaks settings in the United States.

Keywords: United States; acute gastroenteritis; enteric infections; food safety; foodborne diseases; norovirus; outbreaks; reproduction number; transmission; viruses.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Caliciviridae Infections* / epidemiology
  • Disease Outbreaks
  • Foodborne Diseases* / epidemiology
  • Gastroenteritis* / epidemiology
  • Humans
  • Norovirus*
  • Seasons
  • United States / epidemiology