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Transmission routes of rare seasonal diseases: the case of norovirus infections

Lookup NU author(s): Professor Stephen Rushton, Dr Roy SandersonORCiD, Dr William Reid, Dr Mark ShirleyORCiD, Professor Sarah O'Brien



This is the authors' accepted manuscript of an article that has been published in its final definitive form by Royal Society Publishing, 2019.

For re-use rights please refer to the publisher's terms and conditions.


Norovirus (NoV) is the most commonly recognised cause of acute gastroenteritis, with over a million cases globally per year. Whilst usually self-limiting, NoV poses a substantial economic burden because it is highly contagious and there are multiple transmission routes. Infection occurs through inhalation of vomitus; faecal-oral spread; food, water and environmental contamination. Whilst the incidence of disease is predictably seasonal, much less is known about the relative contribution of the various exposure pathways in causing disease. Additionally asymptomatic excretion and viral shedding make forecasting disease burden difficult. We develop a novel stochastic dynamic network model to investigate the contributions of different transmission pathways in multiple coupled social networks representing schools, hospitals, care-homes, and family households in a community setting. We analyse how the networks impact on transmission. We used ward-level demographic data from Northumberland, UK to create a simulation cohort. We compared the results with extant data on NoV cases from the IID2 study. Connectivity across the simulated cohort was high. Cases of NoV showed marked seasonality, peaking in early winter and declining through the summer. For the first time we show that fomites and food appear to be the most important exposure routes in determining the population burden of disease.

Publication metadata

Author(s): Rushton SP, Sanderson RA, Reid WDK, Shirley MDF, Harris JP, Hunter PR, O'Brien SJ

Publication type: Article

Publication status: Published

Journal: Philosophical Transactions of the Royal Society B: Biological Sciences

Year: 2019

Volume: 374

Issue: 1776

Print publication date: 01/07/2019

Online publication date: 20/05/2019

Acceptance date: 07/11/2018

Date deposited: 11/12/2018

ISSN (print): 0962-8436

ISSN (electronic): 1471-2970

Publisher: Royal Society Publishing


DOI: 10.1098/rstb.2018.0267


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