TY - GEN T1 - Emergence of new norovirus variants on spring cruise ships and prediction of winter epidemics. AU - Verhoef, Linda AU - Depoortere, Evelyn AU - Boxman, Ingeborg AU - Duizer, Erwin AU - Duynhoven, Yvonne van AU - Harris, John AU - Johnsen, Christina AU - Kroneman, Annelies AU - Schreier, Eckart AB - In June 2006, reported outbreaks of norovirus on cruise ships suddenly increased; 43 outbreaks occurred on 13 vessels. All outbreaks investigated manifested person-to-person transmission. Detection of a point source was impossible because of limited investigation of initial outbreaks and data sharing. The most probable explanation for these outbreaks is increased norovirus activity in the community, which coincided with the emergence of 2 new GGII.4 variant strains in Europe and the Pacific. As in 2002, a new GGII.4 variant detected in the spring and summer corresponded with high norovirus activity in the subsequent winter. Because outbreaks on cruise ships are likely to occur when new variants circulate, an active reporting system could function as an early warning system. Internationally accepted guidelines are needed for reporting, investigating, and controlling norovirus illness on cruise ships in Europe. KW - Humans KW - Travel KW - Gastroenteritis/epidemiology KW - Population Surveillance/methods KW - Norovirus/classification KW - Norovirus/isolation & purification KW - Europe/epidemiology KW - Communicable Diseases KW - Emerging/epidemiology KW - Emerging/virology KW - Seasons KW - Caliciviridae Infections/virology KW - Caliciviridae Infections/epidemiology KW - Disease Outbreaks*/statistics & numerical data KW - Gastroenteritis/virology KW - Genetic Variation KW - Ships KW - 610 Medizin PY - 2008 LA - eng PB - Robert Koch-Institut, Infektionsepidemiologie VL - 14 IS - 2 DO - http://dx.doi.org/10.25646/455 ER -