ArticlePloS one2018
Asymptomatic norovirus infection associated with swimming at a tropical beach: A prospective cohort study.
Article in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 38 citations in OpenAlex.
- Asymptomatic viruses detectable in saliva in the first year of life: a narrative review.Pediatric research · 2024Pooled it
- Evaluating health risks associated with exposure to ambient surface waters during recreational activities: A systematic review and meta-analysis.Water research · 2020Pooled it
- A Review of the Human Health Risks from Microbial Hazards in Recreational Beach Sand.International journal of environmental research and public health · 2025Review
- Development of an enteric pathogen multiplex immunoassay to measure antibody responses in blood and saliva for integrated serology applications.Journal of immunological methods · 2025Article
- Pilot application of an inflammation and physiological dysregulation index based on noninvasive salivary biomarkers.BMC research notes · 2025Article
- Persistence of Human Norovirus (GII) in Surface Water: Decay Rate Constants and Inactivation Mechanisms.Environmental science & technology · 2023Article
- Detection of Autoantibodies in Saliva as New Avenue for the Diagnosis and Management of Autoimmune Patients.Diagnostics (Basel, Switzerland) · 2022Article
- A Multiplex Noninvasive Salivary Antibody Assay for SARS-CoV-2 Infection and Its Application in a Population-Based Survey by Mail.Microbiology spectrum · 2021Article
- Salivary Antibodies against Multiple Environmental Pathogens Found in Individuals Recreating at an Iowa Beach.International journal of environmental research and public health · 2021Article
- Environmental effects of stratospheric ozone depletion, UV radiation, and interactions with climate change: UNEP Environmental Effects Assessment Panel, Update 2020.Photochemical & photobiological sciences : Official journal of the European Photochemistry Association and the European Society for Photobiology · 2021Article
- Natural Host-Environmental Media-Human: A New Potential Pathway of COVID-19 Outbreak.Engineering (Beijing, China) · 2020Article
- Rapid Salivary IgG Antibody Screening for Hepatitis A.Journal of clinical microbiology · 2020Article
- Child Salivary SIgA and Its Relationship to Enteric Infections and EED Biomarkers in Maputo, Mozambique.International journal of environmental research and public health · 2020Article
- Application of a multiplex salivary immunoassay to detect sporadic incident norovirus infections.Scientific reports · 2019Article
- Enteropathogen antibody dynamics and force of infection among children in low-resource settings.eLife · 2019Article
- Flood protection ecosystem services in the coast of Puerto Rico: Associations between extreme weather, flood hazard mitigation and gastrointestinal illness.The Science of the total environment · 2019Article
- Minimally Invasive Saliva Testing to Monitor Norovirus Infection in Community Settings.The Journal of infectious diseases · 2019Article
- Visitors to a Tropical Marine Beach Show Evidence of Immunoconversions to Multiple Waterborne Pathogens.Frontiers in public health · 2019Article
- Application of a salivary immunoassay in a prospective community study of waterborne infections.Water research · 2018Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSwimming in fecally-contaminated waterbodies can result in gastrointestinal infections. However, the pathogenic microorganisms responsible are not well understood because sporadic cases of illness are not reported completely, exposure information is often not collected, and epidemiology studies rely on self-reported symptoms. Noroviruses are considered a likely cause because they are found in high densities in sewage, resistant to wastewater treatment and survive in the environment. In this study, saliva samples were collected from subjects at a beach in Puerto Rico and tested for evidence of norovirus-specific IgG responses as an indicator of incident norovirus infection.
methodsSaliva samples were collected from 1298 participants using an oral swab. Samples were collected on the day of the beach visit (S1); after 10-12 days (S2); and after three weeks (S3). Saliva was tested for IgG responses to GI.1 and GII.4 noroviruses using a microsphere based multiplex salivary immunoassay. Immunoconversion was defined as a four-fold increase in median fluorescence intensity (MFI) from S1 to S2 with the S3 sample at least three times above the S1 MFI.
resultsThirty-four subjects (2.6%) immunoconverted to GI.1 or GII.4 norovirus. Swimmers who immersed their head in water had a higher rate of immunoconversion (3.4%), compared to either non-swimmers (0.0%, p = 0.003) or waders and non-swimmers combined (0.4%, Odds Ratio: 5.07, 95% Confidence Interval:1.48-17.00). Immunoconversion was not associated with gastrointestinal symptoms.
conclusionsThis is the first study to demonstrate an association between swimming at a beach impacted by fecal contamination and asymptomatic norovirus infection. The findings implicate recreational water as potentially important transmission pathway for norovirus infection.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.