ArticleOpen forum infectious diseases2017
Can Use of Viral Load Improve Norovirus Clinical Diagnosis and Disease Attribution?
Article in Open forum infectious diseases, 2017. 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.
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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.
- Global prevalence of asymptomatic norovirus infection in outbreaks: a systematic review and meta-analysis.BMC infectious diseases · 2023Pooled it
- Birth Cohort Studies Assessing Norovirus Infection and Immunity in Young Children: A Review.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2019Pooled it
- Comparable Norovirus Shedding in Symptomatic and Asymptomatic Individuals: A Hospital-Based Study in Bangladesh.Open forum infectious diseases · 2026Article
- Symptomatic and Asymptomatic Norovirus Infections in Early Life; the PREVAIL Cohort, 2017-2020.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Epidemiology of Norovirus Outbreaks in Kindergartens, Primary Schools, and Junior High Schools in Xi'an, China, From October 2020 to February 2023.Medical science monitor : international medical journal of experimental and clinical research · 2025Article
- Prevalence and Genetic Diversity of Adenovirus 40/41, Astrovirus, and Sapovirus in Children With Acute Gastroenteritis in Kansas City, 2011-2016.The Journal of infectious diseases · 2025Article
- Norovirus Epidemiology and Genotype Circulation during the COVID-19 Pandemic in Brazil, 2019-2022.Pathogens (Basel, Switzerland) · 2023Article
- Age-associated features of norovirus infection analysed in mice.Nature microbiology · 2023Article
- Epidemiology of GII.4 and GII.2 norovirus outbreaks in closed and semi-closed institutions in 2017 and 2018.Scientific reports · 2023Article
- Norovirus outbreaks in long-term care facilities in Catalonia from 2017 to 2018.Scientific reports · 2021Article
- Characteristics of GII.4 Norovirus Versus Other Genotypes in Sporadic Pediatric Infections in Davidson County, Tennessee, USA.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Evaluation of PCR cycle threshold values by patient population with the quidel lyra SARS-CoV-2 assay.Diagnostic microbiology and infectious disease · 2021Article
- Virological and Epidemiological Features of Norovirus Infections in Brazil, 2017-2018.Viruses · 2021Article
- The Changing Landscape of Pediatric Viral Enteropathogens in the Post-Rotavirus Vaccine Era.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Associations Between Relative Viral Load at Diagnosis and Influenza A Symptoms and Recovery.Open forum infectious diseases · 2020Article
- Use of Human Intestinal Enteroids to Detect Human Norovirus Infectivity.Emerging infectious diseases · 2019Article
- Higher Viral Load of Emerging Norovirus GII.P16-GII.2 than Pandemic GII.4 and Epidemic GII.17, Hong Kong, China.Emerging infectious diseases · 2019Article
- Sensitive Genotyping of Foodborne-Associated Human Noroviruses and Hepatitis A Virus Using an Array-Based Platform.Sensors (Basel, Switzerland) · 2017Article
- Understanding Asymptomatic Norovirus Infections.EClinicalMedicineArticle
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
backgroundReal-time reverse-transcriptase polymerase chain reaction (RT-PCR) is the state-of-the-art diagnostic for norovirus. Cycle threshold (Ct), an indicator of viral load, may be associated with symptomatic disease as well as demographic and outbreak characteristics.
methodsData on (1) outbreak and sporadic cases and (2) asymptomatic controls in the United States and Latin America were analyzed. With multivariate regression models, we assessed relationships between various factors and Ct values, and we calculated odds ratios (ORs) for the presence of symptoms and attributable fractions of norovirus. Receiver-operating characteristic analysis was performed to define an optimal Ct cutoff to identify disease-causing infections.
resultsCycle threshold values were lower (ie, higher viral loads) among symptomatic cases (model-adjusted mean ± standard error: 25.3 ± 1.2) compared with asymptomatic controls (28.5 ± 1.4). Cycle threshold values were significantly different across age groups, norovirus genogroups, timing of specimen collection, outbreak settings, and transmission modes. Genogroup II (GII) Ct values were associated with presence of symptoms (OR = 1.1), allowing us to estimate that 16% of diarrheal disease was attributable to norovirus. The optimized Ct cutoff led to poor sensitivity and specificity for genogroup I and GII.
conclusionsCycle threshold values were associated with host, pathogen, and outbreak factors. Cycle threshold values may not effectively distinguish disease-causing infection for individual patients, but they are useful for epidemiological studies aiming to attribute disease.
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