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Int. J. Environ. Res. Public Health 2017, 14(12), 1571;

Airborne or Fomite Transmission for Norovirus? A Case Study Revisited

Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester LE1 7RH, UK
Infection, Immunity, Inflammation, University of Leicester, Leicester LE1 7RH, UK
Author to whom correspondence should be addressed.
Received: 28 October 2017 / Revised: 10 December 2017 / Accepted: 12 December 2017 / Published: 14 December 2017
(This article belongs to the Special Issue Environmental Hygiene)
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Norovirus infection, a highly prevalent condition associated with a high rate of morbidity, comprises a significant health issue. Although norovirus transmission mainly occurs via the fecal-oral and vomit-oral routes, airborne transmission has been proposed in recent decades. This paper re-examines a previously described norovirus outbreak in a hotel restaurant wherein airborne transmission was originally inferred. Specifically, the original evidence that suggested airborne transmission was re-analyzed by exploring an alternative hypothesis: could this outbreak instead have occurred via fomite transmission? This re-analysis was based on whether fomite transmission could have yielded similar attack rate distribution patterns. Seven representative serving pathways used by waiters were considered, and the infection risk distributions of the alternative fomite transmission routes were predicted using a multi-agent model. These distributions were compared to the reported attack rate distribution in the original study using a least square methods approach. The results show that with some reasonable assumptions of human behavior patterns and parameter values, the attack rate distribution corresponded well with that of the infection risk via the fomite route. This finding offers an alternative interpretation of the transmission routes that underlay this particular norovirus outbreak and an important consideration in the development of infection control guidelines and the investigation of similar norovirus outbreaks in future. View Full-Text
Keywords: norovirus; multi-agent simulation; fomite; airborne; outbreak analyses norovirus; multi-agent simulation; fomite; airborne; outbreak analyses

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Xiao, S.; Tang, J.W.; Li, Y. Airborne or Fomite Transmission for Norovirus? A Case Study Revisited. Int. J. Environ. Res. Public Health 2017, 14, 1571.

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