Estimating Norovirus Seroprevalence in the US Population Using Finite Mixture Modeling on NHANES Stored Biologic Specimens Open Access

Abstract

Background and Purpose- Norovirus is the most common form of viral gastroenteritis in the world. Previous studies have estimated that 23 million cases of norovirus occur in the United States every year.

Methods- Quanitative ELISA tests were run on 2,168 serum samples from 16-49 year olds in the 1999-2000 and 2003-2004 National Health and Nutrition Examination Survey (NHANES). Finite mixture modeling was used to estimate the seroprevalence of norovirus for GI.4, GII.3, and GII.4 US-95/96 strains of norovirus. Seroprevalences were modeled by norovirus strain, age group, and NHANES collection cycle.

Results- Predicted average seroprevalences of three strains of norovirus in the United Stated ranged between 55-60%. The seroprevalence of all three strains decreased significantly from the 1999-2000 NHANES collection to the 2003-2004 collection. GII.4 US-95/96 dropped from 61% to 54% between the two years (χ² p<0.002). It is hypothesized this decrease is partly because of the emergence of the Farmington Hills strain during this time frame. The most burdened age groups varied by strain, possibly due to differences in transmission routes.

Conclusions-Finite mixture modeling is a beneficial tool to estimate seroprevalence while decreasing sources of bias found in other serological studies.

Table of Contents

Literature Review. 7

Norovirus structure and characteristics. 7

Clinical Attributes and Epidemiology. 10

Burden of Disease. 13

Challenges of Estimating Burden of Disease. 15

Materials and Methods. 19

Research Design. 19

VLP creation. 20

Quantitative IgG ELISA. 21

Data analysis.. 21

Results. 24

Validation with GI.I Challenge Data. 24

Aggregated Results. 25

Collection cycle comparison. 28

Age Group Comparisons. 30

Discussion. 34

Limitations. 36

Future Directions. 37

Appendix. 39

Bibliography. 45

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Biology, Virology Health Sciences, Epidemiology
Keyword	Norovirus seroprevalence finite mixture model NHANES
Committee Chair / Thesis Advisor	Kirby, Amy, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs CDC

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