The Indicators of Norovirus and Hepatitis A Virus In Six Environmental Samples Types: A Systematic Review Pubblico

Abstract

Norovirus and Hepatitis A Virus (HAV) are the two most prevalent enteric viruses that cause gastroenteritis in the US and globally. To test for these enteric viruses indicators, organisms developed assess fecal contamination, and are used in place of directly testing for the viruses themselves. The goal of this study was to investigate which indicators were most prevalent in each environmental sample of the agriculture environment, including water, faeces, food, soil, hands, and surfaces. This systematic review examines, from US and global sources, a comprehensive list of indicators used to test for enteric viruses. The results were organized based on environmental sample and indicator group, including bacterial and viral. A total of 297 articles were included in the database of results. Out of these, 67 were included for final review. 98 viral indicators and 92 bacterial indicators were found in at least 49 articles regarding Norovirus. 37 viral indicators and 27 bacterial indicators were found in at least six articles discussing HAV. The most prevalent indicator for Norovirus in water was E. coli and the most prevalent indicator of HAV in food was also E. coli. E. coli and Adenovirus were the most strongly connected with Norovirus and HAV. This systematic review demonstrates which indicators would be the most prevalent for assisting with identifying enteric viruses in the agricultural environment.

Table of Contents

CHAPTER I: LITERATURE REVIEW 1

INTRODUCTION 1

US and Global Burden of Norovirus and Hepatitis A Virus 1

CLINICAL DISEASE AND EPIDEMIOLOGY OF NOROVIRUS AND HAV 2

Clinical Disease 2

Epidemiology 2

MORTALITY AND MORBIDITY ASSOCIATED WITH NOROVIRUS AND HAV 3

Norovirus and HAV Mortality and Morbidity in the US and the World 3

Serotypes and Geographic Distribution 5

THE SIX TRANSMISSION VEHICLES OF NOROVIRUS AND HAV 5

Stool 7

Water 7

Hands 8

Soil 9

Produce 10

Surfaces 10

DIFFICULTIES IN DETECTING ENTERIC VIRUSES 11

INDICATORS AND THE NEED FOR STANDARDIZED PROXY INDICATORS 11

Shortcomings of Laboratory and Testing Methods 11

OVERVIEW OF IDEAL INDICATORS FOR DETECTING ENTERIC VIRUSES 12

TYPES OF INDICATORS AND CURRENT USE WITH ENTERIC VIRUSES 13

Viral Indicators 13

Total Coliforms, Coliform Bacteria, and Fecal Coliforms 14

Fecal Streptococci 14

Bacteriophage 15

Other Indicators 15

GOALS AND AIMS 16

CONCLUSION 16

CHAPTER II: METHODS 18

PROTOCOL AND REGISTRATION 18

CRITERIA FOR NOROVIRUS AND HAV INDICATORS DATABASE 18

Research Protocol Objective 18

Possible Outcomes and Additional Information 19

Search Criteria for Systematic Review 19

Article Inclusion and Exclusion Criteria 19

Information Extracted from Articles into Database 20

STUDY SELECTION 20

CHAPTER III: RESULTS 21

DESCRIPTION OF DATASET 21

INDICATORS OF NOROVIRUS IN EACH ENVIRONMENTAL SAMPLE AND BACTERIAL OR VIRAL GROUP 22 INDICATORS OF HAV IN EACH ENVIRONMENTAL SAMPLE AND BACTERIAL OR VIRAL GROUP 22

INDICATOR RELATIONSHIPS FOUND FOR THE ENVIRONMENTAL SAMPLES 23

NO INDICATOR RELATIONSHIPS FOUND FOR THE ENVIRONMENTAL SAMPLES 24

INDICATORS WITH SIMPLE PRESENCE AND STATISTICAL MEASURES AND OR EFFECT SIZES 24

DESCRIPTION OF THE ASSOCIATIONS 25

Norovirus and the indicator 25

HAV and the Indicator 26

APPROVALS AND DISAPPROVALS OF USING INDICATORS 26

CHAPTER IV: DISCUSSION 29

LIMITATIONS AND STRENGTHS 30

IMPLICATIONS 30 CONCLUSIONS 31

PUBLIC HEALTH IMPLICATIONS 32

REFERENCES 33

TABLES AND FIGURES 39

TABLE 1: CRITERIA FOR AN IDEAL INDICATOR ORGANISM 39

TABLE 2: CRITERIA FOR DESIRABLE ATTRIBUTES OF METHODS FOR TESTING FOR INDICATORS 40

FIGURE 1: FLOW CHART OF SYSTEMATIC REVIEW 41

TABLE 3: INDICATORS OF NOROVIRUS IN SIX TRANSMISSION VEHICLES AND INDICATOR GROUPS (NUMBER OF ARTICLES FOUND IN SYSTEMATIC REVIEW) 43

TABLE 4: INDICATORS OF HAV IN SIX TRANSMISSION VEHICLES AND INDICATOR GROUPS (NUMBER OF ARTICLES FOUND IN SYSTEMATIC REVIEW) 44

TABLE 5: NUMBER OF ARTICLES WITH SIMPLE PRESENCE AND STATISTICAL MEASURES OF ALL INDICATORS OF NOROVIRUS AND HAV 45

TABLE 6: INDICATOR RELATIONSHIPS FOUND FOR THE ENVIRONMENTAL SAMPLES 46

TABLE 7: NO INDICATOR RELATIONSHIPS FOUND FOR THE ENVIRONMENTAL SAMPLES 52

APPENDIX 56 MORE INFORMATION ON INDICATOR RELATIONSHIPS FOUND 56

MORE INFORMATION ON NO INDICATOR RELATIONSHIPS FOUND 58

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Environmental Health
Parola chiave	Norovirus Indicators Systematic review Hepatitis A Virus
Committee Chair / Thesis Advisor	Leon, Juan, Emory University

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