Transmission routes of rare seasonal diseases: The case of norovirus infections

Stephen P. Rushton, Roy A. Sanderson*, William D.K. Reid, Mark D.F. Shirley, John Harris, Paul R. Hunter, Sarah J. O'Brien

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Norovirus (NoV) is the most commonly recognized cause of acute gastroenteritis, with over a million cases globally per year. While usually self-limiting, NoV poses a substantial economic burden because it is highly contagious and there are multiple transmission routes. Infection occurs through inhalation of vomitus; faecal-oral spread; and food, water and environmental contamination. While the incidence of the disease is predictably seasonal, much less is known about the relative contribution of the various exposure pathways in causing disease. Additionally, asymptomatic excretion and viral shedding make forecasting disease burden difficult. We develop a novel stochastic dynamic network model to investigate the contributions of different transmission pathways in multiple coupled social networks representing schools, hospitals, care-homes and family households in a community setting. We analyse how the networks impact on transmission. We used ward-level demographic data from Northumberland, UK to create a simulation cohort. We compared the results with extant data on NoV cases from the IID2 study. Connectivity across the simulated cohort was high. Cases of NoV showed marked seasonality, peaking in early winter and declining through the summer. For the first time, we show that fomites and food appear to be the most important exposure routes in determining the population burden of disease. This article is part of the theme issue 'Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control'. This theme issue is linked with the earlier issue 'Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes'.

Original languageEnglish
Article number20180267
JournalPhilosophical transactions of the Royal Society of London. Series B, Biological sciences
Issue number1776
Publication statusPublished - 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2019 The Author(s) Published by the Royal Society. All rights reserved.


  • Community infection
  • Coupled dynamic social networks
  • Fomites
  • Food
  • Norovirus
  • Stochastic


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