Back to Top Skip to main content Skip to sub-navigation

Surveillance Snapshot: Norovirus Outbreaks in Military Forces, 2015–2019

Recommended Content:

Medical Surveillance Monthly Report

Norovirus (NoV) infections are a leading cause of acute gastroenteritis outbreaks in both the U.S. and worldwide.1 Although most cases of NoV illness are mild and self-resolving, NoV outbreaks can cause significant morbidity in military personnel and have a significant operational impact on affected units.2,3

NoV outbreaks are difficult to prevent because of several characteristics. NoVs are highly contagious and transmitted through multiple routes, including person-to-person direct contact and exposure to contaminated food, water, aerosols, and fomites. NoVs have demonstrated long-term stability in the environment and resistance to temperature extremes and standard disinfection methods. Human infections with NoV are associated with a prolonged shedding period that promotes secondary transmission. Finally, previous NoV infection often does not confer lasting immunity to reinfection with the same NoV strain or to different strains.4

Previously, the MSMR has summarized published reports of NoV outbreaks in military forces.5,6 This update captures NoV outbreak reports in military forces published in the 5-year period between 2015 and 2019 (Table).7–13 The surveillance period included the years 2015 and 2016 (covered in a previous report) in order to identify NoV outbreak reports published since the last MSMR summary. Attack rates are provided when explicitly stated or when they could be derived from the data provided in published reports. This summary includes only outbreaks in military settings where the authors explicitly reported NoVs as a primary cause of the outbreak.

Several of the published reports documented significant operational impacts due to the NoV outbreak. Notably, the Camp Arifjan outbreak (and the public health response to contain it) resulted in the shutdown of a key personnel transit station in the U.S. Central Command for approximately 10 days,13 while the 2016 outbreak among French military personnel resulted in the cancellation of a field exercise because of a lack of personnel able to participate.11

The number of military-associated NoV outbreaks reported in peer-reviewed literature likely represents only a small fraction of all NoV outbreaks in military populations. During the surveillance period in this update, several large, military-associated NoV outbreaks were also reported in the press. Notable examples include a 2017 NoV outbreak originating in base child care centers at Hurlburt Field (the headquarters of the Air Force’s 1st Special Operation Wing) that resulted in more than 100 cases14 and a 2019 outbreak at the U.S. Air Force Academy that affected about 400 cadets.15 Military enteric disease surveillance programs also routinely identify NoV outbreaks that are not published in the peer-reviewed literature. For example, between 2011 and 2016, the Naval Health Research Center’s Operational Infectious Disease Directorate identified 18 NoV GI- and 26 NoV GII-associated outbreaks in U.S. military recruits.16 This finding highlights the importance of enteric disease surveillance programs in accurately quantifying the burden of NoV outbreaks in military populations.

REFERENCES

1. Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention. Updated norovirus outbreak management and disease prevention guidelines. MMWR Recomm Rep. 2011;60(RR-3):1–18.

2. Delacour H, Dubrous P, Koeck JL. Noroviruses: a challenge for military forces. J R Army Med Corps. 2010;156(4):251–254.

3. Queiros-Reis L, Lopes-João A, Mesquita JR, Penha-Goncalves C, Nascimento MSJ. Norovirus gastroenteritis outbreaks in military units: a systematic review [published online ahead of print 13 May 2020]. BMJ Mil Health.

4. Glass RI, Parashar UD, Estes MK. Norovirus gastroenteritis. N Engl J Med. 2009;361(18):1776–1785.

5. Armed Forces Health Surveillance Center. Historical perspective: norovirus gastroenteritis outbreaks in military forces. MSMR. 2011;18(11):7–8.

6. Armed Forces Health Surveillance Branch. Surveillance snapshot: Norovirus outbreaks among military forces, 2008–2016. MSMR. 2017;24(7):30–31.

7. Lopes-João A, Mesquita JR, de Sousa R, Oleastro M, Penha-Gonçalves C, Nascimento MSJ. Acute gastroenteritis outbreak associated to norovirus GI.9 in a Portuguese army base. J Med Virol. 2017;89(5):922–925.

8. Neo FJX, Loh JJP, Ting P, et al. Outbreak of caliciviruses in the Singapore military, 2015. BMC Infect Dis. 2017;17(1):719.

9. Lopes-João A, Mesquita JR, de Sousa R, et al. Country-wide surveillance of norovirus outbreaks in the Portuguese Army, 2015–2017. J R Army Med Corps. 2018;164(6):419–422.

10. Watier-Grillot S, Boni M, Tong C, et al. Challenging investigation of a norovirus foodborne disease outbreak during a military deployment in Central African Republic. Food Environ Virol. 2017;9(4):498–501.

11. Sanchez MA, Corcostégui SP, De Broucker CA, et al. Norovirus GII.17 outbreak linked to an infected post-symptomatic food worker in a French military unit located in France. Food Environ Virol. 2017;9(2):234–237.

12. Lopes-João A, Mesquita JR, de Sousa R, Oleastro M, Penha-Gonçalves C, Nascimento MSJ. Simultaneous norovirus outbreak in three Portuguese army bases in the Lisbon region, December 2017 [published online ahead of print 4 July 2019]. J R Army Med Corps. 2019;jramc-2019-001242.

13. Kebisek J, Richards EE, Buckelew V, Hourihan MK, Finder S, Ambrose JF. Norovirus outbreak in Army service members, Camp Arifjan, Kuwait, May 2018. MSMR. 2019;26(6):8–13.

14. Thompson J. More than 100 norovirus cases at Hurlburt. North West Florida Daily News. 16 December 2017. https://www.nwfdailynews.com/news/20171216/more-than-100-norovirus-cases-at-hurlburt. Accessed 12 April 2020.

15. Roeder T. Hundreds of Air Force Academy cadets sickened in norovirus outbreak. Colorado Springs Gazette. 20 November 2019. https://gazette.com/military/hundreds-of-air-forceacademy-cadets-sickened-in-norovirus-outbreak/article_118b372a-0be7-11ea-8384-6f631e8afc31.html. Accessed 19 April 2020.

16. Brooks KM, Zeighami R, Hansen CJ, McCaffrey RL, Graf PCF, Myers CA. Surveillance for norovirus and enteric bacterial pathogens as etiologies of acute gastroenteritis at U.S. military recruit training centers, 2011–2016. MSMR. 2018;25(8):8–12.

TABLE. Reported NoV outbreaks in military forces, 2015–2019

You also may be interested in...

Update: Malaria, U.S. Armed Forces, 2020

Article
2/1/2021
Preventive medicine specialists check an insect trap

Recommended Content:

Medical Surveillance Monthly Report

Exertional Rhabdomyolysis and Sickle Cell Trait Status in the U.S. Air Force, January 2009–December 2018

Article
1/1/2021
Master Sgt. Daniel Bedford prepares to pump up a gold medal lift in the bench press during the United States Powerlifting Association 2020 Texas State Bench Press Championship

Exertional Rhabdomyolysis and Sickle Cell Trait Status in the U.S. Air Force, January 2009–December 2018

Recommended Content:

Medical Surveillance Monthly Report

The Prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) and ADHD Medication Treatment in Active Component Service Members, U.S. Armed Forces, 2014–2018

Article
1/1/2021
New Recruits are screened after arriving at Depot

Recommended Content:

Medical Surveillance Monthly Report

Attrition Rates and Incidence of Mental Health Disorders in an Attention-Deficit/Hyperactivity Disorder (ADHD) Cohort, Active Component, U.S. Armed Forces, 2014–2018

Article
1/1/2021
Capt. Michelle Tsai, the behavioral health officer for the 4th Brigade, 2nd Infantry Division, reviews medical information in her office at the Joint Readiness Training Center June 17. Tsai, an Alexandria, Va., native, is here with the Raider Brigade in support of training operations for the unit's upcoming deployment to Iraq. (Photo by Pfc. Luke Rollins)

Recommended Content:

Medical Surveillance Monthly Report

Cases of Coronavirus Disease 2019 and Comorbidities Among Military Health System Beneficiaries, 1 January 2020 through 30 September 2020

Article
12/1/2020
A U.S. Army nurse paratrooper provides patient care in support of preventative efforts against COVID-19

Recommended Content:

Medical Surveillance Monthly Report

SARS-CoV-2 and Influenza Coinfection in a Deployed Military Setting—Two Case Reports

Article
12/1/2020
Illustration reveals ultrastructural morphology exhibited by coronaviruses

Recommended Content:

Medical Surveillance Monthly Report

Characteristics of U.S. Army Beneficiary Cases of COVID-19 in Europe, 12 March 2020–17 April 2020

Article
12/1/2020
Three U.S. Air Force medical Airmen exit a C-17 Globemaster III aircraft

Recommended Content:

Medical Surveillance Monthly Report

Air Evacuation of Service Members for COVID-19 in U.S. Central Command and U.S. European Command From 11 March 2020 Through 30 September 2020

Article
12/1/2020
3D graphical representation of a generic Influenza virion’s ultrastructure

Recommended Content:

Medical Surveillance Monthly Report

Update: Cold Weather Injuries, Active and Reserve Components, U.S. Armed Forces, July 2015–June 2020

Article
11/1/2020

Update: Cold Weather Injuries, Active and Reserve Components, U.S. Armed Forces, July 2015–June 2020

Recommended Content:

Medical Surveillance Monthly Report

Fibromyalgia: Prevalence and Burden of Disease Among Active Component Service Fibromyalgia: Prevalence and Burden of Disease Among Active Component Service Members, U.S. Armed Forces, 2018

Article
11/1/2020

Recommended Content:

Medical Surveillance Monthly Report

Acute Respiratory Infections Among Active Component Service Members Who Use Combustible Tobacco Products and/or E-cigarette/Vaping Products, U.S. Armed Forces, 2018–2019

Article
11/1/2020

Recommended Content:

Medical Surveillance Monthly Report

Characterizing the Contribution of Chronic Pain Diagnoses to the Neurologic Burden of Disease, Active Component, U.S. Armed Forces, 2009–2018

Article
10/1/2020
A physical therapist adjusts the neck of a person

Recommended Content:

Medical Surveillance Monthly Report

Acute and Chronic Pancreatitis, Active Component, U.S. Armed Forces, 2004–2018

Article
10/1/2020
3D illustration of human body organs (pancreas).

Acute and Chronic Pancreatitis, Active Component, U.S. Armed Forces, 2004–2018

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: Influenza Immunization Among U.S. Armed Forces Healthcare Workers, August 2015–April 2020

Article
10/1/2020
Lt. Sipriano Marte administers an influenza vaccination to Airman Tyler French

Surveillance Snapshot: Influenza Immunization Among U.S. Armed Forces Healthcare Workers, August 2015–April 2020

Recommended Content:

Medical Surveillance Monthly Report

Update: Incidence of Inguinal Hernia and Repair Procedures and Rate of Subsequent Pain Diagnoses, Active Component Service Members, U.S. Armed Forces, 2010–2019

Article
9/1/2020
Medical care professionals repair a hernia

Recommended Content:

Medical Surveillance Monthly Report
<< < 1 2 3 4 5  ... > >> 
Showing results 61 - 75 Page 5 of 16
Refine your search
Last Updated: September 14, 2020

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.