Primary care physician knowledge, attitudes, and diagnostic testing practices for norovirus and acute gastroenteritis

Autoři: Cristina V. Cardemil aff001;  Sean T. O’Leary aff002;  Brenda L. Beaty aff002;  Katy Ivey aff001;  Megan C. Lindley aff001;  Allison Kempe aff002;  Lori A. Crane aff002;  Laura P. Hurley aff002;  Michaela Brtnikova aff002;  Aron J. Hall aff001
Působiště autorů: National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, United States aff001;  Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States aff002;  Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States aff003;  Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States aff004;  Division of General Internal Medicine, Denver Health, Denver, CO, United States aff005
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article



Norovirus is a leading cause of acute gastroenteritis (AGE) across the age spectrum; candidate vaccines are in clinical trials. While norovirus diagnostic testing is increasingly available, stool testing may not be performed routinely, which can hamper surveillance and burden of disease estimates. Additionally, lack of knowledge of the burden of disease may inhibit provider vaccine recommendations, which could affect coverage rates and ultimately the impact of the vaccine. Our objectives were to understand physicians’ stool testing practices in outpatients with AGE, and physician knowledge of norovirus, in order to improve surveillance and prepare for vaccine introduction.


Internet and mail survey on AGE, norovirus, and future norovirus vaccines conducted January to March 2018 among national networks of primary care pediatricians, family practice and general internal medicine physicians.


The response rate was 59% (820/1383). During peak AGE season, physicians estimated they ordered stool tests for a median of 15% (interquartile range: 5–33%) of their outpatients with AGE. Stool tests were reported as more often available for ova and parasites, Clostridioides difficile, and bacterial culture (>95% for all specialties) than for norovirus (6–33% across specialties); even when available, norovirus-specific tests were infrequently ordered. Most providers were unaware that norovirus is a leading cause of AGE across all age groups (Pediatricians 80%, Family Practice 86%, General Internal Medicine 89%) or that alcohol-based hand sanitizers are ineffective against norovirus (Pediatricians 51%, Family Practice 66%, General Internal Medicine 62%). Concerns cited as major barriers to implementing a future norovirus vaccine included if the vaccine is not covered by insurance (General Internal Medicine 64%, Pediatricians 67%, Family Practice 74%) and lack of adequate reimbursement for vaccination (Pediatricians 43%, General Internal Medicine 46%, Family Practice 50%). Factors that providers believed were ‘not at all a barrier’ or ‘minor barrier’ to new vaccine introduction included the belief that “my patients won’t need this vaccine” (General Internal Medicine 78%, Family Practice 86%, Pediatricians 90%) and “my patients already get too many vaccines” (Family Practice 89%, General Internal Medicine 92%, Pediatricians 95%).


Primary care physicians had few concerns regarding future norovirus vaccine introduction, but have knowledge gaps on norovirus prevalence and hand hygiene for prevention. Also, physicians infrequently order stool tests for outpatients with AGE, which limits surveillance estimates that rely on physician-ordered stool diagnostics. Closing physician knowledge gaps on norovirus burden and transmission can help support norovirus vaccine introduction.

Klíčová slova:

Diagnostic medicine – Disease surveillance – Norovirus – Outpatients – Pediatrics – Physicians – Public and occupational health – Vaccines


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