The Clinical and Economic Burden of Norovirus Gastroenteritis in the United States

Sarah M. Bartsch, Kelly J. O'shea, Bruce Y. Lee

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Although norovirus outbreaks periodically make headlines, it is unclear how much attention norovirus may receive otherwise. A better understanding of the burden could help determine how to prioritize norovirus prevention and control. Methods: We developed a computational simulation model to quantify the clinical and economic burden of norovirus in the United States. Results: A symptomatic case generated $48 in direct medical costs, $416 in productivity losses ($464 total). The median yearly cost of outbreaks was $7.6 million (range across years, $7.5-$8.2 million) in direct medical costs, and $165.3 million ($161.1-$176.4 million) in productivity losses ($173.5 million total). Sporadic illnesses in the community (incidence, 10-150/1000 population) resulted in 14 118-211 705 hospitalizations, 8.2-122.9 million missed school/work days, $0.2-$2.3 billion in direct medical costs, and $1.4-$20.7 billion in productivity losses ($1.5-$23.1 billion total). The total cost was $10.6 billion based on the current incidence estimate (68.9/1000). Conclusion: Our study quantified norovirus' burden. Of the total burden, sporadic cases constituted >90% (thus, annual burden may vary depending on incidence) and productivity losses represented 89%. More than half the economic burden is in adults ≥45, more than half occurs in winter months, and >90% of outbreak costs are due to person-to-person transmission, offering insights into where and when prevention/control efforts may yield returns.

Original languageEnglish (US)
Pages (from-to)1910-1919
Number of pages10
JournalJournal of Infectious Diseases
Issue number11
StatePublished - Dec 1 2020


  • burden
  • community
  • cost
  • norovirus
  • outbreaks

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases


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