{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T20:06:44Z","timestamp":1770149204200,"version":"3.49.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1,25]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Norovirus, a contagious disease that spreads rapidly in close-quartered communities, has a debilitating effect in military settings, affecting troops\u2019 health, productivity, and mission-readiness. This research presents a model of norovirus transmission, testing the vaccination\u2019s effectiveness in military training centers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Transmission was modeled using structured ordinary differential equations, including symptomatic and asymptomatic infection, genetic resistance, vaccination, and herd-immunity effects, within a hypothetical cohort of trainees and support staff. The modeled vaccine had an efficacy of 72%, 4 weeks after a single dose in phase 2 clinical trials. The transmission model was calibrated against data from a norovirus outbreak in a university setting. Sensitivity and uncertainty analyses were performed on 22 parameters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The greatest reduction in norovirus cases resulted from prophylactic environmental decontamination and vaccination of trainee and staff populations. These combined interventions prevented more than 6,800 cases of norovirus over the 10-year simulated period\u2014a 15% reduction over the baseline scenario of no interventions. Implementing vaccination and environmental decontamination with an outbreak response threshold of 0.1%, prevented more than 5,300 infections; raising the threshold to 0.2% to 0.5% significantly reduced effectiveness. Environmental decontamination and contact reduction alone had little impact on overall norovirus cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Given vaccine characteristics, the model predicted that up to 15% of norovirus cases occurring in training settings over a 10-year period could be prevented by vaccinating all trainees and staff members immediately upon arrival on-base combined with continuous environmental decontamination. There was an impact on morbidity from implementing vaccination of trainees, alone and in combination with staff members. However, vaccinating staff alone prevented few cases over the simulation period, indicating the importance of trainees in norovirus transmission. Likewise, the negligible impact of environmental decontamination or contact reduction alone highlights the importance of addressing both person-to-person and environmental transmission together to minimize illnesses and training downtime.<\/jats:p><\/jats:sec>","DOI":"10.1093\/milmed\/usaa381","type":"journal-article","created":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T01:56:15Z","timestamp":1611626175000},"page":"91-99","source":"Crossref","is-referenced-by-count":1,"title":["Modeling the Potential Impact of Norovirus Vaccination Among DoD Forces"],"prefix":"10.1093","volume":"186","author":[{"given":"Colleen","family":"Burgess","sequence":"first","affiliation":[{"name":"Ramboll US Corporation, Amherst, MA 01002"},{"name":"MathEcology LLC, Phoenix, AZ 85086"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lis","family":"Nelis","sequence":"additional","affiliation":[{"name":"Ramboll US Corporation, Seattle, Washington 98164"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cassie","family":"Huang","sequence":"additional","affiliation":[{"name":"Ramboll US Corporation, Boston, MA 02108"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,1,25]]},"reference":[{"issue":"3","key":"2021012914053626400_R1","first-page":"1","article-title":"Updated norovirus outbreak management and disease prevention guidelines","volume":"60","author":"Hall","year":"2011","journal-title":"Morb Mortal Weekly Report Recommen Reports"},{"issue":"1","key":"2021012914053626400_R2","article-title":"Norovirus: new developments and implications for travelers\u2019 diarrhea","volume":"2","author":"Simons","year":"2016","journal-title":"Trop Dis Travel Med Vacc"},{"issue":"4","key":"2021012914053626400_R3","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1136\/jramc-156-04-10","article-title":"Noroviruses: a challenge for military forces","volume":"156","author":"Delacour","year":"2010","journal-title":"J Royal Arm Med Corps"},{"key":"2021012914053626400_R4","article-title":"Norovirus","author":"Centers for Disease Control and Prevention"},{"issue":"8","key":"2021012914053626400_R5","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.3201\/eid1908.130472","article-title":"Duration of immunity to norovirus gastroenteritis","volume":"19","author":"Simmons","year":"2013","journal-title":"Emerg Infect Dis"},{"issue":"49","key":"2021012914053626400_R6","doi-asserted-by":"crossref","first-page":"7097","DOI":"10.1016\/j.vaccine.2012.09.040","article-title":"The potential economic value of a human norovirus vaccine for the United States","volume":"30","author":"Bartsch","year":"2012","journal-title":"Vaccine"},{"issue":"24","key":"2021012914053626400_R7","doi-asserted-by":"crossref","first-page":"3580","DOI":"10.1016\/j.vaccine.2012.03.050","article-title":"Immunogenicity and specificity of norovirus Consensus GII.4 virus-like particles in monovalent and bivalent vaccine formulations","volume":"30","author":"Parra","year":"2012","journal-title":"Vaccine"},{"issue":"1","key":"2021012914053626400_R8","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2334-10-30","article-title":"Food-borne norovirus-outbreak at a military base, Germany, 2009","volume":"10","author":"Wadl","year":"2010","journal-title":"BMC Infect Dis"},{"issue":"4","key":"2021012914053626400_R9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0148505","article-title":"Incidence of norovirus-associated medical encounters among active duty United States military personnel and their dependents","volume":"11","author":"Rha","year":"2016","journal-title":"PloS One"},{"key":"2021012914053626400_R10","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1097\/EDE.0b013e3181e5463a","article-title":"How infections propagate after point-source outbreaks! 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