{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T02:46:07Z","timestamp":1755225967859,"version":"3.43.0"},"reference-count":50,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Mil Health"],"accepted":{"date-parts":[[2020,4,26]]},"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Norovirus gastroenteritis is one of the most frequent causes of personnel unavailability in military units, being associated with significant morbidity and degradation of their operational effectiveness. The disease is usually mild but can be severe and life-threatening in young and healthy soldiers, who are prone to dehydration due to intensive daily activity. Despite its impact, the full extent of the norovirus gastroenteritis burden in military forces remains unclear. This systematic review aims to evaluate the impact and ascertain clinical and epidemiological features of norovirus outbreaks that have occurred in the military forces.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The systematic review followed the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guidelines and used three databases: PubMed, Scopus, and LILACs. Papers published up to 1 September 2019 were included without restrictions if they reported one or more outbreaks in the military forces on active duty, either on national territories or deployed overseas.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 343 papers were retrieved from the literature search. After inclusion\/exclusion criteria a total of 39 eligible papers were considered. From 1988 (first reported outbreak in the military) to 2018 more than 101 norovirus outbreaks have been reported in the military, accounting for at least 24\u2009332 cases. Secondary transmission was emphasised as the main route of norovirus transmission in the military forces, with eating outside the military setting an important route for the primary cases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The present review highlights that norovirus gastroenteritis has been a burden to military troops both in combat and on peacekeeping operations. Norovirus disease has been shown to exact a substantial toll on mission readiness and operational effectiveness. It is noteworthy that the impact of norovirus outbreaks among military units is underestimated because the literature review retrieved information from the armed forces from only nine countries.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjmilitary-2019-001341","type":"journal-article","created":{"date-parts":[[2020,5,14]],"date-time":"2020-05-14T05:35:11Z","timestamp":1589434511000},"page":"59-62","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Norovirus gastroenteritis outbreaks in military units: a systematic review"],"prefix":"10.1136","volume":"167","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5204-5046","authenticated-orcid":false,"given":"Luis","family":"Queiros-Reis","sequence":"first","affiliation":[{"name":"Laborat\u00f3rio de Microbiologia, Departamento de Ci\u00eancias Biol\u00f3gicas, Faculdade de Farm\u00e1cia da Universidade do Porto (FFUP), Porto, Portugal"}]},{"given":"A","family":"Lopes-Jo\u00e3o","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Bromatologia e Defesa Biol\u00f3gica do Ex\u00e9rcito (LBDB), Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8769-8103","authenticated-orcid":false,"given":"J R","family":"Mesquita","sequence":"additional","affiliation":[{"name":"Departamento de Ci\u00eancias Veterin\u00e1rias, Instituto de Ci\u00eancias Biom\u00e9dicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal"},{"name":"Epidemiology Research Unit (EPIUnit), Instituto de Sa\u00fade P\u00fablica da Universidade do Porto, Porto, Portugal"}]},{"given":"C","family":"Penha-Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Bromatologia e Defesa Biol\u00f3gica do Ex\u00e9rcito (LBDB), Lisboa, Portugal"},{"name":"Fundacao Calouste Gulbenkian, Lisboa, Portugal"}]},{"given":"M S J","family":"Nascimento","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Microbiologia, Departamento de Ci\u00eancias Biol\u00f3gicas, Faculdade de Farm\u00e1cia da Universidade do Porto (FFUP), Porto, Portugal"},{"name":"Epidemiology Research Unit (EPIUnit), Instituto de Sa\u00fade P\u00fablica da Universidade do Porto, Porto, Portugal"}]}],"member":"239","published-online":{"date-parts":[[2020,5,13]]},"reference":[{"key":"2025081315024245000_167.1.59.1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001921"},{"key":"2025081315024245000_167.1.59.2","doi-asserted-by":"crossref","first-page":"S387","DOI":"10.1086\/315582","article-title":"Norwalk-like virus infection in military forces: epidemic potential, sporadic disease, and the future direction of prevention and control efforts","volume":"181 Suppl 2","author":"McCarthy","year":"2000","journal-title":"J Infect Dis"},{"key":"2025081315024245000_167.1.59.3","first-page":"249","article-title":"Outbreak of acute norovirus gastroenteritis in a military facility in Singapore: a public health perspective","volume":"53","author":"Yap","year":"2012","journal-title":"Singap Med J"},{"key":"2025081315024245000_167.1.59.4","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2334-10-30","article-title":"Food-borne norovirus-outbreak at a military base, Germany, 2009","volume":"7","author":"Wadl","year":"2010","journal-title":"BMC Infect Dis"},{"key":"2025081315024245000_167.1.59.5","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-2019-001242"},{"key":"2025081315024245000_167.1.59.6","doi-asserted-by":"publisher","DOI":"10.1099\/jgv.0.001318"},{"key":"2025081315024245000_167.1.59.7","doi-asserted-by":"crossref","DOI":"10.1017\/S0950268819001146","article-title":"Working group for the study of outbreaks of acute gastroenteritis in Catalonia. 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