{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T02:41:45Z","timestamp":1755225705933,"version":"3.43.0"},"reference-count":17,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J R Army Med Corps"],"accepted":{"date-parts":[[2018,7,17]]},"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Gastrointestinal infections are among the most common foodborne and waterborne diseases in military populations, with direct implications in operational efficiency and force readiness. Through the surveillance system of reportable acute gastrointestinal illness in the Portuguese Army, four norovirus outbreaks were identified between October 2015 and October 2017 in mainland Portugal and the Azores archipelago. The present study documents the epidemiological, clinical and laboratory investigations of these norovirus outbreaks.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Cases were investigated and epidemiological questionnaires were distributed to all soldiers in each military setting where the outbreaks occurred. Stool samples from soldiers with acute gastroenteritis illness were collected and screened for common enteropathogenic agents. Food and water samples served on the settings were also collected for microbiological investigation. Norovirus-positive samples were further characterised by sequence analysis using a public automated genotyping tool.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The four outbreaks affected a total of 99 soldiers among the 618 stationed on base units and in a military exercise. A total of 27 soldiers provided a stool sample, of which 20 were positive for norovirus by real-time PCR. Phylogenetic analysis showed that the noroviruses involved were all genogroup II, namely GII.17, GII.Pe-GII.4 Sydney 2012, GII.P2-GII.2 and GII.P16-GII.2. Of note, 30 soldiers had to receive treatment at the military hospital due to severity of symptoms.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In this short, two-year surveillance period, a total of four norovirus gastroenteritis outbreaks were detected in the Portuguese Army which caused a considerable morbidity, showing once again the impact of norovirus on Army effectiveness and force readiness.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jramc-2018-000991","type":"journal-article","created":{"date-parts":[[2018,8,3]],"date-time":"2018-08-03T03:35:41Z","timestamp":1533267341000},"page":"419-422","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Country-wide surveillance of norovirus outbreaks in the Portuguese Army, 2015\u20132017"],"prefix":"10.1136","volume":"164","author":[{"given":"Ant\u00f3nio","family":"Lopes-Jo\u00e3o","sequence":"first","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":"Instituto Polit\u00e9cnico de Viseu \u2013 Escola Superior Agr\u00e1ria (ESAV), Viseu, Portugal"},{"name":"Epidemiology Research Unit (EPIUnit), Instituto de Sa\u00fade P\u00fablica da Universidade do Porto, Porto, Portugal"}]},{"given":"R","family":"de Sousa","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio Nacional de Refer\u00eancia para as Infe\u00e7\u00f5es Gastrointestinais, Departamento de Doen\u00e7as Infecciosas, Instituto Nacional de Sa\u00fade Dr Ricardo Jorge, Lisboa, Portugal"}]},{"given":"M","family":"Oleastro","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio Nacional de Refer\u00eancia para as Infe\u00e7\u00f5es Gastrointestinais, Departamento de Doen\u00e7as Infecciosas, Instituto Nacional de Sa\u00fade Dr Ricardo Jorge, Lisboa, Portugal"}]},{"given":"C","family":"Silva","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio Nacional de Refer\u00eancia para as Infe\u00e7\u00f5es Gastrointestinais, Departamento de Doen\u00e7as Infecciosas, Instituto Nacional de Sa\u00fade Dr Ricardo Jorge, Lisboa, 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"}]},{"given":"M S J","family":"Nascimento","sequence":"additional","affiliation":[{"name":"Epidemiology Research Unit (EPIUnit), Instituto de Sa\u00fade P\u00fablica da Universidade do Porto, Porto, Portugal"},{"name":"Laborat\u00f3rio de Microbiologia, Departamento de Ci\u00eancias Biol\u00f3gicas, Faculdade de Farm\u00e1cia da Universidade do Porto, Porto, Portugal"}]}],"member":"239","published-online":{"date-parts":[[2018,8,3]]},"reference":[{"key":"2025081309355867000_164.6.419.1","unstructured":"Armed Forces Health Surveillance Center. Gastrointestinal infections, active component, U.S. Armed Forces, 2002\u20132012 Medical Surveillance Monthly Reports. 2013;20:7\u201311."},{"key":"2025081309355867000_164.6.419.2","unstructured":"Armed Forces Health Surveillance Center. Absolute and relative morbidity burdens attributable to various illnesses and injuries, U.S. Armed Forces, 2012. Medical Surveillance Monthly Reports. 2013;20:5\u201310."},{"key":"2025081309355867000_164.6.419.3","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-154-03-04"},{"issue":"S2","key":"2025081309355867000_164.6.419.4","doi-asserted-by":"crossref","first-page":"4","DOI":"10.7205\/MILMED-D-17-00064","article-title":"Travelers' diarrhea: an update on the incidence, etiology, and risk in military deployments and similar travel populations","volume":"182","author":"Porter","year":"2017","journal-title":"Mil Med"},{"key":"2025081309355867000_164.6.419.5","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.jcv.2015.05.008","article-title":"Multiple enteropathogenic viruses in a gastroenteritis outbreak in a military exercise of the Portuguese Army","volume":"68","author":"Lopes-Jo\u00e3o","year":"2015","journal-title":"J Clin Virol"},{"key":"2025081309355867000_164.6.419.6","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1002\/jmv.24704","article-title":"Acute gastroenteritis outbreak associated to norovirus GI.9 in a Portuguese army base","volume":"89","author":"Lopes-Jo\u00e3o","year":"2017","journal-title":"J Med Virol"},{"key":"2025081309355867000_164.6.419.7","doi-asserted-by":"publisher","DOI":"10.1086\/427501"},{"key":"2025081309355867000_164.6.419.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jviromet.2003.11.001"},{"key":"2025081309355867000_164.6.419.9","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES2013.18.25.20506"},{"key":"2025081309355867000_164.6.419.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2011.03.006"},{"key":"2025081309355867000_164.6.419.11","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/S1473-3099(18)30059-8","article-title":"Molecular surveillance of norovirus, 2005-16: an epidemiological analysis of data collected from the NoroNet network","volume":"18","author":"van Beek","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2025081309355867000_164.6.419.12","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00455-17"},{"key":"2025081309355867000_164.6.419.13","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jis251"},{"key":"2025081309355867000_164.6.419.14","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-10-269"},{"key":"2025081309355867000_164.6.419.15","doi-asserted-by":"publisher","DOI":"10.3201\/eid1101.040426"},{"key":"2025081309355867000_164.6.419.16","doi-asserted-by":"crossref","first-page":"pii: 30508","DOI":"10.2807\/1560-7917.ES.2017.22.15.30508","article-title":"Emergence of new recombinant noroviruses GII.p16-GII.4 and GII.p16-GII.2, France, winter 2016 to 2017","volume":"22","author":"Bidalot","year":"2017","journal-title":"Euro Surveill"},{"key":"2025081309355867000_164.6.419.17","doi-asserted-by":"publisher","DOI":"10.3201\/eid1010.030941"}],"container-title":["Journal of the Royal Army Medical Corps"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jramc-2018-000991","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T16:36:04Z","timestamp":1755102964000},"score":1,"resource":{"primary":{"URL":"https:\/\/militaryhealth.bmj.com\/lookup\/doi\/10.1136\/jramc-2018-000991"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,3]]},"references-count":17,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2018,11,6]]},"published-print":{"date-parts":[[2018,11]]}},"alternative-id":["10.1136\/jramc-2018-000991"],"URL":"https:\/\/doi.org\/10.1136\/jramc-2018-000991","relation":{},"ISSN":["0035-8665","2052-0468"],"issn-type":[{"type":"print","value":"0035-8665"},{"type":"electronic","value":"2052-0468"}],"subject":[],"published":{"date-parts":[[2018,8,3]]}}}