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Norovirus and seasonality

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Norovirus and seasonality
I was asked to review this review this graph and interpret the results, given the research that is available for Norovirus and long-term care facilities.  I know that there is a correlation between seasons and Norovirus (i.e. the winter months- Nov. Dec. Jan. and Feb).  However, in this graph there is only outbreaks prevalent in Nov. and Dec.. I am also aware that for the data collected it was the first time this survey was utilized- so possibly those who collected the data were not used to the survey structure, and knowledge of how to implement the survey.  Including this information can you see any other points that can be inferred from this graph (keeping in mind that it should be mentioned that this is the first time this data was collected, and that seasonality is only partially seen).  Also, do you know of any papers that provide back up for this graph, and how it can be utilized in explaining this graph.  

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Solution Summary

The expert examines the norovirus and seasonality. The review of graphs are provided to interpret the results.

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Some Important Points about the Graph:
* For analyzing disease outbreaks, this sample size is very small.
* Most explanation & Interpretation of the graphed results will be anecdotal (hypotheses forming, "seems to be...," theoretical, etc.) and qualitative (not quantitative).
*Seasonality seems to be pretty clear, but it is only one season.
*Avoid using words like "definitely...," "absolutely...," "always...," etc. when explaining any interpretations from the graph.

Important Disease Factors to consider in your explanations/interpretations:
*How does the disease spread & how does this contribute to the outbreaks?
*Assuming that the facilities surveyed are in temperate climates of the US, the outbreaks correspond with winter/cold weather seasons.
*Winter and cold weather do not cause (infectious) diseases, do they? -No, bacteria, viruses, protozoans, and parasites do!
*Winter and cold weather place significant stresses on the physiological systems of people and even more so for the already stressed bodies of long term care patients.
*The stresses of cold weather make long term care patients very susceptible to infectious diseases, not just the norovirus.
*In a dense population of susceptible patients (more susceptible in the cold weather months), disease outbreaks will be more common.
*Other factors that affect the susceptibility of the patients must be considered as well (it wasn't in the graph), including other short or long term illnesses they may have, if they have had surgery within 30 days, nutrition (lack of, dehydration), etc.
*Is there a difference in outbreak occurrence between population groups- male/female, vegetarian/omnivores, etc.

The Norovirus Graph Interpretation:

*Some norovirus notes and sources are below.
*The norovirus may be the cause behind many of these outbreaks since it may be more resistant to the standard hygenic, cleaning, and disinfecting practices of a typical long term care facility (more resistant than other common bacterial causes, ...

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