BACKGROUND Norovirus is a leading cause of acute gastroenteritis (AGE) across the age spectrum; candidate vaccines are in clinical trials. While norovirus diagnostic testing is increasingly available, stool testing may not be performed routinely, which can hamper surveillance and burden of disease estimates. Additionally, lack of knowledge of the burden of disease may inhibit provider vaccine recommendations, which could affect coverage rates and ultimately the impact of the vaccine. Our objectives were to understand physicians' stool testing practices in outpatients with AGE, and physician knowledge of norovirus, in order to improve surveillance and prepare for vaccine introduction. METHODS Internet and mail survey on AGE, norovirus, and future norovirus vaccines conducted January to March 2018 among national networks of primary care pediatricians, family practice and general internal medicine physicians. RESULTS The response rate was 59% (820/1383). During peak AGE season, physicians estimated they ordered stool tests for a median of 15% (interquartile range: 5-33%) of their outpatients with AGE. Stool tests were reported as more often available for ova and parasites, Clostridioides difficile, and bacterial culture (>95% for all specialties) than for norovirus (6-33% across specialties); even when available, norovirus-specific tests were infrequently ordered. Most providers were unaware that norovirus is a leading cause of AGE across all age groups (Pediatricians 80%, Family Practice 86%, General Internal Medicine 89%) or that alcohol-based hand sanitizers are ineffective against norovirus (Pediatricians 51%, Family Practice 66%, General Internal Medicine 62%). Concerns cited as major barriers to implementing a future norovirus vaccine included if the vaccine is not covered by insurance (General Internal Medicine 64%, Pediatricians 67%, Family Practice 74%) and lack of adequate reimbursement for vaccination (Pediatricians 43%, General Internal Medicine 46%, Family Practice 50%). Factors that providers believed were 'not at all a barrier' or 'minor barrier' to new vaccine introduction included the belief that "my patients won't need this vaccine" (General Internal Medicine 78%, Family Practice 86%, Pediatricians 90%) and "my patients already get too many vaccines" (Family Practice 89%, General Internal Medicine 92%, Pediatricians 95%). CONCLUSIONS Primary care physicians had few concerns regarding future norovirus vaccine introduction, but have knowledge gaps on norovirus prevalence and hand hygiene for prevention. Also, physicians infrequently order stool tests for outpatients with AGE, which limits surveillance estimates that rely on physician-ordered stool diagnostics. Closing physician knowledge gaps on norovirus burden and transmission can help support norovirus vaccine introduction.

中文翻译：

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诺如病毒和急性胃肠炎的初级保健医师知识，态度和诊断测试方法。

背景诺如病毒是整个年龄段急性胃肠炎（AGE）的主要原因。候选疫苗正在临床试验中。尽管诺如病毒诊断测试越来越多，但可能无法常规进行粪便测试，这可能会妨碍监视和疾病估计负担。此外，对疾病负担的了解不足可能会抑制提供者疫苗的推荐，这可能会影响覆盖率，最终影响疫苗的效果。我们的目标是了解AGE患者门诊医生的粪便检测方法，以及医生对诺如病毒的了解，以改善监控并为疫苗的引入做准备。方法对AGE，诺如病毒，以及将来的诺如病毒疫苗将于2018年1月至3月在全国初级保健儿科医生，家庭医生和普通内科医师网络中进行。结果回应率为59％（820/1383）。在AGE高峰季节，医生估计他们下令进行粪便检查的中位数为AGE门诊患者的15％（四分位间距：5-33％）。据报道，粪便测试可用于卵子和寄生虫，艰难梭菌和细菌培养（所有专业> 95％）比诺如病毒（所有专业中6-33％）更多；即使有空病毒，也很少订购诺如病毒特异性测试。大多数提供者都不知道诺如病毒是所有年龄段的AGE的主要原因（儿科医生80％，家庭实践86％，普通内科药物为89％）或酒精类洗手液对诺如病毒无效（儿科医生为51％，家庭医生为66％，普通内科药物为62％）。如果疫苗不在保险范围内（普通内科64％，儿科医生67％，家庭医生74％）并且疫苗接种报销不足（儿科医生43％，普通内科），则被认为是实施未来诺如病毒疫苗的主要障碍。医学46％，家庭实践50％）。提供者认为对引入新疫苗“根本没有障碍”或“较小障碍”的因素包括相信“我的患者不需要这种疫苗”（普通内科医师为78％，家庭医生为86％，儿科医生为90％ ）和“我的患者已经接种了太多疫苗”（家庭实践89％，普通内科92％，儿科医生95％。结论基层医疗医生对未来诺如病毒疫苗的引入几乎没有担忧，但是在诺如病毒的流行和手部卫生预防方面存在知识空白。同样，医师很少为患有AGE的门诊患者下令进行粪便检查，这限制了依靠医师下令进行粪便诊断的监测估计。缩小医师对诺如病毒负担和传播的知识差距可以帮助支持诺如病毒疫苗的引入。这就限制了依靠医生命令进行粪便诊断的监测估计。缩小医师对诺如病毒负担和传播的知识差距可以帮助支持诺如病毒疫苗的引入。这就限制了依靠医生命令进行粪便诊断的监测估计。缩小医师对诺如病毒负担和传播的知识差距可以帮助支持诺如病毒疫苗的引入。