Emergence of GI.6 Outbreaks in a High School in Fangshan District, Beijing, China
Science Journal of Public Health
Volume 6, Issue 4, July 2018, Pages: 106-110
Received: Jun. 24, 2018;
Accepted: Jul. 7, 2018;
Published: Jul. 30, 2018
Views 678 Downloads 37
Liu Haibo, Microbiology Laboratory, Fangshan District Center for Disease Control and Prevention, Beijing, China
Shi Wengfeng, Microbiology Laboratory, Fangshan District Center for Disease Control and Prevention, Beijing, China
[Background] An outbreak of gastroenteritis happened in a high school in Fangshan District, Beijing, China in March 2016，in which 44 students developed the symptoms of vomiting, nausea, diarrhea and abdominal pain. Epidemiological investigation, laboratory investigation and Statistical analysis were conducted to identify the agent and source of this outbreak.[Methods] A case–control study was performed to discover the factors associated with this infection. Questionnaires and clinical data from those infection-exposed people were assessed. Here an outbreak case was defined as a student who developed at least three following symptoms: diarrhea, vomiting, abdominal pain and nausea in 72 hours after the lunch on 2nd March., and controls were those who study or work in the school but did not have lunch on the day. Samples (Stool samples, rectal swabs and vomit samples) from infection-exposed students and controls, as well as environmental samples like food were collected to test for the existence of any suspicious bacteria or viruses. Detection of norovirus wasdone by real-time TaqMan RT-PCR and sequence analysis. Chi-square test was used to decide whether those differences could be of any statistical significance. [Results] The total number of respondents with complete data was 44. An epidemiological data combined with the epidemic curve indicated that the outbreak started initially from a point source type, and was followed by a secondary transmission. Five stool samples, three rectal swabs and one vomit sample from case group turned out to be positive for norovirus genotype I by real-time PCR, and two asymptomatic food handlers in control group were positive for NoV GI. Sequence analysis of GI positive sample confirmed that the norovirus GI.6 variant was the etiological agent of the outbreak. Comparasion between the tested results from samples of those students who had lunch in school canteen and those who did notindicates that the difference of incidence was of statistical significance (P<0.01, 95% CI:4.22-324.41). Food and environmental samples were tested to be bacteria-negative. [Conclusions] Our result suggested that the etiological agent of the outbreak was norvirus GI.6, which leads to gastroenteritis. We identified that asymptomatic infected food handlers were most likely to be the source of the outbreak. Therefore，hand hygiene practices strict adherence to regulations and access to hand washing facilities should be strengthened.
Emergence of GI.6 Outbreaks in a High School in Fangshan District, Beijing, China, Science Journal of Public Health.
Vol. 6, No. 4,
2018, pp. 106-110.
E Robilotti, S Deresinski, BA Pinsky. Norovirus. Clin Microbiol Rev. 2015; 28(1):134-64.
AJ Hall, BA Lopman, DC Payne, et al. Norovirus disease in the United States. Emerg Infect Dis. 2013; 19(8):1198-205.
SM Ahmed, AJ Hall, AE Robinson, et al. Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis. Lancet Infect Dis. 2014; 14(8):725-30.
AJ Hall, ME Wikswo, K Manikonda, et al. Acute gastroenteritis surveillance through the National Outbreak Reporting System, United States. Emerg Infect Dis. 2013; 19(8):1305-9.
J Mans, GE Armah, AD Steele, et al. Norovirus Epidemiology in Africa: A Review. PLoS One. 2016; 11(4):e0146280.
MY Chen, WC Chen, PC Chen, et al. An outbreak of norovirus gastroenteritis associated with asymptomatic food handlers in Kinmen, Taiwan. BMC Public Health. 2016; 16372.
ME Wikswo, A Kambhampati, K Shioda, et al. Outbreaks of Acute Gastroenteritis Transmitted by Person-to-Person Contact, Environmental Contamination, and Unknown Modes of Transmission--United States, 2009-2013. MMWR Surveill Summ. 2015; 64 (12): 1-16.
S Xiao, JW Tang, Y Li. Airborne or Fomite Transmission for Norovirus? A Case Study Revisited. Int J Environ Res Public Health. 2017; 14 (12): E1571.
AJ Hall, ME Wikswo, K Pringle, et al. Vital signs: foodborne norovirus outbreaks - United States, 2009-2012. MMWR Morb Mortal Wkly Rep. 2014; 63(22):491-5.
KC Smith, T Inns, V Decraene, et al. An outbreak of norovirus GI-6 infection following a wedding in North West England. Epidemiol Infect. 2017; 145 (6):1239-1245.
LD Bruggink, O Oluwatoyin, R Sameer, et al. Molecular and epidemiological features of gastroenteritis outbreaks involving genogroup I norovirus in Victoria, Australia, 2002-2010. J Med Virol. 2012; 84(9):1437-48.
SW Qin, TC Chan, J Cai, et al. Genotypic and Epidemiological Trends of Acute Gastroenteritis Associated with Noroviruses in China from 2006 to 2016. Int J Environ Res Public Health. 2017; 14(11): E1341.
H Chen, S Wang, W Wang. Complete Genome Sequence of a Human Norovirus Strain from the United States Classified as Genotype GII. P6_GII. 6. Genome Announc. 2018; 6 (22): e00489-18.
J Vinje. Advances in laboratory methods for detection and typing of norovirus. J Clin Microbiol. 2015; 53(2):373-81.
E Leshem, L Barclay, M Wikswo, et al. Genotype GI. 6 norovirus, United States, 2010-2012. Emerg Infect Dis. 2013; 19(8):1317-20.
L Muller, AC Schultz, J Fonager, et al. Separate norovirus outbreaks linked to one source of imported frozen raspberries by molecular analysis, Denmark, 2010-2011. Epidemiol Infect. 2015; 143(11):2299-307.
LD Bruggink, NL Dunbar, MG Catton, et al. Norovirus genotype diversity associated with gastroenteritis outbreaks in Victoria in 2013. Commun Dis Intell Q Rep. 2015; 39(1):E34-41.
QM Zheng, HT Zeng, CW Dai, et al. Epidemiological investigation of a norovirus GII. 4 Sydney outbreak in a China elder care facility. Jpn J Infect Dis. 2015; 68(1):70-4.
BJ Jones, J Flint, J Collins, et al. Gastroenteritis outbreak at a health function caused by an emerging recombinant strain of Norovirus GII. P16/GII. 4 Sydney 2012, Australia. Epidemiol Infect. 2018; 146 (8):970-971.
MC Medici, F Tummolo, V Martella, et al. Emergence of novel recombinant GII. P16_GII. 2 and GII. P16_GII. 4 Sydney 2012 norovirus strains in Italy, winter 2016/2017. New Microbiol. 2018; 41 (1):71-72.
R Solano, M Alseda, P Godoy, et al. Person-to-person transmission of norovirus resulting in an outbreak of acute gastroenteritis at a summer camp. Eur J Gastroenterol Hepatol. 2014; 26(10):1160-6.
ME Wikswo, A Kambhampati, K Shioda, et al. Outbreaks of Acute Gastroenteritis Transmitted by Person-to-Person Contact, Environmental Contamination, and Unknown Modes of Transmission--United States, 2009-2013. MMWR Surveill Summ. 2015; 64 (12):1-16.
Terio V, Bottaro M, Pavoni E, et al. Occurrence of hepatitis A and E and norovirus GI and GII in ready-to-eat vegetables in Italy. Int J Food Microbiol. 2017; 249: 61-65.
L Verhoef, J Hewitt, L Barclay, et al. Norovirus genotype profiles associated with foodborne transmission, 1999-2012. Emerg Infect Dis. 2015; 21(4):592-9.
C Rumble, S Addiman, S Balasegaram, et al. Role of Food Handlers in Norovirus Outbreaks in London and South East England, 2013 to 2015. J Food Prot. 2017; 80 (2):257-264.
M de Graaf, J van Beek, MP Koopmans. Human norovirus transmission and evolution in a changing world. Nat Rev Microbiol. 2016; 14 (7): 421-33.
HS Koo, MO Lee, PT Ku. Molecular epidemiology of norovirus in asymptomatic food handlers in Busan, Korea, and emergence of genotype GII. 17. J Microbiol. 2016; 54 (10): 686-94.
MY Chen, WC Chen, PC Chen, et al. An outbreak of norovirus gastroenteritis associated with asymptomatic food handlers in Kinmen, Taiwan. BMC Public Health. 2016; 16: 372.