[Investigation of a norovirus outbreak through contaminated centralized water supply system].
OBJECTIVE
To investigate the etiology and source of an infectious diarrhea outbreak and control the epidemic.


METHODS
Through the retrospective cohort study, we had surveyed all the residents who complained symptoms of diarrhea or vomiting since Nov. 20th,2007 from the five villages in the north of town Y, and collected hygiene information on the water supply system of the five villages, the environment information of three villages and hygiene information of some case-indexed families, and tested the etiological biomarker, including nucleoside acid of norovirus through Real-time PCR and nested PCR technologies.


RESULTS
From Nov. 24th to Dec. 3th in 2007, 435 diarrhea or vomiting cases were found in the north of Y town, where tap water A was supplied for daily use. The attack rate was 12.93%. The diarrhea cases were distributed among all country groups who has used tap water A and the attack rate was ranged from 5.21% (20/384) to 21.23% (100/471). Drinking the tap water A was significantly associated with an increased risk of infection (RR = 9.246, 95% CI: 6.25 -13.68). About 85.9% (262/ 305) of the cases were from Nov. 25th to 27th. An investigation of a country of S2 group showed that the incidence of different age groups was distributed as the following: 0 - year-old 20.0% (3/15); 10 - year-old 17.3% (9/52); 20 - year-old 15.2% (16/105); older than 60 year-old 23.3% (7/30). No statistical significance was identified between age and infection(chi2 = 1.15, P >0.05). Most of the patients were not serious and well prognostic, and no hospitalized or dead cases were reported. On site investigation and daily water quality monitoring showed that disinfection procedures were not strictly followed. The monitoring data also indicated the bacteriology index of tap water A was disqualified. The test of Salmonella, Shigella and Staphylococcus aureus were negative in two vomit and one stool samples from patients. Three specimens by Real-time PCR, and six by nested PCR were positive for norovirus among the three feces and three anal swabs samples. With the drinking water sterilization and health education, the epidemic had been controlled rapidly and effectively.


CONCLUSIONS
The epidemic was a diarrhea outbreak that might be caused by norovirus through drinking the contaminated tap water A.
Zheng
Hui-Zhen
HZ
Institute of Epidemic Disease Prevention and Control, Center for Disease Control and Prevention of Guangdong Province, Guangzhou, China.
Guo
Ru-Ning
RN
Li
Jian-Sen
JS
Zhang
Zheng-Min
ZM
Li
Hui
H
D000293:Adolescent; D000328:Adult; D017250:Caliciviridae Infections / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology* / Q000821:virology; D004196:Disease Outbreaks; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D012189:Retrospective Studies; D014876:Water Pollution; D014881:Water Supply; D055815:Young Adult