title: An outbreak of norovirus gastroenteritis associated with a secondary water supply system in a factory in south China.
abstract: BACKGROUND
  Between September 17 and October 3, 2009, hundreds of workers employed in a manufacturing factory in Shenzhen, a city in south China developed a sudden onset of acute gastroenteritis. A retrospective cohort study is designed to identify the risk factors and control this outbreak.
  
  
  METHODS
  Information on demographic characteristics, working place, the history of contact with a person having diarrhea and/or vomiting, drink water preference and frequency, eating in the company cafeteria or outside the company, hand-washing habits and eating habits is included. Furthermore, in order to find the contamination source, we investigated the environment around the underground reservoir and collected water samples from the junction between municipal supply water system and underground reservoir to test potential bacteria and virus, examine the seepage tracks on the wall of the underground reservoir from the side of septic tank, and check the integrity and attitude of this lid. Relative risk was presented and Chi-square test was performed. All the analyses were performed with OpenEpi software version 2.3.1 online.
  
  
  RESULTS
  The cohort study demonstrated that the workers who had direct drink water were 3.0 fold more likely to suffer from acute gastroenteritis than those who consumed commercial bottled water. The direct drinking water, water of the tank of buildings, and the underground reservoir were positive only for norovirus. Norovirus was also detected from stool and rectal swab samples from patients with acute gastroenteritis. The underground reservoir was found to be the primary contamination source. Further environmental investigation showed that the norovirus contaminated substance entered into the underground reservoir via access holes in lid covering this underground reservoir.
  
  
  CONCLUSIONS
  This acute gastroenteritis outbreak was caused by the secondary supply system contaminated by norovirus in this factory. The outbreak of gastroenteritis cases caused by norovirus frequently occurred in China due to a lack of surveillance and supervision, and due to faults in the construction of such water systems. Therefore, more attentions should pay to the secondary supply water system in China.
authors.affiliation: Department of infectious disease prevention and control, Shenzhen bao’an center for disease control and prevention, 116 Longjinger Road, Shenzhen 51810, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Li
authors.forename: Hongxiong
authors.initials: H
authors.lastname: Guo
authors.forename: Zhenghui
authors.initials: Z
authors.lastname: Xu
authors.forename: Xiaotao
authors.initials: X
authors.lastname: Zhou
authors.forename: Hailong
authors.initials: H
authors.lastname: Zhang
authors.forename: Lijie
authors.initials: L
authors.lastname: Zhang
authors.forename: Jing
authors.initials: J
authors.lastname: Miao
authors.forename: Yi
authors.initials: Y
authors.lastname: Pan
mesh_terms: D000208:Acute Disease; D016009:Chi-Square Distribution; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology* / Q000821:virology; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data*; D060766:Drinking Water / Q000382:microbiology*; D004781:Environmental Exposure; D005260:Female; D005759:Gastroenteritis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007221:Industry; D008297:Male; D029322:Norovirus / Q000302:isolation & purification*; D016273:Occupational Exposure / Q000706:statistics & numerical data*; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies; D018570:Risk Assessment; D018571:Sentinel Surveillance; D012959:Socioeconomic Factors; D014871:Water Microbiology / Q000592:standards; D014881:Water Supply / Q000592:standards
chemical_list: D060766:Drinking Water
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