A waterborne norovirus gastroenteritis outbreak in a school, eastern China.
In late 2014, a gastroenteritis outbreak occurred in a school in Shandong Province, eastern China. Hundreds of individuals developed the symptoms of diarrhoea and vomiting. Epidemiological investigation showed that food consumption was not linked to this outbreak, and unboiled direct drinking water was identified as the independent risk factor with a relative risk of 1·37 (95% confidence interval 1·03-1·83). Furthermore, examination of common bacterial and viral gastroenteritis pathogens was conducted on different specimens. Norovirus GI.1, GI.2, GI.6, GII.4, GII.6 and GII.13 were detected in clinical specimens and a water sample. GII.4 sequences between clinical specimens and the water sample displayed a close relationship and belonged to GII.4 variant Sydney 2012. These results indicate that direct drinking water contaminated by norovirus was responsible for this gastroenteritis outbreak. This study enriches our knowledge of waterborne norovirus outbreaks in China, and presents valuable prevention and control practices for policy-makers. In future, strengthened surveillance and supervision of direct drinking-water systems is needed.
Department of Epidemiology,School of Public Health,Shandong University,Jinan,People's Republic of China.
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Zhou
Academy of Preventive Medicine,Shandong University,Jinan,People's Republic of China.
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Zhang
Academy of Preventive Medicine,Shandong University,Jinan,People's Republic of China.
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Lin
Academy of Preventive Medicine,Shandong University,Jinan,People's Republic of China.
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Hou
Academy of Preventive Medicine,Shandong University,Jinan,People's Republic of China.
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Wang
Academy of Preventive Medicine,Shandong University,Jinan,People's Republic of China.
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Tao
Academy of Preventive Medicine,Shandong University,Jinan,People's Republic of China.
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Bi
Department of Epidemiology,School of Public Health,Shandong University,Jinan,People's Republic of China.
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Xu
D000293:Adolescent; D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000635:transmission; D002648:Child; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D004196:Disease Outbreaks; D060766:Drinking Water / Q000821:virology*; D005759:Gastroenteritis / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D008969:Molecular Sequence Data; D029322:Norovirus / Q000235:genetics / Q000302:isolation & purification*; D010802:Phylogeny; D012189:Retrospective Studies; D012574:Schools; D017422:Sequence Analysis, DNA; D014764:Viral Proteins / Q000235:genetics; D000069578:Waterborne Diseases / Q000453:epidemiology* / Q000635:transmission / Q000821:virology
D060766:Drinking Water; D014764:Viral Proteins
Norwalk agent and related viruses; outbreaks; waterborne infections