title: Norovirus gastroenteritis outbreak transmitted by food and vomit in a high school.
abstract: We investigated an outbreak of norovirus that affected students and teachers of a high school in Lleida, Spain through various transmission mechanisms. A case-control epidemiological study of the risk of disease and the relative importance of each mode of transmission was carried out. Cases and controls were selected from a systematic sample of students and teachers present at the school on 28 January. Faecal samples were taken from three food handlers and 16 cases. The influence of each factor was studied using the adjusted odds ratio (aOR) and the estimated population attributable risk (ePAR) with 95% confidence intervals (CI). We interviewed 210 people (42 cases, 168 controls). The proportion of symptoms in these individuals was nausea 78·6%, vomiting 59·5%, diarrhoea 45·2%, and fever 19·0%. The epidemic curve showed transmission for at least 4 days. The risk of disease was associated with exposure to food (aOR 5·8) in 66·1% of cases and vomit (aOR 4·7) in 24·8% of cases. Faecal samples from 11 patients and two food handlers were positive for norovirus GII.12 g. Vomit may co-exist with other modes of transmission in norovirus outbreaks and could explain a large number of cases.
authors.affiliation: Departament de Salut,Generalitat de Catalunya,Lleida,Spain.
authors.forename: P
authors.initials: P
authors.lastname: Godoy
authors.affiliation: Departament de Salut,Generalitat de Catalunya,Lleida,Spain.
authors.forename: M
authors.initials: M
authors.lastname: Alsedà
authors.affiliation: Hospital de la Vall d'Hebrón,Barcelona,Spain.
authors.forename: R
authors.initials: R
authors.lastname: Bartolomé
authors.affiliation: Departament de Salut,Generalitat de Catalunya,Lleida,Spain.
authors.forename: D
authors.initials: D
authors.lastname: Clavería
authors.affiliation: Departament de Salut,Generalitat de Catalunya,Lleida,Spain.
authors.forename: I
authors.initials: I
authors.lastname: Módol
authors.affiliation: Departament de Salut,Generalitat de Catalunya,Lleida,Spain.
authors.forename: P
authors.initials: P
authors.lastname: Bach
authors.affiliation: Departament de Salut,Generalitat de Catalunya,Lleida,Spain.
authors.forename: G
authors.initials: G
authors.lastname: Mirada
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP),Madrid,Spain.
authors.forename: À
authors.initials: À
authors.lastname: Domínguez
mesh_terms: D000293:Adolescent; D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D016022:Case-Control Studies; D002648:Child; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious; D016021:Epidemiologic Studies; D005243:Feces / Q000821:virology; D005260:Female; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000821:virology; D005759:Gastroenteritis / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D029322:Norovirus / Q000302:isolation & purification*; D000070777:School Teachers; D012574:Schools; D013030:Spain / Q000453:epidemiology; D013334:Students; D014839:Vomiting / Q000453:epidemiology* / Q000821:virology
keywords: Caliciviruses; Norwalk agent and related viruses; epidemiology; outbreaks; public health