title: An outbreak of acute GII.17 norovirus gastroenteritis in a long-term care facility in China: The role of nursing assistants.
abstract: More than 30 residents and nursing assistants in a geriatric nursing hospital developed acute gastroenteritis from December 7th to December 18th, 2014 in Shanghai, China. An immediate epidemiological investigation was conducted to identify the etiological agent of the outbreak, mode of transmission and the risk factors. Cases were investigated according to an epidemiological questionnaire. Samples from cases, highly transmissible environmental surfaces and drinking water were collected for pathogens detection. A retrospective cohort study was conducted to explore the transmission mode. A total of 34 cases were affected in this acute gastroenteritis outbreak, including 23 residents, 9 nursing assistants and 2 doctors. 13 out of 30 samples were positive for GII.17 norovirus, no other pathogen was detected. Nursing assistants who developed gastroenteritis symptoms had a higher attack rate in residents they cared than those who did not develop any gastroenteritis symptoms (p<0.001). The acute gastroenteritis outbreak was caused by GII.17 norovirus. Person-to-person close contact and contaminated environmental surfaces were the probable transmission route. Nursing assistants were considered to play an important role in the secondary spread of norovirus. The poor medical skill and personal hygiene habits of nursing assistants in China should be paid attention and improved urgently which is critically important to prevent hospital infections.
authors.affiliation: Shanghai Pudong New Area Center for Disease Control and Prevention, Fudan University Pudong Institute of Preventive Medicine, 3039 Zhangyang Road, Shanghai 200136, China; Department of Infectious Disease, Pudong New Area Center for Disease Control and Prevention, Shanghai, China.
authors.forename: Chang
authors.initials: C
authors.lastname: Cui
authors.affiliation: Shanghai Pudong New Area Center for Disease Control and Prevention, Fudan University Pudong Institute of Preventive Medicine, 3039 Zhangyang Road, Shanghai 200136, China.
authors.forename: Lifeng
authors.initials: L
authors.lastname: Pan
authors.affiliation: Shanghai Pudong New Area Center for Disease Control and Prevention, Fudan University Pudong Institute of Preventive Medicine, 3039 Zhangyang Road, Shanghai 200136, China; Department of Infectious Disease, Pudong New Area Center for Disease Control and Prevention, Shanghai, China.
authors.forename: Yuanping
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Shanghai Pudong New Area Center for Disease Control and Prevention, Fudan University Pudong Institute of Preventive Medicine, 3039 Zhangyang Road, Shanghai 200136, China; Department of Infectious Disease, Pudong New Area Center for Disease Control and Prevention, Shanghai, China.
authors.forename: Caoyi
authors.initials: C
authors.lastname: Xue
authors.affiliation: Shanghai Pudong New Area Center for Disease Control and Prevention, Fudan University Pudong Institute of Preventive Medicine, 3039 Zhangyang Road, Shanghai 200136, China; Department of Infectious Disease, Pudong New Area Center for Disease Control and Prevention, Shanghai, China.
authors.forename: Weiping
authors.initials: W
authors.lastname: Zhu
authors.affiliation: Shanghai Pudong New Area Center for Disease Control and Prevention, Fudan University Pudong Institute of Preventive Medicine, 3039 Zhangyang Road, Shanghai 200136, China.
authors.forename: Linying
authors.initials: L
authors.lastname: Zhu
authors.affiliation: Shanghai Pudong New Area Center for Disease Control and Prevention, Fudan University Pudong Institute of Preventive Medicine, 3039 Zhangyang Road, Shanghai 200136, China; Department of Infectious Disease, Pudong New Area Center for Disease Control and Prevention, Shanghai, China.
authors.forename: Chuchu
authors.initials: C
authors.lastname: Ye
authors.affiliation: Shanghai Pudong New Area Center for Disease Control and Prevention, Fudan University Pudong Institute of Preventive Medicine, 3039 Zhangyang Road, Shanghai 200136, China; Department of Infectious Disease, Pudong New Area Center for Disease Control and Prevention, Shanghai, China.
authors.forename: Xianghua
authors.initials: X
authors.lastname: Lu
authors.affiliation: Shanghai Pudong New Area Center for Disease Control and Prevention, Fudan University Pudong Institute of Preventive Medicine, 3039 Zhangyang Road, Shanghai 200136, China.
authors.forename: Haihong
authors.initials: H
authors.lastname: Song
authors.affiliation: Shanghai Pudong New Area Center for Disease Control and Prevention, Fudan University Pudong Institute of Preventive Medicine, 3039 Zhangyang Road, Shanghai 200136, China. Electronic address: fuyifei73@163.com.
authors.forename: Yifei
authors.initials: Y
authors.lastname: Fu
authors.affiliation: Shanghai Pudong New Area Center for Disease Control and Prevention, Fudan University Pudong Institute of Preventive Medicine, 3039 Zhangyang Road, Shanghai 200136, China. Electronic address: q_sun@pdcdc.sh.cn.
authors.forename: Qiao
authors.initials: Q
authors.lastname: Sun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D002681:China; D003428:Cross Infection / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious; D004783:Environmental Microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000821:virology; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D029322:Norovirus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D009726:Nurses; D009735:Nursing Homes; D012189:Retrospective Studies
keywords: China; Gastroenteritis outbreak; Long term care facility; Norovirus; Nursing assistants