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BMC Public Health

, 14:1092

Infectious Disease epidemiology


BackgroundMore than 200 students and teachers at a boarding school in Shanghai developed acute gastroenteritis in December, 2012. The transmission mode remained largely unknown. An immediate epidemiological investigation was conducted to identify it.

MethodsUsing a retrospective cohort design, we investigated demographic characteristics, school environment, and previous contacts with people who had diarrhea and-or vomiting, drinking water conditions, recalls of food consumption in the school cafeteria, hand-washing habits and eating habits. Rectal swabs of the new cases and food handlers as well as water and food samples were collected to test potential bacteria and viruses. Norovirus was detected by real-time reverse transcription-polymerase chain reaction RT-PCR.

ResultsA total of 278 cases developed gastrointestinal symptoms in this outbreak, and the overall attack rate was 13.9%. The main symptoms included vomiting 50.0%, abdominal cramps 40.3%, nausea 27.0%, diarrhea 6.8% and fever 6.8%. Twenty rectal swab samples were detected as Norovirus–positive, including 11 from student cases and 9 from asymptomatic food handlers non-cases. Among environmental surface samples from the kitchen, 8 samples were also detected as Norovirus-positive. The genotypes of viral strains were the same GII in patients, asymptomatic food handlers and environmental surfaces. Other samples, including rectal swabs, water samples and food samples were negative for any bacteria and other tested viruses. Asymptomatic food handlers may have contaminated the cooked food during the food preparation.

ConclusionThe study detected that the outbreak was caused by Norovirus and should be controlled by thorough disinfection and excluding asymptomatic food handlers from food preparation. Early identification of the predominant mode of transmission in this outbreak was necessary to prevent new cases. Furthermore, good hygiene practices such as regular hand washing and efficient daily disinfection should be promoted to prevent such infection and outbreaks.

KeywordsNorovirus Acute gastroenteritis Outbreak Asymptomatic food handler Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-14-1092 contains supplementary material, which is available to authorized users.

Caoyi Xue, Yifei Fu contributed equally to this work.

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Autor: Caoyi Xue - Yifei Fu - Weiping Zhu - Yi Fei - Linying Zhu - Hong Zhang - Lifeng Pan - Hongmei Xu - Yong Wang - Wenqin Wa


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