Abstract
BackgroundGII noroviruses are a common cause of acute gastroenteritis (AGE) outbreaks in institutional settings globally. However, AGE outbreaks caused by GI norovirus, especially the GI.5 genotype, are relatively uncommon.MethodsIn February 2017, an AGE outbreak occurred in a primary school in Shanghai, China. An outbreak investigation was undertaken, and fecal specimens, rectal swabs, and environmental swabs were collected. Pathogen detection was performed and the positive specimens were characterized by gene sequencing.ResultsThe descriptive epidemiological analysis suggested that this outbreak, involving 19 cases in two classes (designated classes A and B), was a small-scale propagated epidemic and person-to-person transmission was the most plausible transmission mode. The outbreak comprised two peaks, with 15 cases occurring in class A during the main peak and four cases occurring in class B in the subsequent minor peak. The primary attack rate was 38% and the secondary attack rate was 10%. Univariable logistic regression indicated that contacting a suspect case was a risk factor for norovirus infection, with an unadjusted OR of 5.6 (95% CI: 1.6–20.1). Six fecal specimens were positive for GI norovirus, with a single genotype, GI.5 norovirus, being involved, as characterized by genotyping. This outbreak was the first reported outbreak of GI.5 norovirus in China.ConclusionsThis study implies that GI.5 norovirus is a potential agent of outbreaks spread by person-to-person transmission in institutional settings. The investigation highlights the importance of sensitive surveillance, timely isolation of individuals who are ill, adequate hand hygiene, and proper environmental disinfection for prevention and control of AGE outbreaks caused by norovirus.
Highlights
GII noroviruses are a common cause of acute gastroenteritis (AGE) outbreaks in institutional settings globally
This paper describes an investigation of an AGE outbreak associated with person-to-person transmission in a primary school in Jinshan district, Shanghai, China, and the identification of GI.5 norovirus, which is the first reported outbreak by GI.5 norovirus infection in China
It is known that human gastroenteritis is caused primarily by GI and GII noroviruses, and GII.4 noroviruses have been responsible for most AGE outbreaks in the past decade [18]
Summary
GII noroviruses are a common cause of acute gastroenteritis (AGE) outbreaks in institutional settings globally. AGE outbreaks caused by GI norovirus, especially the GI. genotype, are relatively uncommon. Noroviruses are recognized as the leading etiological agent of acute gastroenteritis (AGE) outbreaks in institutional settings, including schools, cruise ships, kindergartens, and health care facilities around the world [1,2,3], and there has been increasing concern about noroviruses. The GII. genotype is recognized as the major cause of AGE outbreaks due to the emergence of new variants every 2–4 years, induced by the evolutionary mechanisms of recombination and mutations [8]. In China, more AGE outbreaks caused by norovirus have been reported in recent years and they have resulted in a significant disease burden [10]. AGE outbreaks caused by GI norovirus were relatively uncommon. This paper describes an investigation of an AGE outbreak associated with person-to-person transmission in a primary school in Jinshan district, Shanghai, China, and the identification of GI. norovirus, which is the first reported outbreak by GI. norovirus infection in China
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