Abstract
A gastroenteritis outbreak occurred in a university in May, 2017, Wuhan, China. The epidemiological survey and pathogen analysis were conducted to identify the pathogen and control this outbreak. Feces or anal swabs from individuals, water, and swabs taken from tap surfaces of the secondary water supply system (SWSS) and foods were collected for the detection of viruses and pathogenic enteric bacteria by real-time RT-PCR and culture, respectively. Nucleotide sequences were determined by RT-PCR and direct sequencing. Genotyping, phylogenetic, and recombination analyses were conducted by a web-based genotyping tool, MEGA, and RDP4 programs, respectively. Of 144 individuals enrolled, 75 met the case definitions. The epidemic curve showed one peak of incidence suggesting the most probable spread of a single common source. In total, 33 specimens were collected before disinfection of the SWSS. Of these, norovirus was detected and identified as GII.P17-GII.17 with 100% nucleotide sequence identity among the strains detected in ten students (10/14), a maintenance worker (1/2) dealing with the SWSS, four water samples (4/8), and two swabs taken from tap surfaces (2/3). Pathogens including Vibrio cholerae, Salmonella, Shigella, Vibrio parahaemolyticus, Bacillus cereus, enteropathogenic Escherichia coli, rotavirus, astrovirus, and sapovirus were negative. The GII.17 strains in this outbreak clustered closely in the same branch of the phylogenetic tree, and slightly apart from the strains of other cities in China, neighboring countries and regions, European and American countries. This gastroenteritis outbreak was deduced to be attributed to GII.P17-GII.17 norovirus contamination of the SWSS.
Highlights
Noroviruses belong to the family Caliciviridae, genus Norovirus
We report a gastroenteritis outbreak associated with a norovirus genogroup II (GII).17-contaminated secondary water supply system (SWSS)
This study describes an epidemiological survey and pathogen analysis of a norovirus outbreak
Summary
Norovirus is the major pathogen of acute non-bacterial gastroenteritis around the world (Green 2007). Waterborne transmission accounts for 1.5% of norovirus outbreaks worldwide, it has been rarely reported in China (Kroneman et al 2008; Qin et al 2016; Zhou et al 2016). The new GII. variant (Kawasaki variant) emerged as the major cause of norovirus gastroenteritis outbreaks in China in late 2014 and spread across four continents (Chan et al 2017). From April 28th through May 8th 2017, an acute gastroenteritis outbreak causing cases with a sudden onset of vomiting and diarrhea in a university was reported to the National Notifiable Reportable Diseases Surveillance System and notified to Wuhan Centers for Disease Prevention and Control in Wuhan, Hubei, China. In order to identify the pathogen and control the outbreak, epidemiological and environmental surveys and laboratory detection were conducted
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