Abstract
Objective: To describe the epidemiological characteristics of norovirus outbreaks in Jiangsu Province, utilize the total attack rate (TAR) and transmissibility (Runc) as the measurement indicators of the outbreak, and a statistical difference in risk factors associated with TAR and transmissibility was compared. Ultimately, this study aimed to provide scientific suggestions to develop the most appropriate prevention and control measures.Method: We collected epidemiological data from investigation reports of all norovirus outbreaks in Jiangsu Province from 2012 to 2018 and performed epidemiological descriptions, sequenced the genes of the positive specimens collected that were eligible for sequencing, created a database and calculated the TAR, constructed SEIAR and SEIARW transmission dynamic models to calculate Runc, and performed statistical analyses of risk factors associated with the TAR and Runc.Results: We collected a total of 206 reported outbreaks, of which 145 could be used to calculate transmissibility. The mean TAR in was 2.6% and the mean Runc was 12.2. The epidemiological characteristics of norovirus outbreaks showed an overall increasing trend in the number of norovirus outbreaks from 2012 to 2018; more outbreaks in southern Jiangsu than northern Jiangsu; more outbreaks in urban areas than in rural areas; outbreaks occurred mostly in autumn and winter. Most of the sites where outbreaks occurred were schools, especially primary schools. Interpersonal transmission accounted for the majority. Analysis of the genotypes of noroviruses revealed that the major genotypes of the viruses changed every 3 years, with the GII.2 [P16] type of norovirus dominating from 2016 to 2018. Statistical analysis of TAR associated with risk factors found statistical differences in all risk factors, including time (year, month, season), location (geographic location, type of settlement, type of premises), population (total number of susceptible people at the outbreak site), transmission route, and genotype (P < 0.05). Statistical analysis of transmissibility associated with risk factors revealed that only transmissibility was statistically different between sites.Conclusions: The number of norovirus outbreaks in Jiangsu Province continues to increase during the follow-up period. Our findings highlight the impact of different factors on norovirus outbreaks and identify the key points of prevention and control in Jiangsu Province.
Highlights
Norovirus, initially known as winter vomiting disease, was identified as the cause of the outbreak in 1972 when researchers observed 27-nm-virus particles by immune electron microscopy in the infected fecal filtrate from an acute outbreak of gastroenteritis in Norwalk, Ohio, in 1968, and named “Norwalk virus” [1, 2]
We observed that the GII.2 [P16] genotype caused more than half of the norovirus outbreaks in Jiangsu province in 2017 and 2018
We found that the mean TAR of norovirus outbreaks was highest in outbreaks with
Summary
Initially known as winter vomiting disease, was identified as the cause of the outbreak in 1972 when researchers observed 27-nm-virus particles by immune electron microscopy in the infected fecal filtrate from an acute outbreak of gastroenteritis in Norwalk, Ohio, in 1968, and named “Norwalk virus” [1, 2]. The disease burden of norovirus is becoming increasingly serious worldwide and in China, causing ∼684 million cases and 212,000 deaths, annually [4]. Existing studies have found significant differences in the epidemiological characteristics of norovirus outbreaks between China and other countries. Whole populations are susceptible to norovirus infection [7]; the outbreak sites are different. In the past two decades, the GII. virus has caused norovirus outbreaks in most age groups worldwide [17]. Norovirus genotypes are constantly changing in China with the emergence of new genotypes and differences in genotypes observed in different regions
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