An outbreak of norovirus-associated acute gastroenteritis associated with contaminated barrelled water in many schools in Zhejiang, China.
An outbreak of norovirus-associated acute gastroenteritis associated with contaminated barrelled water in many schools in Zhejiang, China.
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DOI：
10.1371/journal.pone.0171307
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Chai C
中科院分区：
文献类型：
--
作者：
Shang X;Fu X;Zhang P;Sheng M;Song J;He F;Qiu Y;Wu H;Lu Q;Feng Y;Lin J;Chen E;Chai C
2014年2月，嘉兴市多所学校的900多名师生患上了急性胃肠炎。立即进行了流行病学调查，以确定病原体、感染源和传播途径。疑似病例和确诊病例被定义为自2014年2月学期开始以来出现腹泻或呕吐的学生或教师。在学生和教师中进行了积极的搜索，寻找未确诊的病例。通过统一的流行病学问卷收集了人口统计特征、胃肠道症状、饮用水偏好和频率等详细信息。进行病例对照研究，计算优势比(OR)和95%可信区间。采集了几名患者、食品加工人员和桶装自来水厂工人的直肠拭子，以及水和食物样本，以检测潜在的细菌和病毒。共有924例符合疑似病例的定义，包括2014年2月12日至2月21日嘉兴市13所学校发生的8例经实验室确认的诺沃克病毒感染病例。病例对照研究显示，桶装水是危险因素(OR：2 0.15，95%CI：2.5 9~156.76)，瓶装水和开水是保护因素(OR：0.31，95%CI：0.13~0.70，OR：0.36，95%CI：0.16~0.77)。11份直肠标本和8份桶装水样均检出诺沃克病毒阳性，各毒株的基因分型一致(GII)。污染桶装水的诺沃克病毒主要来自没有症状的工人。这次急性胃肠炎暴发是由被诺沃克病毒污染的桶装水引起的。在停止供应桶装水后，疫情得到了控制。由于缺乏监测和监督，中国的桶装水供应是急性胃肠炎爆发的潜在来源。因此，这方面应该引起更多的关注。
More than 900 students and teachers at many schools in Jiaxing city developed acute gastroenteritis in February 2014. An immediate epidemiological investigation was conducted to identify the pathogen, infection sources and route of transmission. The probable cases and confirmed cases were defined as students or teachers with diarrhoea or vomiting present since the term began in February 2014. An active search was conducted for undiagnosed cases among students and teachers. Details such as demographic characteristics, gastrointestinal symptoms, and drinking water preference and frequency were collected via a uniform epidemiological questionnaire. A case-control study was implemented, and odds ratios (ORs) and 95% confidence intervals were calculated. Rectal swabs from several patients, food handlers and barrelled water factory workers, as well as water and food samples, were collected to test for potential bacteria and viruses. A total of 924 cases fit the definition of the probable case, including 8 cases of laboratory-confirmed norovirus infection at 13 schools in Jiaxing city between February 12 and February 21, 2014. The case-control study demonstrated that barrelled water was a risk factor (OR: 20.15, 95% CI: 2.59–156.76) and that bottled water and boiled barrelled water were protective factors (OR: 0.31, 95% CI: 0.13–0.70, and OR: 0.36, 95% CI: 0.16–0.77). A total of 11 rectal samples and 8 barrelled water samples were detected as norovirus-positive, and the genotypes of viral strains were the same (GII). The norovirus that contaminated the barrelled water largely came from the asymptomatic workers. This acute gastroenteritis outbreak was caused by barrelled water contaminated by norovirus. The outbreak was controlled after stopping the supply of barrelled water. The barrelled water supply in China represents a potential source of acute gastroenteritis outbreaks due to the lack of surveillance and supervision. Therefore, more attention should be paid to this area.