An outbreak caused by the co-infection of Sapovirus and Norovirus at a university in Jiangxi Province, China, 2018

  • Water or foodborne
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Background:
65 students presented with diarrhea in a Jiangxi university were reported from Nov 25th to 28th, 2018. We conducted an investigation to determine the etiology, identify risk factors, and recommend preventive and control measures.

Methods:
Suspected cases were defined as onset with diarrhea, or vomiting among students or staff at the university from Nov 15th - Dec 12th, 2018. Confirmed cases were students or staff with Sapovirus or Norovirus nucleic acid positive. We reviewed medical records, interviewed students and staff to search for cases. A case-control study was conducted to evaluate associated risk factors. Environmental investigation of food and water sources was conducted to identify possible sources of exposure. Samples from cases, water, utensils and canteen workers were taken for testing including Sapovirus and Norovirus by PCR testing.

Results:
363 suspected and 20 confirmed case were identified, attack rate was 3.1% (375/12,000) for students, 3.2% (8/250) for canteen workers, no teacher cases. Student cases distributed in 12 departments of the university. Clinical features included diarrhea (88%), abdominal pain (77%), nausea (58%), vomiting (38%) and fever (14%). There were two canteens and their water were supplied by different reservoirs, all canteen worker cases worked in the first canteen. 83.9% (52/62) student cases ate at the first canteen compared with 75.4% (46/68) controls (OR = 2.5, 95% CI: 1.1-5.8). 13 water specimens and 20 stool specimens were positive. The reservoir which supplied the first canteen was contaminated with positive Sapovirus and Norovirus test. Sewage was beside the reservoir. Heavy rains right before outbreak may have played a role.

Conclusion:
This outbreak was caused by the co-infection of Sapovirus and Norovirus. The source of infection was secondary to contaminated reservoirs. We recommend reconstructing the water reservoirs to assure no cross-contamination, and the water source should be strictly disinfected before supply.

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