An Outbreak of Norovirus at a Middle School - Guangdong Province, China, 2018

  • Water or foodborne
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Background:
On 11 October 2018, a number of students who developed vomiting and diarrhea was reported in a middle school in township in Guangdong province. There were 296 boarding students and 570 non-boarding students in school. An investigation was conducted to identify the cause of disease and risk factors, and propose control measures and preventive recommendations.

Methods:
A suspected case was defined as a student or staff who vomited 1x or more or had diarrhea 3x or more in 24 hours during October 6-16. A confirmed case was a suspected case and norovirus positive from a rectal swab RT-PCR and an asymptomatic carrier with RT-PCR (+) but no clinical symptoms. We surveyed water sources and foods in school. We selected 36 cases and 36 controls, matched by class and compared their exposures to foods, water and contact.

Results:
We identified 39 cases (7 confirmed as norovirus GII) and 1 asymptomatic carrier who was a kitchen worker. 35 cases were boarding students, 1 case was non-boarding student and 3 cases were intern teachers who lived in the student dorm. The kitchen worker also lived in student dorm. The outbreak peaked at 48 hours after the first case occurred. The vomitus was thrown to dustbin in third floor in dorm by first case. The incidence rate of boarding students (12%) was significantly higher than that in non-boarding students (0.18%). And the incidence rate of those who walked through third floor (20%) was significantly higher than those who didn’t (8.2%). The case-control study showed that, exposure to vomitus was a risk factor (OR=5.67, 95%CI: 1.13-28.44) and using hand sanitizer or soap was a protect factor (OR=0.09, 95%CI: 0.03-0.29).

Conclusion:
This norovirus outbreak was the most possibly caused by exposure to vomitus from the patients. The high-risk exposed site was the dorm. We recommend strengthen morning check and isolated vomiting patients and disinfect the vomitus in school.

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