Gastroenteritis outbreaks caused by Norovirus genotype II.7 in a college in China (Zhuhai, Guangdong) in 2011

Abstract

Background: Noroviruses are the most common cause of epidemic gastroenteritis worldwide. Noroviruses are comprised of at least five genogroups (GI-GV) and >35 genotypes. GII.7 is a nonpredominant genotype associated with Norovirus outbreaks. On November 17, 2011, Zhuhai Center for Disease Control monitored an increasing number of gastroenteritis cases at a local college. To determine the causes and control the outbreak effectively, we carried out an epidemiologic investigation.

Methods: Suspected cases were defined as those with one of the following symptoms: nausea, vomiting, abdominal pain, or diarrhea presenting on or after November 15 among the people who lived at the college. Probable cases were defined as cases with vomiting or diarrhea over three times per day on or after November 15. Confirmed cases were suspected or probable cases positive for Norovirus (nucleic acid). We conducted a case-control study to identify risk factors of the outbreak. Norovirus was tested by real-time reverse transcription-polymerase chain reaction, and Norovirus polymerase chain reaction products were further sequenced.

Results: In total, 63 cases were identified, which were scattered in all 14 departments of the college. The outbreak lasted for 84 h. Time distribution mode indicated a point-source outbreak. Fifty-one cases and 94 controls were contacted. Seventy-five percent of the cases compared to 19% of the controls were exposed to delicatessens (various salad and meat products) from the "Y" convenience store (odds ratio=12, 95% confidence interval 5.4-28). Laboratory tests showed 14 of the 15 cases and two asymptomatic food handlers were positive for Norovirus nucleic acid. There was 100% similarity between the cases and the food handlers when we compared the nucleotide sequences of Norovirus, which clustered with GII.7 genotype.

Conclusions: Delicatessens from the "Y" convenience store were associated with the GII.7 Norovirus outbreak. We strongly recommend food supervision and quality control in convenience stores to decrease the risk of future Norovirus outbreaks.