Norovirus gastroenteritis outbreak transmitted by food and vomit in a high school

Abstract

We investigated an outbreak of norovirus that affected students and teachers of a high school in Lleida, Spain through various transmission mechanisms. A case-control epidemiological study of the risk of disease and the relative importance of each mode of transmission was carried out. Cases and controls were selected from a systematic sample of students and teachers present at the school on 28 January. Faecal samples were taken from three food handlers and 16 cases. The influence of each factor was studied using the adjusted odds ratio (aOR) and the estimated population attributable risk (ePAR) with 95% confidence intervals (CI). We interviewed 210 people (42 cases, 168 controls). The proportion of symptoms in these individuals was nausea 78·6%, vomiting 59·5%, diarrhoea 45·2%, and fever 19·0%. The epidemic curve showed transmission for at least 4 days. The risk of disease was associated with exposure to food (aOR 5·8) in 66·1% of cases and vomit (aOR 4·7) in 24·8% of cases. Faecal samples from 11 patients and two food handlers were positive for norovirus GII.12 g. Vomit may co-exist with other modes of transmission in norovirus outbreaks and could explain a large number of cases.

Keywords: Caliciviruses; Norwalk agent and related viruses; epidemiology; outbreaks; public health.

Fig. 1.

Epidemic curve of a norovirus outbreak in a high school, Lleida, Spain (n = 39). ^a Subtraction of the minimum incubation period (–24 h) from the first case in the epidemic curve. ^b Subtraction of the maximum incubation period (–48 h) from the last case in the epidemic curve. ^c To calculate the days of transmission, we determined the time between the dates resulting from subtracting the minimum incubation period from the first case [23 January (23/1)] in the epidemic curve and the maximum incubation period from the last case [26 January (26/1)].