Epidemiology of Norovirus Outbreaks Reported to the Public Health Emergency Event Surveillance System, China, 2014–2017

We conducted a retrospective analysis of norovirus outbreaks reported to the National Public Health Emergency Event Surveillance System (PHEESS) in China from January 1, 2014 to December 31, 2017. We reviewed all acute gastroenteritis outbreaks (n = 692) submitted to PHEESS to identify the frequency, seasonality, geographic distribution, setting, and transmission mode of outbreaks due to norovirus. A total of 616 norovirus outbreaks resulting in 30,848 cases were reported. Among these outbreaks, 571 (93%) occurred in school settings including 239 (39%) in primary schools, 136 (22%) in childcare facilities, and 121 (20%) in secondary schools. The majority of outbreaks (63%) were due to person-to-person transmission, followed by multiple modes of transmission (11%), foodborne (5%) and waterborne (3%) transmission. These findings highlight the importance of improving hand hygiene and environmental disinfection in high-risk settings. Developing a standard and quantitative outbreak reporting structure could improve the usefulness of PHEESS for monitoring norovirus outbreaks.

[1]  Ping-Hua Mo,et al.  An acute gastroenteritis outbreak associated with person-to-person transmission in a primary school in Shanghai: first report of a GI.5 norovirus outbreak in China , 2018, BMC Infectious Diseases.

[2]  J. Qi,et al.  Genetic Analysis of Reemerging GII.P16-GII.2 Noroviruses in 2016–2017 in China , 2018, The Journal of infectious diseases.

[3]  A. Ryo,et al.  Phylogeny and Immunoreactivity of Norovirus GII.P16-GII.2, Japan, Winter 2016–17 , 2018, Emerging infectious diseases.

[4]  T. Leung,et al.  Increased Detection of Emergent Recombinant Norovirus GII.P16-GII.2 Strains in Young Adults, Hong Kong, China, 2016–2017 , 2017, Emerging infectious diseases.

[5]  Xi Jiang,et al.  Burden of acute gastroenteritis caused by norovirus in China: A systematic review. , 2017, The Journal of infection.

[6]  Yaqing He,et al.  Norovirus GII.P16/GII.2–Associated Gastroenteritis, China, 2016 , 2017, Emerging infectious diseases.

[7]  A. Hall,et al.  Recombinant GII.P16-GII.2 Norovirus, Taiwan, 2016 , 2017, Emerging infectious diseases.

[8]  Li-ping Wang,et al.  Surveillance and early warning systems of infectious disease in China: From 2012 to 2014 , 2017, The International journal of health planning and management.

[9]  Qiong Huang,et al.  [Norovirus infection surveillance in early warning of outbreaks in population in oyster farming areas]. , 2017, Wei sheng yan jiu = Journal of hygiene research.

[10]  E. Chen,et al.  An outbreak of norovirus-associated acute gastroenteritis associated with contaminated barrelled water in many schools in Zhejiang, China , 2017, PloS one.

[11]  Bian-Li Xu,et al.  A large outbreak of acute gastroenteritis caused by the human norovirus GII.17 strain at a university in Henan Province, China , 2017, Infectious Diseases of Poverty.

[12]  H. Jung,et al.  Emergence of Norovirus GII.17-associated Outbreak and Sporadic Cases in Korea from 2014 to 2015 , 2017, Osong public health and research perspectives.

[13]  J. Hofmann,et al.  Steep rise in norovirus cases and emergence of a new recombinant strain GII.P16-GII.2, Germany, winter 2016 , 2017, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[14]  S. Usuku,et al.  Norovirus genotype distribution in outbreaks of acute gastroenteritis among children and older people: an 8-year study , 2016, BMC Infectious Diseases.

[15]  Shuang Zhang,et al.  Characterization of the new GII.17 norovirus variant that emerged recently as the predominant strain in China. , 2016, The Journal of general virology.

[16]  Z. Duan,et al.  Norovirus outbreaks in Fengtai District, Beijing, China, 2014 , 2016, Archives of Virology.

[17]  J. Ding,et al.  An outbreak of multiple norovirus strains on a cruise ship in China, 2014 , 2016, Journal of applied microbiology.

[18]  Z. Duan,et al.  [Guidelines on outbreak investigation, prevention and control of norovirus infection (2015)]. , 2016, Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine].

[19]  R. Black,et al.  Aetiology-Specific Estimates of the Global and Regional Incidence and Mortality of Diarrhoeal Diseases Commonly Transmitted through Food , 2015, PloS one.

[20]  C. Chiu,et al.  Emerging norovirus GII.17 in Taiwan. , 2015, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[21]  J. Vinjé,et al.  Epidemiology and molecular characteristics of norovirus GII.4 Sydney outbreaks in Taiwan, January 2012–December 2013 , 2015, Journal of medical virology.

[22]  A. Ryo,et al.  Genetic analyses of GII.17 norovirus strains in diarrheal disease outbreaks from December 2014 to March 2015 in Japan reveal a novel polymerase sequence and amino acid substitutions in the capsid region. , 2015, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[23]  Marion Koopmans,et al.  Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis. , 2014, The Lancet. Infectious diseases.

[24]  V. Vaillant,et al.  Surveillance for outbreaks of gastroenteritis in elderly long-term care facilities in France, November 2010 to May 2012. , 2014, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[25]  D. Graham,et al.  Determination of the 50% human infectious dose for Norwalk virus. , 2014, The Journal of infectious diseases.

[26]  J. Vinjé,et al.  Genotypic and Epidemiologic Trends of Norovirus Outbreaks in the United States, 2009 to 2013 , 2013, Journal of Clinical Microbiology.

[27]  L. Gould,et al.  Acute Gastroenteritis Surveillance through the National Outbreak Reporting System, United States , 2013, Emerging infectious diseases.

[28]  Hui-lai Ma,et al.  [A norovirus-borne outbreak caused by contaminated bottled spring water in a school, Zhejiang province]. , 2011, Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi.

[29]  M. Sobsey,et al.  Norovirus outbreak associated with undercooked oysters and secondary household transmission , 2011, Epidemiology and Infection.

[30]  D. Fisman,et al.  Why “Winter” Vomiting Disease? Seasonality, Hydrology, and Norovirus Epidemiology in Toronto, Canada , 2009, EcoHealth.

[31]  J. Rohayem Norovirus seasonality and the potential impact of climate change. , 2009, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[32]  P. Teunis,et al.  Norovirus outbreaks in nursing homes: the evaluation of infection control measures , 2009, Epidemiology and Infection.

[33]  M. Estes,et al.  Norovirus gastroenteritis. , 2009, The New England journal of medicine.

[34]  Jan Vinjé,et al.  Noroviruses: a comprehensive review. , 2009, Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology.

[35]  D. Graham,et al.  Norwalk Virus Shedding after Experimental Human Infection , 2008, Emerging infectious diseases.

[36]  P. Teunis,et al.  Norwalk virus: How infectious is it? , 2008, Journal of medical virology.

[37]  W. Lim,et al.  High rate and changing molecular epidemiology pattern of norovirus infections in sporadic cases and outbreaks of gastroenteritis in Hong Kong , 2004, Journal of medical virology.

[38]  Marion Koopmans,et al.  Viral Gastroenteritis Outbreaks in Europe, 1995–2000 , 2003, Emerging infectious diseases.