Gastroenteritis Outbreaks Associated with Sapovirus in a Restaurant-Taichung County, 2010

On March 26, 2010, several gastroenteritis outbreaks associated with dining in a restaurant (Restaurant X) in Taichung County were reported to local health bureau. Field Epidemiology Training Program (FETP) of Taiwan Centers for Diseases Control (Taiwan CDC) also received the notification and soon conducted a field investigation. The two confirmed outbreaks (Outbreak A and Outbreak C) occurred on March 10 and March 20, 2010, involving 353 (Attack rate, AA=69%) and 20 (AA=91%) people respectively. The major symptoms were diarrhea, abdominal pain, nausea, and vomiting. Fecal specimens from 5 patients in Outbreak A and 3 patients in Outbreak C were positive for sapoviurs, but there was no residual food available for further examination. Among the restaurant workers, fecal specimens from 2 asymptomatic administrative personnel and 1 waitress who used to have gastroenteritis symptoms were also positive for sapovirus. Environmental survey was negative. Based on epidemiological and laboratory studies, sapovirus could be the pathogen in both outbreaks. Infected restaurant employees could result in widespread transmissions, but the definitive transmission route remained to be clarified. Public health officials suspended the restaurant until one week after the last case was found. Infected restaurant workers were asked to stop working. The importance of hand hygiene was emphasized. Temporary kitchens and piping bypassing the original tap water system were used. By April 3, the number of case ceased to increase. In order to respond to suspected outbreaks rapidly, public health authorities should be more vigilant on clusters with temporal or geographic associations; health care providers, on the other hand, should report as soon as possible.

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