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. 2019 Apr 11;11(4):342.
doi: 10.3390/v11040342.

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

Yiyao Lian  1 , Shuyu Wu  2 , Li Luo  3 , Bin Lv  4 , Qiaohong Liao  5 , Zhongjie Li  6 , Jeanette J Rainey  7 , Aron J Hall  8 , Lu Ran  9
Affiliations

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

Yiyao Lian et al. Viruses. .

Abstract

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.

Keywords: China; disease outbreaks; gastroenteritis; norovirus.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Annual rate of reported norovirus outbreaks per 10 million population by province in China, 2014–2017. The number given in each province indicates the total number of outbreaks over the 4-year study period; the shading denoted by the legend indicates the reporting rate by quartiles.
Figure 2
Figure 2
Number of reported norovirus outbreaks by month in China, 2014–2017.
Figure 3
Figure 3
Percentage of norovirus outbreaks by setting attributed to transmission mode, China, 2014–2017. Other schools included vocational schools (12), training organizations (1), and comprehensive schools that consisted of one or more child-care facility, primary school, and secondary school (26). Others included tourism resorts (2), passenger liners (2), prisons (1), nursing homes for the elderly (1), children’s homes (1).
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