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一起诺如病毒引起的急性胃肠炎暴发疫情调查及溯源分析
Investigation and traceability analysis of an acute gastroenteritis outbreak caused by norovirus
目的 调查并分析某公司2025年发生的一起急性胃肠炎暴发疫情，明确病原体、传播特征及危险因素，为急性胃肠炎疫情防控提供依据。方法 采用现场流行病学与病例对照研究方法分析危险因素。采集病例肛拭子、环境涂抹样及留样食品，进行常见致病菌培养和诺如病毒核酸检测，对阳性标本测序分型开展同源性分析。结果 共调查374人，发现病例147例，发病率为39.30%。主要临床表现为腹泻（87.07%，128/147）。病例在空间分布上呈现聚集性，首发病例所在部门的罹患率（55.26%）显著高于其他部门（χ2=20.295，P=0.028）。病例对照研究显示，2月11日晚间聚餐与发病无统计学关联，排除食源性传播。分子溯源表明，8例病例肛拭子与饮水机水龙头涂抹样中检出诺如病毒均为GⅡ.17[P17]型，核苷酸序列同源性为99.45%~100.00%。结论 本次疫情是由诺如病毒GⅡ.17[P17]型引起、以人际接触传播为主的急性胃肠炎暴发。建议集体单位建立症状监测机制，加强对高频接触物体表面的消毒，并完善员工健康管理制度。
Objective To investigate and analyze an outbreak of acute gastroenteritis that occurred in a company in 2025, identify the causative pathogen, explore its transmission characteristics and risk factors, and provide a scientific basis for the prevention and control of acute gastroenteritis outbreaks. Methods A combination of on-site epidemiological investigation and a case-control study was used to analyze risk factors. Case samples, environmental samples, and retained food samples were collected for culture of common pathogenic bacteria and real-time fluorescence quantitative PCR (RT-qPCR) detection of norovirus. Positive samples were sequenced and classified for homology analysis. Results A total of 374 individuals were investigated in the outbreak, among which 147 were cases, with an incidence rate of 39.30%. The main clinical manifestations were diarrhea (87.07%, 128/147). The distribution of cases showed spatial clustering.The attack rate of the department where the first case was found (55.26%) was significantly higher than that of other departments (χ2=20.295, P=0.028). The case-control study showed that the dinner on the evening of February 11th had no statistical association with the disease onset, and foodborne transmission was excluded.Molecular tracing revealed that the norovirus detected in the anal swabs from eight cases was of the same GⅡ.17[P17] type as that detected on the water faucet of the drinking dispenser, with a high homology of 99.45% to 100.00% in nucleotide sequence. Conclusion This epidemic was caused by norovirus GⅡ.17[P17] and was an outbreak of acute gastroenteritis mainly transmitted through person-to-person contact. It is recommended that collective units establish a symptom monitoring mechanism, strengthen disinfection of high-touch surfaces and improve employee health monitoring systems.
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Norovirus is a leading cause of acute gastroenteritis, adding to strain on healthcare systems. Diagnostic test reporting of norovirus is often delayed, resulting in incomplete data for real-time surveillance.
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We investigated the molecular epidemiology of human norovirus (HuNoV) in all age groups using samples from April 2019 to March 2023, before and after the COVID-19 countermeasures were implemented. GII.2[P16] and GII.4[P31], the prevalent strains in Japan before COVID-19 countermeasures, remained prevalent during the COVID-19 pandemic, except from April to November 2020; in 2021, the prevalence of GII.2[P16] increased among children. Furthermore, there was an increase in the prevalence of GII.4[P16] after December 2022. Phylogenetic analysis of GII.P31 RdRp showed that some strains detected in 2022 belonged to a different cluster of other strains obtained during the present study period, suggesting that HuNoV strains will evolve differently even if they have the same type of RdRp. An analysis of the amino acid sequence of VP1 showed that some antigenic sites of GII.4[P16] were different from those of GII.4[P31]. The present study showed high infectivity of HuNoV despite the COVID-19 countermeasures and revealed changes in the prevalent genotypes and mutations of each genotype. In the future, we will investigate whether GII.4[P16] becomes more prevalent, providing new insights by comparing the new data with those analyzed in the present study.
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Norovirus is a common cause of sporadic cases and outbreaks of gastroenteritis worldwide, although its prevalence and the dominant genotypes responsible for gastroenteritis outbreaks remain obscure. A systematic review was conducted on norovirus infection in China between January 2009 and March 2021. A meta-analysis and beta-binomial regression model were used to explore the epidemiological and clinical characteristics of norovirus infection and the potential factors contributing to the attack rate of the norovirus outbreaks, respectively. A total of 1132 articles with 155,865 confirmed cases were included, with a pooled positive test rate of 11.54% among 991,786 patients with acute diarrhea and a pooled attack rate of 6.73% in 500 norovirus outbreaks. GII.4 was the predominant genotype in both the etiological surveillance and outbreaks, followed by GII.3 in the etiological surveillance, and GII.17 in the outbreaks, with the proportion of recombinant genotypes increasing in recent years. A higher attack rate in the norovirus outbreaks was associated with age group (older adults), settings (nurseries, primary schools, etc.) and region (North China). The nation-wide pooled positive rate in the etiological surveillance of norovirus is lower than elsewhere in the global population, while the dominant genotypes are similar in both the etiological surveillance and the outbreak investigations. This study contributes to the understanding of norovirus infection with different genotypes in China. The prevention and control of norovirus outbreaks during the cold season should be intensified, with special attention paid to and enhanced surveillance performed in nurseries, schools and nursing homes from November to March.
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Norovirus GII.17 outbreaks in the United States increased from <10% during the 2022-23 season to 75% during the 2024-25 season, surpassing the number of GII.4 outbreaks. The norovirus season also started earlier in 2024-25 than in previous seasons. Continued norovirus surveillance is needed to detect and monitor emerging strains.
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