| BMC Public Health | |
| Epidemiological investigation of two parallel gastroenteritis outbreaks in school settings | |
| Apostolos Vantarakis1  Theano Georgakopoulou2  Panos Ziros1  Petros Kokkinos1  Maria Potamiti-Komi2  Theologia Sideroglou2  Kassiani Mellou2  | |
| [1] Environmental Microbiology Unit, Department of Public Health, School of Medicine, University of Patras, Patras, Greece;Hellenic Center for Disease Control and Prevention, Athens, Greece | |
| 关键词: School settings; Norovirus; Waterborne viruses; Gastrointestinal infections; Community outbreaks; | |
| Others : 1162439 DOI : 10.1186/1471-2458-13-241 |
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| received in 2012-08-24, accepted in 2013-03-13, 发布年份 2013 | |
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【 摘 要 】
Background
Two parallel gastroenteritis outbreaks occurred in an elementary school and a neighboring kindergarten in Kilkis, Northern Greece in 2012. The aim of the study was the investigation of these two parallel outbreaks as well as their possible source.
Methods
Two retrospective cohort studies were performed to identify the mode and the vehicle of transmission as well as the possible connection between them.
Results
Elementary school and kindergarten populations of 79.9% (119/149) and 51.1% (23/45) respectively, participated in the study. Case definition was satisfied by 65 pupils from the elementary school and 14 from the kindergarten. For elementary school, 53 cases were considered primary cases of the outbreak and were included in the analysis. Based on the results of the multivariate analysis, consumption of tap water was the only statistically significant independent risk factor of gastroenteritis (RR = 2.34, 95% C.I.: 1.55-3.53).; a finding supported by the shape of the epidemic curve which referred to a common point source outbreak with secondary cases. For kindergarten, no statistically significant risk factor was identified, and the epidemic curve supported a person-to-person transmission according univariate analysis. Norovirus GI and GII and human Adenovirus were detected by Real Time PCR in stool samples from seven children of elementary school, but stool samples were not collected by children of the kindergarten.
Conclusions
Even though the etiological agent of the outbreak was not verified, combined epidemiological and laboratory results were in favor of a waterborne viral gastroenteritis outbreak at the elementary school, followed by a person to person spread at the kindergarten.
【 授权许可】
2013 Mellou et al.; licensee BioMed Central Ltd.
【 预 览 】
| Files | Size | Format | View |
|---|---|---|---|
| 20150413064839813.pdf | 380KB | ||
| Figure 2. | 42KB | Image | |
| Figure 1. | 57KB | Image |
【 图 表 】
Figure 1.
Figure 2.
【 参考文献 】
- [1]Zhou X, Li H, Sun L, Mo Y, Chen S, Wu X, Liang J, Zheng H, Ke C, Varma JK, Klena JD, Chen Q, Zou L, Yang X: Epidemiological and molecular analysis of a waterborne outbreak of norovirus GII.4. Epidemiol Infect 2012, 8:1-8. [Epub ahead of print]
- [2]Glass RI, Parashar UD, Estes MK: Norovirus gastroenteritis. N Engl J Med 2009, 361(18):1776-1785.
- [3]Centers for Disease Control and Prevention (CDC).: : Norovirus outbreak in an elementary school-District of Columbia, February 2007. MMWR Morb Mortal Wkly Rep 2008, 56(51–52):1340-1343.
- [4]Centers for Disease Control and Prevention (CDC): Updated Norovirus Outbreak Management and Disease Prevention Guidelines. MMWR Recommendations Reports 2011, 60(RR03):1-15.
- [5]Lee MB, Greig JD: A review of gastrointestinal outbreaks in schools: effective infection control interventions. J Sch Health 2010, 80(12):588-598.
- [6]Gonçalves G, Gouveia E, Mesquita JR, Almeida A, Ribeiro A, Rocha-Pereira J, São José Nascimento M: Outbreak of acute gastroenteritis caused by adenovirus type 41 in a kindergarten. Epidemiol Infect 2011, 139(11):1672-1675.
- [7]Gross TP, Conde JG, Gary GW, Harting D, Goeller D, Israel E: An outbreak of acute infectious nonbacterial gastroenteritis in a high school in Maryland. Publ Health Rep 1989, 104(2):164-169.
- [8]Gaulin C, Lévesque B, Gauvin D, Krizanova V: Outbreak of non-bacterial gastroenteritis in a school. Can J Publ Health 1996, 87(4):264-267.
- [9]Georgiadou SP, Loukeris D, Smilakou S, Daikos GL, Sipsas NV: Effective control of an acute gastroenteritis outbreak due to norovirus infection in a hospital wards in Athens, Greece, April 2011. Euro Surveill 2011, 14:16(28).
- [10]Kokkinos P, Ziros P, Meri D, Filippidou S, Kolla S, Galanis A, Vantarakis A: Environmental surveillance. An additional/alternative approach for virological surveillance in Greece? Int J Environ Res Publ Health 2011, 8(6):1914-1922.
- [11]Levidiotou S, Gartzonika C, Papaventsis D, Christaki C, Priavali E, Zotos N, Kapsali E, Vrioni G: Viral agents of acute gastroenteritis in hospitalized children in Greece. Clin Microbiol Infect 2009, 15(6):596-598.
- [12]Papadopoulos VP, Vlachos O, Isidoriou E, Kasmeridis C, Pappa Z, Goutzouvelidis A: A gastroenteritis outbreak due to norovirus infection in Xanthi, northern Greece: management and public health consequences. J Gastrointestin Liver Di 2006, 15(1):27-30.
- [13]Vantarakis A, Mellou K, Spala G, Kokkinos P, Alamanos Y: A gastroenteritis outbreak caused by noroviruses in Greece. Int J Environ Res Publ Health 2011, 8(8):3468-3478.
- [14]Council of the European Economic Community Directive 98/83/EEC: On the quality of water intended for human consumption. Counc Eur Communities 1998, 5.12(L330):32-54.
- [15]Calgua B, Mengewein A, Grunert A, Bofill-Mas S, Clemente-Casares P, Hundesa A, Wyn-Jones AP, López-Pila JM, Girones R: Development and application of a one-step low cost procedure to concentrate viruses from seawater samples. J Virol Meth 2008, 153(2):79-83.
- [16]Hernroth BE, Conden-Hansson AC, Rehnstam-Holm AS, Girones R, Allard AK: Environmental factors influencing human viral pathogens and their potential indicator organisms in the blue mussel, Mytilus edulis: the first Scandinavian report. Appl Environ Microbiol 2002, 68:4523-4533.
- [17]Svraka S, Duizer E, Vennema H, de Bruin E, van der Veer B, Dorresteijn B, Koopmans M: Etiological role of viruses in outbreaks of acute gastroenteritis in The Netherlands from 1994 through 2005. J Clin Microbiol 2007, 45(5):1389-1394.
- [18]da Silva AK, Le Saux JC, Parnaudeau S, Pommepuy M, Elimelech M, Le Guyader FS: Evaluation of removal of noroviruses during wastewater treatment, using Real-Time Reverse Transcription-PCR: different behaviors of genogroups I and II. Appl Environ Microbiol 2007, 73(24):7891-7897.
- [19]Riera-Montes M, Brus Sjölander K, Allestam G, Hallin E, Hedlund KO, Löfdahl M: Waterborne norovirus outbreak in a municipal drinking-water supply in Sweden. Epidemiol Infect 2011, 139(12):1928-1935.
- [20]Räsänen S, Lappalainen S, Kaikkonen S, Hämäläinen M, Salminen M, Vesikari T: Mixed viral infections causing acute gastroenteritis in children in a waterborne outbreak. Epidemiol Infect 2010, 138(9):1227-1234.
- [21]Mena KD, Gerba CP: Waterborne adenovirus. Rev Environ Contam Toxicol 2009, 198:133-167.
- [22]Pina S, Puig M, Lucena F, Jofre J, Girones R: Viral pollution in the environment and shellfish: human adenovirus detection by PCR as an index of human viruses. Appl Environ Microbiol 1998, 64:3376-3382.
- [23]Leclerc H, Schwartzbrod L, Dei-Cas E: Microbial agents associated with waterborne diseases. Crit Rev Microbiol 2002, 28:371-409.
- [24]Kopilović B, Ucakar V, Koren N, Krek M, Kraigher A: Waterborne outbreak of acute gastroenteritis in a costal area in Slovenia in June and July 2008. Eurosurveillance 2008., 13(34) pii=18957
- [25]O'Reilly CE, Bowen AB, Perez NE: A waterborne outbreak of gastroenteritis with multiple etiologies among resort island visitors and residents: Ohio, 2004. Clin Infect Dis 2007, 44:506-512.
- [26]Beaudeau P, de Valk H, Vaillant V, Mannschott C, Tillier C, Mouly D, Ledrans M: Lessons learned from ten investigations of waterborne gastroenteritis outbreaks, France, 1998–2006. J Water Health 2008, 6:491-503.
- [27]Greene SK, Huang J, Abrams AM, Gilliss D, Reed M, Platt R, Huang SS, Kulldorff M: Gastrointestinal disease outbreak detection using multiple data streams from electronic medical records. Foodborne Pathog Dis 2012, 9(5):431-441.
- [28]Yoder J, Roberts V, Craun GF: Surveillance for waterborne disease and outbreaks associated with recreational water use and other aquatic facility-associated health events - United States, 2005—2006. MMWR Surveillance Summaries 2008, 57(SS09):1-29.
- [29]Hunter PR: Climate change and water-borne and vector-borne disease. J Appl Microbiol 2003, 94(Suppl):37S-46S.
- [30]Cann KF, Thomas DR, Salmon RL, Wyn-Jones AP, Kay D: Extreme water-related weather events and waterborne disease. Epidemiol Infect 2012, 9:1-16.
- [31]Tinker SC, Moe CL, Klein M, Flanders WD, Uber J, Amirtharajah A, Singer P, Tolbert PE: Drinking water turbidity and emergency department visits for gastrointestinal illness in Atlanta, 1993–2004. J Expo Sci Environ Epidemiol 2010, 20:19-28.
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