Food-borne norovirus-outbreak at a military base, Germany, 2009

BMC Infectious Diseases

Research Article

Renate Gatzer¹  Jörg Schulenburg²  Lüppo Ellerbroek³  Reimar Johne³  Uta Thielbein⁴  Maria Wadl⁵  Judith Koch⁶  Klaus Stark⁶  Christina Frank⁶  Marina Hoehne⁶  Helen Bernard⁶  Sabine Diedrich⁶  Stine Nielsen⁷  Kathrin Scherer⁸  Günter Klein⁸ 

[1] Central Institute of the Bundeswehr Medical Service, Berlin, Kiel, Germany;Central Institute of the Bundeswehr Medical Service, Berlin, Kiel, Germany;Bundeswehr School of Dog Handling, Ulmen, Germany;Federal Institute for Risk Assessment, Berlin, Germany;Major Medical Clinic with Specialty Services, Leipzig, Germany;Postgraduate Training for Applied Epidemiology (PAE), Germany;Robert Koch Institute, Berlin, Germany;Robert Koch Institute, Berlin, Germany;Robert Koch Institute, Berlin, Germany;European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden;University of Veterinary Medicine Hannover, Germany;

关键词: Food Item;    Sick Leave;    Stool Sample;    Attack Rate;    Acute Gastroenteritis;   

DOI  :  10.1186/1471-2334-10-30

 received in 2009-10-12, accepted in 2010-02-17,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundNorovirus is often transmitted from person-to-person. Transmission may also be food-borne, but only few norovirus outbreak investigations have identified food items as likely vehicles of norovirus transmission through an analytical epidemiological study.During 7-9 January, 2009, 36 persons at a military base in Germany fell ill with acute gastroenteritis. Food from the military base's canteen was suspected as vehicle of infection, norovirus as the pathogen causing the illnesses. An investigation was initiated to describe the outbreak's extent, to verify the pathogen, and to identify modes of transmission and source of infection to prevent further cases.MethodsFor descriptive analysis, ill persons were defined as members of the military base with acute onset of diarrhoea or vomiting between 24 December 2008, and 3 February 2009, without detection of a pathogen other than norovirus in stools. We conducted a retrospective cohort study within the headquarters company. Cases were military base members with onset of diarrhoea or vomiting during 5-9 January. We collected information on demographics, food items eaten at the canteen and contact to ill persons or vomit, using a self-administered questionnaire. We compared attack rates (AR) in exposed and unexposed persons, using bivariable and multivariable logistic regression modelling. Stool specimens of ill persons and canteen employees, canteen food served during 5-7 January and environmental swabs were investigated by laboratory analysis.ResultsOverall, 101/815 (AR 12.4%) persons fell ill between 24 December 2008 and 3 February 2009. None were canteen employees. Most persons (n = 49) had disease onset during 7-9 January. Ill persons were a median of 22 years old, 92.9% were male. The response for the cohort study was 178/274 (72.1%). Of 27 cases (AR 15.2%), 25 had eaten at the canteen and 21 had consumed salad. Salad consumption on 6 January (aOR: 8.1; 95%CI: 1.5-45.4) and 7 January (aOR: 15.7; 95%CI: 2.2-74.1) were independently associated with increased risk of disease.Norovirus was detected in 8/28 ill persons' and 4/25 canteen employees' stools, 6/55 environmental swabs and 0/33 food items. Sequences were identical in environmental and stool samples (subtype II.4 2006b), except for those of canteen employees. Control measures comprised cohort isolation of symptomatic persons, exclusion of norovirus-positive canteen employees from work and disinfection of the canteen's kitchen.ConclusionsOur investigation indicated that consumption of norovirus-contaminated salad caused the peak of the outbreak on 7-9 January. Strict personal hygiene and proper disinfection of environmental surfaces remain crucial to prevent norovirus transmission.

【 授权许可】

CC BY   
© Wadl et al; licensee BioMed Central Ltd. 2010