Abstract:
Objective To investigate and analyze the source of infection in an outbreak of gastroenteritis in a kindergarten of Xinjiang Production and Construction Corps, and to provide a reference for formulating epidemic prevention and control strategies.
Methods Cases were identified through face-to-face interviews, telephone follow-ups, and by reviewing kindergarten attendance records, medical institution outpatient logs, and admission/discharge registers. Fecal samples, vomitus, anal swabs, food samples, leftover ingredients, and environmental samples from kitchens and classrooms were collected. These samples were simultaneously screened for norovirus using real-time fluorescent reverse transcription polymerase chain reaction (RT-PCR) and for enteric pathogens such as Salmonella, diarrheagenic Escherichia coli, and Staphylococcus aureus using real-time fluorescent quantitative PCR.
Results From May 7 to 10, 2024, a total of 114 children (64 boys and 50 girls) were enrolled in the kindergarten, including 26 children in the younger class. A total of 15 norovirus cases were identified, all from the younger class, resulting in an overall attack rate of 13.16% (15/114). The main clinical symptoms included vomiting (93.33%), diarrhea (80.00%), fever (20.00%), and abdominal pain (6.67%). The male-to-female case ratio was 1.5:1 (9:6), with most cases occurring among 4-year-olds, accounting for 73.33% (11/15) of all cases. The outbreak lasted 63 h 40 min. A total of 42 samples were collected, including 13 clinical specimens (5 vomit samples, 7 fecal samples, and 1 anal swab), 4 food samples and leftover ingredients from the 48-hour food retention period, 5 environmental samples from the cafeteria, and 20 environmental samples from the small class classroom (3 storage boxes, 2 bedding sets, 4 LEGO walls, 3 watercolor pens, 4 toy cabinets, 3 cup wipe samples, and 1 tap water sample from the direct drinking water dispenser). RT-PCR results showed a positivity rate of 53.85% (7/13) among patient specimens, with 5 patients testing positive for norovirus GII genotype. The positivity rates for vomitus and fecal samples were 40.00% (2/5) and 71.43% (5/7), respectively. Norovirus GII genotype was detected in 5 out of 20 environmental samples from the younger class classroom, yielding a positivity rate of 25.00% (5/20).
Conclusion This incident is an outbreak and cluster of infections caused by norovirus type GⅡ in a kindergarten. It is necessary to strengthen health education, enhance the disease prevention awareness of teachers, students and parents, develop good hygiene habits, and detect and handle the disease as early as possible.