一起幼儿园诺如病毒暴发疫情调查及分子流行病学特征分析

张辉; 李倩; 唐红; 刘继锋; 李思瑶; 李焱

doi:10.3784/jbjc.202109150508

一起幼儿园诺如病毒暴发疫情调查及分子流行病学特征分析

doi: 10.3784/jbjc.202109150508

西安市疾病预防控制中心, 陕西西安 710054

基金项目: 陕西省2020年自然科学基础研究（No. 2020JQ-969）

详细信息

作者简介:
张辉，男，陕西省渭南市人，硕士，副主任医师，主要从事传染病预防控制工作，Email: 493490422@qq.com

通讯作者:
李焱，Tel: 029–85520062, Email:1532578737@qq.com

中图分类号: R211; R373.9
计量
- 文章访问数: 270
- HTML全文浏览量: 100
- PDF下载量: 57
- 被引次数: 0
出版历程
- 收稿日期: 2021-09-15
- 网络出版日期: 2022-01-13
- 刊出日期: 2022-07-14

Investigation of a norovirus infection outbreak in a kindergarten and analysis on pathogen molecular epidemiological characteristics

Xi′an Center for Disease Control and Prevention, Xi′an 710054, Shaanxi, China

Funds: This study was supported by the Natural Science Basic Research Project of Shaanxi Province (No. 2020JQ-969)

More Information

Corresponding author: Li Yan, Email: 1532578737@qq.com

摘要

摘要: 目的调查2021年西安市一起幼儿园诺如病毒暴发疫情的流行特征和暴发原因，并对病原体进行分子鉴定分型。方法根据诺如病毒疑似病例定义主动搜索病例，同时开展现场卫生学调查；采用描述性流行病学方法描述病例的临床症状和三间分布特征，结合队列研究方法分析疫情暴发原因；采集典型病例肛拭子样本进行诺如病毒核酸检测和基因测序分型。结果该起暴发疫情共持续3 d，累计报告病例31例，病例均为幼儿，罹患率为14.16%（31/219），其中4岁病例占比最大（93.55%，29/31），小（4）班罹患率最高（40.00%，12/30）；病例临床症状主要为呕吐（100%）、腹泻（12.90%）和腹痛（6.45%），无重症和死亡病例。流行曲线提示疫情为一次性暴露后同源感染引起。队列研究显示近距离暴露呕吐物幼儿发病风险是远距离暴露幼儿的3.98倍（相对危险度 = 3.98，95% 置信区间: 2.159～7.334）。病例样本诺如病毒阳性检出率为61.54%（8/13），经基因测序和鉴定分型确定渉疫毒株为GⅡ.3[P12]基因型诺如病毒。结论该起疫情暴发原因是托幼儿童暴露于首发病例呕吐物形成的气溶胶，感染毒株为GⅡ.3[P12]基因型诺如病毒。建议托幼机构加强教职工诺如病毒疫情防控知识培训，尤其是对病例呕吐物和排泄物的应急处置，防止类似疫情再次发生。
- 诺如病毒 /
- GⅡ.3[P12]基因型 /
- 暴发 /
- 流行病学 /
- 重组
Abstract: Objective To investigate the epidemiological characteristics and identify the cause of a norovirus infection outbreak in a kindergarten of Xi′an in 2021, and the pathogen was identified by molecular typing. Methods Active case finding was carried out according to the definition of suspected norovirus cases, and field hygienic survey was conducted. The clinical manifestations and the distribution of the cases were described with descriptive epidemiological method, and cohort-study was used to find out the cause of this outbreak. Anal swab samples were collected from typical cases for norovirus nucleic acid detection and gene sequencing. Results This norovirus outbreak lasted for 3 days, and a total of 31 cases were reported, all the cases were children, with an average attack rate of 14.16% (31/219). Among them, the cases aged 4-year-old accounted for the highest proportion (93.55%, 29/31), and the class 4 of grade 1 had the highest attack rate (40.00%, 12/30). The main clinical symptoms were vomiting (100%), diarrhea (12.90%) and abdominal pain (6.45%). No severe cases or deaths were reported. The epidemic curve showed that the outbreak was caused by one-time same source exposure. The cohort-study showed that the risk of close exposure to vomit was 3.98 times higher than that of long-distance exposure (RR=3.98, 95% CI:2.159–7.334). The positive rate of norovirus in case samples was 61.54% (8/13). Gene sequencing and type identification indicated that the pathogen was norovirus GⅡ.3[P12]. Conclusion This outbreak was caused by the exposure to aerosols from vomit of the index case, and the pathogen was norovirus GⅡ.3[P12] . It is necessary to strengthen the training of staff in child care settings on norovirus prevention and control, especially on emergency disposal of excreta and vomit, to prevent such epidemics.
- Norovirus /
- GⅡ.3[P12] /
- Outbreak /
- Epidemiology /
- Recombination

HTML全文

图 1 西安市某幼儿园诺如病毒感染暴发疫情病例发病时间分布

Figure 1. Time distribution of norovirus infection cases in a kindergarten in Xi'an

下载: 全尺寸图片幻灯片

图 2 诺如病毒基于RdRp区核苷酸序列系统进化分析

Figure 2. Phylogenetic analysis on nucleotide sequence of norovirus polymerase region

下载: 全尺寸图片幻灯片

图 3 诺如病毒基于衣壳区核苷酸序列系统进化分析

Figure 3. Phylogenetic analysis on nucleotide sequence of capsid region of norovirus

下载: 全尺寸图片幻灯片

图 4 诺如病毒Nov/Xian/Y18110204毒株基因重组特征分析

Figure 4. Gene reassortant characteristics of norovirus Nov/Xian/Y18110204 strain

下载: 全尺寸图片幻灯片

参考文献(14)

[1]	张静, 常昭瑞, 孙军玲, 等. 我国诺如病毒感染性腹泻流行现状及防制措施建议[J]. 疾病监测,2014,29(7):516–521. DOI:10.3784/j.issn.1003−9961.2014.07.004. Zhang J, Chang ZR, Sun JL, et al. Infectious diarrhea epidemics caused by norovirus and its control strategy in China[J]. Dis Surveill, 2014, 29(7): 516–521. DOI: 10.3784/j.issn.1003−9961.2014.07.004.
[2]	Ahmed SM, Hall AJ, Robinson AE, et al. Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis[J]. Lancet Infect Dis, 2014, 14(8): 725–730. DOI: 10.1016/S1473−3099(14)70767−4.
[3]	Siebenga JJ, Lemey P, Pond SLK, et al. Phylodynamic reconstruction reveals norovirus GⅡ. 4 epidemic expansions and their molecular determinants[J]. PLoS Pathog, 2010, 6(5): e1000884. DOI: 10.1371/journal.ppat.1000884.
[4]	Boonchan M, Guntapong R, Sripirom N, et al. The dynamics of norovirus genotypes and genetic analysis of a novel recombinant GⅡ. P12-GⅡ. 3 among infants and children in Bangkok, Thailand between 2014 and 2016[J]. Infect Genet Evol, 2018, 60: 133–139. DOI: 10.1016/j.meegid.2018.02.028.
[5]	Matsushima Y, Ishikawa M, Shimizu T, et al. Genetic analyses of GⅡ. 17 norovirus strains in diarrheal disease outbreaks from December 2014 to March 2015 in Japan reveal a novel polymerase sequence and amino acid substitutions in the capsid region[J]. Euro Surveill, 2015, 20(26): 21173. DOI: 10.2807/1560−7917.es2015.20.26.21173.
[6]	姚栋, 陈静芳, 叶文, 等. 一起诺如病毒GⅡ.17型引起的急性胃肠炎病原学诊断及基因特征分析[J]. 中国人兽共患病学报,2016,32(7):641–643,650. DOI:10.3969/j.issn.1002−2694.2016.07.010. Yao D, Chen JF, Ye W, et al. Etiology and genotype features analysis of an acute gastroenteritis outbreak associated with norovirus GⅡ.17[J]. Chin J Zoon, 2016, 32(7): 641–643,650. DOI: 10.3969/j.issn.1002−2694.2016.07.010.
[7]	Niendorf S, Jacobsen S, Faber M, et al. Steep rise in norovirus cases and emergence of a new recombinant strain GⅡ. P16-GⅡ. 2, Germany, winter 2016[J]. Euro Surveill, 2017, 22(4): 30447. DOI: 10.2807/1560−7917.ES.2017.22.4.30447.
[8]	中国疾病预防控制中心. 诺如病毒感染暴发调查和预防控制技术指南(2015版)[J]. 中国病毒病杂志,2015,5(6):448–458. DOI:10.16505/j.2095−0136.2015.06.003. Chinese Center for Disease Control and Prevention. Guidelines on outbreak investigation, prevention and control of norovirus infection (2015)[J]. Chin J Viral Dis, 2015, 5(6): 448–458. DOI: 10.16505/j.2095−0136.2015.06.003.
[9]	陈静芳, 姚栋, 张如胜, 等. 重组GⅡ型诺如病毒长沙株全基因组序列的测定与分析[J]. 现代预防医学,2019,46(19):3593–3596. Chen JF, Yao D, Zhang RS, et al. Complete genome analysis of a recombinant GⅡ norovirus identified, Changsha[J]. Mod Prev Med, 2019, 46(19): 3593–3596.
[10]	Bull RA, Tanaka MM, White PA. Norovirus recombination[J]. J Gen Virol, 2007, 88(Pt 12): 3347-3359. DOI: 10.1099/vir.0.83321-0.
[11]	王婧, 张会芳, 靳淼, 等. GⅡ.3型诺如病毒GZ31597株变异情况及与受体组织血型抗原结合模式分析[J]. 病毒学报,2019,35(1):37–44. DOI: 10.13242/j.cnki.bingduxuebao.003493. Wang J, Zhang HF, Jin M, et al. Analyses of variation of norovirus GⅡ.3 strain GZ31597 and its binding profile with human histo-blood group antigens[J]. Chin J Virol, 2019, 35(1): 37–44. DOI: 10.13242/j.cnki.bingduxuebao.003493.
[12]	Yun SI, Kim JK, Song BH, et al. Complete genome sequence and phylogenetic analysis of a recombinant Korean norovirus, CBNU1, recovered from a 2006 outbreak[J]. Virus Res, 2010, 152(1/2): 137–152. DOI: 10.1016/j.virusres.2010.06.018.
[13]	任燕, 许少坚, 陈宏标, 等. 2018年深圳市龙华区诺如病毒基因型特征[J]. 热带医学杂志,2020,20(2):203–207. DOI:10.3969/j.issn.1672−3619.2020.02.015. Ren Y, Xu SJ, Chen HB, et al. Analysis of genotypic characteristics of norovirus in Longhua district of Shenzhen city in 2018[J]. J Trop Med, 2020, 20(2): 203–207. DOI: 10.3969/j.issn.1672−3619.2020.02.015.
[14]	钟逶迤, 姚云英, 李燕, 等. 诺如病毒疫情暴发的分子流行病学特征[J]. 检验医学与临床,2018,15(24):3735–3737. DOI:10.3969/j.issn.1672−9455.2018.24.025. Zhong WY, Yao YY, Li Y, et al. Molecular epidemiological characteristics of norovirus epidemic outbreaks[J]. Lab Med Clin, 2018, 15(24): 3735–3737. DOI: 10.3969/j.issn.1672−9455.2018.24.025.