Improper handling of vomitus as a risk factor in the human norovirus outbreak in a kindergarten in Wuyi County, Zhejiang Province, China

Abstract

This study investigated an outbreak in a kindergarten in Wuyi County of acute gastroenteritis concerning a large number of students and teachers. We performed a case-control study, and collected information on the layout of the school, symptoms, onset time of all cases and vomiting sites. A total of 62 individuals fit the definition of probable cases; among these, there were 19 cases of laboratory-confirmed norovirus infection. Nausea and vomiting were the most common symptoms in the outbreak. Seven student norovirus patients vomited in the school. The odds ratio (OR) of norovirus illness was 15.75 times higher among teachers who handled or interacted with student vomitus without respiratory protection than compared to those without this type of exposure (OR 15.75, 95% CI 1.75–141.40). Nine samples were successfully genotyped; eight samples were norovirus GII.2[P16], one sample was norovirus GII.4 Sydney[P16]. This study revealed that improper handling of vomitus is a risk factor of norovirus infection. Therefore, more attention should be given to train school staff in knowledge of disinfection.

Measures for preventing norovirus outbreaks on campus in economically underdeveloped areas and countries: evidence from rural areas in Western China

“…Waterborne and foodborne outbreaks are more likely to result in larger-scale infections and outbreaks within populations ( 30–32 ). While there are still reports of small-scale outbreaks caused by aerosol transmission ( 22 , 33 ). During the early stages of Norovirus infection, vomitus can contain a high viral load, facilitating its spread in enclosed dormitories, public spaces, and on surfaces of public objects ( 24 , 34 ), aerosols which are easily formed can be inhaled, leading to infection ( 33 , 35 , 36 ).…”

“…While there are still reports of small-scale outbreaks caused by aerosol transmission ( 22 , 33 ). During the early stages of Norovirus infection, vomitus can contain a high viral load, facilitating its spread in enclosed dormitories, public spaces, and on surfaces of public objects ( 24 , 34 ), aerosols which are easily formed can be inhaled, leading to infection ( 33 , 35 , 36 ). Studies in the United States, Germany, and Australia have demonstrated that the outbreak and detection rate of norovirus infection have decreased significantly through non-pharmaceutical interventions such as closing schools, restaurants, and other public places, promoting social distancing, and raising personal hygiene awareness since the COVID-19 outbreak in 2020 ( 37–39 ).…”

“…The current study emphasizes the correct handling and disinfection methods for norovirus vomitus, which are crucial in preventing the outbreak and spread of norovirus. Therefore, we suggest the following procedure for the proper handling of vomitus from norovirus cases ( 33 , 42 , 43 ): (1) Evacuate people around the vomitus, If in a closed space, windows should be opened to improve ventilation and reduce the concentration of virus aerosols in the air, which can help prevent the spread of norovirus. (2) Personnel should wear protective gear for handling vomitus, including a cap, two pairs of gloves, a mask, and shoe covers.…”

Improving knowledge, attitude and practice on norovirus infection diarrhea among staff of kindergartens and schools: a before-after study

“…Secondly, similar to parents [ 10 ], most staff members lack accurate understanding regarding the duration and symptoms of the disease, which may lead to an increased possibility of children attending classes while ill. Finally, Improper handling of children's vomit can undoubtedly lead to secondary transmission [ 3 ]. Therefore, it is crucial to pay close attention to students with gastrointestinal symptoms during morning screenings in order to minimize the occurrence of vomiting in classrooms and prevent large-scale outbreaks caused by NoV infections [ 30 ].…”

“…A study encompassing 45 countries globally revealed that 17.7% of pediatric gastroenteritis cases were attributed to NoVs, thereby urgently highlighting its role as the second leading cause of AGE [ 2 ]. Genogroups GI and GII of NoVs primarily contribute to acute gastroenteritis episodes [ 3 ], particularly in southern China. Furthermore, the virus's highly contagious nature and survival ability are accountable for its widespread transmission.…”