{"title":"2021 年印度喀拉拉邦因饮用水污染和可能的人际传播爆发诺罗病毒疫情","authors":"Amjith Rajeevan , Manikandanesan Sakthivel , Nikhilesh Menon , Sachin KC , Harisree Sudersanan , Ramya Nagarajan , Mohankumar Raju , Sharan Murali , Chethrapilly Purushothaman Girish Kumar , Anukumar Balakrishnan , Renuka Raveendran , Dineesh Perumbil , Devaki Antherjanam , Sherin Joseph Xavier Kallupurackal , Bipin Balakrishnan , Nandu Krishna , Sibin Samuel , Prabhdeep Kaur , Manoj Vasant Murehkar","doi":"10.1016/j.jiph.2024.102568","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>In July 2021, the Alappuzha district in Kerala, India, reported an unexpected number of acute gastroenteritis (772) cases (Outbreak A). On October 10, 2021, a university in Wayanad, Kerala, reported 25 acute gastroenteritis cases (Outbreak B). We described both the outbreaks and determined the agent, source and risk factors.</div></div><div><h3>Methods</h3><div>We defined a suspected case as the occurrence of vomiting or at least three episodes of loose stools within 24 h and a confirmed case as those with stool samples/rectal swabs positive for norovirus. We did a matched case-control study in Outbreak A and a retrospective cohort study in Outbreak B. We calculated the adjusted odds ratio (aOR) in outbreak A, relative risk (aRR) in outbreak B and population attributable fraction (PAF). We tested stool and water samples for bacteria and viruses.</div></div><div><h3>Results</h3><div>We identified Group II norovirus in stool samples in both outbreaks and 4/5 water samples in Outbreak A. Suspected norovirus infection was associated with drinking inadequately boiled water from the municipal water supply in outbreak A [aOR: 4.5; 95 % C.I: 1.2–15.8; PAF: 0.23] and well water in hostels in outbreak B [aRR: 2.2; 95 % C.I: 1.2–3.9; PAF: 0.15]. In Outbreak A, groundwater from tube wells was mixed in the municipal water supply overhead tanks without chlorination.</div></div><div><h3>Conclusion</h3><div>The gastroenteritis outbreaks were caused by Group II norovirus due to the consumption of inadequately boiled contaminated groundwater (outbreak A) and well water (outbreak B). We recommended superchlorination of overhead tanks and wells and boiled water for drinking.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"17 12","pages":"Article 102568"},"PeriodicalIF":4.7000,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Norovirus outbreaks due to contaminated drinking water and probable person-to-person transmission, Kerala, India, 2021\",\"authors\":\"Amjith Rajeevan , Manikandanesan Sakthivel , Nikhilesh Menon , Sachin KC , Harisree Sudersanan , Ramya Nagarajan , Mohankumar Raju , Sharan Murali , Chethrapilly Purushothaman Girish Kumar , Anukumar Balakrishnan , Renuka Raveendran , Dineesh Perumbil , Devaki Antherjanam , Sherin Joseph Xavier Kallupurackal , Bipin Balakrishnan , Nandu Krishna , Sibin Samuel , Prabhdeep Kaur , Manoj Vasant Murehkar\",\"doi\":\"10.1016/j.jiph.2024.102568\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>In July 2021, the Alappuzha district in Kerala, India, reported an unexpected number of acute gastroenteritis (772) cases (Outbreak A). On October 10, 2021, a university in Wayanad, Kerala, reported 25 acute gastroenteritis cases (Outbreak B). We described both the outbreaks and determined the agent, source and risk factors.</div></div><div><h3>Methods</h3><div>We defined a suspected case as the occurrence of vomiting or at least three episodes of loose stools within 24 h and a confirmed case as those with stool samples/rectal swabs positive for norovirus. We did a matched case-control study in Outbreak A and a retrospective cohort study in Outbreak B. We calculated the adjusted odds ratio (aOR) in outbreak A, relative risk (aRR) in outbreak B and population attributable fraction (PAF). We tested stool and water samples for bacteria and viruses.</div></div><div><h3>Results</h3><div>We identified Group II norovirus in stool samples in both outbreaks and 4/5 water samples in Outbreak A. Suspected norovirus infection was associated with drinking inadequately boiled water from the municipal water supply in outbreak A [aOR: 4.5; 95 % C.I: 1.2–15.8; PAF: 0.23] and well water in hostels in outbreak B [aRR: 2.2; 95 % C.I: 1.2–3.9; PAF: 0.15]. In Outbreak A, groundwater from tube wells was mixed in the municipal water supply overhead tanks without chlorination.</div></div><div><h3>Conclusion</h3><div>The gastroenteritis outbreaks were caused by Group II norovirus due to the consumption of inadequately boiled contaminated groundwater (outbreak A) and well water (outbreak B). We recommended superchlorination of overhead tanks and wells and boiled water for drinking.</div></div>\",\"PeriodicalId\":16087,\"journal\":{\"name\":\"Journal of Infection and Public Health\",\"volume\":\"17 12\",\"pages\":\"Article 102568\"},\"PeriodicalIF\":4.7000,\"publicationDate\":\"2024-10-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Infection and Public Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1876034124003022\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Infection and Public Health","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1876034124003022","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
摘要
背景2021 年 7 月，印度喀拉拉邦阿拉普扎地区报告了数量出乎意料的急性肠胃炎病例（772 例）（疫情 A）。2021 年 10 月 10 日，喀拉拉邦 Wayanad 的一所大学报告了 25 例急性肠胃炎病例（疫情 B）。我们对这两起疫情进行了描述，并确定了病原体、来源和风险因素。我们将 24 小时内出现呕吐或至少三次稀便定义为疑似病例，将粪便样本/直肠拭子对诺如病毒呈阳性定义为确诊病例。我们在疫情 A 中进行了匹配病例对照研究，在疫情 B 中进行了回顾性队列研究。我们计算了疫情 A 中的调整赔率（aOR）、疫情 B 中的相对风险（aRR）和人群归因分数（PAF）。我们对粪便和水样进行了细菌和病毒检测。在疫情 A 中，疑似诺如病毒感染与饮用未经充分煮沸的市政供水有关[aOR：4.5；95 % C.I：1.2-15.8；PAF：0.23]，在疫情 B 中，疑似诺如病毒感染与饮用宿舍的井水有关[aRR：2.2；95 % C.I：1.2-3.9；PAF：0.15]。在疫情 A 中，来自管井的地下水未经加氯处理就混入了市政供水高架水箱。我们建议对高架水箱和井水进行超氯消毒，并将水煮沸后饮用。
Norovirus outbreaks due to contaminated drinking water and probable person-to-person transmission, Kerala, India, 2021
Background
In July 2021, the Alappuzha district in Kerala, India, reported an unexpected number of acute gastroenteritis (772) cases (Outbreak A). On October 10, 2021, a university in Wayanad, Kerala, reported 25 acute gastroenteritis cases (Outbreak B). We described both the outbreaks and determined the agent, source and risk factors.
Methods
We defined a suspected case as the occurrence of vomiting or at least three episodes of loose stools within 24 h and a confirmed case as those with stool samples/rectal swabs positive for norovirus. We did a matched case-control study in Outbreak A and a retrospective cohort study in Outbreak B. We calculated the adjusted odds ratio (aOR) in outbreak A, relative risk (aRR) in outbreak B and population attributable fraction (PAF). We tested stool and water samples for bacteria and viruses.
Results
We identified Group II norovirus in stool samples in both outbreaks and 4/5 water samples in Outbreak A. Suspected norovirus infection was associated with drinking inadequately boiled water from the municipal water supply in outbreak A [aOR: 4.5; 95 % C.I: 1.2–15.8; PAF: 0.23] and well water in hostels in outbreak B [aRR: 2.2; 95 % C.I: 1.2–3.9; PAF: 0.15]. In Outbreak A, groundwater from tube wells was mixed in the municipal water supply overhead tanks without chlorination.
Conclusion
The gastroenteritis outbreaks were caused by Group II norovirus due to the consumption of inadequately boiled contaminated groundwater (outbreak A) and well water (outbreak B). We recommended superchlorination of overhead tanks and wells and boiled water for drinking.
期刊介绍：
The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other.
The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners.
It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.
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