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Research article
Dongwan Chen
Shunyi Center for Disease Control and Prevention
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
On 4 September 2018, a boarding school in the Shunyi District of Beijing, China reported an outbreak of acute gastroenteritis. At least 209 affected students developed the symptoms of diarrhea and vomiting. Investigations were conducted to identify the agent and source of this outbreak, and to implement controls to prevent further transmission.
Methods
A retrospective cohort study was conducted among the school students and staff in order to test hypothesis that food served at the school canteen. We collected information on demographics, refectory records at the canteen and contact to ill persons or vomit, using a uniform epidemiological questionnaire. Risk ratios (RR) and 95% confidence intervals (CI) were calculated. Stool specimens of cases and canteen employees, food served, water, and environmental swabs were investigated by laboratory analysis.
Results
We identified 209 cases(including 28 laboratory-confirmed cases) that occurred from August 29 to September 10. All cases were students, and the median age was 20 years, 52% were male. The outbreak lasted for 13 days, and peaked on September 5. Consumption of Drinks window and Rice flour window on 1 September(RR: 3.4, 95% CI: 1.5-7.8, and RR: 7.6, 95% CI: 2.8-20.2), Rice flour window and Fish meal window on 2 September(RR: 4.0, 95% CI: 1.2-13.6, and RR: 4.6, 95% CI: 1.7-12.5), Moslem meal window on 4 September(RR: 2.7, 95%CI: 1.3-5.4), Barbeque window on 5 September(RR: 3.0, 95%CI: 1.2-7.0) were independently associated with increased risk of disease within the following 2 days. Rectal swabs or stool samples from twenty-five cases and ten canteen employees were positive for norovirus GI.6. Five cases were positive for Bacillus cereus, among them, two stool samples were detected by a mixed infection of Norovirus and Bacillus cereus. Four retained food specimens were positive for Bacillus cereus, and environmental samples were negative for any viruses or bacteria.
Conclusion
Our investigation indicated that consumption of high-risk windows was the source of this outbreak. The high rate of infection of both pathogens was exacerbated by unhygienic manipulation and Inappropriate hygiene practices in canteen employees.
Keywords
Foodborne, Gastroenteritis, norovirus, Bacillus cereus, Outbreak, Cohort study
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CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
No community comments so far
Submission checks complete
On 06 Nov, 2019
Editorial decision: Accept
On 15 Oct, 2019
Editor assigned
On 15 Oct, 2019
Editor invited
On 14 Oct, 2019
No comments provided
Editorial decision: Minor revision
On 09 Oct, 2019
Review #2 received
Received 08 Oct, 2019
Reviewer #2 agreed
On 07 Oct, 2019
Review #1 received
Received 24 Sep, 2019
Editor assigned
On 23 Sep, 2019
Reviewers invited
Invitations sent on 23 Sep, 2019
Reviewer #1 agreed
On 23 Sep, 2019
Submission checks complete
On 22 Sep, 2019
Editor invited
On 22 Sep, 2019
Version 1
Posted 05 Jun, 2019
No comments provided
Editorial decision: Major revision
On 02 Sep, 2019
Review #2 received
Received 20 Aug, 2019
Reviewer #2 agreed
On 09 Aug, 2019
Reviewer #3 agreed
On 09 Aug, 2019
Review #1 received
Received 02 Aug, 2019
Reviewer #1 agreed
On 16 Jul, 2019
Reviewers invited
Invitations sent on 15 Jul, 2019
Editor assigned
On 19 Jun, 2019
Submission checks complete
On 04 Jun, 2019
Editor invited
On 04 Jun, 2019
First submitted
On 24 May, 2019
Metrics
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PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
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See the published version of this preprint at BMC Infectious Diseases.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Dongwan Chen
Shunyi Center for Disease Control and Prevention
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
No community comments so far
Submission checks complete
On 06 Nov, 2019
Editorial decision: Accept
On 15 Oct, 2019
Editor assigned
On 15 Oct, 2019
Editor invited
On 14 Oct, 2019
No comments provided
Editorial decision: Minor revision
On 09 Oct, 2019
Review #2 received
Received 08 Oct, 2019
Reviewer #2 agreed
On 07 Oct, 2019
Review #1 received
Received 24 Sep, 2019
Editor assigned
On 23 Sep, 2019
Reviewers invited
Invitations sent on 23 Sep, 2019
Reviewer #1 agreed
On 23 Sep, 2019
Submission checks complete
On 22 Sep, 2019
Editor invited
On 22 Sep, 2019
Version 1
Posted 05 Jun, 2019
No comments provided
Editorial decision: Major revision
On 02 Sep, 2019
Review #2 received
Received 20 Aug, 2019
Reviewer #2 agreed
On 09 Aug, 2019
Reviewer #3 agreed
On 09 Aug, 2019
Review #1 received
Received 02 Aug, 2019
Reviewer #1 agreed
On 16 Jul, 2019
Reviewers invited
Invitations sent on 15 Jul, 2019
Editor assigned
On 19 Jun, 2019
Submission checks complete
On 04 Jun, 2019
Editor invited
On 04 Jun, 2019
First submitted
On 24 May, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Infectious Diseases.
Background
On 4 September 2018, a boarding school in the Shunyi District of Beijing, China reported an outbreak of acute gastroenteritis. At least 209 affected students developed the symptoms of diarrhea and vomiting. Investigations were conducted to identify the agent and source of this outbreak, and to implement controls to prevent further transmission.
Methods
A retrospective cohort study was conducted among the school students and staff in order to test hypothesis that food served at the school canteen. We collected information on demographics, refectory records at the canteen and contact to ill persons or vomit, using a uniform epidemiological questionnaire. Risk ratios (RR) and 95% confidence intervals (CI) were calculated. Stool specimens of cases and canteen employees, food served, water, and environmental swabs were investigated by laboratory analysis.
Results
We identified 209 cases(including 28 laboratory-confirmed cases) that occurred from August 29 to September 10. All cases were students, and the median age was 20 years, 52% were male. The outbreak lasted for 13 days, and peaked on September 5. Consumption of Drinks window and Rice flour window on 1 September(RR: 3.4, 95% CI: 1.5-7.8, and RR: 7.6, 95% CI: 2.8-20.2), Rice flour window and Fish meal window on 2 September(RR: 4.0, 95% CI: 1.2-13.6, and RR: 4.6, 95% CI: 1.7-12.5), Moslem meal window on 4 September(RR: 2.7, 95%CI: 1.3-5.4), Barbeque window on 5 September(RR: 3.0, 95%CI: 1.2-7.0) were independently associated with increased risk of disease within the following 2 days. Rectal swabs or stool samples from twenty-five cases and ten canteen employees were positive for norovirus GI.6. Five cases were positive for Bacillus cereus, among them, two stool samples were detected by a mixed infection of Norovirus and Bacillus cereus. Four retained food specimens were positive for Bacillus cereus, and environmental samples were negative for any viruses or bacteria.
Conclusion
Our investigation indicated that consumption of high-risk windows was the source of this outbreak. The high rate of infection of both pathogens was exacerbated by unhygienic manipulation and Inappropriate hygiene practices in canteen employees.
Figure 1
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