Investigation of a norovirus outbreak among hospital staff in Zhejiang, China: tracing the source to contaminated “red bean cake”

While nosocomial norovirus transmission in hospitalized patients is well characterized, its transmission dynamics among HCWs remain poorly documented. This investigation of HCW-focused norovirus transmission provides critical epidemiological evidence to refine infection control protocols for gastroe...

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Main Authors: Xiaojian Duan, Jing Wang, Yi Wang, Zhaokai He, Xiaobin Ren, Zhe Wang, Qingjun Kao, Kai Song, Liangliang Huo
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-07-01
Series:Frontiers in Public Health
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Online Access:https://www.frontiersin.org/articles/10.3389/fpubh.2025.1631091/full
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author Xiaojian Duan
Jing Wang
Yi Wang
Zhaokai He
Xiaobin Ren
Zhe Wang
Qingjun Kao
Kai Song
Liangliang Huo
author_facet Xiaojian Duan
Jing Wang
Yi Wang
Zhaokai He
Xiaobin Ren
Zhe Wang
Qingjun Kao
Kai Song
Liangliang Huo
author_sort Xiaojian Duan
collection DOAJ
description While nosocomial norovirus transmission in hospitalized patients is well characterized, its transmission dynamics among HCWs remain poorly documented. This investigation of HCW-focused norovirus transmission provides critical epidemiological evidence to refine infection control protocols for gastroenteritis in healthcare settings. This study utilized a retrospective case–control design to systematically analyze outbreak transmission dynamics. Structured questionnaires were implemented ≤72 h post-symptom onset to capture dietary exposures during the three-day exposure window, minimizing recall bias. Potential high-risk dining periods and food items were further analyzed via a case-control study. The outbreak investigation identified 52 cases, including 48 HCWs and 4 cafeteria staff, yielding an overall attack rate of 2.21% (52/2352). Epidemiological evidence supports a point-source origin, as demonstrated by the single-peak epidemic curve. Case–control analysis revealed the lunch on 19th June as the primary exposure window (statistically significant OR = 25.21; 95% CI: 3.35–189.69), with the “red bean cake” served in the implicated meal being the significantly associated food item (OR = 1248.75; 95% CI: 170.64–9138.33). RT-qPCR confirmed norovirus GII RNA in clinical specimens from cases and the implicated “red bean cake” food sample. These findings definitively established the “red bean cake” as the outbreak’s etiological source.
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publishDate 2025-07-01
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spelling doaj-art-6e2bf5ce156d4797a32ed7a4c4bda4cb2025-08-20T03:32:20ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-07-011310.3389/fpubh.2025.16310911631091Investigation of a norovirus outbreak among hospital staff in Zhejiang, China: tracing the source to contaminated “red bean cake”Xiaojian DuanJing WangYi WangZhaokai HeXiaobin RenZhe WangQingjun KaoKai SongLiangliang HuoWhile nosocomial norovirus transmission in hospitalized patients is well characterized, its transmission dynamics among HCWs remain poorly documented. This investigation of HCW-focused norovirus transmission provides critical epidemiological evidence to refine infection control protocols for gastroenteritis in healthcare settings. This study utilized a retrospective case–control design to systematically analyze outbreak transmission dynamics. Structured questionnaires were implemented ≤72 h post-symptom onset to capture dietary exposures during the three-day exposure window, minimizing recall bias. Potential high-risk dining periods and food items were further analyzed via a case-control study. The outbreak investigation identified 52 cases, including 48 HCWs and 4 cafeteria staff, yielding an overall attack rate of 2.21% (52/2352). Epidemiological evidence supports a point-source origin, as demonstrated by the single-peak epidemic curve. Case–control analysis revealed the lunch on 19th June as the primary exposure window (statistically significant OR = 25.21; 95% CI: 3.35–189.69), with the “red bean cake” served in the implicated meal being the significantly associated food item (OR = 1248.75; 95% CI: 170.64–9138.33). RT-qPCR confirmed norovirus GII RNA in clinical specimens from cases and the implicated “red bean cake” food sample. These findings definitively established the “red bean cake” as the outbreak’s etiological source.https://www.frontiersin.org/articles/10.3389/fpubh.2025.1631091/fullnorovirushealthcare workerscase-control studyoutbreak investigationsource tracing
spellingShingle Xiaojian Duan
Jing Wang
Yi Wang
Zhaokai He
Xiaobin Ren
Zhe Wang
Qingjun Kao
Kai Song
Liangliang Huo
Investigation of a norovirus outbreak among hospital staff in Zhejiang, China: tracing the source to contaminated “red bean cake”
Frontiers in Public Health
norovirus
healthcare workers
case-control study
outbreak investigation
source tracing
title Investigation of a norovirus outbreak among hospital staff in Zhejiang, China: tracing the source to contaminated “red bean cake”
title_full Investigation of a norovirus outbreak among hospital staff in Zhejiang, China: tracing the source to contaminated “red bean cake”
title_fullStr Investigation of a norovirus outbreak among hospital staff in Zhejiang, China: tracing the source to contaminated “red bean cake”
title_full_unstemmed Investigation of a norovirus outbreak among hospital staff in Zhejiang, China: tracing the source to contaminated “red bean cake”
title_short Investigation of a norovirus outbreak among hospital staff in Zhejiang, China: tracing the source to contaminated “red bean cake”
title_sort investigation of a norovirus outbreak among hospital staff in zhejiang china tracing the source to contaminated red bean cake
topic norovirus
healthcare workers
case-control study
outbreak investigation
source tracing
url https://www.frontiersin.org/articles/10.3389/fpubh.2025.1631091/full
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