Jansen A, Beyer A, Brandt C, Höhne M, Schreier E, Schulzke J, Zeitz M, Schneider T
Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, I. Medizinische Klinik - Gastroenterologie/Infektiologie/Rheumatologie, Berlin.
Z Gastroenterol. 2004 Apr;42(4):311-6. doi: 10.1055/s-2004-812908.
During the winter 2002/2003, an increased number of outbreaks of acute gastroenteritis caused by norovirus was reported from Germany, some other European countries and the USA. In this study, the epidemiological and clinical features of the Berlin norovirus outbreak were investigated in order to identify the reasons for the spread of norovirus gastroenteritis and possible control measures.
Cases and spread of norovirus infection in eleven long-term care facilities and a university hospital in Berlin were monitored from October 2002 to February 2003. To investigate the symptomatology and routes of transmission, a retrospective and interview-based study of infected staff members was performed.
Norovirus outbreaks in eleven long-term care facilities affected 314 patients (attack rate: 28.3 %, rate of hospitalisation: 20.7 %). 219 persons were affected in the hospital, during a period of four months. Sequence analysis revealed the circulation of Norovirus genogroup II (Grimsby-like viruses). The mean duration of symptoms was 69 hours. The duration of outbreaks on specific wards was negatively correlated with the time of returning to work (mean: 1.8 days) of the staff members after the disease.
This report demonstrates the potential of norovirus to cause large outbreaks by person to person transmission. Spread by aerosols generated by vomiting and environmental contamination seem to be particular important in institutional settings. The duration of symptoms was longer than reported previously, reflecting a possible increased virulence. Besides this, the outbreak was facilitated by insufficient preventive measures.
在2002/2003年冬季，德国、其他一些欧洲国家和美国报告了由诺如病毒引起的急性胃肠炎暴发数量增加。在本研究中，对柏林诺如病毒暴发的流行病学和临床特征进行了调查，以确定诺如病毒胃肠炎传播的原因及可能的控制措施。
2002年10月至2003年2月期间，对柏林11家长期护理机构和一家大学医院的诺如病毒感染病例及传播情况进行了监测。为调查症状学和传播途径，对受感染的工作人员进行了一项基于访谈的回顾性研究。
11家长期护理机构中的诺如病毒暴发影响了314名患者（罹患率：28.3%，住院率：20.7%）。在四个月的时间里，医院中有219人受到影响。序列分析显示诺如病毒基因组II型（类似格里姆斯比病毒）在传播。症状的平均持续时间为69小时。特定病房暴发的持续时间与患病后工作人员返回工作岗位的时间（平均：1.8天）呈负相关。
本报告证明了诺如病毒通过人际传播引发大规模暴发的可能性。呕吐产生的气溶胶传播和环境污染在机构环境中似乎尤为重要。症状持续时间比之前报道的更长，这反映出其毒力可能增强。除此之外，预防措施不足也助长了此次暴发。
