Epidemic characteristics and spatial distribution of vomiting and diarrhea outbreaks in schools and kindergartens in Shanghai from 2015 to 2019
Objective To retrospectively analyze the epidemic characteristics and spatial distribution of vomiting and diarrhea outbreaks in schools and kindergartens in Shanghai from 2015 to 2019,so as to provide the scientific evidence for optimizing pre-vention and control of vomiting and diarrhea outbreaks in schools and kindergartens.Methods Data collection and analysis were carried out on the vomiting and diarrhea outbreaks reported to Shanghai Municipal Center for Disease Control and Prevention from 2015 to 2019.Epidemiological characteristics were analyzed and compared.The proportion and incidence of outbreaks in schools and kindergartens were calculated,and the influencing factors of outbreaks were analyzed by multivariate Logistic regression.The index of Moran's Ⅰ was used for the global and local spatial auto-correlation analysis.Results Among the 344 vomiting and diarrhea outbreaks,98.26％occurred in kindergartens,primary schools,middle schools and other educational institutions.The median num-ber of cases per outbreak was 15.The number of suspected outbreaks and the percentage of cases involved peaked in 2015(60.00％,84.35％)and then decreased year by year to 16.00％and 38.80％in 2019.About 86.98％of the outbreaks were trans-mitted by human-to-human contact.Among the 329 outbreaks with samples collected from cases and/or environments,the main pathogen detected was norovirus(n=280),and sapovirus was detected in outbreak for the first time in 2016.The outbreaks showed obvious seasonality,with two peaks(November,March)and one trough(July),and the majority of outbreaks occurred in primary schools(44.38％)and kindergartens(32.84％).Compared with kindergartens,the probabilities of suspected epidemic outbreaks in primary schools,combined schools,middle schools and other educational institutions were higher(adjusted OR=6.40,9.16,12.64,5.58,P＜0.01).The proportion and incidence of outbreaks in educational institutions in different districts showed no high-high aggregation areas.Conclusions Primary schools and kindergartens are key places for the prevention and control of vomiting and diarrhea outbreaks.Targeted prevention and control measures should be strengthened at the beginning of each semester and be-fore the peak of the epidemic each year.Timely reporting of symptoms,suspension of school admissions after symptoms appear and standardized disposal of vomit are effective measures to reduce interpersonal transmission and control the scale of an outbreak.
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