Epidemic management in a measles outbreak in 2023,the return of vaccine-preventable diseases:A single center,retrospective observational study

Objective:To investigate the importance of immunization in preventing measles infection and to determine the most useful laboratory tests for confirmation of measles.Methods:This study included pediatric cases evaluated with a presumed diagnosis of measles between December 2022 and June 2023,at Marmara University Pendik Training and Research Hospital.The effects of vaccination status and underlying disease on the clinical course,treatments,and complications were evaluated.Results:In total,117 patients were enrolled in the study with a median age of 80 months(IQR:32.5-125.0).Twelve patients with contact history were asymptomatic and had an underlying disorder,and intravenous immunoglobulin was given to them for post-exposure prophylaxis.Fifty-one patients had confirmed measles diagnosis.Ribavirin treatment was given to three patients(a newborn,a girl with rhabdomyosarcoma,and a healthy boy)with respiratory distress.Seventy-eight percent of confirmed measles cases were unvaccinated,and all hospitalized cases were unvaccinated or under-vaccinated.Four full-vaccinated children had confirmed measles infection.Measles PCR from nasopharyngeal swabs was negative in all of them,and their diagnosis was established with anti-measles IgM positivity.Conclusions:The measles vaccine is the most effective way to protect from measles and measles-related complications.Although measles can also occur in fully vaccinated patients,the disease is milder than in unvaccinated patients.Using ELISA and RT-PCR tests together may be beneficial in patients with high clinical suspicion for early diagnosis.

Epidemiology of Mpox Outbreaks and Implications for Surveillance in Imo State, Nigeria

Mpox disease is caused by a double-stranded DNA virus, genus Orthopoxvirus of the family Poxviridae. The incubation period is usually 6 to 13 days but can range from 5 to 21 days while symptoms and signs may persist for 2 to 5 weeks. Although, the clinical features are usually less severe when compared to the deadly smallpox, the disease can be fatal with case fatality rate between 1% and 10%. In Imo State, Nigeria, there has been a changing epidemiology of the disease in the last 6 years and the frequency and geographic distribution of cases have progressively increased. This study aims to conduct a review of the disease epidemiology between 2017 and 2023 and implications for surveillance in Imo State. Surveillance data from the Surveillance Outbreak Response and Management System (SORMAS) was extracted between January 2017 and December 2023 across the 27 Local Government Areas (LGAs) of Imo State. A line list of 231 suspected cases was downloaded into an excel template and analyzed using SPSS® version 20 software. Analysis was done using descriptive statistics and associations were tested using Fischer’s exact at 0.05 level of significance. Of the 231 suspected cases, 57.1% (132) were males, 42.9% (99) were females and the modal age group was between the ages of 0 - 4 (32.5%). Eight (8) LGAs (districts) accounted for 71% (n = 164) of all the suspected cases. 21.2% (49) were confirmed positive, 27 males (55.1%) and 22 females (44.9%) (p > 0.05). Modal age group was 20 - 24 (22.4%, n = 11), 18% (9) were children under 14 years, p > 0.05. Case fatality rate was 8% (n = 4). There was no significant association between mortality and age group. Five (5) LGAs accounted for about 60% (29) of all confirmed cases. These LGAs contribute only 20% to the total population in the State. Only 5.6% and 4% of suspected and confirmed cases, respectively, had knowledge of contact with an infectious source. The study described the epidemiology of Mpox outbreaks between 2017 and 2023 and the findings have significant implications on detection and outbreak response activities.

Epidemiological Characteristics and Spatiotemporal Distribution Patterns of Human Norovirus Outbreaks in China, 2012–2018

Objective To clarify the epidemiological characteristics and spatial distribution patterns of human norovirus outbreaks in China, identify high-risk areas, and provide guidance for epidemic prevention and control.Methods This study analyzed 964 human norovirus outbreaks involving 50,548 cases in 26 provinces reported from 2012 to 2018. Epidemiological analysis and spatiotemporal scanning analysis were conducted to analyze the distribution of norovirus outbreaks in China.Results The outbreaks showed typical seasonality, with more outbreaks in winter and fewer in summer, and the total number of infected cases increased over time. Schools, especially middle schools and primary schools, are the most common settings of norovirus outbreaks, with the major transmission route being life contact. More outbreaks occurred in southeast coastal areas in China and showed significant spatial aggregation. The highly clustered areas of norovirus outbreaks have expanded northeast over time.Conclusion By identifying the epidemiological characteristics and high-risk areas of norovirus outbreaks, this study provides important scientific support for the development of preventive and control measures for norovirus outbreaks, which is conducive to the administrative management of high-risk settings and reduction of disease burden in susceptible areas.

Monkeypox outbreak: a novel threat after COVID-19?

Dear Editor,Monkeypox is a zoonosis caused by monkeypox virus (MPXV)infection first reported in Central and West Africa[1]. The first outbreak of monkeypox outside of Africa was reported in2003[2].Afterthat,Israel,theUnitedKingdom(UK),Singapore, and other countries have reported monkeypox cases among travelers back from Nigeria since 2018[3].

A Campylobacteriosis Outbreak Caused by One Asymptomatic Food Handler Carrier

In August 2021,three students with diarrhea from the same school visited a local hospital in the S district of Beijing.An epidemic investigation showed that there were more students with diarrhea in the same school and they had one meal together.Campylobacter jejuni was isolated from both patients with diarrhea and asymptomatic food handlers;however,the latter also carried Campylobacter coli.Phylogenomic analysis showed that there was a campylobacteriosis outbreak among the students,and the asymptomatic food handler may have been the source of the infection.Routine inspection and surveillance for Campylobacter is needed for the food producing staff,particularly those cooking in the cafeteria in schools or other public food services.

Review of the prevalence,diagnostics,and containment measures of the current mpox outbreak

Monkeypox(mpox),is a disease from the Poxviridae family that can cause several serious medical issues.This mini-review sought to analyze the existing literature regarding the current mpox outbreak with a focus on the prevalence,diagnostics,and containment measures.Mpox cases have been reported to World Health Organization(WHO)from 85 Member States in all six WHO regions during the period of January 1,2022,through August 3,2022.Standardized or optimized guidelines for the clinical care of patients with mpox are limited,particularly in low-resource settings.In an effort to achieve guidance and meet standards,special attention should be paid to this outbreak in order to eradicate such a rare infectious disease by analyzing prevention and control measures.Patient outcomes may also be poor,and their illnesses may last for a long time.The spectrum of clinical symptoms,including complications and sequelae,as well as aspects of the illness may be indicators of sickness severity and complications;therefore,its clinical presentation must be better understood to improve containment measures.In addition,it is important to create and evaluate a standard of care that takes a variety of parameters into account,including antiviral,immune therapies,and clinical metrics that are particular to mpox.The global emergence of mpox has presented new challenges for public health and has called for further investigation into its epidemiological profile across international contexts.

Impact of lockdown policies during the COVID-19 outbreak on a trauma center of a tertiary hospital in China

BACKGROUND Coronavirus disease 2019(COVID-19)is a major and costly public health emergency.AIM To investigate the impact of China’s lockdown policies during the COVID-19 outbreak on the level I trauma center of a tertiary comprehensive hospital of Traditional Chinese Medicine.METHODS All patients admitted to our trauma center during a lockdown in 2020 and the same period in 2019 were enrolled.We collected data on demographics,daily visits,injury type,injury mechanism,injury severity score,and patient management for comparative analysis.RESULTS The total number of patients in the trauma center of our hospital decreased by 50.38%during the COVID-19 Lockdown in 2020 compared to the same period in 2019.The average number of trauma visits per day in 2019 was 47.94,compared to 23.79 in 2020.Comparing the patients’demographic data,loss of employment was the most predominate characteristic in 2020 compared to 2019,while there was no significant difference in gender,age,and marital status between both periods.During the lockdown period,the proportion of traffic accident-related injuries,injuries due to falls greater than 1.5 m,and mechanical injuries decreased significantly,whereas the proportion of injuries caused by falls less than 1.5 m,cuts,assault,bites,and suicidal tendencies and other injuries increased relatively.In addition,the proportion of patients with minor injuries increased and serious injuries decreased during the lockdown.The hospitalization rate increased significantly,and there was no significant difference in emergency surgery and death rates.CONCLUSION The lockdown policies during the COVID-19 outbreak significantly altered the number and mechanism of traumatic events in our hospital,which can be monitored regularly.Our results suggest that mandatory public health prevention and control measures by the government can reduce the incidence of traumatic events and the severity of traumatic injuries.Emergency surgery and mortality rates remain high,increased because of factors such as family injury and penetrating injury,and hospitalization rates have increased significantly.Therefore,our trauma center still needs to be fully staffed.Finally,from the perspective of the injury mechanism,indoor trauma is a major risk during a lockdown,and it is particularly important to develop prevention strategies for such trauma to reduce the medical burden of the next catastrophic epidemic.

The aggregate and sectoral time‑varying market efficiency during crisis periods in Turkey:a comparative analysis with COVID‑19 outbreak and the global financial crisis

This study aims to examine the time-varying efficiency of the Turkish stock market’s major stock index and eight sectoral indices,including the industrial,financial,service,information technology,basic metals,tourism,real estate investment,and chemical petrol plastic,during the COVID-19 outbreak and the global financial crisis(GFC)within the framework of the adaptive market hypothesis.This study employs multifractal detrended fluctuation analysis to illustrate these sectors’multifractality and short-and long-term dependence.The results show that all sectoral returns have greater persis-tence during the COVID-19 outbreak than during the GFC.Second,the real estate and information technology industries had the lowest levels of efficiency during the GFC and the COVID-19 outbreak.Lastly,the fat-tailed distribution has a greater effect on multifractality in these industries.Our results validate the conclusions of the adaptive market hypothesis,according to which arbitrage opportunities vary over time,and contribute to policy formulation for future outbreak-induced economic crises.

Investigation on Outbreak of Sesamia inferens and Smut in Cane-growing Regions of Yunnan Province

[Objectives]This study was conducted to clarify the outbreak and disaster characteristics of Sesamia inferens Walker and smut in cane-growing regions in the low-latitude plateau of Yunnan Province,where there is continuous high temperature and drought in spring and summer.[Methods]A systematic investigation and analysis was conducted on different varieties in different types of fields in 16 cane-growing regions with outbreak of S.inferens and smut in Yunnan from 2019 to 2021.[Results]The outbreak of S.inferens and smut in cane-growing regions in the low-latitude plateau of Yunnan Province resulted in an average percent of dry hearts in the range of 17.3%-56.3%,and as high as 84.0%in severe cases.70%thiamethoxam seed treatment dispersible powder and clothianidin or thiamethoxam fertilizer granules were ineffective against S.inferens,while 10%monosultap·thiamethoxam or 10%clothianidin·monosultap granules had a significant control efficacy on S.inferens.The average diseased plant rate ranged from 14.8%to 89.7%in susceptible varieties with smut,and was as high as 100%in severe cases.ROC 1,Yuetang 93-159,Yuetang 00-236,and Liucheng 05-136 had strong resistance,with an average diseased plant rate of 0-5.5%and the highest rate of 7.6%.S.inferens and smut both broke out in cane-growing regions with an altitude below 1200 m.It is recommended to pay attention to disease and pest monitoring in cane-growing regions with an altitude below 1200 m,and combine it with the management of new plants and ratoon plants to effectively prevent and control the first and second generation of S.inferens-infested seedlings from March to May.It is also recommended to strengthen the promotion and application of excellent disease-resistant varieties,so as to achieve a reasonable distribution of varieties and fundamentally control the outbreak and epidemic of sugarcane smut.[Conclusions]This study provides a basis for the effective prevention and control of catastrophic S.inferens and smut caused by extreme climate.

Differences in the US Mpox Outbreaks of 2003 and 2022: A Review

Objectives: This research aims to focus on the differences in mpox outbreaks that occurred in 2003 and 2022 in the United States. Methods: We searched the following databases Medline, Google Scholar, Gayle Power Search, PubMed, and Springerlink using the following search terms “mpox virus”, “MPX”, “mpox in the US”, “US mpox virus 2003”, “US mpox virus 2022”, “US mpox outbreak 2003” and US mpox outbreak 2022”. The only articles selected were those written between 2003 and 2022. Results: Findings showed more Mpox research was conducted during the first US Mpox outbreak in 2003 compared to the US Mpox outbreak in 2022. Findings also indicated that the mpox outbreak of 2003 consisted of more animal-to-human transmissions acquired from sick prairie dogs compared to more human-to-human from an infected international traveler from Nigeria to the US. Conclusion: Major differences in the mpox outbreaks in the US include the number, location of lesions, and transmission type. We recommend further research to increase awareness of the human-to-human transmission of mpox via sexual contact to assist healthcare professionals and public health leaders in providing prevention and wellness in US communities.

Setting up the Goal of Eliminating Outbreaks of Blue-green Alga, Innovating the Idea of Controlling the Taihu Lake, and Ensuring the Safety of Water Supply in the Taihu Lake

Since the water supply crisis in the Taihu Lake on May 29,2007,the control of the Taihu Lake has achieved remarkable results,and the eutrophication has been greatly reduced.Existing problems are as follows:outbreaks of blue-green alga still appear seriously every year,and there is no goal to eliminate outbreaks of blue-green alga;the load into the lake greatly exceeds the environmental capacity;reed wetlands are greatly reduced;there is still the possibility of a water supply crisis;the research of eliminating outbreak of blue-green alga is weak.In this paper,the experience of controlling the Taihu Lake is summarized,and the ultimate goals of eliminating eutrophication and outbreaks of blue-green alga and restoring wetlands and biodiversity are proposed.Control measures are proposed,such as deepening the promotion of the lake chief system,establishing the lake chief system in an all-round way,and increasing applied scientific and technological efforts and capital investment.The necessity and possibility of further controlling the Taihu Lake to eliminate outbreaks of blue-green alga should be recognized.Relying on controlling eutrophication alone cannot eliminate outbreaks of blue-green alga.The point that phosphorus control is the key to eliminate outbreaks of blue-green alga is not suitable for the Taihu Lake.The integration ideas of"three types"of technologies should be innovated.The first one is"double reduction and double increase"measures to eliminate eutrophication,of which"double reduction"is to reduce external point sources and non-point sources and internal blue-green alga in sediment;for external sources,the treatment standard of sewage plants should be paid special attention to.The second one is"double algae removal"measures to salvage blue-green alga,suppresses and kills algae.The blue-green alga on the surface,middle and bottom of water should be thoroughly salvaged and eliminated from various water areas.The third one is"double restoration"measures to restore wetlands and biodiversity.The area of wetlands should be restored to the area from the 1960s to the 1970s before outbreaks of blue-green alga,and vegetation coverage reaches 25%-30%.The Taihu Lake is controlled in different waters to ensure water supply safety in water sources.Five suggestions are proposed,such as revising the"Overall Plan for the Comprehensive Treatment of Water Environment in the Taihu Lake Basin"again,incorporating the goal of eliminating outbreaks of blue-green alga in the plan,setting up this research topic,greatly improving sewage treatment standards in local legislation.

H2 strain attenuated live hepatitis A vaccines:protective efficacy in a hepatitis A outbreak

AIM To investigate the protective efficacy ofH2 strain attenuated live hepatitis A vaccines（H2-strain vaccines）in hepatitis A（HA）outbreaks.METHODS With the permission of theirparents,5551 pre-school and grade 1-3 primaryschool children were inoculated with 1 dose(106.5TCID50)of H2-strain vaccines in anonrandomized,controlled trial conducted inFucheng County,Hebei Province in May 1997.Another 6485 children in the same grades andcompatible in gender and age were enrolled ascontrols.Epidemiological and serological surveywas conducted to evaluate the protectiveefficacy of the vaccines.ELISA was used todetect serum IgM anti-HAV.RESULTS HA outbreak started in early May1998,peaked in the middle of the same month,and lasted about 80 days.Overall 302 HA caseswere found,192（53.58%）were 5-9 years old.One vaccinee and 25 control cases were found tohave hepatitis A,which account for 0.28%（1/356）and 5.92%（25/422）of all vaccinees andcontrols in the 14 villages,respectively.The protective efficacy of vaccines was 95.27%（95% Cl:85.83%-104.72%）.In subjects testedfor anti-HAV IgM from 13 villages,1（0.40%）overt and 11（4.06%）asymptomatic HAV caseswere found in 271 vaccinees,but 21（6.69%）ofovert and asymptomatic ones were found in 314controls.CONCLUSION H2 strain vaccines were excellent in preventing overt hepatitis A, but not so effective in preventing asymptomatic hepatitis A virus infection. A booster dose might be needed to get permanent reliable immunity.

Acute gastroenteritis outbreak caused by a GII.6 norovirus

AIM:To report an acute gastroenteritis outbreak caused by a genogroup 2 genotype 6(GII.6) strain norovirus in Shanghai,China.METHODS:Noroviruses are responsible for approximately half of all reported gastroenteritis outbreaks in many countries.Genogroup 2 genotype 4 strains are the most prevalent.Rare outbreaks caused by GII.6 strains have been reported.An acute gastroenteritis outbreak occurred in an elementary school in Shanghai in December of 2013.Field and molecular epidemiologic investigations were conducted.RESULTS:The outbreak was limited to one class in an elementary school located in southwest Shanghai.The age of the students ranged from 9 to 10 years.The first case emerged on December 10,2013,and the last case emerged on December 14,2013.The cases peaked on December 11,2013,with 21 new cases.Of 45 students in the class,32 were affected.The main symptom was gastroenteritis,and 15.6%(5/32) of the cases exhibited a fever.A field epidemiologic investigation showed the pathogen may have been transmitted to the elementary school from employees in a delicatessen via the first case student,who had eaten food from the delicatessen one day before the gastroenteritis episodes began.A molecular epidemiologic investigation identified the cause of the gastroenteritis as norovirus strain GII.6;the viral sequence of the student cases showed 100% homology with that of the shop employees.Genetic relatedness analyses showed that the new viral strain is closely related to previously reported GII.6 sequences,especially to a strain reported in Japan.CONCLUSION:This is the first report to show that norovirus strain GII.6 can cause a gastroenteritis outbreak.Thus,the prevalence of GII.6 noroviruses requires attention.

Imported cases of 2019-novel coronavirus (2019-nCoV) infections in Thailand: Mathematical modelling of the outbreak

Outbreak of a new emerging disease is usually an important consideration in medicine and public health. In December 2019, a new emerging disease started in China and becomes the global concern in early January 2020[1,2]. The disease, 2019-novel coronavirus(2019-nCoV) infection, already existed outside China and the importation of disease is the cause of emerging 2019-nCoV infections in new settings.

CAUSES OF OUTBREAK OF THE LARCH CATERPILLAR(Dendrolimus superans Butler) IN DAXINGAN MOUNTAIN AND ITS CONTROL STRATEGY

In 1991, in Daxingan Mountain, an outbreak of larch caterpillar (Dendrolim us superans Butler) happened on large areas of more than one million hectares, where stands of larch were seriously damaged because needles on the trees were almost eaten up by the pest. causing enormous economic losses. Analysis of data collected indicated that the main cause of the outbreak of larch caterpillar on large areas was that, after thirty years of exploitation, mature and overmature forests decreased rapidly. middle-aged and young forests incresed in large amount. significant changes occurred in individual ecological conditions of stands, especially those tended. with decreasing canoPy density and better light condition in the forest, and all these were adventageous to the outbreak of the pest. In addition, in recent years, the climatic condition in Daxingan Mountain changed significantly. The yearly average temperature raised gradually and the soil surface temperature in April and October increased year by year, which were advantageous to the outbreak of larch caterpillars. In short. the significant changes in the ecological conditions in Daxingan Mountain provided suitable conditions for the outbreak of the larch caberpill ar, and after several years of increase in population number, the larch caterpillar outbroke into a serious disaster on vast areas. In the paper, composite control strategy was also discussed.

Outbreak of Dengue Fever in Central China,2013

In 2013,the first dengue fever（DF） outbreak in central China was reported in the central of Henan province,northern temperate regions,although they have been sequentially recorded in Southern China.106 suspected DF cases were reported and 73 patients were confirmed dengue virus type 3（DEN-3） infections.62/392（15.8%） local health persons showed DEN antibodies positive.To this day Henan is the northernmost province in China which has been reported about outbreak of DF and what is important is that it warns us the endemic range of DF has been expanded geographically in China.

Misinformation on salt water use among Nigerians during 2014 Ebola outbreak and the role of social media

Objective: To determine the spread of misinformation on salt water among Nigerians, salt water use for Ebola prophylaxis, and the role played by the social media during the 2014 Ebola outbreak.Methods: Information was collected from the general Nigerian population through online Google forms which were majorly disseminated via Facebook and WhatsApp platforms. The data retrieved was analysed using descriptive statistics, Chi-square test and multivariate logistic regression.Results: A total of 703 questionnaires were included in the final analysis. The respondents' mean age was(30.2±6.7) years, predominantly male(73.2%). Almost all of them(95.0%) had received some message to use salt water, 37.4% of whom received such message on social media. Around a half of them ever made an attempt to verify the health information they received on social media(50.9%), and about a quarter(24.0%) of them had used salt water during the outbreak. Many of them had used salt water because they believed it would not harm them(52.0%). Salt water was less likely to be used by those who had received such message on social media, as well as by those who had received some contrary information to salt use.Conclusions: Social media could serve as an effective tool in propagating health information and should be actively engaged by health agencies, to spread accurate information.

Present Situation and Control of Outbreaks of Algal Blooms in the Three Gorges Reservoir

After water storage in the Three Gorges Reservoir Region,there are no outbreaks of algal blooms in the main stream of the reservoir region,but the density of algae increases obviously. Outbreaks of algal blooms mainly appeared in the tributaries of the reservoir region such as the Xiangxi River,Daning River,Shennong River and Xiaojiang River,but they did not occur every year. The reasons for outbreaks of algal blooms in the tributaries are shown as follows: the existence of sources of algae(blue-green algae) in the Three Gorges Reservoir is the root cause,and the sources include sources existing and being produced in the reservoir and sources from upstream main stream and its tributaries and other related lakes and reservoirs,of which the sources are mainly from the Dianchi Lake; slight or moderate eutrophication of water is the basic condition;hydrologic and hydrodynamic conditions and suitable temperature are conducive to proliferation and aggregation of algae(blue-green algae) after the operation of the Three Gorges Reservoir until outbreaks of algal blooms appear. Outbreaks of algal blooms in the tributaries of the Three Gorges Reservoir Region mainly appear in backwater reaches; they mainly occur in the tributaries in the north of the reservoir region and near to the dam;they mainly appear from March to July; the dominant species of algae( blue-green algae) in the Three Gorges Reservoir are Pyrrophyta,Bacillariophyta and Chlorophyta,but they tend to change into blue-green algae and other algae. To control outbreaks of algal blooms in the tributaries of the Three Gorges Reservoir Region,it is needed to prevent water containing blue-green algae collected from the Dianchi Lake and other lakes and reservoirs from being input into the lower reaches,reduce pollution load flowing into the Three Gorges Reservoir,use enclosures to change hydrodynamic conditions of backwater reaches of the tributaries appropriately,and adopt biological measures such as culturing fish and planting plants to improve ecosystem of the tributaries and other measures to inhibit and eliminate algae and decrease eutrophication level.

Siberian silkmoth outbreaks surpassed geoclimatic barrier in Siberian Mountains

Siberian silkmoth(SSM,Dendrolimus sibiricus Tschetv.)is the most important defoliator of Siberian pine(Pinus sibirica Du Tour)and fir(Abies sibirica Ledeb.)stands.Warming-induced SSM outbreaks are one of the major driving factors of successions within the taiga zone.It is suggested that climate change impacted the SSM range and life cycle.We analyzed the migration of alpine and northerly SSM outbreak boundaries in Siberia and the impact of the climate variables and topography on the outbreak dynamics.We used time-series scenes(multispectral data,and vegetation indexes EVI and NDII)in combination with field studies,climate variables,and GIS techniques.We found that SSM outbreaks in the area of alpine boundary shifted about 370 m uphill since the mid of 1950.The outbreak onset was promoted by increased dryness and active temperatures and decreased root zone moisture content in the spring-early summer period.The terrain topography strongly affected SSM outbreak onset and dynamics.Initially,the outbreak was located at the middle elevations on the gentle concave southeastern slopes,which are the favorable insect habitats between outbreaks.Then the outbreak expanded uphill and downhill,to steeper slopes,and both concave and convex terrains.Alongside with elevation range expansion,SSM surpassed its northern historical outbreak boundary:the potential outbreaks’boundary moved about 300 km northward.Climate warming contributes to SSM migration into former outbreak free conifer stands located in highlands and at northern latitudes.

Epidemiological Survey and Analysis on an Outbreak of Gastroenteritis due to Water Contamination

Objective To document the investigation and control of an outbreak of gastroenteritis in City G, South China, and provide a reference for preventing future outbreaks. Methods An ambispective cohort study was designed. Attack rate （AR） and relative risks （RR） were calculated to identify the causes of gastroenteritis. Investigations using questionnaires included personal interviews with patients and doctors, reviews of medical records, laboratory examinations of fecal specimens and continuous hygiene monitoring of water samples from the waterworks. Results Overall, 427/71534 （AR=5.97%o） cases were identified between October 31 and November 12 2010. Geographic distribution was highly localized, with 80% of cases occurring in the areas supplied by waterworks-A. Consumption of water provided solely by waterworks-A was found to be associated with illness （RR=8.20, 95 C1%：6.12-10.99） compared with that from waterworks-B. Microbiological analyses confirmed the presence of Norovirus in six of eight fecal samples from symptomatic patients, two water samples from waterworks-A and two sewage samples. After taking effective measures, the hygienic indices of waterworks-A met health criteria again on November 9 and no cases were reported 3 days later.Conclusion The outbreak reported here was caused by drinking tap water contaminated with sewage at the source. Early identification of possible contamination sources and awareness of changes that might negatively impact water quality are important preventive measures to protect public health.