{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T23:11:28Z","timestamp":1790291488948,"version":"4.1.0"},"reference-count":40,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2019,4,11]],"date-time":"2019-04-11T00:00:00Z","timestamp":1554940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Ministry of Science and Technology of the People's Republic of China","award":["2017YFC1602004"],"award-info":[{"award-number":["2017YFC1602004"]}]},{"name":"U.S. Centers for Disease Control and Prevention","award":["131031001000015001"],"award-info":[{"award-number":["131031001000015001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>We conducted a retrospective analysis of norovirus outbreaks reported to the National Public Health Emergency Event Surveillance System (PHEESS) in China from January 1, 2014 to December 31, 2017. We reviewed all acute gastroenteritis outbreaks (n = 692) submitted to PHEESS to identify the frequency, seasonality, geographic distribution, setting, and transmission mode of outbreaks due to norovirus. A total of 616 norovirus outbreaks resulting in 30,848 cases were reported. Among these outbreaks, 571 (93%) occurred in school settings including 239 (39%) in primary schools, 136 (22%) in childcare facilities, and 121 (20%) in secondary schools. The majority of outbreaks (63%) were due to person-to-person transmission, followed by multiple modes of transmission (11%), foodborne (5%) and waterborne (3%) transmission. These findings highlight the importance of improving hand hygiene and environmental disinfection in high-risk settings. Developing a standard and quantitative outbreak reporting structure could improve the usefulness of PHEESS for monitoring norovirus outbreaks.<\/jats:p>","DOI":"10.3390\/v11040342","type":"journal-article","created":{"date-parts":[[2019,4,12]],"date-time":"2019-04-12T03:46:37Z","timestamp":1555040797000},"page":"342","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Epidemiology of Norovirus Outbreaks Reported to the Public Health Emergency Event Surveillance System, China, 2014\u20132017"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5042-6016","authenticated-orcid":false,"given":"Yiyao","family":"Lian","sequence":"first","affiliation":[{"name":"Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing 102206, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuyu","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Beijing 100600, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Luo","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing 102206, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Lv","sequence":"additional","affiliation":[{"name":"Xiaogan Center for Disease Control and Prevention, Xiaogan 432000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaohong","family":"Liao","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing 102206, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongjie","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing 102206, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanette J.","family":"Rainey","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Beijing 100600, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aron J.","family":"Hall","sequence":"additional","affiliation":[{"name":"Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30333, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Ran","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing 102206, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,4,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/S1473-3099(14)70767-4","article-title":"Global prevalence of norovirus in cases of gastroenteritis: A systematic review and meta-analysis","volume":"14","author":"Ahmed","year":"2014","journal-title":"Lancet Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jcv.2008.10.009","article-title":"Noroviruses: A comprehensive review","volume":"44","author":"Patel","year":"2009","journal-title":"J. Clin. Virol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Pires, S.M., Fischer-Walker, C.L., Lanata, C.F., Brecht, D., Hall, A.J., Kirk, M.D., Duarte, A.S.R., Black, R.E., and Angulo, F.J. (2015). Aetiology-Specific Estimates of the Global and Regional Incidence and Mortality of Diarrhoeal Diseases Commonly Transmitted through Food. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0142927"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.1056\/NEJMra0804575","article-title":"Norovirus gastroenteritis","volume":"361","author":"Glass","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1093\/infdis\/jit620","article-title":"Determination of the 50% human infectious dose for Norwalk virus","volume":"209","author":"Atmar","year":"2014","journal-title":"J. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1002\/jmv.21237","article-title":"Norwalk virus: How infectious is it?","volume":"80","author":"Teunis","year":"2010","journal-title":"J. Med. Virol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.3201\/eid1908.130482","article-title":"Acute gastroenteritis surveillance through the National Outbreak Reporting System, United States","volume":"19","author":"Hall","year":"2013","journal-title":"Emerg. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.3201\/eid1410.080117","article-title":"Norwalk virus shedding after experimental human infection","volume":"14","author":"Atmar","year":"2008","journal-title":"Emerg. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Shang, X., Fu, X., Zhang, P., Sheng, M., Song, J., He, F., Qiu, Y., Wu, H., Lu, Q., and Feng, Y. (2017). An outbreak of norovirus-associated acute gastroenteritis associated with contaminated barrelled water in many schools in Zhejiang, China. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0171307"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.jinf.2017.06.004","article-title":"Burden of acute gastroenteritis caused by norovirus in China: A systematic review","volume":"75","author":"Zhou","year":"2017","journal-title":"J. Infect."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1002\/hpm.2434","article-title":"Surveillance and early warning systems of infectious disease in China: From 2012 to 2014","volume":"32","author":"Zhang","year":"2017","journal-title":"Int. J. Health Plan. Manag."},{"key":"ref_12","unstructured":"(2019, March 12). National Public Health Emergency Event Information Report and Management Regulations 2005. Available online: http:\/\/61.49.18.65\/uploadfile\/200629113745905.doc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s40249-017-0236-z","article-title":"A large outbreak of acute gastroenteritis caused by the human norovirus GII.17 strain at a university in Henan Province, China","volume":"6","author":"Huang","year":"2017","journal-title":"Infect. Dis. Poverty"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1111\/jam.12978","article-title":"An outbreak of multiple norovirus strains on a cruise ship in China, 2014","volume":"120","author":"Wang","year":"2016","journal-title":"J. Appl. Microbiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2855","DOI":"10.1007\/s00705-016-2954-0","article-title":"Norovirus outbreaks in Fengtai District, Beijing, China, 2014","volume":"161","author":"Li","year":"2016","journal-title":"Arch. Virol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1017\/S0950268811000665","article-title":"Norovirus outbreak associated with undercooked oysters and secondary household transmission","volume":"140","author":"Sweat","year":"2012","journal-title":"Epidemiol. Infect."},{"key":"ref_17","first-page":"7","article-title":"Guidelines on outbreak investigation, prevention and control of norovirus infection (2015)","volume":"50","author":"Liao","year":"2016","journal-title":"Zhonghua Yu Fang Yi Xue Za Zhi"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"90","DOI":"10.3201\/eid0901.020184","article-title":"Viral gastroenteritis outbreaks in Europe, 1995\u20132000","volume":"9","author":"Lopman","year":"2003","journal-title":"Emerg. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1111\/j.1469-0691.2009.02846.x","article-title":"Norovirus seasonality and the potential impact of climate change","volume":"15","author":"Rohayem","year":"2009","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1007\/s10393-009-0247-8","article-title":"Why \u201cWinter\u201d Vomiting Disease? Seasonality, Hydrology, and Norovirus Epidemiology in Toronto, Canada","volume":"6","author":"Greer","year":"2009","journal-title":"Ecohealth"},{"key":"ref_21","first-page":"201","article-title":"Norovirus infection surveillance in early warning of outbreaks in population in oyster farming areas","volume":"46","author":"Lin","year":"2017","journal-title":"J. Hyg. Res."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Kumazaki, M., and Usuku, S. (2016). Norovirus genotype distribution in outbreaks of acute gastroenteritis among children and older people: An 8-year study. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-1999-8"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1002\/jmv.24208","article-title":"Epidemiology and molecular characteristics of norovirus GII.4 Sydney outbreaks in Taiwan, January 2012\u2013December 2013","volume":"87","author":"Wu","year":"2015","journal-title":"J. Med. Virol."},{"key":"ref_24","first-page":"113","article-title":"High rate and changing molecular epidemiology pattern of norovirus infections in sporadic cases and outbreaks of gastroenteritis in Hong Kong","volume":"73","author":"Wheatley","year":"2010","journal-title":"J. Med. Virol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1128\/JCM.02680-13","article-title":"Genotypic and epidemiologic trends of norovirus outbreaks in the United States, 2009 to 2013","volume":"52","author":"Everardo","year":"2014","journal-title":"J. Clin. Microbiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1017\/S095026880900274X","article-title":"Norovirus outbreaks in nursing homes: The evaluation of infection control measures","volume":"137","author":"Friesema","year":"2009","journal-title":"Epidemiol. Infect."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"20859","DOI":"10.2807\/1560-7917.ES2014.19.29.20859","article-title":"Surveillance for outbreaks of gastroenteritis in elderly long-term care facilities in France, November 2010 to May 2012","volume":"19","author":"Barret","year":"2014","journal-title":"Eurosurveillance"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Li, J., Gao, X., Ye, Y.L., Wan, T., Zang, H., Mo, P.H., and Song, C.L. (2018). An acute gastroenteritis outbreak associated with person-to-person transmission in a primary school in Shanghai: First report of a GI.5 norovirus outbreak in China. BMC Infect. Dis., 18.","DOI":"10.1186\/s12879-018-3224-4"},{"key":"ref_29","first-page":"800","article-title":"A norovirus-borne outbreak caused by contaminated bottled spring water in a school, Zhejiang province","volume":"32","author":"Shen","year":"2011","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"ref_30","unstructured":"(2019, March 12). Criterion for Reporting Infectious Diseases in Schools and Child-Care Institutions (for Trial Implementation), Available online: http:\/\/www.nhc.gov.cn\/zhjcj\/s5853\/201304\/5765acfb22604d91aaf167bfc1247fbd.shtml."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.3201\/eid2307.170034","article-title":"Norovirus GII.P16\/GII.2-Associated Gastroenteritis, China, 2016","volume":"23","author":"Ao","year":"2017","journal-title":"Emerg. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1093\/infdis\/jiy182","article-title":"Genetic Analysis of Re-Emerging GII.P16-GII.2 Noroviruses in 2016\u20132017 in China","volume":"218","author":"Ao","year":"2018","journal-title":"J. Infect. Dis."},{"key":"ref_33","first-page":"21173","article-title":"Genetic analyses of GII.17 norovirus strains in diarrheal disease outbreaks from December 2014 to March 2015 in Japan reveal a novel polymerase sequence and amino acid substitutions in the capsid region","volume":"26","author":"Matsushima","year":"2015","journal-title":"Eurosurveillance"},{"key":"ref_34","first-page":"1762","article-title":"Emerging norovirus GII.17 in Taiwan","volume":"61","author":"Lee","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"86","DOI":"10.24171\/j.phrp.2017.8.1.12","article-title":"Emergence of Norovirus GII.17-associated Outbreak and Sporadic Cases in Korea from 2014 to 2015","volume":"8","author":"Jung","year":"2017","journal-title":"Osong Public Health Res. Perspect."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2620","DOI":"10.1099\/jgv.0.000582","article-title":"Characterization of the new GII.17 variant that emerged recently as the predominant strain in China","volume":"97","author":"Jin","year":"2016","journal-title":"J. Gen. Virol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"30447","DOI":"10.2807\/1560-7917.ES.2017.22.4.30447","article-title":"Steep rise in norovirus cases and emergence of a new recombinant strain GII.P16-GII.2, Germany, winter 2016","volume":"22","author":"Niendorf","year":"2017","journal-title":"Eurosurveillance"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.3201\/eid2307.170212","article-title":"Recombinant GII.P16-GII.2 Norovirus, Taiwan, 2016","volume":"23","author":"Liu","year":"2017","journal-title":"Emerg. Infect. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"144","DOI":"10.3201\/eid2401.170284","article-title":"Phylogeny and Immunoreactivity of Norovirus GII.P16-GII.2, Japan, Winter 2016\u201317","volume":"24","author":"Nagasawa","year":"2018","journal-title":"Emerg. Infect. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.3201\/eid2311.170561","article-title":"Increased Detection of Emergent Recombinant Norovirus GII.P16-GII.2 Strains in Young Adults, Hong Kong, China, 2016\u20132017","volume":"23","author":"Kwok","year":"2017","journal-title":"Emerg. Infect. Dis."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/11\/4\/342\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:44:41Z","timestamp":1760186681000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/11\/4\/342"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,11]]},"references-count":40,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019,4]]}},"alternative-id":["v11040342"],"URL":"https:\/\/doi.org\/10.3390\/v11040342","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,11]]}}}