Ying-Shih Su1, Hao-hsin Wu1, Wan-Chin Chen1, Yi-Chun Lo1, Hyung-min Lee2, Donghyok Kwon2 1. Taiwan Centers for Disease Control 2.Korea Centers for Disease Control and Prevention

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Result

Taiwanese Media reported the events.TCDC initiatedthe investigation.

KCDC got theinformation and performed epi-demic investigation.Norovirus was foundin tourists’ stool

KCDC got theinformation and performed epi-demic investigation.Norovirus was foundin tourists’ stool

Hong Kong me-dia: Clusters of diar-rhea in travelers thatrecently visited Korea.

Confirm food items consumed

Confirm food items consumed

Design question-naire

Design question-naire

Interviewed Sampled tourists

Interviewed Sampled tourists

TCDC con-ducted active case find-ing at the air-port quarantine and collected touristsinformation.

TCDC con-ducted active case find-ing at the air-port quarantine and collected touristsinformation.

The suspected Restaurants wasidentified by comparing itineraries of tour groups.

The suspected Restaurants wasidentified by comparing itineraries of tour groups.

Restaurant X was requested for suspension. No more cases af-ter 1/7.

Restaurant X was requested for suspension. No more cases af-ter 1/7.

TimelineTimeline

Norovirus gastroenteritis outbreak identified among 25 Taiwan tourist groups returning from Korea from December 24, 2013 to January 13, 2014

TCDC collaborated with KCDC in investigating the outbreak.

Background

Active Case FindingHealth advisory on Jan 2, 2014, mandated travel agents to report gastroenteritis occurring among tour groups in Korea

Case-control study*.Purposive Sampling of 5 tour groups for questionnaire

interviews

*. Case definition: Acute onset of diarrhea or vomiting during December 24, 2013 to January 12, 2014 in a group tourist while traveling in Korea

Laboratory investigation

*. Rectal swabs and stool samples from tourists and food handlers

*. Water source from the implicated restaurant

*. Tested for bacteria culture and norovirus & rotavirus PCR

Active case find-ings

Active case find-ings Lab. resultsLab. results

Negative for bacteria pathogen (0/44)Negative for bacteria pathogen (0/44)

Case-control study

Case-control study

Table 1. Analysis of risk factors

Table 1. Analysis of risk factors

Table 2. Genogroup of norovirus(From stool)

Table 2. Genogroup of norovirus(From stool)

*. Two Taiwanese tourists identified with 2 genogroups of norovirus**. Norovirus(genotype GI.9, GII.4, GII.6) detected in water source used in Restaurant X

*. Two Taiwanese tourists identified with 2 genogroups of norovirus**. Norovirus(genotype GI.9, GII.4, GII.6) detected in water source used in Restaurant X

Source of the outbreak : contamination of water source of the restaurant

Prompt international cooperation and information sharing were key to control and detection outbreak

Division of Epidemic Intelligence Service, Korea Centers for Disease Control and PreventionHealth departments in Taiwan and Korea that investigated the outbreak.

Conclusion

AcknowledgementMaterial & Methods

Results

12/27

36 Taiwanese tourists haddiarrhea andvomiting dur-ing travel in Korea

36 Taiwanese tourists haddiarrhea andvomiting dur-ing travel in Korea

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Public health messaging to passengers ininbound flightfrom Korea

Public health messaging to passengers ininbound flightfrom Korea

E-mail communica-tion between TCDC and KCDCinitiated

Menu of Restaurant Xwas shared by KCDC.

Menu of Restaurant Xwas shared by KCDC.

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Further informa-tion

Further informa-tion

E-mail address : sih0818@cdc.gov.tw URL: http://goo.gl/jR1RWT

Outbreak of Norovirus Gastroenteritis among Overseas Group Tourists

Get the informa-tion

through social media

Get the informa-tion

through social media

Korea CDC(KCDC)

Korea CDC(KCDC)

Taiwan CDC

(TCDC)

Taiwan CDC

(TCDC)

Restaurant

X food

handler

Taiwan

Tourist

(TCDC)

Taiwan

Tourist

(KCDC)

No. of tested 2 31 12

No. of positive 2 18 10

GI

Gl.2 1

GI.8

GI.9 3

GI.12 2

GI.14 1

Other GI 1 1

GII

GII.4 1 5 5

GII.5 4

GII.6 7 2

Other GII 1

2013 2014

Case Control Odds ratio 95%CI

Water 22/28 6/7 0.6 (0.06, 6.1)

Romaine 36/57 10/13 0.5 (0.12, 2.08)

Bean curd 8/34 0/8 Undefined Undefined

Soya-bean sprout 24/54 3/9 1.6 (0.36, 7.07)

Korean Kimchi 44/56 8/13 2.3 (0.63, 8.29)

Kelp 22/27 5/6 0.9 (0.08, 9.28)

Tempura 11/28 3/6 0.6 (0.11, 3.80)

Soup 51/56 12/12 0 Undefined

Rice 52/57 10/11 1.0 (0.10,9.87)

Drinks 35/46 6/8 1.1 (0.18,6.02)

Pickled radish 12/28 3/7 1 (0.18,5.33)