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Outbreak of caliciviruses in the Singapore military, 2015
Freddy Jun Xian Neo1, Jimmy Jin Phang Loh1, Peijun Ting1
1DSO National Laboratories, 27, Medical Drive, #09-01, Singapore, 117510, Singapore.
Background:
From 31 August to 9 September 2015, a total of 150 military personnel at a military institution in Singapore were infected with acute gastroenteritis (AGE) with an attack rate of approximately 3%. This study aimed to determine the epidemiology of the outbreak, investigate its origins, and discuss measures to prevent future occurrences.
Methods:
After the AGE outbreak was declared on 31 August 2015, symptom surveys, hygiene inspections, and the testing of water, food, and stool samples were initiated. We collected 86 stool samples from AGE cases and 58 samples from food-handlers during the course of the outbreak and these stool samples were tested for 8 bacterial pathogens and 2 viral pathogens (i.e., norovirus and sapovirus).
Results:
We detected Sapovirus (SaV), group I Norovirus (NoV GI) and group II Norovirus (NoV GII) from the stool samples of AGE cases. Further sequence analyses showed that the AGE outbreak in August was caused mainly by three rarely reported calicivirus novel genotypes: NoV GI.7, NoV GII.17 and SaV GII.3. Control measures implemented focused on the escalation of personal and environmental hygiene, which included the separation of affected and unaffected soldiers, enforcement of rigorous hand-washing and hygiene, raising awareness of food and water safety, and disinfection of communal areas with bleach.
Conclusions:
This study identified both NoV and SaV as the causative agents for an AGE outbreak at a Singapore military camp in August 2015. This study is also the first to report SaV as one of the main causative agents, highlighting the importance of caliciviruses as causative agents of AGE outbreaks in the Singapore military. As there are no commercially available vaccines against caliciviruses, strict personal hygiene and proper disinfection of environmental surfaces remain crucial to prevent calicivirus outbreak and transmission.
Insights
Acute gastroenteritis (AGE) outbreaks in Singapore military camps were caused by Norovirus (NoV) and Sapovirus (SaV). Strict hygiene measures are essential for preventing future viral gastroenteritis outbreaks.
Area of Science:
- Infectious Disease Epidemiology
- Public Health Microbiology
- Viral Pathogenesis
Background:
- A significant outbreak of acute gastroenteritis (AGE) affected 150 military personnel in Singapore between August 31 and September 9, 2015.
- The outbreak had an approximate attack rate of 3%, necessitating an investigation into its origins and epidemiology.
Purpose of the Study:
- To determine the epidemiology of the AGE outbreak within the military institution.
- To identify the causative agents and origins of the outbreak.
- To recommend preventive measures against future occurrences.
Main Methods:
- Conducted symptom surveys and hygiene inspections.
- Collected and analyzed 86 stool samples from cases and 58 from food handlers.
- Tested samples for bacterial and viral pathogens, including norovirus and sapovirus.
Main Results:
- Detected Sapovirus (SaV), Norovirus GI (NoV GI), and Norovirus GII (NoV GII) in stool samples.
- Identified three rare calicivirus genotypes as the primary cause: NoV GI.7, NoV GII.17, and SaV GII.3.
- Implemented control measures focused on enhanced personal and environmental hygiene, including disinfection and soldier segregation.
Conclusions:
- Norovirus and Sapovirus were identified as the causative agents of the AGE outbreak.
- This is the first study to report Sapovirus as a primary cause of AGE outbreaks in the Singapore military.
- Emphasized the critical role of personal hygiene and environmental disinfection in preventing calicivirus transmission due to the absence of vaccines.
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