# Epidemiologic Trends, Genetic Diversity, and Risk Factors of Norovirus Outbreaks in Beijing, China, 2016−2022

## TL;DR

Norovirus outbreaks in Beijing, China, from 2016 to 2022 were most common in schools, with specific genotypes dominating over time and outbreak size linked to transmission routes and delayed responses.

## Contribution

The study identifies trends in norovirus genotypes and risk factors for outbreak scale in Beijing, China, from 2016 to 2022.

## Key findings

- GII.2[P16] was the dominant norovirus genotype from 2016–2021, and GII.3[P12] from 2021–2022.
- Outbreaks in higher-level schools had larger case numbers but lower attack rates compared to lower-level schools.
- Foodborne and waterborne outbreaks were larger in scale than person-to-person transmission outbreaks.

## Abstract

Norovirus is the leading cause of acute gastroenteritis outbreaks worldwide. A total of 1859 norovirus outbreaks were reported from 2016 to 2022 in Beijing, China. GII.2[P16] was the predominant genotype during 2016–2021, and GII.3[P12] during 2021–2022. In the early stage of the COVID-19 epidemic (January to June of 2020), strict prevention and control measures were implemented, and only eight norovirus outbreaks were reported. Most norovirus outbreaks occurred in schools (95.6%, 1778). As the level of schooling rises, the scale of norovirus outbreaks also increases (median case numbers: 8 for kindergarten, 10 for primary school, 11 for secondary school, and 14 for college; p trend < 0.001), while the attack rate decreases (median attack rates were correspondingly 25.8%, 17.5%, 10.0%, and 8.8%; p trend < 0.001). Compared to outbreaks caused by person-to-person transmission, foodborne and waterborne outbreaks are larger in scale. Delayed outbreak response is also a risk factor for larger-scale outbreaks. Norovirus outbreaks have emerged as a significant concern for public health in Beijing. Persistent genotyping efforts are essential to facilitate early warning. Outbreaks in different locations or through different transmission routes require specific prevention and control measures.