An objective law was observed that naive case fatality rates (CFRs) of a disease will decrease early and then gradually increase infinitely near the true CFR as time went on during an outbreak. The normal growth of naive CFR was an inherent character rather than indicating the disease was becoming more severe. According to the law, by monitoring real-time naive CFRs, it can help outbreak-controllers know if there were many cases left unconfirmed or undiscovered in the outbreak. We reflected on the use of the naive CFR in the context of COVID-19 outbreaks. The results showed that Hubei Province of China, France and South Korea had cases that were not confirmed in a timely manner during the initial stages of the outbreak. Delayed case confirmations existed for long periods of time in France, Italy, the United Kingdom, the Netherlands and Spain. Monitoring of real-time naive CFRs could be helpful for decision-makers to identify under-reporting of cases during pandemics.

ABSTRACT The full-length genome sequence of a human enterovirus 71 (EV71) strain (EV71/CZTN01/CHN/2017) was isolated from a throat swab from a child in Changzhou, China, in 2017. According to the phylogenetic analyses, the full-genome sequence in this study belongs to sub-subgenotype C4a.

Background: Studies about asymptomatic norovirus infections have been frequently reported. We aim to assess the global prevalence of asymptomatic infections. Method: We identified publications that included the proportion of asymptomatic norovirus infections by searching in PubMed, Ovid, Scopus, and Web of Science and by screening references from the articles reviewed. The principal summary data were the prevalence of asymptomatic norovirus infection. Random-effect models for meta-analysis were fitted to generate estimates of overall and subgroup prevalence. Findings: Of 81 studies included, asymptomatic norovirus prevalence was estimated at 7% (95% CI: 6%-9%). Africa, Meso America and South America had higher prevalence (15%, 14%, 11%, respectively) while the prevalence in Europe and North America was lower (4%). Prevalence was similar between community and hospital (9%). Prevalence was higher in children (8%) than adults (4%). For food handlers, prevalence was estimated at 3%. In context of outbreaks, prevalence estimated from 15 studies was as high as 18% (95% CI: 10%-30%). Interpretation: This knowledge could have an impact on the development of transmission prevention strategies in the future. The high prevalence indicated asymptomatic individuals must not be overlooked. Outstanding questions: The high prevalence indicated asymptomatic individuals must not be overlooked. Asymptomatic individuals may play an important role in norovirus transmission. This knowledge could have an impact on the development of transmission prevention strategies. (C) 2018 Published by Elsevier Ltd.

We describe the epidemiology of 2 outbreaks of norovirus (GII) gastroenteritis in elementary schools in a city in eastern China using data from field investigations, pathogen testing, and face-to-face interviews. The transmission shows a point source type. In a case-control study, we identified airborne and person-to-person transmission as the source of the outbreaks.