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An Outbreak of Diarrhea in a Neonatal Medium Care Unit Caused by a Novel Strain of Rotavirus: Investigation Using Both Epidemiologic and Microbiological Methods

Published online by Cambridge University Press:  02 January 2015

Marc-Alain Widdowson
Affiliation:
European Programme for Intervention Epidemiology and Training, Amsterdam, the Netherlands National Institute for Public Health and Environment (RIVM), Bilthoven, Amsterdam, the Netherlands
Gerard J.J. van Doornum
Affiliation:
Slotervaart Hospital, Amsterdam, the Netherlands
Wim H.M. van der Poel
Affiliation:
National Institute for Public Health and Environment (RIVM), Bilthoven, Amsterdam, the Netherlands
Annette S. de Boer
Affiliation:
National Institute for Public Health and Environment (RIVM), Bilthoven, Amsterdam, the Netherlands
Reina van de Heide
Affiliation:
National Institute for Public Health and Environment (RIVM), Bilthoven, Amsterdam, the Netherlands
Ulrike Mahdi
Affiliation:
Slotervaart Hospital, Amsterdam, the Netherlands
Paul Haanen
Affiliation:
Slotervaart Hospital, Amsterdam, the Netherlands
Jacob L. Kool
Affiliation:
National Institute for Public Health and Environment (RIVM), Bilthoven, Amsterdam, the Netherlands
Marion Koopmans
Affiliation:
National Institute for Public Health and Environment (RIVM), Bilthoven, Amsterdam, the Netherlands

Abstract

Objective:

In December 1999, an outbreak of diarrhea was reported in a general hospital neonatal medium care unit (NMCU) caused by a novel strain of rotavirus with genotype P[6], G9. An investigation was conducted to determine risk factors for illness among neonates.

Design:

Rotavirus diagnosis was by latex agglutination and typing by reverse transcriptase polymerase chain reaction. A case-control study was performed using data collected from medical records on exposures in a 3-day period before illness (cases) or a random 3-day period (controls). Environmental swabs were tested for rotavirus. Antenatal blood samples from mothers and blood samples provided by hospital staff were analyzed for rotavirus antibodies.

Results:

Fifty-six cases of rotaviral illness were confirmed by latex agglutination. Forty-seven of these were among 118 neonates exposed to the NMCU (attack rate, 40%). There was a 4-week period with no clinical cases in the course of the outbreak. Increased frequency (s≥ 15 times in 3 days) of ungloved nasogastric feeding was a significant risk factor (adjusted odds ratio, 8.79), controlling for birth weight and gestational age. Environmental sampling showed persistence of the virus on ward surfaces despite cleaning. None of 24 NMCU staff members had high levels of antibodies against P[6], G9. Three (8%) of 38 mothers had high antibody levels; 2 had infants who became ill. The outbreak ended with a 7-day ward closure, disinfection, and introduction of gloved nasogastric feeding.

Conclusions:

Case-control studies can be successful in identifying risk factors for nosocomial outbreaks of diarrhea. High levels of rotavirus antibodies in mothers may not protect infants. The environment may be the most important reservoir of rotavirus during outbreaks.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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References

1.Kapikian, AZ. Viral gastroenteritis. In: Evans, AS, Kaslow, RA eds. Viral Infections of Humans: Epidemiology and Control, 4th ed. New York: Plenum; 1997:285343.CrossRefGoogle Scholar
2.Institute of Medicine. Prospects for Immunizing Against Rotavirus: New Vaccine Development, Establishing Priorities. Washington, DC: National Academy Press; 1985:410423.Google Scholar
3.Kapikian, AZ, Chanock, RM. Rotaviruses. In: Fields, BN, Knipe, DM, Howley, PM, et al, eds. Fields Virology, 3rd ed. Philadelphia: LippincottRaven; 1996:16571708.Google Scholar
4.Bhan, MK, Lew, JF, Sazawal, S, Das, BK, Gentsch, JR, Glass, RI. Protection conferred by neonatal rotavirus infection against subsequent diarrhea. J Infect Dis 1993;168:282287.CrossRefGoogle ScholarPubMed
5.Bishop, RF, Barnes, GL, Cipriani, E, Lund, JS. Clinical immunity after neonatal rotavirus infection: a prospective longitudinal study in young children. N Engl J Med 1983;309:7276.CrossRefGoogle Scholar
6.Cicirello, HG, Das, BK, Gupta, Aet al. High prevalence of rotavirus infection among neonates born at hospitals in Delhi, India: predisposition of newborns for infection with unusual rotavirus. Pediatr Infect Dis J 1994;13:720724.CrossRefGoogle Scholar
7.Rao, GG. Control of outbreaks of viral diarrhoea in hospitals: a practical approach. J Hosp Infect 1995;30:16.CrossRefGoogle ScholarPubMed
8.Gerna, G, Forster, J, Parea, M, et al. Nosocomial outbreak of neonatal gastroenteritis caused by a new serotype 4, subtype 4B human rotavirus. J Med Virol 1990;31:175182.CrossRefGoogle ScholarPubMed
9.Rotbart, HA, Nelson, WL, Glode, MP, et al. Neonatal rotavirus-associated necrotizing enterocolitis: case control study and prospective surveillance during an outbreak. J Pediatr 1988;112:8793.CrossRefGoogle ScholarPubMed
10.Ramachandran, M, Gentsch, JR, Parashar, UD, et al. Detection and characterization of novel rotavirus strains in the United States. J Clin Microbiol 1998;36:32233229.Google ScholarPubMed
11.Widdowson, M-A, Van Doornum, GJ, Van der Poel, WHM, de Boer, AS, Mahdi, U, Koopmans, M. Emerging group A rotavirus and a nosocomial outbreak of diarrhoea. Lancet 2000;356:11611162.CrossRefGoogle Scholar
12.Gouvea, V, Glass, RI, Woods, P, et al. Polymerase chain reaction amplification and typing of rotavirus nucleic acid from stool specimens. J Clin Microbiol 1990;28:276282.Google ScholarPubMed
13.Gentsch, JR, Glass, RI, Woods, P, et al. Identification of group A rotavirus gene 4 types by polymerase chain reaction. J Clin Microbiol 1992;30:13651373.Google Scholar
14.Beards, GM, Pilford, JN, Thouless, ME, Flewett, TH. Rotavirus serotypes by serum neutralisation. J Med Virol 1980;5:231237.CrossRefGoogle ScholarPubMed
15.Chiba, S, Yokoyama, T, Nakata, S, et al. Protective effect of naturally acquired homotypic and heterotypic rotavirus antibodies. Lancet 1986;2:417421.CrossRefGoogle ScholarPubMed
16.Boom, R, Sol, CJA, Salimans, MMM, Jansen, CL, Wertheim-Van Dillen, PME, Van Der Noordaa, J. Rapid and simple method for purification of nucleic acids. J Clin Microbiol 1990;28:495503.Google ScholarPubMed
17.Abad, FX, Pinto, RM, Bosch, A. Survival of enteric viruses on environmental fomites. Appl Environ Microbiol 1994;60:37043710.Google ScholarPubMed
18.Bellamy, K, Alcock, R, Babb, JR, Davies, JG, Ayliffe, GA. A test for the assessment of ‘hygienic’ hand disinfection using rotavirus. J Hosp Infect 1993;24:201210.CrossRefGoogle ScholarPubMed
19.Ward, RL, Bernstein, DI, Young, EC, Sherwood, JR. Knowlton, DR, Schiff, GM. Human rotavirus studies in volunteers: determination of infectious dose and serologic response to infection. J Infect Dis 1986;154:871880.CrossRefGoogle Scholar
20.Glass, RI, Stall, BJ, Wyatt, RG, Hoshino, Y, Banu, H, Kapikian, AZ. Observations questioning a protective role for breast-feeding in severe rotavirus diarrhea. Acta Paediatr Scand 1986;75:713718.CrossRefGoogle ScholarPubMed
21.Chrystie, IL, Totterdell, B, Baker, MJ, Scopea, JW, Banatvala, JE. Rotavirus infections in a maternity unit. Lancet 1975;12:79.CrossRefGoogle Scholar
22.Clemens, J, Rao, M, Ahmed, F, et al. Breast-feeding and the risk of life-threatening rotavirus diarrhea: prevention or postponement? Pediatrics 1993;92:680685.Google ScholarPubMed
23.Newman, RD, Grupp-Phelan, J, Shay, DK, Davis, RL. Perinatal risk factors for infant hospitalization with viral gastroenteritis. Pediatrics 1999;103:e3.CrossRefGoogle ScholarPubMed
24.Bon, F, Fromantin, C, Aho, S, Pothier, P, Kohli, E. G and P genotyping of rotavirus strains circulating in France over a three-year period: detection of G9 and P[6] strains at low frequencies. J Clin Microbiol 2000; 38:16811683.Google Scholar
25.Cubitt, WD, Steele, AD, Iturriza, M. Characterisation of rotaviruses from children treated at a London hospital during 1996: emergence of strains G9P2A[6] and G3P2A[6]. J Med Virol 2000;61:150154.3.0.CO;2-W>CrossRefGoogle Scholar
26.Unicomb, LE, Podder, G, Gentsch, JR, et al. Evidence of high-frequency genomic reassortment of group A rotavirus strains in Bangladesh: emergence of type G9 in 1995. J Clin Microbiol 1999;37:18851891.Google Scholar

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