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An Outbreak of Acute Gastroenteritis in a Geriatric Long-Term–Care Facility: Combined Application of Epidemiological and Molecular Diagnostic Methods

Published online by Cambridge University Press:  02 January 2015

Arthur Marx
Affiliation:
Viral Gastroenteritis Section, Respiratory and Enteric Viruses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
David K. Shay
Affiliation:
Department of Pediatrics, University of Washington, Seattle, Washington
Jacqueline S. Noel
Affiliation:
Viral Gastroenteritis Section, Respiratory and Enteric Viruses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
Carol Brage
Affiliation:
Sun Healthcare Group, Albuquerque, New Mexico
Joseph S. Bresee
Affiliation:
Viral Gastroenteritis Section, Respiratory and Enteric Viruses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
Sherry Lipsky
Affiliation:
Seattle-King County Department of Public Health, Seattle, Washington
Stephan S. Monroe
Affiliation:
Viral Gastroenteritis Section, Respiratory and Enteric Viruses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
Tamie Ando
Affiliation:
Viral Gastroenteritis Section, Respiratory and Enteric Viruses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
Charles D. Humphrey
Affiliation:
Infectious Disease Pathology Activity, Centers for Disease Control and Prevention, Atlanta, Georgia
E. Russell Alexander
Affiliation:
Seattle-King County Department of Public Health, Seattle, Washington
Roger I. Glass*
Affiliation:
Viral Gastroenteritis Section, Respiratory and Enteric Viruses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Centers for Disease Control and Prevention, Viral Gastroenteritis Section, 1600 Clifton Rd, NE, Mailstop G-04, Atlanta, GA 30333

Abstract

Objective:

To assess possible transmission modes of, and risk factors for, gastroenteritis associated with Norwalk-like viruses (NLVs) in a geriatric long-term-care facility.

Methods:

During a prolonged outbreak of acute gastroenteritis, epidemiological data on illness among residents and employees were collected in conjunction with stool, vomitus, and environmental specimens for viral testing. NLVs were identified by electron microscopy in stool and vomitus specimens, and further characterized by reverse-transcriptase polymerase chain reaction and nucleotide sequencing. Potential risk factors were examined through medical-record review, personal interview, and a self-administered questionnaire sent to all employees.

Results:

During the outbreak period, 52 (57%) of 91 residents and 34 (35%) of 90 employees developed acute gastroenteritis. Four case-residents were hospitalized; three residents died at the facility shortly after onset of illness. A point source was not identified; no association between food or water consumption and gastroenteritis was identified. A single NLV strain genetically related to Toronto virus was the only pathogen identified. Residents were at significantly higher risk of gastroenteritis if they were physically debilitated (relative risk [RR], 3.5; 95% confidence interval [CI95], 1.0-12.9), as were employees exposed to residents with acute gastroenteritis (RR, 2.6; CI95, 1.1-6.5) or ill household members (RR, 2.3; CI95, 1.4-3.6). Adherence to infection control measures among the nursing staff may have reduced the risk of gastroenteritis, but the reduction did not reach statistical significance.

Conclusions:

In the absence of evidence for food-borne or waterborne transmission, NLVs likely spread among residents and employees of a long-term-care facility through person-to-person or airborne droplet transmission. Rapid notification of local health officials, collection of clinical specimens, and institution of infection control measures are necessary if viral gastroenteritis transmission is to be limited in institutional settings

Type
Orginal Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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