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An Outbreak of Acute Nonbacterial Gastroenteritis in a Nursing Home

Published online by Cambridge University Press:  21 June 2016

David A. Pegues  and
Charles H. Woernle
David A. Pegues
Affiliation:
Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia, Alabama Department of Public Health, Atlanta, Georgia
Charles H. Woernle*
Affiliation:
Division of Epidemiology, Alabama Department of Public Health, Montgomery Alabama, Atlanta, Georgia
*
Alabama Dept. of Public Health, Div. of Epidemiology, 434 Monroe St., Montgomery Alabama 36130-l 701
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Abstract

Objective:

To determine risk factors for and modes of transmission of an outbreak of acute nonbacterial gastroenteritis among residents and staff in a nursing home.

Design:

Cohort study of residents and questionnaire survey of employees.

Setting:

One hundred twenty-bed nursing home in Alabama.

Patients:

From July 11,1991, through July 25,1991,77 of 120 residents (attack rate = 64%) and at least 14 of 49 employees (minimum attack rate = 29%) developed acute gastroenteritis characterized by vomiting and diarrhea; few residents developed fever > 100°F. Nine residents required intravenous rehydration, and 2 residents died.

Results:

The risk of developing illness was greater for female residents (64/92 versus 13/28; relative risk [RR] = 1.5; 95% confidence interval [CI95 ]=1.0-2.3) and for employees who reported handling residents' soiled linen, stools, or vomitus more frequently (>5 times a shift versus = 5 times a shift: 7/13 versus 7/31; RR=2.4; CI95 = 1.1-5.4). Direct transmission of infection, probably via person-to-person spread, sustained the outbreak. Temporal clustering analysis demonstrated that the risk of becoming ill 1 or 2 days after a roommate became ill was significantly greater than that of becoming ill at other times during the outbreak (RR= 2.2; CI95 = 1.3-3.8). No Salmonella or Shigella species, ova, or parasites were identified from 12 fecal specimens obtained from ill residents.

Conclusions:

Although stool and serum specimens were not available for viral studies, the clinical symptoms and incubation period were consistent with illness due to Norwalk-like viral agents. This outbreak emphasizes the severity of acute nonbacterial gastroenteritis among elderly and debilitated residents of nursing homes and the need for prompt use of enteric precautions in controlling outbreaks of gastroenteritis in these facilities.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 14 , Issue 2 , February 1993 , pp. 87 - 94
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1993

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References

1. National Center for Health Statistics. Nursing home characteristics 1986: inventory of long-term care places. Vital Health Stat 14 1989; No. 33. US Dept of Health and Human Services publication PHS 891828.Google Scholar
2. Kaplan, JE, Schonberger, LB, Varano, G, et al. An outbreak of acute nonbacterial gastroenteritis in a nursing home: demonstration of person-to-person transmission by temporal clustering of cases. Am J Epidemiol. 1982;116:940–948.CrossRefGoogle Scholar
3. Gordon, SM, Oshiro, LS, Jarvis, WR, et al. Foodborne snow mountain agent gastroenteritis with secondary person-to-person spread in a retirement community Am J Epidemiol. 1990:131:702–710.CrossRefGoogle Scholar
4. Levine, WC, Smart, JF, Archer, DL, et al. Foodbome disease outbreaks in nursing homes, 1975 through 1987. JAMA. 1991;226:2105–2119.CrossRefGoogle Scholar
5. Gellert, GA, Waterman, SH, Ewert, D, et al. An outbreak of acute gastroenteritis caused by a small round structured virus in a geriatric convalescent facility. Infect Control Hosp Epidemiol. 1990;11:459–464.CrossRefGoogle Scholar
6. Viral agents of gastroenteritis. MMWR. 1990;39:1–21.Google Scholar
7. Blacklow, NR, Greenberg, HB. Viral gastroenteritis. N Engl J Med 1991;325:252–264.CrossRefGoogle ScholarPubMed
8. Kaplan, JE, Feldman, R, Campbell, DS, et al. The frequency of a Norwalk-like pattern of illness in outbreaks of acute gastroenteritis. Am J Pub Health. 1982;66:1329–1332.CrossRefGoogle Scholar
9. Kaplan, JE, Gary, GW, Baron, RC, et al. Epidemiology of Norwalk gastroenteritis and the role of Norwalk virus in outbreaks of acute nonbacterial gastroenteritis. Ann Intern Med. 1982;96:756–761.CrossRefGoogle ScholarPubMed
10. Lew, JF, Glass, RI, Gangarossa, RE, et al. Diarrhea1 deaths in the United States, 1979 through 1987: a special problem for the elderly. JAMA. 1991;265:3280–3284.CrossRefGoogle ScholarPubMed
11. Greenberg, HB, Valdesuso, J, Yolken, RH, et al. Role of Norwalk virus in outbreaks of nonbacterial gastroenteritis. J Infect Dis. 1979;139:564–568.CrossRefGoogle ScholarPubMed
12. Warner, RD, Carr, RW, McCleskey, FK, et al. A large nontypical outbreak of Norwalk virus gastroenteritis associated with exposing celery to nonpotable water and with Citrobacter freundii . Arch Intern Med. 1991;151:2419–2424.CrossRefGoogle ScholarPubMed
13. Kurisky, JN, Osterholm, MT, Greenberg, HB, et al. Norwalk gastroenteritis: a community outbreak associated with bakery product consumption. Ann intern Med. 1984;100:519–521.CrossRefGoogle Scholar
14. Cubitt, WD, Pead, PJ, Saeed, AA A new serotype of calcivirus associated with an outbreak of gastroenteritis in a residential home for the elderly. J Clin Pathol. 1980;33:306–308.CrossRefGoogle Scholar
15. Gamer, JS, Simmons, BP Guidelines for isolation precautions in hospitals. Infect Control. 1983;4:245–325.Google Scholar
16. Swayer, LA, Murphy, JJ, Kaplan, JE, et al. 25- to 30-nm virus particle associate with a hospital outbreak of acute gastroenteritis with evidence for airborne transmission. Am J Epidemiol. 1988;127:1261–1271.CrossRefGoogle Scholar
17. Ho, M-S, Glass, RI, Monroe, SS, et al. Viral gastroenteritis aboard a cruise ship. Lancet. 1989:ii:961–965.CrossRefGoogle Scholar
18. CDC. Guideline for handwashing and hospital environmental control, 1985. Infect Control. 1986;7:231–242.CrossRefGoogle Scholar
19. Recommendations for collection of laboratory specimens associated with outbreaks of gastroenteritis. MMWR. 1990;39:1–13.Google Scholar