A large-scale gastroenteritis outbreak associated with Norovirus in nursing homes

Abstract

An increase in gastroenteritis outbreaks due to Norovirus has been reported worldwide. We investigated a large-scale outbreak affecting 246 residents and 33 staff members in six nursing homes in the Tel-Aviv district, Israel, during 3 weeks in 2002. Person-to-person spread was noticed in all nursing homes. The spread of disease could not be attributed to social interactions. Among the elderly residents, the hospitalization rate was 10.2% and the case-fatality rate was 2.0%. Bacteriological cultures were negative. Overall, 7 out of 15 stool specimens were positive for Norovirus by RT-PCR. All were sequenced and found to be 90% identical. The characteristics of this outbreak and the RT-PCR results suggest that illness was caused by Norovirus. Due to the high case-fatality rate of Norovirus gastroenteritis, there should be a high index of suspicion when encountering a gastroenteritis outbreak among the elderly. This will enable prompt action to stop the spread of illness.

Norovirus-Ausbruch in einem Altenheim und Krankenhaus in Österreich

“…Outbreaks occur frequently during the winter months ("winter vomiting") and often affect closed and semi-closed settings such as residential homes, nursing homes, staff accommodation and hospitals. Outbreaks in healthcare facilities and care institutions for the elderly can have significant effects, with major impact on the care of patients or the elderly and on finances [1][2][3].…”

Mapping Broadly Reactive Norovirus Genogroup I and II Monoclonal Antibodies

“…In the United States, NoVs cause 19 to 21 million cases each year (4,5). NoV outbreaks have been identified in children (6), the elderly (7), military personnel (8,9), immunocompromised individuals (10), restaurant patrons (11,12), travelers to developing countries (13,14), passengers of cruise ships (15), residents of health care facilities such as nursing homes (16,17) and hospitals (18), and other populations housed in close quarters (19). The increasing incidence of NoV infections emphasizes the need to quickly detect and identify the causative agent, because early diagnosis of NoV infection can be crucial in the effective control of outbreaks and can decrease the secondary attack rate (20).…”

Diagnostic Accuracy and Analytical Sensitivity of IDEIA Norovirus Assay for Routine Screening of Human Norovirus

“…Major factors for the public health impact of NoVs include: (i) great strain diversity (five genogroups [GI to -V] and 32 genotypes) (33,52,53), (ii) low infectious dose (as low as 18 particles) (46), (iii) prolonged asymptomatic shedding (3), (iv) environmental stability (10), and (v) the lack of long-term immunity (38,46). NoV outbreaks often occur in semiclosed environments that favor person-to-person transmission, including long-term care facilities, cruise ships, prisons, hospitals, and recreational facilities (6,9,20,23,24,36,41,45,49).…”