An Outbreak of Acute Nonbacterial Gastroenteritis in a Nursing Home

Kaplan, Jonathan E.; Schonberger, Lawrence B.; Varano, Gianluca Maria; Jackman, N.; Bied, J; Gary, G. William

doi:10.1093/oxfordjournals.aje.a113496

Cited by 100 publications

(16 citation statements)

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“…Consistent with previous studies, [35][36][37][38] diarrhea was defined as having two or more loose stools or a loose stool containing blood or mucus in a given day. Longitudinal prevalence of diarrhea was calculated by dividing the total number of diarrhea-days (numerator) by the total number of days of follow-up per child (denominator).…”

Section: Methodsmentioning

confidence: 87%

Modeling Risk Categories to Predict the Longitudinal Prevalence of Childhood Diarrhea in Indonesia

Sima¹,

Ng²,

Elimelech³

2013

The American Society of Tropical Medicine and Hygiene

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Abstract. We present an innovative approach for analyzing diarrheal prevalence data that uses latent variables to model the relationships between multiple, interdependent environmental risk factors, and socioeconomic mediators. This strategy was applied to elucidate diarrheal longitudinal prevalence risk factors in children 1-4 years of age in lowincome areas of Jakarta, Indonesia. Through a prospective cohort study, we identified 257 children who had at least one episode of diarrhea. At the onset of the study, we collected responses to 44 indicators, covering a wide range of previously identified diarrhea risk factors, including demographic and socioeconomic factors. We used exploratory factor analysis to uncover four latent categories of risk factors and their respective indicators from the initial pool of 44 indicators. Thereafter, we used structural equation modeling to model the relationships between the four risk categories and diarrheal longitudinal prevalence, controlling for socioeconomic and demographic covariates. Our final model elucidated several pathways to longitudinal diarrheal prevalence. Most notably, poverty exerts its effect on increased diarrheal prevalence via dual pathways: poor household hygiene and food quality, controlling for covariates. Implications of this and other findings for disease control in Jakarta are discussed.

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Section: Methodsmentioning

confidence: 87%

Modeling Risk Categories to Predict the Longitudinal Prevalence of Childhood Diarrhea in Indonesia

Sima¹,

Ng²,

Elimelech³

2013

The American Society of Tropical Medicine and Hygiene

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“…However, 20 (65%) of 31 Norwalk virus outbreaks in the United States from 1967 through 1980 (reviewed by Kaplan et al [69]) occurred during the spring (April through June) or fall (October through December) (69) (71). In a second outbreak, 55% of residents and 25% of staff in a geriatric convalescent facility became ill during an outbreak that persisted for 9 weeks.…”

Section: Methods For Norwalk-like Virusesmentioning

confidence: 99%

Outbreaks of food-borne and waterborne viral gastroenteritis

1993

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Norwalk virus infection is the epidemiologic prototype for outbreaks of food-borne and waterborne gastroenteritis. Around the world, Norwalk virus and Norwalk-like viruses appear to be major causes of food-borne and waterborne illness. Assessment of the overall significance of viral agents to the epidemiology of food-borne and waterborne illness is hampered by the lack of surveillance throughout much of the world. In areas where food-borne and waterborne illness surveillance is conducted, outbreaks of viral gastroenteritis are underreported because of the lack of availability of routine laboratory services to confirm the viral etiology. Routine use of epidemiologic criteria as an alternative to laboratory confirmation will allow better assessments of the importance of viral gastroenteritis until effective laboratory methods can be widely implemented. Outbreaks of viral gastroenteritis have been propagated by contamination of water supplies, raw foods, and ill food handlers. Controlling an outbreak depends on identifying and removing the source of contamination. The demonstrated occurrence of person-to-person transmission and the likely occurrence of transmission of Norwalk-like viruses by aerosol make it necessary to evaluate the potential for transmission by food handlers and servers in every outbreak, regardless of primary source.

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“…Their infectious dose is low [3]. The main mode of transmission is person-to-person [4], either faecal-orally or through aerosolised vomit. Indirect transmission via contaminated food, water, or environmental surfaces may also occur [5].…”

Section: Introductionmentioning

confidence: 99%

Food-borne norovirus-outbreak at a military base, Germany, 2009

et al. 2010

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BackgroundNorovirus is often transmitted from person-to-person. Transmission may also be food-borne, but only few norovirus outbreak investigations have identified food items as likely vehicles of norovirus transmission through an analytical epidemiological study.During 7-9 January, 2009, 36 persons at a military base in Germany fell ill with acute gastroenteritis. Food from the military base's canteen was suspected as vehicle of infection, norovirus as the pathogen causing the illnesses. An investigation was initiated to describe the outbreak's extent, to verify the pathogen, and to identify modes of transmission and source of infection to prevent further cases.MethodsFor descriptive analysis, ill persons were defined as members of the military base with acute onset of diarrhoea or vomiting between 24 December 2008, and 3 February 2009, without detection of a pathogen other than norovirus in stools. We conducted a retrospective cohort study within the headquarters company. Cases were military base members with onset of diarrhoea or vomiting during 5-9 January. We collected information on demographics, food items eaten at the canteen and contact to ill persons or vomit, using a self-administered questionnaire. We compared attack rates (AR) in exposed and unexposed persons, using bivariable and multivariable logistic regression modelling. Stool specimens of ill persons and canteen employees, canteen food served during 5-7 January and environmental swabs were investigated by laboratory analysis.ResultsOverall, 101/815 (AR 12.4%) persons fell ill between 24 December 2008 and 3 February 2009. None were canteen employees. Most persons (n = 49) had disease onset during 7-9 January. Ill persons were a median of 22 years old, 92.9% were male. The response for the cohort study was 178/274 (72.1%). Of 27 cases (AR 15.2%), 25 had eaten at the canteen and 21 had consumed salad. Salad consumption on 6 January (aOR: 8.1; 95%CI: 1.5-45.4) and 7 January (aOR: 15.7; 95%CI: 2.2-74.1) were independently associated with increased risk of disease.Norovirus was detected in 8/28 ill persons' and 4/25 canteen employees' stools, 6/55 environmental swabs and 0/33 food items. Sequences were identical in environmental and stool samples (subtype II.4 2006b), except for those of canteen employees. Control measures comprised cohort isolation of symptomatic persons, exclusion of norovirus-positive canteen employees from work and disinfection of the canteen's kitchen.ConclusionsOur investigation indicated that consumption of norovirus-contaminated salad caused the peak of the outbreak on 7-9 January. Strict personal hygiene and proper disinfection of environmental surfaces remain crucial to prevent norovirus transmission.

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An Outbreak of Acute Nonbacterial Gastroenteritis in a Nursing Home

Cited by 100 publications

References 0 publications

Modeling Risk Categories to Predict the Longitudinal Prevalence of Childhood Diarrhea in Indonesia

Modeling Risk Categories to Predict the Longitudinal Prevalence of Childhood Diarrhea in Indonesia

Outbreaks of food-borne and waterborne viral gastroenteritis

Food-borne norovirus-outbreak at a military base, Germany, 2009

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