Author: Gerber, Susan I; Cortese, Margaret M; Bowen, Michael D
Date published: October 28, 2011
In February 2011, three residents of a retirement community in Illinois were hospitalized for acute gastroenteritis. The admitting physicians ordered testing of stool specimens for several pathogens, including rotavirus. The hospital laboratory detected rotavirus antigen in specimens from each patient, and the hospital infection control practitioner reported that information to the Cook County Department of Public Health. Two additional residents were hospitalized for rotavirus gastroenteritis shortly thereafter. The health department sent stool specimens from the five patients to CDC for testing for rotavirus and norovirus. Rotavirus was detected in each specimen; norovirus was not detected. During a subsequent investigation, all available residents were queried regarding recent diarrheal symptoms. Preliminary data indicated that 22% of residents had confirmed or probable rotavirus disease and 10 residents were hospitalized. In May 2011, another outbreak of rotavirus gastroenteritis was detected at a second retirement community in the county. On preliminary analysis, the overall attack rate in the second retirement community was 11%, and 20 residents were hospitalized. No deaths were identified in either outbreak. Based on preliminary results of the investigations and general knowledge of rotavirus transmission, within each community, rotavirus likely was transmitted from person to person via contaminated hands or fomites (e.g., environmental surfaces). The outbreaks lasted >4 weeks.
Rotavirus is well recognized as a major cause of severe gastroenteritis in young children. Rotavirus also can cause gastroenteritis in adults (1), but estimates of the disease burden are imprecise because rotavirus testing of adults rarely is performed. The extent to which rotavirus outbreaks occur among elderly adults in residential facilities (e.g., retirement communities and assisted living facilities) in the United States (2,3) also is unknown because rotavirus testing usually is not performed during outbreak investigations of diarrheal disease in these settings and rotavirus outbreaks are not nationally reportable. Norovirus, however, frequently has been reported as a cause of diarrhea outbreaks among elderly persons in assisted living or long-term-care facilities. From 1998 to 2000, CDC screened specimens from 263 gastroenteritis outbreaks (not restricted to outbreaks among elderly adults). Specimens from all but 32 (12%) of those outbreaks tested positive for norovirus, and rotavirus was identified as the causative agent in three of the remaining 32 outbreaks (1% of the overall 263 outbreaks) (3).
Health professionals who care for elderly persons in residential facilities or who investigate diarrheal disease outbreaks should consider rotavirus as a possible cause of acute diarrhea, especially during the months when rotavirus circulates (usually January to June). If an outbreak of rotavirus gastroenteritis is identified, good hand hygiene practices among residents and staff members should be reinforced. Environmental surfaces should be disinfected using a freshly made solution of 1 part household bleach to 2 parts water (providing approximately 20,000 ppm of free chlorine) or another product that has confirmed virucidal activity against rotavirus (4,5). Surfaces visibly contaminated with fecal material should be cleaned to remove the material and then disinfected. CDC is gathering information about rotavirus outbreaks among elderly adults in residential facilities. State and local public health agencies involved in these investigations of suspected or confirmed rotavirus outbreaks are encouraged to contact the CDCs Division of Viral Diseases at 404-639-8253.
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2. Edmonson LM, Ebbert JO, Evans JM. Report of a rotavirus outbreak in an adult nursing home population. J Am Med Dir Assoc 2000; 1:175-9.
3. Griffin DD, Fletcher M, Levy ME, et al. Outbreaks of adult gastroenteritis traced to a single genotype of rotavirus. J Infect Dis 2002; 185: 1 502-5.
4. Rao GG. Control of outbreaks in viral diarrhoea in hospitals - a practical approach. J Hosp Infect 1995;30:1-6.
5. Springthorpe VS, Grenier JL, Lloyd-Evans N, Sattar SA. Chemical disinfection of human rotaviruses: efficacy of commercially available products in suspension tests. J Hyg (Lond) 1986;97:139-61.
Susan I. Gerber, MD, Cook County Dept of Public Health. Margaret M. Cortese, MD, Michael D. Bowen, PhD, Div of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC Corresponding contributor: Margaret M. Cortese, email@example.com, 404-639-1929.