Abstract
BackgroundTwo parallel gastroenteritis outbreaks occurred in an elementary school and a neighboring kindergarten in Kilkis, Northern Greece in 2012. The aim of the study was the investigation of these two parallel outbreaks as well as their possible source.MethodsTwo retrospective cohort studies were performed to identify the mode and the vehicle of transmission as well as the possible connection between them.ResultsElementary school and kindergarten populations of 79.9% (119/149) and 51.1% (23/45) respectively, participated in the study. Case definition was satisfied by 65 pupils from the elementary school and 14 from the kindergarten. For elementary school, 53 cases were considered primary cases of the outbreak and were included in the analysis. Based on the results of the multivariate analysis, consumption of tap water was the only statistically significant independent risk factor of gastroenteritis (RR = 2.34, 95% C.I.: 1.55-3.53).; a finding supported by the shape of the epidemic curve which referred to a common point source outbreak with secondary cases. For kindergarten, no statistically significant risk factor was identified, and the epidemic curve supported a person-to-person transmission according univariate analysis. Norovirus GI and GII and human Adenovirus were detected by Real Time PCR in stool samples from seven children of elementary school, but stool samples were not collected by children of the kindergarten.ConclusionsEven though the etiological agent of the outbreak was not verified, combined epidemiological and laboratory results were in favor of a waterborne viral gastroenteritis outbreak at the elementary school, followed by a person to person spread at the kindergarten.
Highlights
Two parallel gastroenteritis outbreaks occurred in an elementary school and a neighboring kindergarten in Kilkis, Northern Greece in 2012
Even though the etiological agent of the outbreak was not verified, combined epidemiological and laboratory results were in favor of a waterborne viral gastroenteritis outbreak at the elementary school, followed by a person to person spread at the kindergarten
Epidemiological investigation Elementary school The elementary school population comprised of 149 people, 130 of which were pupils, 18 members of the teaching staff and one was a cleaning staff member
Summary
Two parallel gastroenteritis outbreaks occurred in an elementary school and a neighboring kindergarten in Kilkis, Northern Greece in 2012. Viral gastroenteritis is a major health problem worldwide. Viruses cause both seasonal acute gastroenteritis and occasional outbreaks associated with the consumption of contaminated food or water [1]. These outbreaks involve a number of high-risk groups, young children, the elderly and immunocompromised patients [2,3,4,5,6]; they are frequent in semi-enclosed environments, such as school settings due to the increased number of people and the increased personal contacts among them. On 16 January 2012, HCDCP was informed on an increased number of pupils with gastroenteritis at an elementary school of Nea Santa Kilkis, a village with 1,538
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