Estimating the burden of care home gastroenteritis outbreaks in England, 2014\u20132016

Thomas Inns,Natalie Adams,Sarah J O’Brien,Roberto Vivancos,John P Harris,Helen E Clough

doi:10.1186/s12879-018-3642-3

Abstract

BackgroundOutbreaks of infectious gastroenteritis in care homes are common, with norovirus a frequent cause. In England there is no co-ordinated national surveillance system. We aimed to estimate the burden of these outbreaks.MethodsUsing a generalised linear mixed effects regression model we described the relationship between the observed number of care home outbreaks and covariates. Estimated model parameters were used to infer uplift in the number of outbreaks expected if all areas were subjected to enhanced surveillance. From this we then estimated the total burden of care home gastroenteritis outbreaks in this period.ResultsWe estimated a total of 14,146 care home gastroenteritis outbreaks in England during 2014–2016; this is 47% higher than the reported total and a rate of 32.4 outbreaks per 100 care homes per year. The median number of outbreaks from the model estimates was 31 (IQR 20–46) compared to 19 (IQR 12–34) reported from routine surveillance.ConclusionsThis estimated care home gastroenteritis burden in England indicates that current surveillance substantially underestimates the number of outbreaks, by almost half. Improving this surveillance could provide better epidemiological knowledge of the burden of norovirus to inform public health policy, particularly with the advent of norovirus vaccines.

Highlights

Outbreaks of infectious gastroenteritis in care homes are common, with norovirus a frequent cause
Statistical methods We described the data by calculating the rate of reported care home gastroenteritis outbreaks per 100 care homes per year for each local authority
From our analysis, we estimate that there were a total of 14,146 care home gastroenteritis outbreaks in England during this period, a 47% increase on the reported total of 9594 outbreaks

Summary

Introduction

Outbreaks of infectious gastroenteritis in care homes are common, with norovirus a frequent cause. Norovirus is the pathogen which has been reported as being the most frequent cause of care home infectious gastroenteritis outbreaks [3]. In England, information on general outbreaks of infectious gastroenteritis in care homes has been collected since 1992 [9]. There is no co-ordinated national surveillance system to collect this information; in most of England, this information is captured locally by PHE using a health protection case management tool [11]. In certain areas of England there are enhanced surveillance systems that capture more detailed information on care home gastroenteritis outbreaks [12, 13]

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