Viral Etiology of Diarrhea Outbreaks in Child Care Centers

Abstract

Infectious Diseases| May 01 2009 Viral Etiology of Diarrhea Outbreaks in Child Care Centers AAP Grand Rounds (2009) 21 (5): 55. https://doi.org/10.1542/gr.21-5-55 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Viral Etiology of Diarrhea Outbreaks in Child Care Centers. AAP Grand Rounds May 2009; 21 (5): 55. https://doi.org/10.1542/gr.21-5-55 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: child day care centers, diarrhea, disease outbreaks, stool specimen Source: Lyman WH, Walsh JF, Kotch JB, et al. Prospective study of etiologic agents of acute gastroenteritis outbreaks in child care centers. J Pediatr. 2009;154(2):253–257; doi:10.1016/j.jpeds.2008.07.057 Investigators from the University of North Carolina-Chapel Hill and the Centers for Disease Control in Atlanta prospectively studied the etiology of outbreaks of acute viral gastroenteritis (AGE) in North Carolina child care centers (CCC) between October 2005 and March 2007. AGE was defined as at least two episodes of diarrhea within 24 hours and an outbreak was defined as two or more children with diarrhea in the same classroom on the same day. The etiology of a confirmed outbreak was defined as at least two positive fecal specimens for the same virus, or if multiple viruses were identified, at least two environmental samples testing positive for the same virus as that detected in the fecal sample. Outbreak information and clinical and environmental specimens were collected from child care health consultants, county health departments, and the North Carolina State Laboratory for Public Health. Stool samples were screened for rotavirus, astrovirus, adenovirus, and two calicviruses, norovirus and sapovirus, using both real-time reverse transcription-polymerase chain reaction (RT-PCR) and PCR. RT-PCR was used for genotyping. If no viral cause was identified, bacterial cultures were performed for Yersinia, Salmonella, Shigella, and Campylobacter. Fifty-three of the 94 statewide health consultants participated in the first season and 41 in the second. Twenty-nine outbreaks were identified, 23 between October and May in the first season (2005–2006), and six between November and mid-March in the second season (2006–2007). Seventy-seven fecal specimens were collected (mean 2.7 samples per outbreak). Sixty percent of the children were 12 to 36 months of age and 36% were <12 months of age. A single virus was determined to be the etiology for 13 (45%) outbreaks (rotavirus in five, astrovirus and norovirus each in three, and sapovirus in two). Of these, three had multiple viruses detected in fecal specimens but only a single virus was detected in two environmental samples. In three other outbreaks multiple viruses were detected in fecal specimens, but no single etiologic agent could be identified based on environmental sampling. In four outbreaks only a single virus-positive fecal specimen was detected. In nine (31%) outbreaks no virus was identified. In these, bacterial cultures were also negative. Rotavirus outbreaks occurred between February and April while norovirus outbreaks occurred throughout the study period. Environmental swabs were collected from 22 outbreaks that had a positive stool specimen, and 13 (59%) of these tested positive for a virus. In 12 outbreaks the virus was the same as in stool specimens. The authors conclude that viruses are the major cause of AGE outbreaks in CCC and that widespread environmental contamination occurs during such outbreaks. Dr. Rathore has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Almost half of the outbreaks of AGE in this study could be... You do not currently have access to this content.