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Evaluation of the Impact of the Source (Patient Versus Staff) on Nosocomial Norovirus Outbreak Severity

Published online by Cambridge University Press:  21 June 2016

Frauke Mattner ,
Lutz Mattner ,
Hans Ulrich Borck  and
Petra Gastmeier
Frauke Mattner*
Affiliation:
Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule Hannover, Hannover, Germany
Lutz Mattner
Affiliation:
Institut für Mathematik, Universität zu Lübeck, Lübeck, Germany
Hans Ulrich Borck
Affiliation:
Institut für Labormedizin, Mikrobiologie, Krankenhaushygiene, Hamburg, Germany
Petra Gastmeier
Affiliation:
Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule Hannover, Hannover, Germany
*
Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule Hannover, Carl Neubergstrabe 1, 30625 Hannover, Germanymattner.frauke@mh-hannover.de
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Abstract

Objective:

To study the dependence of infection risk and outbreak size on the type of index case (ie, patient or staff).

Methods:

Nosocomial outbreaks were reviewed and categorized into those started by patients and those started by staff. Infection risks and outbreak sizes were evaluated taking into account the index case category.

Results:

Of the 30 nosocomial outbreaks of norovirus with person-to-person transmission, 20 (67%) involved patients as the index cases. Patient-indexed outbreaks affected significantly more patients than did staff-indexed outbreaks (difference in means, 16.25; 95% confidence interval [CI95], 5.1 to 27.0). For the numbers of affected staff, no dependence on the index case category was detectable (difference in means, -1.05; CI95, -9.0 to 6.9). For patients exposed during patient-indexed outbreaks, the risk of acquiring a norovirus infection was approximately 4.8 times as high as the corresponding risk for patients exposed during staff-indexed outbreaks (odds ratio [OR], 4.79; CI95,1.82 to 8.28). The infection risk for exposed staff during patient-indexed outbreaks was approximately 1.5 times as high as the corresponding risk during staff-indexed outbreaks (OR, 1.51; CI95, 0.92 to 2.49).

Conclusions:

Patient-indexed norovirus outbreaks generally affect more patients than do staff-indexed outbreaks. Staff appear to be similarly affected by both outbreak index category groups. This study demonstrates the importance of obtaining complete outbreak data, including the index case classification as staff or patient, during norovirus outbreak investigations. Such information may be useful for further targeting prevention measures.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 3 , March 2005 , pp. 268 - 272
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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References

1.Koch, JSE, Schreier, E. Norovirus infections [in German]. Epidemiologisches Bulletin 2003;6:39–41.Google Scholar
2. Anonymous. Norovirus activity: United States, 2002. MMWR 2003; 52:41–45.Google Scholar
3.Khanna, N, Goldenberger, D, Graber, P, Battegay, M, Widmer, AF. Gastroenteritis outbreak with norovirus in a Swiss university hospital with a newly identified virus strain. J Hosp Infect 2003;55:131–136.Google Scholar
4.Lopman, BA, Adak, GK, Reacher, MH, Brown, DW. Two epidemiologic patterns of norovirus outbreaks: surveillance in England and Wales, 1992-2000. Emerg Infect Dis 2003;9:71–77.Google Scholar
5. Outbreak Worldwide Database [database online]. Norderstedt, Germany: Shulke & Mayr GmbH, Robert-Koch-Institut; 2003. Available at www.outbreak-database.com. Accessed on January 15, 2004.Google Scholar
6.Mattner, F, Sohr, D, Heim, A, Gastmeier, P, Vennema, H, Koopmans, M. Risk groups for clinical complications of norovirus infections: an outbreak investigation. Clin Microbiol Infect. In press.Google Scholar
7.Kaplan, JE, Schonberger, LB, Varano, G, Jackman, N, Bied, J, Gary, GW. An outbreak of acute nonbacterial gastroenteritis in a nursing home: demonstration of person-to-person transmission by temporal clustering of cases. Am J Epidemiol 1982;116:940–948.Google Scholar
8.Gustafson, TL, Kobylik, B, Hutcheson, RH, Schaffner, W. Protective effect of anticholinergic drugs and psyllium in a nosocomial outbreak of Norwalk gastroenteritis. J Hosp Infect 1983;4:367–374.Google Scholar
9.Riordan, T, Wills, A. An outbreak of gastroenteritis in a psycho-geriatric hospital associated with a small round structured virus. J Hosp Infect 1986;8:296–299.Google Scholar
10.Leers, WD, Kasupski, G, Fralick, R, Wartman, S, Garcia, J, Gary, W. Norwalk-like gastroenteritis epidemic in a Toronto hospital. Am J Public Health 1987;77:291–295.Google Scholar
11.Spender, QW, Lewis, D, Price, EH. Norwalk like viruses: study of an outbreak. Arch Dis Child 1986;61:142–147.Google Scholar
12.Geliert, GA, Waterman, SH, Ewert, D, et al.An outbreak of acute gastroenteritis caused by a small round structured virus in a geriatric convalescent facility. Infect Control Hosp Epidemiol 1990;11:459–464.Google Scholar
13.Pegues, DA, Woernle, CH. An outbreak of acute nonbacterial gastroenteritis in a nursing home. Infect Control Hosp Epidemiol 1993;14:87–94.Google Scholar
14.Chadwick, PR, McCann, R. Transmission of a small round structured virus by vomiting during a hospital outbreak of gastroenteritis. J Hosp Infect 1994;26:251–259.CrossRefGoogle ScholarPubMed
15.Cunney, RJ, Costigan, P, McNamara, EB, et al.Investigation of an outbreak of gastroenteritis caused by Norwalk-like virus, using solid phase immune electron microscopy. J Hosp Infect 2000;44:113–118.Google Scholar
16.Green, SM, Lambden, PR, Deng, Y, et al.Polymerase chain reaction detection of small round-structured viruses from two related hospital outbreaks of gastroenteritis using inosine-containing primers. J Med Virol 1995;45:197–202.Google Scholar
17.Green, J, Wright, PA, Gallimore, CI, Mitchell, O, Morgan-Capner, P, Brown, DW. The role of environmental contamination with small round structured viruses in a hospital outbreak investigated by reverse-tran-scriptase polymerase chain reaction assay. J Hosp Infect 1998;39:39–45.Google Scholar
18.Russo, PL, Spelman, DW, Harrington, GA, et al.Hospital outbreak of Norwalk-like virus. Infect Control Hosp Epidemiol 1997;18:576–579.Google Scholar
19.Caceres, VM, Kim, DK, Bresee, JS, et al.A viral gastroenteritis outbreak associated with person-to-person spread among hospital staff. Infect Control Hosp Epidemiol 1998;19:162–167.Google Scholar
20.Marx, A, Shay, DK, Noel, JS, et al.An outbreak of acute gastroenteritis in a geriatric long-term-care facility: combined application of epidemiological and molecular diagnostic methods. Infect Control Hosp Epidemiol 1999;20:306–311.CrossRefGoogle Scholar
21.O'Neill, HJ, McCaughey, C, Wyatt, DE, Mitchell, F, Coyle, PV. Gastroenteritis outbreaks associated with Norwalk-like viruses and their investigation by nested RT-PCR. Bio Med Central Microbiol 2001;1:14.Google Scholar
22.Sinn, G. Norwalk-virus Ausbruch in einem Krankenhaus. Epidemiologisches Bulletin 2001;33:251–253.Google Scholar
23.McCall, J, Smithson, R. Rapid response and strict control measures can contain a hospital outbreak of Norwalk-like virus. Commun Dis Public Health 2002;5:243–246.Google ScholarPubMed
24.Inouye, S, Yamashita, K, Yamadera, S, Yoshikawa, M, Kato, N, Okabe, N. Surveillance of viral gastroenteritis in Japan: pediatric cases and outbreak incidents, J Infect Dis 2000;181(suppl 2) :S270–S274.Google Scholar
25.Sawyer, LA, Murphy, JJ, Kaplan, JE, et al.25- to 30-nm virus particle associated with a hospital outbreak of acute gastroenteritis with evidence for airborne transmission. Am J Epidemiol 1988;127:1261–1271.Google Scholar
26.Koopmans, MP. Outbreaks of viral gastroenteritis, in particular due to the Norwalk virus: an underestimated problem. Ned Tijdschr Geneeskd 2002;146:2401–2404.Google Scholar
27.Lopman, BA, Reacher, MH, Van Duijnhoven, Y, Hanon, FX, Brown, D, Koopmans, M. Viral gastroenteritis outbreaks in Europe, 1995-2000. Emerg Infect Dis 2003;9:90–96.CrossRefGoogle ScholarPubMed
28.Centers for Disease Control and Prevention. “Norwalk-like viruses”: public health consequences and outbreak management. MMWR 2001;50(RR-9):1–17. Available at www.cdc.gov/ncidod/dvrd/revb/gastro/rr5009.pdf. Accessed on February 15, 2004.Google Scholar
29.Viral Gastroenteritis Subcommittee of the Scientific Advisory Committee of the National Disease Surveillance Center. National Guidelines on the Management of Outbreaks of Norovirus Infection in Healthcare Settings. Dublin, Ireland: National Disease Surveillance Center; 2003. Available at www.ndsc.ie/Publications/Norovirus/d819.PDF. Accessed on July 20, 2004.Google Scholar
30. Anonymous. Norwalk-Like Infections. Berlin-Wedding, Germany: Robert Koch Institut; 2000. Available at www.rki.de/INFEKT/INF_A-Z/RAT_MBL/NORWALKPDF. Accessed on January 3,2004.Google Scholar
31.Cowden, JM. Winter vomiting. BMJ 2002;324:249–250.Google Scholar
32.Beck-Sague, C, Jarvis, WR, Martone, WJ. Outbreak investigations. Infect Control Hosp Epidemiol 1997;18:138–145.Google Scholar