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Original Research |

Two Rotavirus Outbreaks Caused by Genotype G2P[4] at Large Retirement Communities: Cohort Studies

Cristina V. Cardemil, MD, MPH; Margaret M. Cortese, MD; Andrew Medina-Marino, PhD; Supriya Jasuja, MD, MPH; Rishi Desai, MD, MPH; Jessica Leung, MPH; Cristina Rodriguez-Hart, MPH; Gissela Villarruel, MPH; Julia Howland, MPH; Osbourne Quaye, PhD; Ka Ian Tam, PhD; Michael D. Bowen, PhD; Umesh D. Parashar, MBBS, MPH; Susan I. Gerber, MD, the Rotavirus Investigation Team
[+] Article and Author Information

* For a list of members of the Rotavirus Investigation Team, see Appendix 1.


From the Centers for Disease Control and Prevention, Atlanta, Georgia; Cook County Department of Public Health, Oak Forest, Illinois; and Illinois Department of Public Health, Chicago, Illinois.

Disclaimer: The findings and conclusions of this article are those of the authors and do not necessarily represent the views of CDC.

Acknowledgment: The authors thank Nicole Gregoricus, MSPH, and Dr. Jan Vinje (CDC) for performing norovirus testing; Freda C. Lyde, BS (CDC), for performing the EIAs; Dr. Kathleen Wannemuehler (CDC) for her expert statistical input; Dr. Ken Sugata (CDC) for his help with translation; Jennifer Shattuck, MSPH, and Kimberly Vogt, MT(ASCP)SM, for their assistance at the hospitals; Purisima Linchangco, BS (CCDPH), for logistical support; and the residents and employees of facility A and B for their participation and assistance in the investigations.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0946.

Reproducible Research Statement: Study protocol, statistical code, and data set: Not available.

Corresponding Author: Margaret M. Cortese, MD, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-A34, Atlanta, GA 30333; e-mail, mcortese@cdc.gov.

Current Author Addresses: Drs. Cardemil, Cortese, Desai, Quaye, Tam, Bowen, and Parashar and Ms. Leung: Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-A34, Atlanta, GA 30333.

Dr. Medina-Merino: University of Witwatersrand, Room 3B22, 7 York Road, Parktown 2193, Johannesburg, South Africa.

Drs. Jasuja and Gerber: Cook County Department of Public Health, 15900 South Cicero Avenue, Building E, 3rd Floor, Oak Forest, IL 60452.

Ms. Rodriguez-Hart: Florida Department of Health, 4052 Bald Cypress Way, BIN A19, Tallahassee, FL 32399.

Ms. Villarruel: 408 Calibre Woods Drive NE, Atlanta, GA 30329.

Ms. Howland: 122 South Michigan Avenue, 7th Floor, Chicago, IL 60603.

Author Contributions: Conception and design: C.V. Cardemil, M.M. Cortese, A. Medina-Marino, S. Jasuja, R. Desai, J. Leung, C. Rodriguez-Hart, G. Villarruel, J. Howland, U.D. Parashar, S.I. Gerber.

Analysis and interpretation of the data: C.V. Cardemil, M.M. Cortese, A. Medina-Marino, S. Jasuja, R. Desai, J. Howland, O. Quaye, K.I. Tam, M.D. Bowen, U.D. Parashar, S.I. Gerber.

Drafting of the article: C.V. Cardemil, M.M. Cortese, M.D. Bowen, U.D. Parashar.

Critical revision of the article for important intellectual content: C.V. Cardemil, M.M. Cortese, S. Jasuja, R. Desai, J. Leung, M.D. Bowen, U.D. Parashar, S.I. Gerber.

Final approval of the article: C.V. Cardemil, M.M. Cortese, A. Medina-Marino, S. Jasuja, R. Desai, J. Leung, C. Rodriguez-Hart, G. Villarruel, J. Howland, O. Quaye, K.I. Tam, M.D. Bowen, U.D. Parashar, S.I. Gerber.

Provision of study materials or patients S.I. Gerber.

Administrative, technical, or logistic support: C.V. Cardemil, M.M. Cortese, A. Medina-Marino, S. Jasuja, R. Desai, J. Leung, C. Rodriguez-Hart, G. Villarruel, J. Howland, O. Quaye, K.I. Tam, M.D. Bowen, S.I. Gerber.

Collection and assembly of data: C.V. Cardemil, M.M. Cortese, A. Medina-Marino, S. Jasuja, R. Desai, J. Leung, C. Rodriguez-Hart, G. Villarruel, J. Howland, O. Quaye, K.I. Tam, M.D. Bowen, S.I. Gerber.


Ann Intern Med. 2012;157(9):621-631. doi:10.7326/0003-4819-157-9-201211060-00006
Text Size: A A A

Background: Outbreaks of rotavirus gastroenteritis in elderly adults are reported infrequently but are often caused by G2P[4] strains. In 2011, outbreaks were reported in 2 Illinois retirement facilities.

Objective: To implement control measures, determine the extent and severity of illness, and assess risk factors for disease among residents and employees.

Design: Cohort studies using surveys and medical chart abstraction.

Setting: Two large retirement facilities in Cook County, Illinois.

Patients: Residents and employees at both facilities and community residents with rotavirus disease.

Measurements: Attack rates, hospitalization rates, and rotavirus genotype.

Results: At facility A, 84 of 324 residents (26%) were identified with clinical or laboratory-confirmed rotavirus gastroenteritis (median age, 84 years) and 11 (13%) were hospitalized. The outbreak lasted 7 weeks. At facility B, 90 case patients among 855 residents (11%) were identified (median age, 88 years) and 19 (21%) were hospitalized. The facility B outbreak lasted 9.3 weeks. Ill employees were identified at both locations. In each facility, attack rates seemed to differ by residential setting, with the lowest rates among those in more separated settings or with high baseline level of infection control measures. The causative genotype for both outbreaks was G2P[4]. Some individuals shed virus detected by enzyme immunoassay or genotyping reverse transcription polymerase chain reaction for at least 35 days. G2P[4] was also identified in 17 of 19 (89%) samples from the older adult community but only 15 of 40 (38%) pediatric samples.

Limitation: Medical or cognitive impairment among residents limited the success of some interviews.

Conclusion: Rotavirus outbreaks can occur among elderly adults in residential facilities and can result in considerable morbidity. Among older adults, G2P[4] may be of unique importance. Health professionals should consider rotavirus as a cause of acute gastroenteritis in adults.

Primary Funding Source: None.

Figures

Grahic Jump Location
Figure.

Epidemic curve of rotavirus gastroenteritis among facility A residents (top) and facility B residents (bottom), by residential setting.

The top graph excludes 1 case with unknown date of onset and 1 nosocomial case. The bottom graph excludes 9 cases with unknown date of onset.

Grahic Jump Location

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