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Jennifer Wyatt, MPH
District 4 Field Epidemiologist
On December 12, 2006, a representative of the Regency Place of Lafayette (RPL) notified the Indiana State Department of Health (ISDH) about an increase in the number of ill residents in one wing of the long-term care facility. RPL indicated that at least 18 residents had developed symptoms of gastroenteritis, characterized primarily by diarrhea, vomiting, and nausea on or around December 10. The ISDH immediately notified the Tippecanoe County Health Department (TCHD) of the possible outbreak.
The ISDH and TCHD initiated a collaborative investigation of this outbreak. An outbreak questionnaire was not developed and distributed, because residents’ symptoms had mostly subsided by the time the investigation began. Information that was collected included symptoms, duration of illness, onset of illness, and number of individuals infected. Approximately 18 (12%) of the residents became ill. Symptoms experienced among residents included nausea, vomiting, and diarrhea. Onset dates ranged from December 10 through December 12. No staff members became ill. According to RPL, illness lasted approximately two days and self-resolved. According to the case data, the illness appeared to be transmitted person to person and not through food or another point source within the facility.
No facility inspection was conducted, since the illness appeared to be transmitted person to person. However, the TCHD recommended that RPL implement several control measures, such as increased handwashing among residents and staff, exclusion of ill staff members, and increased environmental disinfection using freshly prepared bleach solution.
Stool specimens from three RPL residents were submitted to the ISDH Laboratories for analysis. One specimen was deemed unsatisfactory due to improper collection procedures. The specimens were tested for both bacterial and viral agents. Two specimens were positive for Norovirus. These specimens tested negative for Campylobacter, E. coli O157:H7, Salmonella, and Shigella.
This investigation confirms that an outbreak of viral gastroenteritis occurred among the residents and staff at RPL. The causative agent of this outbreak was Norovirus. According to the onset dates of cases, illness was most likely transmitted person to person rather than through food or another point source within the facility. Facility management and staff quickly implemented control measures, which assisted in the rapid control of the outbreak.
In general, most viral gastroenteritis can be prevented by strictly adhering to the following guidelines:
Thoroughly wash hands with soap and water before preparing and serving food;
Thoroughly wash hands with soap and water after using the restroom;
Thoroughly wash hands with soap and water after assisting anyone who is ill with diarrhea and/or vomiting;
Persons with diarrhea and/or vomiting should not prepare food for others and should limit direct contact with others as much as possible;
Patients ill with diarrhea and/or vomiting should not attend meals and activities with other residents who are not experiencing symptoms, and;
Staff with diarrhea and/or vomiting should be excluded from health care and long-term care facilities until symptoms cease.
The management and staff of RPL were very cooperative throughout the investigation and promptly implemented several control measures to prevent further spread of illness. The TCHD staff responded appropriately and in a timely manner to identify and control the spread of the virus. The collaborative effort between TCHD, ISDH, and RPL ensured rapid control and prevention of additional cases.