Outbreaks of gastroenteritis in elderly nursing homes and retirement facilities associated with human caliciviruses

Abstract

Eleven outbreaks of acute gastroenteritis, eight of which were in nursing homes or retirement facilities, were reported in virginia during the winter of 1993-1994. Serum samples (four outbreaks) and stool samples (two outbreaks) from involved people were tested for human calicivirus (HuCV) infection by enzyme immune assays (EIAs) using recombinant Norwalk virus (rNV) and Mexico virus (rMX) capsid antigens and reverse transcription-polymerase chain reaction (RT-PCR). Of the 31 pairs of acute and convalescent serum specimens tested, 24 had a fourfold or more titer increase to rMX and 4 responded to rNV. In all four outbreaks, the geometric mean titers (GMTs) against rMX were significantly higher than those against rNV in the convalescent, but not in the acute phase of illness. The antibody response to rMX among these patients was also higher than to rNV (summary mean 32-fold increase vs. 0.7-fold increase, respectively, P < .001). Antigen was detected in 5 of 21 stool specimens tested by the rMX EIA, RNA in 12 of 17 stool specimens tested by RT-PCR, and small round structured virus (SRSV) particles in 12 of 21 by electron microscopy (EM); none were positive by the rNV EIA. Sequence analysis of the RT-PCR-amplified products from the viral RNA polymerase region revealed 92-93% amino acid identity with Snow Mountain agent (SMA), 86% with MX, 58-59% with NV, and 31-32% with Sapporo HuCV, suggesting that these viruses belong to the SMA HuCV genogroup.

Transmission Events within Outbreaks of Gastroenteritis Determined through Analysis of Nucleotide Sequences of the P2 Domain of Genogroup II Noroviruses

“…NoV outbreaks are frequently associated with semiclosed or closed institutions such as hospitals and homes for the elderly (11,15). Outbreaks also occur in other settings, including eating establishments, cruise ships, concert halls (4,14,26), and schools (19).…”

European Multicenter Evaluation of Commercial Enzyme Immunoassays for Detecting Norovirus Antigen in Fecal Samples

“…Noroviruses (NoVs) are a major cause of nonbacterial gastroenteritis and are associated with outbreaks of diarrheal illness in hospitals (7,10), nursing and residential homes (9,13,15), and other institutional settings. NoV strains exhibit wide genetic diversity, and viruses of both genogroup I (GI) and GII and different genotypes within the genogroups cocirculate in a given geographical region at the same time (8).…”

Diversity of Noroviruses Cocirculating in the North of England from 1998 to 2001

“…NVs are the most common cause of outbreaks of acute nonbacterial gastroenteritis worldwide (21). Outbreaks due to NVs have been associated with closed or semiclosed institutions such as hospitals (7) and homes for the elderly (19). NV outbreaks also occur in other settings, including cruise ships (15), eating establishments (33), and schools (23).…”