title: A large-scale gastroenteritis outbreak associated with Norovirus in nursing homes.
abstract: An increase in gastroenteritis outbreaks due to Norovirus has been reported worldwide. We investigated a large-scale outbreak affecting 246 residents and 33 staff members in six nursing homes in the Tel-Aviv district, Israel, during 3 weeks in 2002. Person-to-person spread was noticed in all nursing homes. The spread of disease could not be attributed to social interactions. Among the elderly residents, the hospitalization rate was 10.2% and the case-fatality rate was 2.0%. Bacteriological cultures were negative. Overall, 7 out of 15 stool specimens were positive for Norovirus by RT-PCR. All were sequenced and found to be 90% identical. The characteristics of this outbreak and the RT-PCR results suggest that illness was caused by Norovirus. Due to the high case-fatality rate of Norovirus gastroenteritis, there should be a high index of suspicion when encountering a gastroenteritis outbreak among the elderly. This will enable prompt action to stop the spread of illness.
authors.affiliation: Hadassah Braun School of Public Health, Hebrew University, Jerusalem, Israel. ronitca@hadassah.org.il
authors.forename: R
authors.initials: R
authors.lastname: Calderon-Margalit
authors.forename: R
authors.initials: R
authors.lastname: Sheffer
authors.forename: T
authors.initials: T
authors.lastname: Halperin
authors.forename: N
authors.initials: N
authors.lastname: Orr
authors.forename: D
authors.initials: D
authors.lastname: Cohen
authors.forename: T
authors.initials: T
authors.lastname: Shohat
mesh_terms: D000328:Adult; D000368:Aged; D017250:Caliciviridae Infections / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D005759:Gastroenteritis / Q000821:virology*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D029322:Norovirus / Q000302:isolation & purification*; D009735:Nursing Homes; D020133:Reverse Transcriptase Polymerase Chain Reaction