Outbreak of necrotizing enterocolitis caused by norovirus in a neonatal intensive care unit.
OBJECTIVE
To investigate an outbreak of necrotizing enterocolitis (NEC) in a neonatal intensive care unit (NICU) and to identify the etiology, describe illness risk factors, and develop control measures.


METHODS
A retrospective case-control study was performed including newborns with NEC and newborns without NEC, examining demographic factors and exposures to medications, staff members, and procedures before illness. Stool samples from affected newborns were collected and tested for bacteria, parasites, and viruses.


RESULTS
We confirmed a NEC outbreak in the NICU in January 1998 with 8 cases, including 2 deaths, clustered in time and space. Norovirus-like particles were identified in all available stools from cases; norovirus (NoV) was confirmed with reverse transcriptase polymerase chain reaction in 4 of 6 samples. NEC cases were younger, had lower Apgar scores, and received antibiotics longer than 25 control subjects. Three NICU health care personnel had more contact with cases than control subjects; 1 staff member recalled having gastroenteritis symptoms around the time of the outbreak.


CONCLUSIONS
This report associates NoV with NEC. NoV appeared to precipitate NEC in predisposed infants. Spatial clustering and epidemiologic links between cases and a health care worker with gastroenteritis suggests that NoV should be investigated among the etiologies of NEC outbreaks and that interventions targeted to interruption of NoV transmission should be considered.
Section of Infectious Diseases, Department of Internal Medicine, Temple University Hospital, Philadelphia, PA, USA.
Reina M
RM
Turcios-Ruiz
Peter
P
Axelrod
Keith
K
St John
Esther
E
Bullitt
Joan
J
Donahue
Nancy
N
Robinson
Helena E
HE
Friss
D003428:Cross Infection / Q000453:epidemiology* / Q000821:virology; D004279:DNA, Viral / Q000032:analysis*; D003937:Diagnosis, Differential; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D005243:Feces / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000706:statistics & numerical data*; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008297:Male; D029322:Norovirus / Q000235:genetics*; D011379:Prognosis; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014481:United States / Q000453:epidemiology
D004279:DNA, Viral