title: A community outbreak of rotavirus diarrhea associated with exposures in a hospital outpatient department in South China.
abstract: BACKGROUND
  Between October 1 and December 10, 2006, Bao'an, China had a 5-fold increase in acute rotavirus gastroenteritis (ARGE) cases compared with the same time in 2005. To identify the risk factors for ARGE during this outbreak, we conducted a case-control study among children ≤ 24 months old from the most heavily affected area.
  
  
  METHODS
  We defined an ARGE case as diarrhea, with group A rotavirus antigen detected from fecal samples by the enzyme-linked immunosorbent assay test. In the case-control study, 86 confirmed ARGE cases were identified. We enrolled 98 healthy control children matched by age. We administered questionnaires about exposures through telephone interviews.
  
  
  RESULTS
  Of 8 general exposure types, we identified the following as being associated with ARGE: visiting outpatient services of hospital X, odds ratio (OR) = 7.1 (95% confidence interval [CI], 2.2-26); contact with other children with diarrhea, OR = 2.1 (95% CI, 1.1-3.7); and hand-washing before eating, OR = 0.48 (95% CI, 0.27-0.82). After improvements in the outpatient department of hospital X, ARGE incidence in the community during the ARGE transmission season (October through December) decreased from 4.3/10000 in 2006 to 1.4/10000 in 2009.
  
  
  CONCLUSIONS
  Outpatient services in hospital X may have contributed to the transmission of ARGE and improvements in infection control practices in this setting were associated a marked decrease incidence of ARGE in this community.
authors.affiliation: Shenzhen Bao'an Centers for Disease Control and Prevention, Shenzhen, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Li
authors.forename: Hongxiong
authors.initials: H
authors.lastname: Guo
authors.forename: Wenti
authors.initials: W
authors.lastname: Xu
authors.forename: Taishun
authors.initials: T
authors.lastname: Wu
authors.forename: Huilai
authors.initials: H
authors.lastname: Ma
authors.forename: Robert E
authors.initials: RE
authors.lastname: Fontaine
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003967:Diarrhea / Q000453:epidemiology* / Q000821:virology*; D004196:Disease Outbreaks; D005260:Female; D006761:Hospitals; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010045:Outpatients; D012111:Residence Characteristics; D012307:Risk Factors; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000635:transmission / Q000821:virology