title: Response to a large rotavirus outbreak on South Tarawa, Kiribati, 2013.
abstract: BACKGROUND
  In July 2013, during annual independence celebrations in Kiribati, staff at Tungaru Central Hospital on South Tarawa reported an increase in children presenting with severe diarrhoea. This report describes the outbreak investigation, findings and response.
  
  
  METHODS
  After notification of the outbreak, all health facilities on South Tarawa began reporting cases of acute diarrhoea and/or vomiting through the early warning syndromic surveillance system on a daily basis. Community awareness was raised and the public was encouraged to present to a health facility if ill with acute gastroenteritis. Specimens were collected and sent for laboratory testing.
  
  
  RESULTS
  Between 10 and 24 July 2013, 1118 cases of gastroenteritis were reported; 103 were hospitalized and six died. The median age of cases was one year (range: 0-68 years); 93.4% were aged less than five years. Rotavirus was identified in 81% of specimens tested. The outbreak response included enhanced surveillance, community education, clinical training and changes to in-hospital patient management for infection control.
  
  
  CONCLUSIONS
  This outbreak was the largest diarrhoea outbreak in Kiribati in five years. Factors that may have contributed to the magnitude and severity of the outbreak included high household density, inadequate sanitation infrastructure and a mass gathering--all increasing the chance of transmission--as well as limited clinical response capacity. The current outbreak highlights the importance of clinical management to minimize severe dehydration and death. Rotavirus vaccination should be considered as an adjunct to other comprehensive enteric disease control measures as recommended by the World Health Organization.
authors: Ministry of Health and Medical Services, Public Health Division, Kiribati .
authors: Teanibuaka
authors: T
authors: Tabunga
authors: Ministry of Health and Medical Services, Public Health Division, Kiribati .
authors: Maryanne
authors: M
authors: Utiera
authors: Ministry of Health and Medical Services, Public Health Division, Kiribati .
authors: Rosemary
authors: R
authors: Tekoaua
authors: Ministry of Health and Medical Services, Public Health Division, Kiribati .
authors: Tebikau
authors: T
authors: Tibwe
authors: Ministry of Health and Medical Services, Public Health Division, Kiribati .
authors: Teatao
authors: T
authors: Tira
authors: Secretariat of the Pacific Community, Public Health Division.
authors: Tebuka
authors: T
authors: Toatu
authors: Secretariat of the Pacific Community, Public Health Division.
authors: Sala Elbourne
authors: SE
authors: Duituturaga
authors: World Health Organization Division of Pacific Technical Support, Emerging Disease Surveillance and Response Unit, Suva, Fiji .
authors: Eric
authors: E
authors: Nilles
authors: World Health Organization Division of Pacific Technical Support, Emerging Disease Surveillance and Response Unit, Suva, Fiji .
authors: Adam
authors: A
authors: Craig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D019468:Disease Management; D004196:Disease Outbreaks; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008849:Micronesia / Q000453:epidemiology; D008875:Middle Aged; D011156:Population Density; D011159:Population Surveillance; D012401:Rotavirus; D012400:Rotavirus Infections / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D012499:Sanitation; D055815:Young Adult