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American Journal of Epidemiology Vol. 127, No. 6: 1261-1271
Copyright © 1988 by The Johns Hopkins University School of Hygiene and Public Health

research-article

25- TO 30-NM VIRUS PARTICLE ASSOCIATED WITH A HOSPITAL OUTBREAK OF ACUTE GASTROENTERITIS WITH EVIDENCE FOR AIRBORNE TRANSMISSION

LEIGH A. SAWYER1,2, JOHN J. MURPHY3, JONATHAN E. KAPLAN1,, PAUL F. PINSKY1, DANIELA CHACON4, SHARON WALMSLEY5, LAWRENCE B. SCHONBERGER1, ANNE PHILLIPS5, KEVIN FORWARD4, CAROL GOLDMAN6, JAMES BRUNTON4,5,6, RICHARD A. FRALICK7, ANNE O. CARTER8, WILLIAM G. GARY, Jr.1, ROGER I. GLASS1 and DONALD E. LOW4,5,6

1Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA 30333
2Dr. Sawyer is presently with the Division of Virology, Center for Biologics Evaluation and Research, FDA, Bethesda, MD
3Hospital Infections Program, Center for Infec- tious Diseases, Centers for Disease Control, Atlanta, GA
4University of Toronto Department of Microbiology, Toronto, Ontario, Canada
5University of Toronto Department of Medicine, Toronto, Ontario, Canada
6Mount Sinai Hospital, Toronto, Ontario, Canada
7City of Toronto, Department of Public Health, Toronto, Ontario, Canada
8Laboratory Centre for Disease Control, Health and Welfare Canada, Toronto, Ontario, Canada

Reprint requests to Dr. Jonathan E. Kaplan at that address

Between November 1 and 22, 1985, an outbreak of acute, nonbacterial gastroenteritis occurred in a 600-bed hospital in Toronto, Ontario, Canada . Illness In 635 of 2,379 (27%) staff was characterized by fatigue, nausea, diarrhea, and vomiting and had a median duration of 24–48 hours. The finding of virus-like particles measuring 25–30 nm in six stool specimens and low rates of serores-ponse to Norwalk virus (3/39) and Snow Mountain agent (1/6) suggest that a Norwalk-like virus was responsible for the outbreak. The outbreak was of abrupt onset and high incidence, affecting 79 people in a single day. No common food or water exposure could be identified. The attack rate was greatest (69%) for staff who had worked in the Emergency Room. Of 100 patients and their companions who visited the Emergency Room on November 11–12 for unrelated problems, 33 (33%) developed gastroenteritis 24–48 hours after their visit, versus 0 of 18 who visited the Emergency Room on November 8 (p < 0.001). An analysis of housekeepers who worked at least once during the period from November 9– 13, which included those who became ill during the period of November 9–14, showed that the risk of becoming ill was four times greater for those who visited or walked through the Emergency Room than for those who did not (p = 0.028). These data are consistent with the possibility of the airborne spread of a virus.

disease outbreaks; gastroenteritis; Norwalk agent; virus diseases


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