American Journal of Epidemiology Vol. 131, No. 4: 702-710
Copyright © 1990 by The Johns Hopkins University School of Hygiene and Public Health
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FOODBORNE SNOW MOUNTAIN AGENT GASTROENTERITIS WITH SECONDARY PERSON-TO-PERSON SPREAD IN A RETIREMENT COMMUNITY
1Hospital Infections Program, Center for Infectious Diseases, Centers for Disease Control, US Public Health Service, Department of Health and Human Services Atlanta, GA
2Viral and Rickettaisi Disease Laboratory, California State Department of Health Services Berkeley, CA
3Bureau of Communicable Disease Control, City and County of San Francisco, Department of Public Health San Francisco, CA
4Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control, US Public Health Service Atlanta, GA
5Division of Gastroentero1o Palo Alto Veterans Administration and Stanford University Medical Center Palo Alto, CA
6Infectious Disease Unit, University of Rochester School of Medicine and Dentistry Rochester, NY
Reprint requests to Dr Ofelia Tablan, Infections Program, Centers for Disease Control Mailstop C-10, Atlanta, GA 30333
A variety of small round-structured viruses are being recognized with increasing frequency as a cause of gastroenterltis in the community, but have rarely been reported to cause outbreaks in hospitals or extended-care facilities. From March 20 through April 15, 1988, an outbreak of gastroenteritis occurred in a retirement facility in the San Francisco Bay area. Illness was characterized by diarrhea, nausea, and vomiting; two residents died. Attack rates were 46% (155 of 336) in residents and 37% (28 of 75) In employees. During the Initial outbreak period, Illness among residents was associated with two shrimp meals served In the facility dining hall (odds ratio=6.7). Person-to-person transmission probably occurred: The risk of becoming ill one or two days after a roommate became ill was significantly greater than that of becoming ill at other times during the outbreak (risk ratio=8.5). Microbiologic examinations for bacterial and parasitic entenc pathogens were negative; however, 27-nm viral particles were detected by immune electron microscopy and by blocking enzyme immunoassay to Snow Mountain agent in stools obtained at the onset of illness from one of six Ill residents. Seroconversion (greater than fourfold antibody rise) to Snow Mountain agent was detected in acute- and convalescent-phase serum specimens from five of six ill residents as measured by enzyme immunoassay, but not for Norwalk agent as measured by radioimmunoassay. This report of an outbreak of Snow Mountain agent gastroenteritis in an extended-care facility documents that these diflicult-to-identify 27-nm viruses can cause outbreaks in inpatient settings.
gastroenteritis; skilled nursing facilities
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