Background: Norovirus is a highly contagious pathogen with potential for prolonged shedding. Diapered infants can present unique challenges in containment of outbreaks.
Methods: We investigated a cluster of infants in our neonatal intensive care unit (NICU) with acute gastrointestinal symptoms. We report the epidemiology, molecular diagnosis and control of this norovirus outbreak.
Results: The index case was an 8 month-old infant born at 39 weeks gestation with congenital anomalies who developed watery stools on February 6, 2015. Within 24 hours, other infants had similar symptoms. Cases were defined as patients in NICU 4 between February 5 and 17 with emesis, increased stooling or watery stools. Infants meeting the case definition were placed in contact isolation and stool samples sent for routine and viral culture, rotavirus EIA and norovirus PCR. The investigation identified twenty-two probable and six laboratory-confirmed cases of genogroup II norovirus. The mean gestational and chronological ages of confirmed cases were 32 weeks (range 25-39) and 10 months (range 3-23), respectively. Diarrhea was the predominant symptom, though some infants experienced emesis and fever. No confirmed cases had severe disease or necrotizing enterocolitis. Twelve hospital workers had norovirus symptoms and were furloughed until 48 hours after resolution of symptoms. Modified infection control practices included soap and water for hand hygiene instead of alcohol-based sanitizers, disinfection of surfaces with a hypochlorite instead of quaternary product. Ill infants were cohorted geographically and this section of the NICU was closed to admissions. Confirmed cases remained in isolation for the duration of their hospitalization or 70 days. No further cases were detected after implementation of modified infection control measures.
Conclusion: Rapid implementation of modified infection control practices allowed for swift containment of this outbreak in a diapered population. Close collaboration between Infection Control, medical leadership, and Environmental Services was critical in controlling this outbreak.
D. Yepes, None
J. Campbell, None