Gordon S M, Oshiro L S, Jarvis W R, Donenfeld D, Ho M S, Taylor F, Greenberg H B, Glass R, Madore H P, Dolin R
Hospital Infections Program, Centers for Disease Control, US Public Health Service, Atlanta, GA.
Am J Epidemiol. 1990 Apr;131(4):702-10. doi: 10.1093/oxfordjournals.aje.a115554.
A variety of small round-structured viruses are being recognized with increasing frequency as a cause of gastroenteritis 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 = 6.5). Microbiologic examinations for bacterial and parasitic enteric 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 difficult-to-identify 27-nm viruses can cause outbreaks in inpatient settings.
越来越多的各种小圆结构病毒被认为是社区胃肠炎的病因，但很少有报道称它们会在医院或长期护理机构引发疫情。1988年3月20日至4月15日，旧金山湾区的一家退休设施爆发了胃肠炎疫情。症状表现为腹泻、恶心和呕吐；两名居民死亡。居民的发病率为46%（336人中155人患病），员工的发病率为37%（75人中28人患病）。在疫情初期，居民患病与设施食堂提供的两顿虾餐有关（优势比=6.7）。可能发生了人际传播：室友患病后一至两天患病的风险明显高于疫情期间其他时间患病的风险（风险比=6.5）。对肠道细菌和寄生虫病原体的微生物学检查均为阴性；然而，通过免疫电子显微镜和对从六名患病居民之一发病初期采集的粪便中检测雪山因子的阻断酶免疫测定法，检测到了27纳米的病毒颗粒。通过酶免疫测定法检测，六名患病居民中有五名在急性期和恢复期血清标本中出现了对雪山因子的血清转化（抗体升高四倍以上），但通过放射免疫测定法检测诺如病毒时未出现血清转化。这份关于长期护理机构中雪山因子胃肠炎疫情的报告证明，这些难以识别的27纳米病毒可在住院环境中引发疫情。
