Viral Gastroenteritis Branch, Division of Viral Diseases.
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
J Pediatric Infect Dis Soc. 2020 Jul 13;9(3):287-292. doi: 10.1093/jpids/piz015.
The introduction of rotavirus vaccine in the United States has reduced rotavirus disease burden, but outbreaks still occur. Complete-series rotavirus vaccination coverage is <75% in the United States, and it might be lower among vulnerable populations. We describe here the clinical characteristics and vaccination status of children during a rotavirus outbreak in a pediatric subacute care facility in 2017.
Clinical history, signs and symptoms, and vaccination history were abstracted for the 26 patients residing in the facility during the time of the outbreak. A case-patient was defined as one who experienced 3 or more loose stools in a period of 24 hours with onset between April 17 and May 17, 2017. Stool samples from 14 resident patients were tested for rotavirus with reverse-transcription polymerase chain reaction.
The median patient age at the facility was 2.9 years. Of the 26 resident patients, 22 (85%) met the case definition. One child died. Stool samples from 11 case-patients were positive according to reverse-transcription polymerase chain reaction for rotavirus. Fifteen case-patients were unvaccinated against rotavirus; 3 were partially vaccinated, and 2 were fully vaccinated. Vaccination status could not be completely determined in 2 cases.
An outbreak of rotavirus affected nearly all resident patients of a subacute care facility and caused 1 death. Because of recommendations against giving rotavirus vaccine in an intensive care setting, infants who require a prolonged intensive care stay might age out of rotavirus vaccine eligibility (the first dose must be given before 15 weeks of age according to Advisory Committee on Immunization Practices recommendations). The result is a vulnerable population of unvaccinated infants who might later congregate in another care setting.
在美国引入轮状病毒疫苗后，轮状病毒疾病负担有所减轻，但仍有暴发。美国完整系列轮状病毒疫苗接种覆盖率<75%，在脆弱人群中可能更低。我们在此描述了 2017 年在一家儿科亚急性护理机构暴发期间，儿童的临床特征和疫苗接种情况。
在暴发期间，从居住在该机构的 26 名患者中提取临床病史、体征和症状以及疫苗接种史。将在 2017 年 4 月 17 日至 5 月 17 日期间出现 3 次或以上稀便且发病的患者定义为病例患者。对 14 名住院患者的粪便样本进行逆转录聚合酶链反应检测轮状病毒。
该机构患者的中位年龄为 2.9 岁。在 26 名住院患者中，22 名（85%）符合病例定义。有 1 名儿童死亡。根据逆转录聚合酶链反应，11 名病例患者的粪便样本检测到轮状病毒呈阳性。15 名病例患者未接种轮状病毒疫苗；3 名部分接种，2 名完全接种。在 2 例中无法完全确定疫苗接种状态。
亚急性护理机构的近所有住院患者都暴发了轮状病毒感染，并导致 1 例死亡。由于在重症监护环境中不建议接种轮状病毒疫苗，因此需要长期重症监护的婴儿可能会错过轮状病毒疫苗接种资格（根据免疫实践咨询委员会的建议，第一剂必须在 15 周龄之前接种）。结果是出现了一群未接种疫苗的脆弱婴儿，他们以后可能会聚集在另一个护理环境中。
