Mandatory Outbreak Reporting

• Long term care facilities (LTCFs)  and hospitals are required to report gastroenteritis outbreaks to the local health authority under OAR 333-018.0000.  Local health authorities are empowered to investigate such outbreaks under OAR 333-019.0000.
• Local health authorities need to report gastroenteritis outbreaks to the state communicable disease epidemiology program (971-673-1111) within 24 hours of receiving an outbreak report (Outbreak Investigation Expectations, 2012).   

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Definitions

• Acute gastroenteritis (AGE): acute-onset vomiting, diarrhea, or both without another apparent cause.

• AGE outbreaks in LTCFs and hospitals: 
  
  
  • general definition: an "unusual" number of patients, residents or employees with AGE clustered by time and place 
  • working definition: two or more patients, residents or employees in the same LTCF or on the same hospital unit with AGE onset dates within 96 hours of each other (two incubation periods of most gastroenteritis agents) of each other
  • lab-confirmed AGE outbreak: 2+ stool samples that test positive for the same pathogen
  • "unexplained" AGE outbreak: 4+ stool samples that test negative for any pathogen (all unexplained AGE outbreaks will now be tested for sapovirus, a Calicivirus similar to norovirus)

Control Measures

• Send facilities Controlling person-to-person Calicivirus transmission (pdf) and Cleaning up vomit and other unpleasant tasks (pdf). 

Stool Samples

• Collect up to 5 stool samples until the etiologic agent is laboratory-confirmed with >2 positive samples or until >4 samples are negative. Stool samples collected by LTCFs and hospitals and tested at commercial laboratories count toward the five-stool target.
• Follow: The Stool Sample Kit: Instructions for [Local Health] Staff.
• Order "Enteric Outbreak Stool Sample Kits"  (AKA "It Kits") from the state public health lab. Consider arranging for LTCFs and hospitals to stock up on "It Kits" before they have outbreaks.

Data Collection and Basic Descriptive Epidemiology

• Use one Gastroenteritis Case Log (pdf) per outbreak-affected unit. The log can be completed by LTCF or hospital infection control staff; establishing a single point of contact is recommended. 
• Ask that the Gastroenteritis Case Logs be updated every day until no more cases occur. 
• Enter case log data in the ACDP GI Case Log Database available via Citrix through the “Directory of Useful Databases for Epidemiologists” (DUDE). For a CDC project attempting near-real time reporting of norovirus-like outbreaks, case log data from the early days of the outbreak should be entered no later than five days after the outbreak is reported to ACDP,
•  Use the tools included in the database to get basic descriptive epidemiology, including an epidemic curve (i.e., cases by onset time) as soon as new data are entered.
•  Monitor the outbreak until the last case has been symptom-free for 48 hours (this is when the outbreak is considered “over”).

• Complete a Control Measures Report (pdf) and enter the report in the ACDP Control Measures Report Database available via Citrix through the “Directory of Useful Databases for Epidemiologists” (DUDE).       

• Within 30 days of the onset date of the last case, enter summary reports of the outbreak investigation in the ACDP Outbreak Database available via Citrix through the “Directory of Useful Databases for Epidemiologists” (DUDE).

Data  

• Reported Outbreaks in long-term-care and assisted living facilities (xls file)
• Norovirus and norovirus-like outbreaks, Oregon,  08/01/2012 through 4/30/2013 (pdf)