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. 2022 Nov 1;150(5):e2021056002.
doi: 10.1542/peds.2021-056002.

Childcare and School Acute Gastroenteritis Outbreaks: 2009-2020

Claire P Mattison  1   2 , Laura E Calderwood  1   2 , Zachary A Marsh  3 , Mary E Wikswo  1 , Neha Balachandran  1   2 , Anita K Kambhampati  1 , Michelle E Gleason  3 , Hannah Lawinger  3 , Sara A Mirza  1
Affiliations

Childcare and School Acute Gastroenteritis Outbreaks: 2009-2020

Claire P Mattison et al. Pediatrics. .

Abstract

Objectives: Acute gastroenteritis (AGE) outbreaks commonly occur in congregate settings, including schools and childcare facilities. These outbreaks disrupt institutions, causing absences and temporary facility closures. This study analyzed the epidemiology of school and childcare AGE outbreaks in the United States.

Methods: We analyzed AGE outbreaks occurring in kindergarten to grade 12 schools and childcare facilities reported via the National Outbreak Reporting System in the United States from 2009 to 2019 and compared this information to 2020 data. Outbreak and case characteristics were compared using the Kruskal-Wallis rank sum test, χ2 goodness-of-fit test, and Fisher exact test.

Results: From 2009 to 2019, there were 2623 school, 1972 childcare, and 38 school and childcare outbreaks. School outbreaks were larger (median, 29 cases) than childcare outbreaks (median, 10 cases). Childcare outbreaks were longer (median, 15 days) than school outbreaks (median, 9 days). Norovirus (2383 outbreaks; 110 190 illnesses) and Shigella spp. (756 outbreaks; 9123 illnesses) were the most reported etiologies. Norovirus was the leading etiology in schools; norovirus and Shigella spp. were dominant etiologies in childcare centers. Most (85.7%) outbreaks were spread via person-to-person contact. In 2020, 123 outbreaks were reported, 85% in the first quarter.

Conclusions: Schools and childcare centers are common AGE outbreak settings in the United States. Most outbreaks were caused by norovirus and Shigella spp. and spread via person-to-person transmission. Fewer outbreaks were reported in 2020 from the COVID-19 pandemic. Prevention and control efforts should focus on interrupting transmission, including environmental disinfection, proper handwashing, safe diapering, and exclusion of ill persons.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to disclose. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Figures

FIGURE 1
FIGURE 1
Percentage of outbreaks per month, stratified by outbreak setting of school or childcare and reported etiology class, reported through the National Outbreak Reporting System, 2009–2019.
FIGURE 2
FIGURE 2
Rate of health care utilization by outbreak setting and etiology class, among AGE outbreaks reported in schools and childcares through the National Outbreak Reporting System, 2009–2019. AGE, acute gastroenteritis.
FIGURE 3
FIGURE 3
Number of outbreaks in schools, childcares, and both settings reported through the National Outbreak Reporting System per year, 2009–2020.
See this image and copyright information in PMC

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