Prospective cohort study to investigate the burden and transmission of acute gastroenteritis in care homes: Epidemiological results

Thomas Inns; Anna Pulawska-Czub; John P. Harris; Roberto Vivancos; Nicholas J. Beeching; Miren Iturriza-Gomara; Sarah J. O'Brien

doi:10.1136/bmjopen-2019-033239

Prospective cohort study to investigate the burden and transmission of acute gastroenteritis in care homes: Epidemiological results

Thomas Inns^*, Anna Pulawska-Czub, John P. Harris, Roberto Vivancos, Nicholas J. Beeching, Miren Iturriza-Gomara, Sarah J. O'Brien

^*Corresponding author for this work

Field Epidemiology (North West)

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

Objectives To estimate the incidence of gastroenteritis in individuals in care homes. Design Prospective cohort study. Setting Five participating care homes in North West England, UK. Participants Residents and staff present at the five study care homes between 15 August 2017 and 30 May 2019 (n=268). Outcome measures We calculated incidence rates for all gastroenteritis cases per 1000 person-years at risk and per 1000 bed-days at risk. We also calculated the incidence rate of gastroenteritis outbreaks per 100 care homes per year. Results In total 45 cases were reported during the surveillance period, equating to 133.7 cases per 1000 person-years at risk. In residents the incidence rate was 0.62 cases per 1000 bed-days. We observed seven outbreaks in all care homes included in surveillance, a rate of 76.4 outbreaks per 100 care homes per year. 15 stool samples were tested; three were positive for norovirus, no other pathogens were detected. Conclusions We found that surveillance of infectious gastroenteritis disease in care homes based on outbreaks, the current general approach, detected a majority of cases of gastroenteritis. However, if policymakers are to estimate the burden of infectious gastroenteritis in this setting using only routine outbreak surveillance data and not accounting for non-outbreak cases, this study implies that the total burden will be underestimated.

Original language	English
Article number	033239
Journal	BMJ Open
Volume	9
Issue number	12
DOIs	https://doi.org/10.1136/bmjopen-2019-033239
Publication status	Published - 8 Dec 2019

Bibliographical note

Funding Information:
The key implication for policymakers to be drawn from this study is that we found that surveillance of infectious gastroenteritis disease based on outbreaks in care homes, the current general approach, detected a majority of cases of gastroenteritis. However, if policymakers are to estimate the burden of infectious gastroenteritis in this setting using only routine outbreak surveillance data and not accounting for non-outbreak cases, this study implies that the total burden will be underestimated. Combining findings from this study with data on the distribution of outbreaks in care homes would be a way for future research to fully estimate the burden of infectious gastroenteritis in this setting. The authors would like to acknowledge the hard work and dedication of the research nurses from Royal Liverpool and Broadgreen University Hospitals NHS Trust and North West Coast Clinical Research Network who worked on this study. We would like to thank the management and staff at each of the study care homes for their engagement in participation in this study. The authors would also like to thank Jonathan M Read and David J Allen for their contribution to the study protocol. Contributors TI, AP-C, JPH, RV, NJB, MI-G and SJO conceived and designed the study. TI and AP-C co-ordinated data collection. TI undertook the analysis, wrote the first draft and revised the manuscript. TI, AP-C, JPH, RV, NJB, MI-G and SJO provided input to the manuscript drafting process. All authors reviewed and approved the final manuscript. Funding This research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with University of East Anglia, University of Oxford and the Quadram Institute. Thomas Inns is based at the University of Liverpool. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England. Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied. Competing interests None declared. Patient consent for publication Not required. Ethics approval The study was approved by the North West–Greater Manchester South NHS Research Ethics Committee (REC Reference: 16/NW/0541). Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available upon reasonable request.

Publisher Copyright:
© Author(s) (or their employer(s)) 2019.

Keywords

epidemiology
gastroenteritis
norovirus
outbreaks
surveillance
viral gastroenteritis

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10.1136/bmjopen-2019-033239

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title = "Prospective cohort study to investigate the burden and transmission of acute gastroenteritis in care homes: Epidemiological results",

abstract = "Objectives To estimate the incidence of gastroenteritis in individuals in care homes. Design Prospective cohort study. Setting Five participating care homes in North West England, UK. Participants Residents and staff present at the five study care homes between 15 August 2017 and 30 May 2019 (n=268). Outcome measures We calculated incidence rates for all gastroenteritis cases per 1000 person-years at risk and per 1000 bed-days at risk. We also calculated the incidence rate of gastroenteritis outbreaks per 100 care homes per year. Results In total 45 cases were reported during the surveillance period, equating to 133.7 cases per 1000 person-years at risk. In residents the incidence rate was 0.62 cases per 1000 bed-days. We observed seven outbreaks in all care homes included in surveillance, a rate of 76.4 outbreaks per 100 care homes per year. 15 stool samples were tested; three were positive for norovirus, no other pathogens were detected. Conclusions We found that surveillance of infectious gastroenteritis disease in care homes based on outbreaks, the current general approach, detected a majority of cases of gastroenteritis. However, if policymakers are to estimate the burden of infectious gastroenteritis in this setting using only routine outbreak surveillance data and not accounting for non-outbreak cases, this study implies that the total burden will be underestimated.",

keywords = "epidemiology, gastroenteritis, norovirus, outbreaks, surveillance, viral gastroenteritis",

author = "Thomas Inns and Anna Pulawska-Czub and Harris, \{John P.\} and Roberto Vivancos and Beeching, \{Nicholas J.\} and Miren Iturriza-Gomara and O'Brien, \{Sarah J.\}",

note = "Funding Information: The key implication for policymakers to be drawn from this study is that we found that surveillance of infectious gastroenteritis disease based on outbreaks in care homes, the current general approach, detected a majority of cases of gastroenteritis. However, if policymakers are to estimate the burden of infectious gastroenteritis in this setting using only routine outbreak surveillance data and not accounting for non-outbreak cases, this study implies that the total burden will be underestimated. Combining findings from this study with data on the distribution of outbreaks in care homes would be a way for future research to fully estimate the burden of infectious gastroenteritis in this setting. The authors would like to acknowledge the hard work and dedication of the research nurses from Royal Liverpool and Broadgreen University Hospitals NHS Trust and North West Coast Clinical Research Network who worked on this study. We would like to thank the management and staff at each of the study care homes for their engagement in participation in this study. The authors would also like to thank Jonathan M Read and David J Allen for their contribution to the study protocol. Contributors TI, AP-C, JPH, RV, NJB, MI-G and SJO conceived and designed the study. TI and AP-C co-ordinated data collection. TI undertook the analysis, wrote the first draft and revised the manuscript. TI, AP-C, JPH, RV, NJB, MI-G and SJO provided input to the manuscript drafting process. All authors reviewed and approved the final manuscript. Funding This research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with University of East Anglia, University of Oxford and the Quadram Institute. Thomas Inns is based at the University of Liverpool. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England. Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied. Competing interests None declared. Patient consent for publication Not required. Ethics approval The study was approved by the North West–Greater Manchester South NHS Research Ethics Committee (REC Reference: 16/NW/0541). Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available upon reasonable request. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2019.",

year = "2019",

month = dec,

day = "8",

doi = "10.1136/bmjopen-2019-033239",

language = "English",

volume = "9",

journal = "BMJ Open",

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T1 - Prospective cohort study to investigate the burden and transmission of acute gastroenteritis in care homes

T2 - Epidemiological results

AU - Inns, Thomas

AU - Pulawska-Czub, Anna

AU - Harris, John P.

AU - Vivancos, Roberto

AU - Beeching, Nicholas J.

AU - Iturriza-Gomara, Miren

AU - O'Brien, Sarah J.

N1 - Funding Information: The key implication for policymakers to be drawn from this study is that we found that surveillance of infectious gastroenteritis disease based on outbreaks in care homes, the current general approach, detected a majority of cases of gastroenteritis. However, if policymakers are to estimate the burden of infectious gastroenteritis in this setting using only routine outbreak surveillance data and not accounting for non-outbreak cases, this study implies that the total burden will be underestimated. Combining findings from this study with data on the distribution of outbreaks in care homes would be a way for future research to fully estimate the burden of infectious gastroenteritis in this setting. The authors would like to acknowledge the hard work and dedication of the research nurses from Royal Liverpool and Broadgreen University Hospitals NHS Trust and North West Coast Clinical Research Network who worked on this study. We would like to thank the management and staff at each of the study care homes for their engagement in participation in this study. The authors would also like to thank Jonathan M Read and David J Allen for their contribution to the study protocol. Contributors TI, AP-C, JPH, RV, NJB, MI-G and SJO conceived and designed the study. TI and AP-C co-ordinated data collection. TI undertook the analysis, wrote the first draft and revised the manuscript. TI, AP-C, JPH, RV, NJB, MI-G and SJO provided input to the manuscript drafting process. All authors reviewed and approved the final manuscript. Funding This research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with University of East Anglia, University of Oxford and the Quadram Institute. Thomas Inns is based at the University of Liverpool. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England. Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied. Competing interests None declared. Patient consent for publication Not required. Ethics approval The study was approved by the North West–Greater Manchester South NHS Research Ethics Committee (REC Reference: 16/NW/0541). Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available upon reasonable request. Publisher Copyright: © Author(s) (or their employer(s)) 2019.

PY - 2019/12/8

Y1 - 2019/12/8

N2 - Objectives To estimate the incidence of gastroenteritis in individuals in care homes. Design Prospective cohort study. Setting Five participating care homes in North West England, UK. Participants Residents and staff present at the five study care homes between 15 August 2017 and 30 May 2019 (n=268). Outcome measures We calculated incidence rates for all gastroenteritis cases per 1000 person-years at risk and per 1000 bed-days at risk. We also calculated the incidence rate of gastroenteritis outbreaks per 100 care homes per year. Results In total 45 cases were reported during the surveillance period, equating to 133.7 cases per 1000 person-years at risk. In residents the incidence rate was 0.62 cases per 1000 bed-days. We observed seven outbreaks in all care homes included in surveillance, a rate of 76.4 outbreaks per 100 care homes per year. 15 stool samples were tested; three were positive for norovirus, no other pathogens were detected. Conclusions We found that surveillance of infectious gastroenteritis disease in care homes based on outbreaks, the current general approach, detected a majority of cases of gastroenteritis. However, if policymakers are to estimate the burden of infectious gastroenteritis in this setting using only routine outbreak surveillance data and not accounting for non-outbreak cases, this study implies that the total burden will be underestimated.

AB - Objectives To estimate the incidence of gastroenteritis in individuals in care homes. Design Prospective cohort study. Setting Five participating care homes in North West England, UK. Participants Residents and staff present at the five study care homes between 15 August 2017 and 30 May 2019 (n=268). Outcome measures We calculated incidence rates for all gastroenteritis cases per 1000 person-years at risk and per 1000 bed-days at risk. We also calculated the incidence rate of gastroenteritis outbreaks per 100 care homes per year. Results In total 45 cases were reported during the surveillance period, equating to 133.7 cases per 1000 person-years at risk. In residents the incidence rate was 0.62 cases per 1000 bed-days. We observed seven outbreaks in all care homes included in surveillance, a rate of 76.4 outbreaks per 100 care homes per year. 15 stool samples were tested; three were positive for norovirus, no other pathogens were detected. Conclusions We found that surveillance of infectious gastroenteritis disease in care homes based on outbreaks, the current general approach, detected a majority of cases of gastroenteritis. However, if policymakers are to estimate the burden of infectious gastroenteritis in this setting using only routine outbreak surveillance data and not accounting for non-outbreak cases, this study implies that the total burden will be underestimated.

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KW - norovirus

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KW - surveillance

KW - viral gastroenteritis

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Prospective cohort study to investigate the burden and transmission of acute gastroenteritis in care homes: Epidemiological results

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Keywords

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