Three Rotavirus Outbreaks in the Postvaccine Era — California, 2017

Rachel M. Burke, PhD; Jacqueline E. Tate, PhD; Nora Barin, MPH; Carly Bock; Michael D. Bowen, PhD; David Chang, MD; Rashi Gautam, PhD; George Han, MD; John Holguin, MPH; Thalia Huynh; Chao-Yang Pan, MPH; Rebecca Quenelle, MPH; Catherine Sallenave, MD; Cindy Torres; Debra Wadford, PhD; Umesh Parashar, MBBS


Morbidity and Mortality Weekly Report. 2018;67(16):470-472. 

In This Article

Outbreak 1: Child Care Center in Long Beach

In late March 2017, the Long Beach Department of Health and Human Services (LBDHHS) was notified of an outbreak of acute gastroenteritis (AGE) at a child care center. The facility provided daycare to 80 children aged 2–5 years and afterschool care to 135 additional children; 27 staff members were employed. LBDHHS emphasized hand hygiene, provided facility-cleaning recommendations consistent with those for norovirus outbreaks, and advised parents to keep ill children home for at least 48 hours after symptom resolution. At a site visit, LBDHHS provided detailed recommendations and education to staff members, and the facility later closed to perform more thorough cleaning. By April 17, 2017, a total of 27 cases of AGE among children and four cases among staff members had been reported; the classrooms for children aged 2 years and 3 years experienced the highest attack rates (43% and 37%, respectively). Five secondary cases among household contacts were reported. Symptom onset dates ranged from March 22 through April 12, 2017. Among 31 patients for whom symptom information was available, 22 (71%) had diarrhea, 17 (55%) had vomiting, 13 (42%) reported abdominal cramps, 12 (38%) had fever, and four (13%) reported nausea. Patient age ranged from 2 to 86 years (median age = 4 years). Three patients visited their primary care provider; no hospitalizations or deaths occurred. Norovirus was initially suspected to be the causative agent, but four stool specimens tested at the Long Beach Public Health Laboratory were norovirus-negative. Specimens were then sent to the California Department of Public Health (CDPH) Viral and Rickettsial Disease Laboratory (VRDL), a CaliciNet Outbreak Support Center, where all specimens tested positive by reverse-transcription polymerase chain reaction (RT-PCR) for rotavirus. These samples were genotyped as G12P[8] by CDC's Rotavirus Surveillance Laboratory. The California immunization registry indicated that six (22%) of the 27 children with rotavirus were vaccinated, including four who were fully vaccinated. However, actual coverage might have been higher in this population because provider use of the registry is not mandated and the facility did not require proof of rotavirus vaccination for enrollment.