Hospital acquired rotavirus infection in adults. Who is at risk?

An outbreak of rotavirus infection among adults in an institution for rehabilitation: long-term residence in a closed community as a risk factor for rotavirus illness

An outbreak of group A rotavirus infection resulted in gastroenteritis among disabled adults in an isolated rehabilitation institution in Kobe, Japan. Of the 95 residents, 16 were diagnosed with rotavirus illness. The causative agent was a single strain of typical human group A rotavirus belonging to VP7 serotype G2, VP4 genotype P[4], and NSP4 genotype A. Mean duration of stay was significantly longer for residents with rotavirus illness (22.1+/-11.8 years) than for residents without the disease (13.5+/-10.6 years; P=0.01). Age, sex, disability and location of resident rooms displayed no significant relationships with illness. These observations suggest that long-term residence in a closed community, which might be related to absence of immuno-stimulation, represents a risk factor for rotavirus illness.

Nosocomial rotavirus infections in adult renal transplant recipients

We conducted a 24-month survey of hospital-acquired rotavirus infections in 20 renal transplant recipients who received their graft during 1988. Four cases of nosocomial rotavirus infection were diagnosed (20% of patients), 3-34 days after graft. Two patients presented with severe diarrhoea and two with fever alone. The cases occurred mainly during the winter months and remained sporadic. None of our patients was found to have chronic excretion of rotaviruses. Contacts from paediatric cases can be ruled out. We concluded that rotavirus nosocomial infections were frequent in adult renal transplant recipients and suggest that screening for rotavirus is regularly performed in these immunodeficient patients who are very susceptible to hypovolaemia.

Outbreaks of astrovirus type 1 and rotavirus gastroenteritis in a geriatric in-patient population

Two outbreaks of viral gastroenteritis occurred in seven psychogeriatric wards of a 469-bed psychiatric hospital. The outbreaks occurred over an eight-week period; the first affected 30 people and rotavirus was detected in 12 of 14 persons from whom faecal specimens were available. The second affected 32 people (15 of whom were affected in the previous outbreak) and astrovirus was detected in 5 of the 24 people from whom specimens were available. Specific IgM to astrovirus was demonstrated in 3 patients. The rotavirus outbreak was characterised by a longer duration of illness (mean 4 days), and more severe symptoms; two elderly female patients had severe symptoms over a 14-15 day period but recovered. In the astrovirus outbreak the duration of illness was shorter and symptoms were milder although the attack rate was higher than that observed for rotavirus.

The development and evaluation of radioimmune assays for the detection of immune globulins M and G against astrovirus

The development and evaluation of radioimmune assays for the detection of IgM and IgG antibodies to astrovirus are described. The test was shown to be sensitive and specific, and suitable for screening large numbers of sera. The use of the assays has established that astrovirus type 1 is prevalent in the United Kingdom and that not only infants but also schoolchildren and elderly patients are affected. Further evidence is given to support the view that Marin County Agent is antigenically related to astrovirus type 1.

Rotavirus infection in a small community

Serial titres of rotavirus specific IgG and IgM have been measured in children and adults living in a small community over a 2 1/4-year period. In all age groups the mean titres of rotavirus specific IgG and IgM rose and fell in parallel with the changes in frequency of gastroenteritis symptoms in the community but after the time when respiratory symptoms reached their peak. Gastroenteritis symptoms were seen most commonly in the children but were also frequent in adults, especially the women. Titres of rotavirus specific IgG changed with age, increasing through childhood into early adult life, but decreased thereafter only to increase again in those over the age of 50 years. Females had higher levels of IgG in all age groups but especially among the children and 30-49-year-old women. The high levels of IgG did not protect the young adults from symptomatic gastroenteritis. Detectable levels of rotavirus specific IgM occurred in all age groups but more commonly in children aged under 10 years and in young adults. Raised levels of IgM were uncommon in the elderly, who rarely suffered gastroenteritis symptoms. An epidemiological model is proposed in which the older members of the community act as a reservoir of rotavirus, passing the infection to the children, who then infect the young adults.

Improved immunofluorescence techniques with microplates for the detection of M and G immunoglobulins against rotavirus

A selection of microplates and an inverted microscope were used for the detection of immuno-fluorescence in large numbers of infected cell monolayers. The optical features of this instrument in combination with either Terasaki or Microlymp plates, simplify procedures and allow economical use of reagents, for determining fluorescent antibody levels. The techniques described were applied for estimating M and G immunoglobulins against rotavirus in elderly patients and the validity of the tests was established.