Gastroentiritis in summer camps. Dr Wim Flipse (Zorg en Gezondheid Agentschap) Dr Carole Schirvel (AViQ)

Transcription

1 Gastroentiritis in summer camps Dr Wim Flipse (Zorg en Gezondheid Agentschap) Dr Carole Schirvel (AViQ)

2 A few questions How many children go to summer camp every year?

3 Summer Camp: - Different settings - Organised for young people by young people - Not at all exceptional: > 5000 camps organised each year in Belgium and abroad

4 Kitchen

5 Bathroom

6 Water supply

7 Outbreak of gastro-entiritis in summer camps Transmission: person-to-person spread Waterborne (drinking water, taking showers, washing dishes) Foodborne Environemental [Animal to person (leptospirosis)]

8 Outbreak of gastro-entiritis in summer camps Gastroenteritis may be caused by a variety of different bacteria, viruses or parasites. Symptoms: Diarrhoea, nausea, vomiting and abdominal pains may be experienced over several hours, days or weeks, and may also be accompanied by fever, headache. Incubation time can vary from a few hours to several days (after the closure of the camp).

9 Outbreak of gastroentiritis in summer camps Pathogens -> Most frequent : NOROVIRUS (!! Aerosol transmission, person-toperson, environmental, water and foodborne) Bacteria (salmonella, campylobacter, E. Coli, shigella, C. perfringens) Virus (norovirus, rotavirus, hepatitis A, ) Parasites (giardia, cryptosporidium, )

10 Focus on NOROVIRUS Highly infectious (transmitted from person to person by faecal-oral spread, via aerosolised vomit and by consuming contaminated food or water, touching contaminated surfaces) Can survive in the environment for weeks Incubation period : hours Symptoms : vomiting, diarrhea and abdominal pain, only hours.

11 When/why it s important to notify GE outbreak to public health authorities? To help prevent further spread of illness To eliminate sources of infection such as contaminated products AFSCA/FAVV notifications Sick staff/huge number of sick people Gravity (112 call, hospitalisations) Responsabilities (local authorities/gp) Following camps Closure?

12 And about notifications in Belgium? Few declarations compared to the number of camps organised Camps already finished when outbreak is notified Difficulty to have human samples Collaboration with local authorities (local delegate)

13 Summer camp in Geel in 2016 Start camp on Thirsday (day 1) 155 participants of whom 30 supervisors

14 drilling the participants Day 3 How?

15 running through this ditch

16 Saturday night fever (day 3) First child diarrea and vomitting

17 Trip to Zilvermeer in Mol Theusday (day 6) Activity swimming 2 leaders and one cook got sick

18 More got sick (day 7) A general practitioner was consulted He collected 3 stool samples

19 Results of 3 samples (day 9) 1 blastocistus hominus 1 giardia lamblia all rapid norovirustests negative

20 Contact with the camp leader day 9 Friday morning More participants got sick Information on activities, exposure and how hygiene was maintained He wondered the camp should be closed

21 A quick decision on Friday morning We decided to visit the camp and to collect some data Also we wanted to take some additional samples We designed a questionnaire in one hour Inclusion of some exposure risks and printed 120 copies We packed some bottles for stool samples We informed our headquarter and went off

22 The results Impression Stone houses as dormitoirs The eldest group used tents Sanitation room spacy with rows of toilets and showers Sufficient taps available with each having a bottle of Dettol. Corvée groups were cleaning sanitary space On different places activities in the open air were going on The cooking group preparing meals under a stone roof Sick-bay with about 10 beds some were bunk beds

23 Problems mentionned Because the place often was used for campingactivities of groups, places to drop waist were considered too few. This caused some odour nuissance. Many of the supervisors were tired because of the cleaning of the dormitoirs when someone got sick, transfers to the sick-bay, caring for the sick, seeking medical help, contact home etc. No agreement within the staff of the camp to end the camp.

24 Actions We provided about 8 people with a bundle of questionnaires and asked them to get them dispersed under the participants (including staff). Another supervisor was responsible to collect 6 stool samples of sick persons Inspection of the premisis Handhygiene and hygiene education I visited the sick-bay

25 questionnaire 102 questionnaires returned (=85% of 120) 47 had gastroenteritis (=46,1%) male/female ratio equal over agegroups equal percentage

26 symptoms diarrea vomitting stomach-ache nausea fever > 37,5 headache tiredness %

27 Epicurve outbreak Counts weekend

28 Association gastroenteritis with exposure exposure OR 95% BI 95% BI number exposed number GE N p-value LL BL lake swimming 1,29 0,54 3, ,55 ingested water lake 1,9 0,84 4, ,12 ditch running 1,75 0,72 4, ,22 ditch water ingested 0,94 0,33 2, ,91 wild berries eaten 0,24 0,01 2, ,22 contact with animals 1,05 0,39 2, ,93

29 Results 6 samples 3 tested positive norovirus of which 1 also aeromonas species

30 conclusion Giardia and blastocystis most likely not acquired but already present Saturday night fever probably the introduction of the norovirus Activities probably related to disease but multifocal Quick and dirty research too dirty to get significant results Hygenic circumstances obvious not very good Isolation probably not effective

31 In addition age by years camp experience y = 0,3953x - 0,3296 R² = 0,

32 Thank you for your attention

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