Original Research

Investigation of two suspected diarrhoeal-illness outbreaks in Northern Cape and KwaZulu-Natal provinces, South Africa, April–July 2013: The role of rotavirus

Andronica M. Shonhiwa, Genevie Ntshoe, Noreen Crisp, Ayo J. Olowolagba, Vusi Mbuthu, Maureen B. Taylor, Juno Thomas, Nicole A. Page
Southern African Journal of Infectious Diseases | Vol 35, No 1 | a159 | DOI: https://doi.org/10.4102/sajid.v35i1.159 | © 2020 Andronica M. Shonhiwa, Genevie Ntshoe, Noreen Crisp, Ayo J. Olowolagba, Vusi Mbuthu, Maureen B. Taylor, Juno Thomas, Nicole A. Page | This work is licensed under CC Attribution 4.0
Submitted: 31 May 2019 | Published: 22 July 2020

About the author(s)

Andronica M. Shonhiwa, Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Sandringham, Johannesburg, South Africa
Genevie Ntshoe, Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Sandringham, Johannesburg, South Africa; and School of Health Systems and Public Health, Faculty of Health Science, University of Pretoria, Pretoria, South Africa
Noreen Crisp, Communicable Disease Control, Department of Health, Kimberley, South Africa
Ayo J. Olowolagba, Communicable Disease Control, eThekwini Metropolitan Municipality Department of Health, Durban, South Africa
Vusi Mbuthu, Communicable Disease Control, eThekwini Metropolitan Municipality Department of Health, Durban, South Africa
Maureen B. Taylor, School of Health Systems and Public Health, Faculty of Health Science, University of Pretoria, Pretoria, South Africa; Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and National Health Laboratory Service, Tshwane Academic Division, Pretoria, South Africa, South Africa
Juno Thomas, Centre for Enteric Diseases, National Institute for Communicable Diseases, National Health Laboratory Service, Sandringham, Johannesburg, South Africa
Nicole A. Page, Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and Centre for Enteric Diseases, National Institute for Communicable Diseases, National Health Laboratory Service, Sandringham, Johannesburg, South Africa


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Abstract

Background: Suspected diarrhoeal-illness outbreaks affecting mostly children < 5 years were investigated between May and July 2013 in Northern Cape province (NCP) and KwaZulu-Natal (KZN) province. This study describes the epidemiological, environmental and clinical characteristics and diarrhoeal-illnesses causative agent(s).

Methods: A descriptive cross-sectional study was conducted. Cases were patients presenting at healthcare facilities with diarrhoeal-illness between 09 April and 09 July 2013 in NCP and 01 May and 31 July 2013 in KZN. Laboratory investigations were performed on stools and water samples using microscopy, culture and sensitivity screening and molecular assays.

Results: A total of 953 cases including six deaths (case fatality rate [CFR]: 0.6%) were recorded in the Northern Cape province outbreak. Children < 5 years accounted for 58% of cases. Enteric viruses were detected in 51% of stools, with rotavirus detected in 43%. The predominant rotavirus strains were G3P[8] (45%) and G9P[8] (42%). Other enteric viruses were detected, with rotavirus co-infections (63%). No enteric pathogens detected in water specimens. KwaZulu-Natal outbreak: A total of 1749 cases including 26 deaths (CFR: 1.5%) were recorded. Children < 5 years accounted for 95% of cases. Rotavirus was detected in 55% of stools; other enteric viruses were detected, mostly as rotavirus co-infections. The predominant rotavirus strains were G2P[4] (54%) and G9P[8] (38%).

Conclusion: Although source(s) of the outbreaks were not identified, the diarrhoeal-illnesses were community-acquired. It is difficult to attribute the outbreaks to one causative agent(s) because of rotavirus co-infections with other enteric pathogens. While rotavirus was predominant, the outbreaks coincided with the annual rotavirus season.


Keywords

diarrhoeal illness; outbreak; rotavirus; rotavirus vaccine; South Africa.

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