August 15, 2018
2 min read

Most acute gastroenteritis outbreaks in youth camps from food, water

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More than half of U.S. states reported outbreaks of acute gastroenteritis among children attending youth camps during a recent study period, according to research published in the Journal of the Pediatric Infectious Diseases Society. Outbreaks were most frequently related to norovirus exposure after food preparation or recreational water activities, researchers said.

“Each year, more than 14 million children and adults attend more than 14,000 overnight or day camps in the United States,” Anita K. Kambhampati, MPH, ORISE Fellow at the CDC’s National Center for Immunization and Respiratory Diseases, and colleagues wrote. “Camps can encourage healthy lifestyles and social skills, but factors such as shared activities and accommodations, rural settings with limited access to municipal drinking water and sewer systems, and minimal health education of campers and staff can facilitate outbreaks of communicable disease, including those of acute gastroenteritis.”

According to Kambhampati and colleagues, defining specific exposures in summer camps that resulted in acute gastroenteritis is difficult because children can be poor historians and nearly all who attend summer camps participate in the same activities and eat the same meals. Transmission is also difficult to stop because multiple camp sessions may be occurring at the same time within the facility, and new campers may be exposed to those who had acquired an infection.

To examine outbreaks of acute gastroenteritis in these settings, Kambhampati and colleagues analyzed data collected between 2009 and 2016 in the National Outbreak Reporting System. Additionally, they searched available literature for outbreaks in camps located around the world and any recommendations regarding prevention and control of outbreaks in a camp setting.

They found 229 youth camp-associated acute gastroenteritis outbreaks reported in 39 U.S. jurisdictions within the study period. Of these, 120 resulted from person-to-person transmission (53%). Other outbreaks reported different sources of transmission, including unknown (19%), food (17%), water (8%), animal contact (2%) and environmental contamination (less than 1%).

When etiologies were suspected or confirmed, the most common ones were norovirus (63%), Salmonella species (9%) and Shiga toxin-producing Escherichia coli (7%).

The researchers noted that they found 43 additional acute gastroenteritis outbreaks in youth camps located in other countries between 1938 and 2014.

Several control measures were included in the literature assessed by the researchers. The most frequently reported actions included closing camps, separating ill campers from healthy campers, disinfecting the camp environment and providing education on food preparation and hand hygiene.

“General food-, water- and animal-safety and infection control guidelines can help prevent camp acute gastroenteritis outbreaks,” Kambhampati and colleagues wrote, “but the combination of factors that facilitate the occurrence and perpetuation of these outbreaks supports the need for camp-specific recommendations, which include consideration of food preparation practices, accommodations, activities and water sources at the camp.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.