Epidemiology and Infection

Short Report

Norovirus

Concurrent outbreaks with co-infection of norovirus and Clostridium difficile in a long-term-care facility

A. LUDWIGa1a2 c1, K. SATOa3, P. SCHIRMERa2, A. MANIARa4a5, C. LUCERO-OBUSANa2, C. FLEMINGa6, R. RYONOa2, G. ODAa2, M. WINTERSa2 and M. HOLODNIYa2a7

a1 Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA

a2 Veterans Health Administration, Office of Public Health, Palo Alto, CA, USA

a3 Quality Improvement Department, Veterans Affairs Northern California Health System, Sacramento, CA, USA

a4 Infectious Disease Section, Veterans Affairs Northern California Health System, Sacramento, CA, USA

a5 Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, CA, USA

a6 Pathology and Laboratory Medicine Services, Veterans Affairs Northern California Health System, Sacramento, CA, USA

a7 Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA

SUMMARY

We describe an outbreak of simultaneous Clostridium difficile and norovirus infections in a long-term-care facility. Thirty patients experienced acute gastroenteritis, and four had co-infection with identical C. difficile 027 and genotype II.4 New Orleans norovirus strains. Co-occurring infection requires improved understanding of risk factors, clinical impact, and testing strategies.

(Received November 29 2012)

(Revised January 14 2013)

(Accepted January 20 2013)

(Online publication February 22 2013)

Key words

  • Clostridium difficile ;
  • Norwalk agent and related viruses;
  • outbreaks

Correspondence

c1 Author for correspondence: A. Ludwig, M.D., Veterans Health Administration, Office of Public Health, 3801 Miranda Avenue (132), Palo Alto, CA 94304, USA. (Email: Alison.Ludwig@va.gov)

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