An Intermittent Gastroenteritis Outbreak of Rotavirus Genotype G9P[8] in a Hotel in Songkhla Province, Thailand, April–May 2019

Abstract

A series of acute gastroenteritis outbreaks occurred among participants of two seminars at a hotel in Songkhla Province during 26–29 Apr 2019 and 8–10 May 2019. Investigations were done to determine the causes of the outbreaks and recommend control measures. A case was defined as a participant who developed diarrhea, vomiting, nausea or abdominal pain between 26–30 April (Seminar 1) or 8–13 May (Seminar 2). Samples of the drinking and cooking water used during the seminars were taken and rectal swabs from cases and food handlers were collected for bacterial culture and viral reverse transcription polymerase chain reaction tests. A retrospective cohort study was conducted to identify risk factors. Of 349 participants interviewed, 237 were cases, giving an attack rate of 67.9%. The ages of the cases ranged from 11–57 years (median 15 years).  The most common symptoms were watery diarrhea (94.1%), abdominal pain (81.0%) and nausea (57.8%). Rotavirus was detected in five cases, three food handlers and a sample of water used for cooking. All were of the same genotype G9P[8]. Implicated dishes included spicy seafood salad (adjusted odds ratio (AOR) 4.5, 95% confidence interval (CI) 1.7–11.8), shrimp in sauce (AOR 2.9, 95% CI 1.0-8.2), roast duck with vegetables (AOR 2.9, 95% CI 1.2–7.3) and water from a cooler (AOR 2.0, 95% CI 1.0–3.9). Contaminated water and infected food handlers were probable sources of cross-contamination. After the hotel’s water system was repaired and the food handlers were educated on safe food handling practices and good personal hygiene, no other outbreaks associated with the hotel were reported.