Investigation of an Outbreak of Acute Diarrheal Disease in a Primary School, Nonthaburi Province, 13 February–7 March 2018

Abstract

Background: On 13 February 2018, Nonthaburi Provincial Health Office was notified that there were the diarrhea outbreak among the students and school personnel at a primary school in Nonthaburi Province. The team then conducted the outbreak and implemented control measures during 13 February–7 March 2018. The objectives were to confirm the diagnosis and the outbreak, to identify causes and risk factors, and to recommend the control measures.
Methods: The descriptive study was performed by interviewing the patients and finding the active cases by case definitions. The case–control study was conducted with the proportion between case and control equal to 1:1. The multivariate logistic regression was applied to identify the risk factors. The environmental survey was conducted in the school. The laboratory study was performed by sending stool exam, hand swab exam and water and ice exam for both bacteria and virus.
Results: The diarrhea outbreak caused by Rotavirus was occurred among the students and school personnel at a primary school in Pak Kret district, Nonthaburi Province. The total number of patients were 192 cases (attack rate 18.6%) Of those, 188 were students while 4 were school personnel. Median age was 9 years (range 4–59 years). Drinking ice water with red syrup was identified as a major risk factor (Adj. OR = 2.31, 95% CI 1.47–3.64, p = 0.003), followed by drinking sweet ice water at school canteen (Adj. OR = 1.63, 95% CI 1.04–2.58, p = 0.034). The laboratory study found the genetic of Rotavirus in the stool samples from students, Adenovirus in the hand swab of a cook and Norovirus in the water and ice at the canteen. The environmental study showed free residual chlorine in the water that entered the refrigerator equal to 0.05 ppm (the standard criteria was 0.2–0.5 ppm)
Recommendations: We recommend the school 1) set the regulatory system for the food venders at the school canteen, 2) set the Inspection system for Tap water and other water sources used in the school, 3) give health education to the cooks at the school, 4) give knowledge about the diarrheal disease prevention and control to students, school personnel and parents, and 5) set the disease surveillance system among the students and school personnel.