Viral prevalence and laboratory investigations of gastroenteritis in institutions for dependent people

Abstract : OBJECTIVES: Viruses are recognized as important agents of gastroenteritis outbreaks in institutions caring for dependent people. We aimed to define norovirus (NoV) and rotavirus (RV) immunochromatographic tests (ICT) and reverse transcription-polymerase chain reaction (RT-PCR) used in gastroenteritis investigations. METHODS: Fourteen sites were monitored from 2010 to 2015, with 360 laboratory investigations. Twenty-two outbreaks and 44 sporadic case patients were investigated with ICTs (114 NoVs and 80 RVs) and RT-PCRs (114 NoVs and 52 RVs). RESULTS: ICTs were useful during outbreaks (identification of NoVs and RVs in respectively 76.5% and 75.0% of episodes) despite the NoV sensitivity limit (55.1%) and the four RV false positive results observed for 10 samples. Given the NoV ICT performance and the observed variations of the NoV and RV prevalence (between 20.0% and 5.0%), ICTs are not appropriate to identify sporadic gastroenteritis case patients. Positive predictive values <60.0% were observed when the prevalence of RV and NoV was low (<5.0%). NoV and RV RT-PCR indications are sporadic gastroenteritis case patients, negative NoV and RV ICT during outbreaks, control of positive RV ICT in cases of suspected NoV and RV co-circulation, patients with long symptom duration, and NoV genogroup and genotype identifications (infection control and epidemiological surveillance). Inclusion of patients with specific clinical symptoms is recommended irrespective of the technique. CONCLUSION: On the basis of the ICT limits identified in this work, RT-PCR development seems essential to improve viral gastroenteritis investigations in institutions caring for dependent people.