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Gastroenteritis Outbreak Investigative Guidelines

Investigation Method

1) Collect preliminary data, specifically

  • are there > 2 non-householders with gastroenteritis?
  • what are the percentages of:
    • vomiting?
    • diarrhea?
    • severe abdominal cramps?
    • fever?
  • where did the > 2 non-householders eat?
  • when did they eat (date and time)?
  • when did they start vomiting or experiencing diarrhea (date and time)?
  • what did they eat?
  • with whom did they eat?
  • did they share other meals in the past week?

2) Call ACDP at 971-673-1111 for referral, if indicated, to the ACDP Urgent Epidemiologic Response Team (UERT).

3) Specimens

  • Give outbreak-affected persons Instructions for Collecting Stools for Viral Culture and PCR (pdf)
  • Use secure, leak-proof containers with screw tops, not flip tops, labeled with name, collection date, and outbreak number.
  • Collect specimens of walnut-size stool, 3 tbsp of diarrheal stool (or vomitus) or 3-4 rectal swabs from six outbreak-affected persons up to four days after onset. Collecting >6 does not increase the chance of finding something.
  • Use proper containers for shipping stool and include OSPHL Virology/Immunology Request Form. Keep fresh stool specimens cold from the time they are produced until the time they reach OSPHL. (See Instructions for Stool Collection (pdf). )
  • Remember that two positives are required to "confirm" the microbial cause of an outbreak. The Oregon State Public Health Laboratory will not test just a single specimen.

4) Paperwork

Special Situations

Refer to the Investigative Guidelines below for:

Definition, suspect foodborne outbreak

  • > 2 non-householders who develop gastroenteritis (acute onset vomiting, diarrhea or both) at about the same time after eating food from the same source

Investigative authority

  • ORS 333-018-0015 authorizes local health departments to investigate foodborne and other common source outbreaks by requiring health care providers to report all such suspected outbreaks immediately.  
  • ORS 333-019-0010 imposes work restrictions on persons who work at food service facilities whilst in a communicable stage of any illness accompanied by diarrhea or vomiting.
  • ORS 6-24-080 authorizes local health departments to collect stool specimens from food handlers.

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