Abstract:
BACKGROUND : Suspected diarrhoeal-illness outbreaks affecting mostly children < 5 years
were investigated between May and July 2013 in Northern Cape province (NCP) and
KwaZulu-Natal (KZN) province. This study describes the epidemiological, environmental
and clinical characteristics and diarrhoeal-illnesses causative agent(s).
METHODS : A descriptive cross-sectional study was conducted. Cases were patients
presenting at healthcare facilities with diarrhoeal-illness between 09 April and 09 July 2013
in NCP and 01 May and 31 July 2013 in KZN. Laboratory investigations were performed
on stools and water samples using microscopy, culture and sensitivity screening and
molecular assays.
RESULTS : A total of 953 cases including six deaths (case fatality rate [CFR]: 0.6%) were
recorded in the Northern Cape province outbreak. Children < 5 years accounted for 58% of
cases. Enteric viruses were detected in 51% of stools, with rotavirus detected in 43%. The
predominant rotavirus strains were G3P[8] (45%) and G9P[8] (42%). Other enteric viruses
were detected, with rotavirus co-infections (63%). No enteric pathogens detected in water
specimens. KwaZulu-Natal outbreak: A total of 1749 cases including 26 deaths (CFR: 1.5%)
were recorded. Children < 5 years accounted for 95% of cases. Rotavirus was detected in
55% of stools; other enteric viruses were detected, mostly as rotavirus co-infections. The
predominant rotavirus strains were G2P[4] (54%) and G9P[8] (38%).
CONCLUSION : Although source(s) of the outbreaks were not identified, the diarrhoeal-illnesses
were community-acquired. It is difficult to attribute the outbreaks to one causative agent(s)
because of rotavirus co-infections with other enteric pathogens. While rotavirus was
predominant, the outbreaks coincided with the annual rotavirus season.