{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T16:07:31Z","timestamp":1793462851652,"version":"4.5.0"},"reference-count":65,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,11,1]]},"abstract":"<jats:sec>\n                  <jats:title\/>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Acute gastroenteritis (AGE) outbreaks commonly occur in congregate settings, including schools and childcare facilities. These outbreaks disrupt institutions, causing absences and temporary facility closures. This study analyzed the epidemiology of school and childcare AGE outbreaks in the United States.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>We analyzed AGE outbreaks occurring in kindergarten to grade 12 schools and childcare facilities reported via the National Outbreak Reporting System in the United States from 2009 to 2019 and compared this information to 2020 data. Outbreak and case characteristics were compared using the Kruskal-Wallis rank sum test, \u03c72 goodness-of-fit test, and Fisher exact test.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>From 2009 to 2019, there were 2623 school, 1972 childcare, and 38 school and childcare outbreaks. School outbreaks were larger (median, 29 cases) than childcare outbreaks (median, 10 cases). Childcare outbreaks were longer (median, 15 days) than school outbreaks (median, 9 days). Norovirus (2383 outbreaks; 110\u2009190 illnesses) and Shigella spp. (756 outbreaks; 9123 illnesses) were the most reported etiologies. Norovirus was the leading etiology in schools; norovirus and Shigella spp. were dominant etiologies in childcare centers. Most (85.7%) outbreaks were spread via person-to-person contact. In 2020, 123 outbreaks were reported, 85% in the first quarter.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Schools and childcare centers are common AGE outbreak settings in the United States. Most outbreaks were caused by norovirus and Shigella spp. and spread via person-to-person transmission. Fewer outbreaks were reported in 2020 from the COVID-19 pandemic. Prevention and control efforts should focus on interrupting transmission, including environmental disinfection, proper handwashing, safe diapering, and exclusion of ill persons.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2021-056002","type":"journal-article","created":{"date-parts":[[2022,10,24]],"date-time":"2022-10-24T08:15:09Z","timestamp":1666599309000},"source":"Crossref","is-referenced-by-count":28,"title":["Childcare and School Acute Gastroenteritis Outbreaks: 2009\u20132020"],"prefix":"10.1542","volume":"150","author":[{"given":"Claire P.","family":"Mattison","sequence":"first","affiliation":[{"name":"aDivision of Viral Diseases, National Center for Immunization and Respiratory Diseases"},{"name":"cCherokee Nation Assurance, Arlington, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura E.","family":"Calderwood","sequence":"additional","affiliation":[{"name":"aDivision of Viral Diseases, National Center for Immunization and Respiratory Diseases"},{"name":"cCherokee Nation Assurance, Arlington, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary A.","family":"Marsh","sequence":"additional","affiliation":[{"name":"bDivision of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E.","family":"Wikswo","sequence":"additional","affiliation":[{"name":"aDivision of Viral Diseases, National Center for Immunization and Respiratory Diseases"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neha","family":"Balachandran","sequence":"additional","affiliation":[{"name":"aDivision of Viral Diseases, National Center for Immunization and Respiratory Diseases"},{"name":"cCherokee Nation Assurance, Arlington, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita K.","family":"Kambhampati","sequence":"additional","affiliation":[{"name":"aDivision of Viral Diseases, National Center for Immunization and Respiratory Diseases"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle E.","family":"Gleason","sequence":"additional","affiliation":[{"name":"bDivision of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Lawinger","sequence":"additional","affiliation":[{"name":"bDivision of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara A.","family":"Mirza","sequence":"additional","affiliation":[{"name":"aDivision of Viral Diseases, National Center for Immunization and Respiratory Diseases"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2022,10,24]]},"reference":[{"issue":"1","key":"2023110816585506000_B1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.3201\/eid1701.P21101","article-title":"Foodborne illness acquired in the United States--unspecified agents","volume":"17","author":"Scallan","year":"2011","journal-title":"Emerg Infect Dis"},{"issue":"9","key":"2023110816585506000_B2","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1017\/S0950268815003283","article-title":"Norovirus gastroenteritis outbreak transmitted by food and vomit in a high school","volume":"144","author":"Godoy","year":"2016","journal-title":"Epidemiol Infect"},{"issue":"11","key":"2023110816585506000_B3","doi-asserted-by":"crossref","first-page":"1906","DOI":"10.1093\/cid\/ciab771","article-title":"Enteric illness outbreaks reported through the National Outbreak Reporting System, United States, 2009-19","volume":"74","author":"Wikswo","year":"2022","journal-title":"Clin Infect Dis"},{"key":"2023110816585506000_B4","unstructured":"de Brey\n              C\n            , SnyderTD, ZhangA, DillowSA. 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