Gastro-Enteritis Outbreak (Tees-side) (Hansard, 7 March 1968)

§ Mr. K. Robinson

The Newcastle Regional Hospital Board has made an inquiry into the circumstances which attended the outbreak of gastro-enteritis among infants on Tees-side during November and December, 1967. In brief, the results of this inquiry, which I have accepted, show firstly that this was a community outbreak of only moderate proportions; secondly, that the deaths which occurred were mainly in weakly babies suffering from some other abnormal condition and were not large in number when compared with similar outbreaks 147W which have occurred from time to time in the past; thirdly, that the clinical care of the babies appears to have been skilfully managed even though it was complicated by infection with intestinal organisms resistant to the action of several antibiotics; fourthly, that local arrangements for the interchange of information during outbreaks of infectious disease need review. This review is now being undertaken by the Regional Hospital Board.

It is impossible to form a precise estimate of the number of cases of gastroenteritis which may have occurred among infants on Tees-side during the fourth quarter of 1967. The reasons for this are that infantile gastro-enteritis is a disease of very variable severity and arises from different causes, not being associated constantly with any one identifiable causative agent or group of agents. Mild forms of the disease are common throughout England and Wales. It the normal way the known extent of infantile gastroenteritis in any community is limited mainly to the more severely affected infants who require medical attention or admission to hospital.

The record of admissions of infants to the unit for the treatment of infectious diseases at West Lane Hospital, Middlesbrough, shows that an outbreak of gastro-enteritis of moderate proportions began in the general community of Tees-side towards the end of October, 1967, and reached a peak in late November or early December. This outbreak coincided in time with an outbreak of acute respiratory illnesses among infants in the same community. There is no clear evidence whether there was any common factor in these apparently distinct outbreaks. An association of gastro-enteritis with respiratory illness has been observed in other outbreaks in the past. As regards the outbreaks on Tees-side neither showed any particular concentration in any one area of the community.

Special attention was focused during the outbreak on the association of cases of gastro-enteritis with certain intestinal bacteria, specific serological types of Escherichia coli, the common colon bacillus, in particular E. coli 0119 and E. coli 0128. A small outbreak of E. coil 0119 infection occurred early in November, 1967, in the Special Care Baby Unit which occupied one ward at Stockton 148W Children's Hospital. This ward was closed and the patients in it transferred to another ward which was then closed, as a precautionary measure, to further admissions of infants. Both wards reopened on 24th December. An indirect result of the closure of these two wards was to place increased pressure on other hospital accommodation for infants in the area, notably in the South Tees-side Hospital Group, at a time when the demand for admission of infants to hospital was rising.

During November and December a number of cases of gastro-enteritis association with E. coli 0128 were observed in the infectious diseases unit at West Lane Hospital, among small babies at Middlesbrough General Hospital and Middlesbrough Maternity Hospital and among some of the infants who remained at Stockton Children's Hospital. An increase in the number of severely ill infants was noted early in December. This appeared to be associated with strains of E. coli 0128 resistant to the action of neomycin, an antibiotic commonly used as a subsidiary measure in the treatment of infantile gastro-enteritis, and to a number of other antibiotics.

When it became apparent that strains of E.coli 0128, showing resistance to several antibiotics, were distributed among infants in the community, were present in the infants' accommodation in several hospitals and were associated with gastro-enteritis of an unusual degree of severity, the hospitals concerned acted together to contain this infection. At a meeting held on 20th December it was decided:

(1) to move the last remaining child from the ward closed to admissions at Stockton Children's Hospital to enable the ward to be disinfected and reopened;
(2) to close the affected ward at Middlesbrough General Hospital to new admissions; and
(3) to concentrate all infants known to be infected with E.coli 0128 in West Lane Hospital in one ward, to which new cases would be admitted only if found to be infected with the same type of organism.

Within a few days all such infants had been accommodated in West Lane Hospital and the outbreak rapidly came to an end.

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Of the infants found to be infected with E.coli 0128, enteritis was regarded as the principal cause of death in 11 cases. Only two of those deaths had occurred among normal infants. The remainder were among infants who had either been born prematurely or were already suffering from some congenital or other abnormality.

This information is being made available to the Press, and the Senior Administrative Medical Officer of the Newcastle Regional Hospital Board is today visiting Tees-side to provide any clarification which may be requested locally.