Norovirus linked to over 80 illnesses at Emory University

Brae Surgeoner, Doug and I had a paper published in the September 2009 Journal of Environmental Health about some research we conducted in the Winter of 2006. The study came about because a whole bunch of kids in the University of Guelph’s residence system started puking from an apparent norovirus outbreak. There were lots of handwashing signs up and we wanted to know whether they changed hygiene behavior (especially if kids were using the tools available when entering the cafeteria). Turns out that students weren’t doing as good of a job at hand hygiene as they reported to us.

Norovirus awareness, including the limitations of alcohol-only-based hand sanitizers have come along way, but outbreaks at universities are still pretty commonplace. According to the Atlanta Journal-Constitution, Emory University has been experiencing an increase of noro-linked illnesses over the past week.norovirus-2-3

As of Friday, 89 students sought care for gastroenteritis at either the student health center or University hospital, according to Beverly Clark, University spokeswoman. Other students have been ill and treated themselves, Clark said.

Patient samples from last Wednesday, the first day of the outbreak, tested positive for the Norovirus, Clark said. The State of Georgia Lab and Emory Medical Lab each tested the samples, confirming the virus Friday night.

In a letter sent to the campus community Saturday, an Emory doctor said the exact cause of the outbreak has not been identified. But some campus dining food samples are being tested. Emory Dining Services sanitized with chlorine-based cleaners Saturday morning, according to Michael J. Huey, assistant vice president and executive director for the Emory University Student Health and Counseling Services.

“While most of us are not fond of the smell of chlorine, when you smell it on the Emory campus over the next few days, it is a good thing,” Huey wrote.

172 Fall Ill after Norovirus outbreak on Princess Cruises Ship headed to L.A.

More than 170 passengers and crew members on board a Princess Cruises cruise ship that was docked in San Pedro Sunday have fallen ill following an outbreak of Norovirus, according to the Centers for Disease Control and Prevention.

vomit cruiseThe Crown Princess ship was sailing from Tahiti to Los Angeles on a month-long cruise when passengers began exhibiting symptoms of the gastrointestinal illness, according to a statement from Princess Cruises that was sent on Sunday.

“Over the last few days, the ship began seeing an increased number” of the cases, the statement read.

About 20 people currently had active cases of the illness, which causes vomiting and diarrhea.

Princess Cruises has taken active steps to combat the virus, including increased cleanings and disinfection procedures, and encouraging hand hygiene and case reporting, the CDC Vessel Sanitation Program reported.

Other steps would be taken once passengers disembarked from the ship to prevent the virus from spreading.

All you could hear was people vomiting and at night in the Sahara, noise travels far’ Desert trekker struck by Norovirus in sand storm

A Sevenoaks fundraiser had to be rescued from the Sahara Desert after he and his team were struck down by norovirus in a sand storm.

sevenoaks.noro.sandstormMike Purtill, of Amherst Place in Riverhead, was five days and 50km into the Alzheimer’s Society trek when disaster hit.

“We were told sleeping outside was a real experience,” said Mr Purtill who was one of 30 to be struck down. “But it was more like a scene from a horror movie. All you could hear was people vomiting and, well, other things. At night in the Sahara, noise travels far.”

With the situation getting out of hand 4x4s were sent to pick up the bedraggled group.

With their symptoms in full effect and the sandstorm raging, the group were taken across the bumpy desert to receive medical attention.

Food Safety Talk 70: A Quick Overnight Servicing

Food Safety Talk, a bi-weekly podcast for food safety nerds, by food safety nerds. The podcast is hosted by Ben Chapman and barfblog contributor Don Schaffner, Extension Specialist in Food Science and Professor at Rutgers University. Every two weeks or so, Ben and Don get together virtually and talk for about an hour.  They talk about what’s on their minds or in the news regarding food safety, and popular culture. They strive to be relevant, funny and informative — sometimes they succeed. You can download the audio recordings right from the website, or subscribe using iTunes.1415905212112

Episode 70 begins with Ben and Don talking about the fall weather and Ben’s podcasting from home (possibly sans pants). The discussion turns to travel and its potential impact on Don’s jury duty. Ben has never served on a jury, but has seen many movies about trials.  Don shares that he has seen some movies about trials, notably Capote and To Kill a Mockingbird.  Both guys are fans of the movie My Cousin Vinny, which is not a book.  The pop culture talk turns to television, and Ben mentions The Americans (spelled with a c, not k, but the c does look like a hammer and sickle in the show logo). Don has been watching Intruders, but he has barely been able to discern what the show is actually about.  Last Tango in Halifax is also good TV; with season two now available on Netflix. Ben wraps up the pop culture part of the show with a mention of a Farm Aid concert he attended with some other foodie-people and mentioned that Neil Young shared about his personal views on some farming issues at the concert.

The conversation moved to politics and cable news.  As a board member of the New Jersey Association for Food Protection, Don was part of a recent conference call regarding the organizing of a GMO foods discussion/debate with invited speakers, potentially including Robyn O’Brien. When Ben got his start in food safety, GMO foods were in the news and he mentioned a recent barfblog post on labeling of GMO foods and their unintended impacts on consumer choice. Ben talked about the summer reading program at NC State, and this years book Tomorrows Table, written by an organic farmer and a food biotechnologist.

Ben recently participated in an IFT sponsored twitter chat on the safety of packed lunches.  Ben noted the difficulty in answering complicated questions in only 140 characters over twitter and the stress of having answered so many questions in a short period of time. The discussion turned to an article about the temperatures of school lunches, and the importance of considering both time and temperature.  Don mentioned a good FightBac webinar that covered cross contamination, and plugged his recent appearance on Academic Minute that covered some of Don’s hand washing experiments.

Ben recently received a risk-type question during an interview, and he was keen to know what Don would answer (PhD students take note: Ben plans to ask this question at every qualifying exam he goes to!).  The question was: What is the riskiest food-related thing that you do? Don provides two answers: 1) he sometimes doesn’t wash his hands for 20 s with soap; 2) sometimes he doesn’t take the temperature of meat on the grill and just believes it is ‘probably good enough’. Ben’s answer included eating fresh restaurant salsa with lots of cilantro and eating a lot of berries.

Ben, Don and regular podcast guest Mike Batz are all trying to eat less and exercise more, and using technology to do it. Mike and Don are using Lose It; Ben is using My Net Diary and Runtastic.

Don announced that he has podcast cheated on Ben by participating on another podcast, Better Know a Jackal, and the discussion moves to podcasting workflows in general.  Don is now using an app to send webpage PDFs to Dropbox.

The conversation then transitioned to some humorous turns-of-phrase that Doug and Ben like to drop into barfblog articles. Ben was disappointed no one commented on a witty double entendre he included in a posting about finding vomit on an airplane. Ben has to repeat the line to Don a few times before laughter ensues.

Protect those who protect our food

Jacob E. Gersen and Benjamin I. Sachs, professors at Harvard Law School, write in the N.Y. Times that every year, 5.5 million people are sickened by norovirus, a highly contagious gastrointestinal bug. According to the Centers for Disease Control and Prevention, norovirus is the leading cause of food-borne illness in the United States and is spread primarily by “infected food workers.” Last year cooks, waiters and other workers were involved in about 70 percent of the outbreaks.

public.healthThis is just one example of the critical role that food workers play in our nation’s economic and public health systems. And yet, while we often tailor employment rules for work that has a special impact on the public, the law has yet to recognize food workers as a distinct class — an approach that harms consumers, the economy and the workers themselves.

Sick restaurant workers provide a particularly vivid example of the kind of legal reform that’s needed. Until recently, very few restaurant workers had the legal right to paid sick time, which meant that many of them went to work very ill (last week voters in Massachusetts and three cities passed paid-sick-leave laws). Federal law can fix this problem by requiring employers to provide their workers with paid time off.

But restaurant workers aren’t the only ones who need special treatment. All food workers are on the front lines of the vast food-production industry, and regularly witness dangerous breaches in safety procedures.

Take farm workers who witness the processing of infected (or “downer”) cows — an illegal but, unfortunately, not uncommon practice that risks spreading a host of diseases to humans. Or workers in poultry-processing facilities, where safety and hygiene regulations are flouted, thus increasing the risk of salmonella, which every year results in more than one million illnesses, more than 350 deaths and over $3 billion in health care and lost productivity costs. Unless we offer specific legal protection for all food workers who come forward to expose such practices — something the law does not do now — we all are at risk.

We should also adjust many of our standard workplace rules to take account of the special nature of food production. To avoid the transmission of bovine spongiform encephalopathy, which causes mad cow disease, workers involved in the processing of beef must fully and carefully remove the dorsal root ganglion, a part of the spinal nerve, from all cattle that are 30 months old or older. That’s because these dorsal root ganglia can contain the infective agent behind B.S.E.

public_restroom_rulesThis is high-stakes stuff, and we should make absolutely sure that the workers responsible for doing it aren’t too worn out, or working too fast, to do it right. That means rethinking rules about line speeds, paid break time, union-organizing protections, vacations and, of course, training requirements. The same is true for agriculture workers who are ultimately responsible for making sure that we don’t get salmonella, or for workers in supermarkets who monitor refrigeration protocols.

The basic problem is, neither state nor federal law today recognizes “food work” or “food workers” as legal categories. The Food Safety Modernization Act, which President Obama signed in 2011, gave whistle-blower protections to some food workers, but not to those who work in critical areas like beef and poultry. At the same time, many states have so-called ag-gag laws, which criminalize audio and video recording of agricultural production facilities, making it harder for certain food workers to blow the whistle. In any case, none of these laws recognize food work and food workers as distinct, comprehensive legal categories.

Once federal law recognizes food workers as a distinct legal category, it could then regulate food work and offer distinct protections to food workers. Such a move would not be entirely unprecedented in the law: We already treat nuclear workers, airline pilots and truck drivers differently because of the special nature of their work.

When it comes to food workers, some of the new protections would extend to everyone in the industry: Whistle-blower protections, for example, should be available to all food workers who report on practices related to food safety. Other protections might be more relevant to some food workers than others: Paid break and vacation time along with maximum hours, for example, seem potentially more critical in slaughterhouses than in restaurants, while paid sick leave might be more relevant in restaurants than in slaughterhouses.

Food workers are distinct from other workers in ways that are critical to food safety and public health, and they ought to be protected by the law in new ways. Otherwise, we run the risk that workers — charged with producing our food — will be unable to protect public safety.


40 sick at NAACP annual gala; Hotel Sofitel Norovirus outbreak wasn’t contained

The outbreak of gastrointestinal illness at Hotel Sofitel in Redwood Shores continued days after last month’s ill-fated NAACP dinner, leading the hotel to temporarily shut down all its food operations for disinfection.

The hotel and San Mateo County Health System confirmed Monday that additional peoplenorovirus-2, including guests and hotel employees, became sick in the days after the NAACP State Convention on Oct. 25, when 12 people were taken by ambulance to hospitals for treatment of dehydration. Others drove themselves to the hospital the night of the gala or rode out the symptoms at home.

The cause of the outbreak remains under investigation. Hotel Sofitel spokeswoman Sandra Duhamel said foodborne illness and a norovirus are both possibilities. County environmental health investigators didn’t find any violations linked to foodborne illnesses, she said. The company hired an epidemiologist who said the symptoms, vomiting and diarrhea with recovery in 24 to 48 hours, indicated a possible norovirus.

The hotel has conducted a propertywide cleaning under the guidance of Belfor Property Restoration, said Duhamel, adding some of the food outlets are now back in operation. The hotel was open for business Monday, and a handful of guests were seen eating downstairs.

39 sick: Norovirus suspected at Minnesota banquet

There were 39 suspected cases of people catching a foodborne illness after attending a YoungLife banquet on Oct. 12 at Willow Creek School, according to the Minnesota Department of Health.

norovirus-2“Foodborne is year-round, although this is the time of year when we see an increase in norovirus, so that’s something to be mindful of,” said Doug Schultz, information officer for MDH.

 Norovirus, known as the winter vomiting bug in the UK, is the leading cause of disease outbreaks from contaminated food in the United States, according to the federal Centers for Disease Control and Prevention.

Epidemic Intelligence Service (EIS) officer for MDH Pam Talley said, “We don’t have a lab confirmation of the norovirus,” because of the 39 people who “met the case definition based on the timing and their symptoms” four agreed to send in a stool sample, but did not follow through.

“It was most likely norovirus,” Schultz said. “Based on symptoms and durations and the fact that it’s during norovirus season, it’s highly likely that it was norovirus.”

Wash hands, sick (and non-sick?) workers stay home: 278 sickened in Norovirus outbreak at Shanghai boarding school, 2012

Researchers conclude in BMC Public Health that this Norovirus outbreak could be limited by good hygiene, daily disinfection and “excluding asymptomatic food handlers from food preparation.”

NorochickI’m not sure how that would work, but based on fecal swabs, nine were Norovirus-positive in asymptomatic food preparers.

Here’s the abstract:

More than 200 students and teachers at a boarding school in Shanghai developed acute gastroenteritis in December, 2012. The transmission mode remained largely unknown.
An immediate epidemiological investigation was conducted to identify it.

Methods: Using a retrospective cohort design, we investigated demographic characteristics, school environment, and previous contacts with people who had diarrhea and/or vomiting, drinking water conditions, recalls of food consumption in the school cafeteria, hand-washing habits and eating habits. Rectal swabs of the new cases and food handlers as well as water and food samples were collected to test potential bacteria and viruses. Norovirus was detected by real-time reverse transcription-polymerase chain reaction (RT-PCR).

Results: A total of 278 cases developed gastrointestinal symptoms in this outbreak, and the overall attack rate was 13.9%. The main symptoms included vomiting (50.0%), abdominal cramps (40.3%), nausea (27.0%), diarrhea (6.8%) and fever (6.8%).
Twenty rectal swab samples were detected as Norovirus-positive, including 11 from student cases and 9 from asymptomatic food handlers (non-cases). Among environmental surface samples from the kitchen, 8 samples were also detected as Norovirus-positive.
The genotypes of viral strains were the same (GII) in patients, asymptomatic food handlers and environmental surfaces. Other samples, including rectal swabs, water samples and food samples were negative for any bacteria and other tested viruses.
Asymptomatic food handlers may have contaminated the cooked food during the food preparation.

Conclusion: The study detected that the outbreak was caused by Norovirus and should be controlled by thorough disinfection and excluding asymptomatic food handlers from food preparation. Early identification of the predominant mode of transmission in this outbreak was necessary to prevent new cases.
Furthermore, good hygiene practices such as regular hand washing and efficient daily disinfection should be promoted to prevent such infection and outbreaks.

Author: Caoyi XueYifei FuWeiping ZhuYi FeiLinying ZhuHong ZhangLifeng PanHongmei XuYong WangWenqin WangQiao Sun

Credits/Source: BMC Public Health 2014, 14:1092

Arizona school’s noro outbreak linked to over 100 ill

I was chatting with a couple of guys at a birthday party of one of Sam’s friends this past weekend and relayed that I do food safety stuff. One dude said “I hate this time of year: between the colds, pink eye and norovirus our kids pick up at school we’ll all be sick until Thanksgiving.”

‘Tis the season for school-related infections.norovirus-2-1

According to AZ Central, the so-called winter vomiting virus is making an appearance in the desert. Over 10%, at least 100 students, of Kyrene de la Colina, a Phoenix (AZ) elementary school called in sick last Thursday – definitely an outbreak.

Kyrene Elementary School District spokeswoman Nancy Dudenhoefer said the absences were reported to the Maricopa County Health Department after more than 10 percent of students who attend the Ahwatukee Foothills school called in sick on Thursday.

The district also sent notices to parents about norovirus symptoms and advised them to keep ill children home from school.

In the Tempe Union High School District, Bruce Kipper, principal of nearby Mountain Pointe High, also notified parents about norovirus symptoms.

Kyrene hired a company that specializes in removing norovirus to clean Colina and its school buses before the Friday morning bell. Colina and all other Kyrene schools were open on Friday.

Maricopa County Health Department spokeswoman Jeanene Fowler said norovirus outbreaks are common in schools. “Norovirus is very common,” Fowler said. The solution is “cleaning and getting kids to stay home if they are sick.” (cleaning and sanitizing, with chlorine-based compounds -ben)

Stay at home, thoroughly clean: Pennyslvania hospital implements improvements after norovirus affects 19 staffers

Children’s Hospital of Philadelphia recently improved its virus-detection process after a state Health Department investigation revealed the room of a patient suffering from norovirus in April was inadequately cleaned amid an outbreak among nurses there.

vomit.toiletThe Health Department report was based on an investigation completed in May after 19 nursing staffers working in the same unit fell ill with norovirus – a highly contagious but generally nonlife-threatening gastrointestinal bug that causes vomiting and diarrhea.

The report found that the room of a patient suffering from the virus in the same unit on the weekend of April 5-6 had not been properly cleaned with bleach as required by the hospital’s infection-control policy. All but three of the affected staffers had developed symptoms between March 11 and March 23, before the inadequate cleaning, according to the report.

The report said hospital procedures also were not properly followed in early March when a patient’s mother displayed norovirus symptoms March 8 while visiting. “There was no documented evidence that [Infection Control] was notified of this incident,” the report said. Whether that patient room was adequately cleaned is unclear in the report.

The Health Department investigation also found that staffers who were out sick with norovirus were not instructed to follow hospital protocol of staying home until they were symptom-free for 48 hours until March 27 – after the majority of the affected staff already had been ill. Only three additional staffers fell ill after that date, the report said.