3 weeks in November: 56 hospital outbreaks of norovirus in West Midlands and North East UK hospitals

Outbreak News Today again, citing Public Health England (PHE) as documenting 56 suspected and laboratory confirmed hospital norovirus outbreaks with the West Midlands and North East regions from the week beginning Nov. 3 through the week beginning Nov. 24.

This brings the annual total to 572 hospital norovirus outbreaks through the week of Nov.24.

53 sickened: Norovirus suspected in outbreak of illness at Nassau Inn

The Princeton Health Department concluded an investigation of Nassau Inn following reports of illness from Thanksgiving diners, the Times of Trenton reported.

norovirus-2Town health officer Jeffrey Grosser said that norovirus is suspected in the majority of reported cases due to the nature of the symptoms and rapid onset of illness, although the department has not obtained confirmed lab specimens from the ill diners.

Officials collected information from 53 customers whose symptoms included vomiting and diarrhea.

As part of the investigation, the department examined the hotel’s practices for heating food, refrigeration and cleaning. Health officers conducted interviews with employees and reminded them to wash their hands, sanitize touchable surfaces and remain home from work if they felt sick.

20 sickened at Subway: Colorado norovirus outbreak in BV serves as warning

Local health officials said they hope a norovirus outbreak in Buena Vista that left approximately 20 people ill in mid-November will serve as a reminder to area restaurants and food providers to be extra cautious.

norovirusThe Mountain Mail reports Chaffee County Public Health received complaints from five people saying they were ill after eating food from the Subway in Buena Vista, according to a restaurant inspection report.

Lab tests on samples from the five individuals all tested positive for norovirus.

Public Health estimates roughly 20 people, mostly students at Buena Vista High School, might have fallen ill in the outbreak.

An investigation by Chaffee County Environmental Health Manager Victor Crocco, who declined to name the restaurant, found that one employee reported feeling ill the day after the illness was originally reported.

Subway manager Brandon Alexander said he did not recall any of the employees being sick around the time of the outbreak.

Crocco’s investigation led him to conclude a sick employee, and not a larger food contamination, most likely caused the contamination.

Alexander said he doesn’t remember anything like this happening in his 8 years at the restaurant.

Barf spreads and why I work at home: How quickly one sick employee can infect an entire workplace

Using tracer viruses, researchers found that contamination of just a single doorknob or tabletop results in the spread of viruses throughout office buildings, hotels, and health care facilities. Within 2 to 4 hours, the virus could be detected on 40 to 60 percent of workers and visitors in the facilities and commonly touched objects, according to research presented at the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), an infectious disease meeting of the American Society for Microbiology.

phageThere is a simple solution, though, says Charles Gerba of the University of Arizona, Tucson, who presented the study.

“Using disinfecting wipes containing quaternary ammonium compounds (QUATS) registered by EPA as effective against viruses like norovirus and flu, along with hand hygiene, reduced virus spread by 80 to 99 percent,” he says.

Norovirus is the most common cause of acute gastroenteritis in the United States, according to the Centers for Disease Control and Prevention (CDC). Each year, it causes an estimated 19-21 million illnesses and contributes to 56,000-71,000 hospitalizations and 570-800 deaths. Touching surfaces or objects contaminated with norovirus then putting your fingers in your mouth is a common source of infection.

In the study, Gerba and his colleagues used bacteriophage MS-2 as a surrogate for the human Norovirus, as it is similar in shape, size and resistance to disinfectants. The phage was placed on 1 to 2 commonly touched surfaces (door knob or table top) at the beginning of the day in office buildings, conference room and a health care facility. After various periods of time (2 to 8 hours)  they sampled 60 to 100 fomites, surfaces capable of carrying infectious organisms (light switches, bed rails, table tops, countertops, push buttons, coffee pots handles, sink tap handles, door knobs, phones and computer equipment), for the phages.

norovirus“Within 2 to 4 hours between 40 to 60% of the fomites sampled were contaminated with virus,” says Gerba.

In the intervention phase cleaning personal and employees were provided with QUATS disinfectant containing wipes and instructed on proper use (use of at least once daily). The number of fomites on which virus was detected was reduced by 80% or greater and the concentration of virus reduced by 99% or more.

There are 90 different EPA-registered quat-based formulations available under 1500 different brand names that are formulated to kill Norovirus on solid surfaces. These are available as wipes or ready-to-use liquids or concentrates for use by professional maintenance teams. 

“The results shown that viral contamination of fomites in facilities occurs quickly, and that a simple intervention can greatly help to reduce exposure to viruses,” says Gerba.

Bring holiday cheer, not norovirus, into care settings

As North Carolinians (and others) get into the festive season, kids (like mine) are visiting retirement residences and nursing homes to bring holiday cheer.

And they also might be bringing norovirus.Stop-norovirus-warning-sign

Today I brought Sam (below, exactly as shown) to a local care center so he and his preschool classmates could sing carols to residents.

Heightened to noro season and control measures I looked for messages around ill visitors. I didn’t see any but I did see some off-the-shelf hand sanitizer that wouldn’t do much to the non-enveloped virus.

In related news, BBC is reporting that Scottish hospitals are asking visitors who have recently been ill to stay away. Something that I’ll suggest to Sam’s preschool organizers.

NHS Greater Glasgow and Clyde (GGC) said people ignoring the advice could end up passing on symptoms to patients.

FullSizeRenderThe appeal is part of wider attempts to minimise the effects of norovirus in hospitals across the area.

Visitors are also being reminded about the “importance of hand hygiene when entering and leaving” hospitals.

Prof Craig Williams, lead infection control doctor at NHS GGC, said: “We understand that when a relative or friend is in hospital you want to offer them comfort and support by visiting them.

“Unfortunately visiting a loved one if you have experienced sickness and diarrhoea in the last 48 hours can have consequences for the person you are visiting. They would potentially catch whatever infection you have leading to their health being compromised.

“We are asking people not to visit friends or relatives in hospital if they have experienced any sickness or diarrhoea in the last 48 hours.”

Prof Williams added: “Norovirus is particularly prevalent during the winter and it’s not unusual to see this type of virus in the community.

Vomit cruise hits New Zealand; infection control steps shared

I’ve never been on a cruise vacation. The closest I’ve been is a river boat dinner voyage in New Orleans. Not quite the same thing. I can’t think of too many better places to conduct some reality research though. With the increased media scrutiny of infection control measures the cruise folks have had to step up their game and respond when an incident happens – and share what they are doing to keep an outbreak from spreading. That helps build trust (if they can verify that steps are correctly being followed).pr_dawn

According to the Otago Daily Times (NZ), when the Princess Cruise Lines’ Dawn Princess docked in Port Chalmers any affected passengers were not able to come in contact with others (on and off the ship – which was a concern for the kiwi media).

About 200 passengers have been confined to their cabins after the norovirus bug spread through the cruise ship while on a trip around New Zealand.

Canterbury Medical Officer of Health Dr Alistair Humphrey said Dawn Princess had its own doctor on board and the ship’s crew were confident they could control the situation.

The cruise line spokesman said most passengers were unaffected by the outbreak and it took relatively few cases for stringent sanitation levels to be implemented to contain any spread of the illness.

The proactive onboard response included disinfecting high-touch surfaces such as railings, door handles and lift buttons; isolating ill passengers in their cabins; closing all self-service food areas; and encouraging passengers to use their own cabin bathroom facilities, he said.

Although he would not confirm if any passengers visiting Dunedin had norovirus, if they did it was standard protocol for the relevant public health authorities to be notified and those passengers would remain isolated in their cabins.

Heston don’t know food safety

Amy and I both had an idiosyncratic experience in Melbourne over the weekend while celebrating Sorenne’s sixth birthday: we read a newspaper.

heston_blumenthalIn print.

On the cover of the Saturday magazine was a fawning piece about chef Heston Blumenthal, who is packing up his famed Fat Duck restaurant and moving it to Melbourne for six months, while the UK location undergoes renovations.

Amy read the piece and said, “I know why he made those 550 people sick at The Fat Duck: he has no training and only four weeks of restaurant experience before opening The Fat Duck.”

Unsurprisingly, the piece doesn’t mention that nasty outbreak of Norovirus that sickened 529 at the Fat Duck, which only seats some 40 people a night, so the virus was circulating between staff and patrons and back again.

A report by the UK Health Protection Agency concluded that Norovirus was probably introduced at the restaurant through contaminated shellfish, including oysters that were served raw and razor clams that may not have been appropriately handled or cooked.

Investigators identified several weaknesses in procedures at the restaurant may have contributed to ongoing transmission including: delayed response to the incident, the use of inappropriate environmental cleaning products, and staff working when ill. Up to 16 of the restaurant’s food handlers were reportedly working with Norovirus symptoms before it was voluntarily closed

Heston shills for Coles, Jamie Oliver shils for Woolworths, and both suck at food safety.

Why does Australia have to rely on overrated Brits for food porn?

So in Feb. 2015, when Blumenthal will leave his British power base and bring his beloved Duck, including almost its entire staff to, of all places, Melbourne’s Crown Casino, I won’t be attending.

The restaurant is being built here, and will operate for six months (while the English Fat Duck building is renovated). Then, when it closes, a second Dinner by Heston Blumenthal restaurant on the same site will remain permanently in Melbourne.

Science! MIT experiencing gastroenteritis outbreak

The boffins at MIT Medical need a refresher course in handwashing following an outbreak of acute gastroenteritis on campus.

scienceAccording to associate medical director Howard Heller, MIT Medical saw two patients with nausea, vomiting, and diarrhea at the beginning of the week and 16 during the day on Wednesday. MIT-EMS responded to a few more cases overnight, and as of noon on Thursday, a small number of additional patients with similar symptoms had come into Urgent Care. Heller notes that cases do not appear to be linked to any specific dorm or dining hall.

“This may or may not be norovirus,” Heller says. Norovirus, which causes a severe and acute form of gastroenteritis, can spread quickly, especially in dense, semi-closed communities. “But whether it’s norovirus or not,” Heller continues, “our response should be the same — paying extra attention to practicing good hygiene. Frequent and consistent hand-washing is the best way to prevent the spread of this type of virus.” 

’Tis the season for holiday illnesses (apparently)

There’s a perception that there are more outbreaks around the holidays because folks don’t know how to cook turkey. The epidemiology isn’t all that strong around amateur bird preparation and illnesses –  but there are a lot of parties and potluck/covered dish dinners this time of year.

And it’s also noro season. img_1787

According to Planet Princeton, over 30 people reported illnesses to health authorities after eating at the Nassau Inn over Thanksgiving – and it looks like norovirus.

The Princeton Health Department received 30 reports between Thanksgiving and Tuesday of individuals experiencing gastrointestinal illnesses.

All 30 people ate at the restaurant at the Nassau Inn on Thanksgiving or the day after the holiday, Princeton Health Officer Jeffrey Grosser said. Many of the people also ate at other restaurants during the time period.

Laboratory testing has not yet confirmed the cause of the illnesses yet, but Grosser said the Norovirus is suspected in most or all of reported cases because of the symptoms and the time frame for the onset of symptoms and the recovery. 

“All the phone calls we received were similar in terms of where people ate, when people became ill (Thursday and Friday) and when they started feeling better (Sunday and Monday),” Grosser said.

An inspection of the restaurant at the hotel only revealed minor issues that can easily be rectified. Grosser said the issues did not cause the illnesses. 

 

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.