Mass norovirus food poisoning at Japanese nurse

A mass food poisoning outbreak caused by Norovirus occurred at a nursery school located in Tokyo’s Shibuya Ward earlier this month.

norovirus-2According to the Tokyo Metropolitan Government, the norovirus outbreak infected a total of 41 kindergarteners and two nursery school teachers at Yoyogi Nursery School, Fuji TV reported. Over the course of three days from June 6 to 9, the infected children and nursery school staff exhibited symptoms of vomiting and diarrhea, and complained of fever as well.

While none of the infected infants and adults were hospitalized, 35 stool samples tested positive for the norovirus. Furthermore, all infected patients consumed the same school meal on June 6, which ward officials said was deep fried chicken, meat and potato stew, and potato salad.

Shibuya Ward suspended the nursery from serving lunches for three days.

Nightmares from camp: Norovirus infects 60 Dutch students on class trip

At least 55 school children from Assen were infected with the Norovirus while on a school trip to a recreation park in Annen, RTV Drenthe reports.

meatballsThe kids are all from primary schools the Marskramer and De Scharmhof. they were visiting the Annen park for a few days.

On Friday about 40 children were suffering from diarrhea, nausea and headaches. Over the weekend another 15 fell sick. GGD doctor Jorien Van Pelt confirmed that they were infected with the highly contagious virus.

Public health service GGD believes that one sick child infected the rest. All children who start showing symptoms are advised to stay at home.


Is gastroenteritis just another name for norovirus?

Maybe it is. Maybe not. A Texas town has a bunch of sick people. The health department folks are investigating.

And, according to News West 9, they’ve released a weird consumer-focused message in the absence of linking illnesses together: wash your hands and your produce, especially melons.

Midland health officials are warning residents to wash their hands and their food following a recent increase in infectious gastroenteritis cases.Screen Shot 2016-06-20 at 10.36.53 PM

City officials said the best defense against the illness is prevention by effective hand washing with plenty of soap and warm water and washing all vegetables and fruits, including melons.

City of Midland Health & Senior Services officials are interviewing patients within the community to help identify any common source of infection. Interviews that have been conducted to this point have not indicated that the illness is stemming from any particular food establishment.

If health officials believe they are looking at a foodborne norovirus outbreak, CDC has data showing 96% outbreaks are not from homes. Not sure produce washing is an effective risk management step.

Handwashing can limit spread of Norovirus

Norovirus (NoV) epidemics normally peak in December in Japan; however, the peak in the 2009-2010 season was delayed until the fourth week of January 2010.

sponge.bob.handwashingWe suspected intensive hand hygiene that was conducted for a previous pandemic influenza in 2009 as the cause of this delay.

We analysed the NoV epidemic trend, based on national surveillance data, and its associations with monthly output data for hand hygiene products, including alcohol-based skin antiseptics and hand soap.

The delayed peak in the NoV incidence in the 2009-2010 season had the lowest number of recorded cases of the five seasons studied (2006-2007 to 2010-2011). GII.4 was the most commonly occurring genotype. The monthly relative risk of NoV and monthly output of both alcohol-based skin antiseptics and hand soap were significantly and negatively correlated. Our findings suggest an association between hand hygiene using these products and prevention of NoV transmission.

Delayed norovirus epidemic in the 2009-2010 season in Japan: potential relationship with intensive hand sanitizer use for pandemic influenza

Epidemiol Infect. 2016 Jun 15:1-7., ahead of print

Inaida, Y. Shobugawa, S. Matsuno, R. Saito, H. Suzuki

Outbreak of something at Lumby Days in Canada

I can’t help but think that Lumby, British Columbia, is named after lumberjacks, but perhaps I’m stereotyping.

Lumby Interior Health is investigating following an outbreak at a Lumby Days’ event left at least two dozen people sick.

lumberjackDr. Silvina Mema, IH medical health officer, said the health authority has received reports of 24 people falling ill after attending the delegates’ luncheon.

She said the event was attended by 75-80 people and more could have been sick, but did not report it.

Among those who fell victim to illness were Vernon Mayor Akbal Mund, Liberal MLA Eric Foster and North Okanagan Regional District board chair Rick Fairbairn.

Mema said officials do not suspect food poisoning, but rather a viral outbreak, possibly norovirus.

People had diarrhea, vomiting and a fever.

“We are thinking it’s a viral disease,” said Mema. “It is quite common and it gets around quite easily. Food poisoning usually develops faster – within a few hours. This was a longer incubation period.” (fail – dp)

Those attending the luncheon will be asked to fill out a questionnaire as officials try to find a common link.

Mema said there were also leftovers that people took home and IH would like to get samples from that food – if any is left – and to speak to anyone who became sick after eating it.

Oregonian newsroom staffers sickened by Norovirus at morale booster

A May 31 cake-and-coffee gathering to recognize outstanding staff performance at The Oregonian went awry according to Williamette Week.

The Multnomah County Health Department is now investigating a potential norovirus outbreak after at least 14 people came down with stomach pain and severe diarrhea after the event.

The county sent samples of the cake to a laboratory for testing, according to health department spokeswoman Julie Sullivan-Springhetti. “One person did test positive to norovirus,” Sullivan-Springhetti says, referring to the stomach-flu-like ailment sometimes called “cruise-ship disease.”

As The Oregonian has reported, norovirus and other foodborne disorders are increasingly common.

“It was definitely unfortunate,” Oregonian Editor Mark Katches says in an email. “But it won’t stop us from doing these types of celebrations in the future.”

Norovirus: Best way to assess risk?

The application of quantitative microbial risk assessments (QMRAs) to understand and mitigate risks associated with norovirus is increasingly common as there is a high frequency of outbreaks worldwide.

norovirus.qmraA key component of QMRA is the dose–response analysis, which is the mathematical characterization of the association between dose and outcome. For Norovirus, multiple dose–response models are available that assume either a disaggregated or an aggregated intake dose. This work reviewed the dose–response models currently used in QMRA, and compared predicted risks from waterborne exposures (recreational and drinking) using all available dose–response models.

The results found that the majority of published QMRAs of norovirus use the 1F1hypergeometric dose–response model with α = 0.04, β = 0.055. This dose–response model predicted relatively high risk estimates compared to other dose–response models for doses in the range of 1–1,000 genomic equivalent copies. The difference in predicted risk among dose–response models was largest for small doses, which has implications for drinking water QMRAs where the concentration of norovirus is low.

Based on the review, a set of best practices was proposed to encourage the careful consideration and reporting of important assumptions in the selection and use of dose–response models in QMRA of norovirus.

Finally, in the absence of one best norovirus dose–response model, multiple models should be used to provide a range of predicted outcomes for probability of infection.

Comparison of risk predicted by multiple norovirus dose–response models and implications for quantitative microbial risk assessment

Nicole Van Abel, Mary E. Schoen, John C. Kissel, J. Scott Meschke

Risk Analysis, June 2016, DOI: 10.1111/risa.12616

The risks of running through mud

Being in France, I’m reminded that on June 20, 2015, about 1,000 of the almost 8,400 runners who took part in Mud Day activities in Nice on the French Riviera were stricken with gastroenteritis.

TMSplash-300x224And now, the paper.

An acute gastroenteritis (AG) outbreak occurred among participants in an obstacle race in France in the summer of 2015.

An investigation in two phases was conducted to identify the source of infection and document the extent of the outbreak.

First, a message on a social media website asked racers to report any symptoms by email to the Regional Health Agency of Provence-Alpes-Côte d’Azur. Second, a retrospective cross-sectional study was conducted through an interactive questionnaire for all participants, followed by an analytical study of potential risks factors.

Of 8,229 persons registered, 1,264 adults reported AG resolved within 48 hours. Of adults who reported AG, 866 met the case definition. Age group, departure time and ingestion of mud were associated with AG. Twenty stool specimens tested negative for bacteria. All four stool samples tested for viruses were positive for Norovirus genogroup I and genotype 2. No indicator bacteria for faecal contamination were found in drinking water but muddy water of ponds tested positive.

The outbreak was possibly caused by human-to-human transmission of a norovirus introduced by one or more persons and transmitted through contaminated mud. Risks related to similar races should be assessed and recommendations be proposed to raise awareness among health authorities and organisers.

Outbreak of diarrhoeal illness in participants in an obstacle adventure race, Alpes-Maritimes, France, June 2015

Eurosurveillance, Volume 21, Issue 23

Six C, Aboukais S, Giron S, D’Oliveira J, Peloux-Petiot F, Franke F, Terrien H, Dassonville F, Deniau J, Ambert-Balay K, Chesnot T, Ruimy R, Pélandakis M, Basset P, Munoz Rivero M, Malfait P.

Exposure to Norovirus at the beach

Swimming in fecally-contaminated natural waterbodies can result in gastrointestinal (GI) infections and associated symptoms. However, the pathogenic microorganisms responsible are often unidentified because studies nearly always rely on self-reported symptoms. Noroviruses have been considered a likely cause because they are relatively resistant to conventional wastewater treatment and can survive in the environment.

norovirus-2Symptoms among swimmers usually occur within a few days of exposure, consistent with a short incubation period characteristic of noroviruses.

In the summer of 2009, we conducted an epidemiology study at a beach in Puerto Rico. We previously reported no association between swimming and self-reported GI symptoms at this beach. As part of this study, we also collected saliva samples from a subset of participants (N=1300) using an Oracol oral swab: on the day of the beach visit (S1); after 10-12 days (S2); and after approximately three weeks (S3), and tested them for IgG antibody responses to two common noroviruses (Norwalk and VA387) using a Luminex platform and a previously published method. An immunoconversion, indicating a potential new infection, was defined as at least a fourfold increase in norovirus-specific median fluorescence intensity (MFI) from the S1 to the S2 sample with the S3 sample remaining at least two times above the baseline (S1) MFI.

Approximately 4.7% (N=61) immunoconverted to at least one of the noroviruses. Swimmers who immersed their head in water had a higher rate of immunoconversion (5.5%) compared to non-swimmers (2.0%) (OR=3.32, 95% CI 1.2-9.5). Immunoconversion to norovirus was not associated with increased self-reported GI symptoms, indicating these infections were largely asymptomatic.

To our knowledge, this is the first epidemiology study to show an association between norovirus infection and swimming exposure. This abstract does not reflect EPA policy.

Evidence for asymptomatic norovirus infection transmission associated with swimming at a tropical beach

Soceity for Epidemiology Research, Miami, FL, June 07 – 16, 2016

Wade, Tim, S. Augustine, S. Griffin, K. Simmons, T. Eason, K. Oshima, E. Sams, A. Egorov, AND A. Dufour

Norovirus? Look to the barf

We investigated an outbreak of norovirus that affected students and teachers of a high school in Lleida, Spain through various transmission mechanisms.

norovirus-2A case-control epidemiological study of the risk of disease and the relative importance of each mode of transmission was carried out. Cases and controls were selected from a systematic sample of students and teachers present at the school on 28 January. Fecal samples were taken from three food handlers and 16 cases. The influence of each factor was studied using the adjusted odds ratio (aOR) and the estimated population attributable risk (ePAR) with 95% confidence intervals (CI). We interviewed 210 people (42 cases, 168 controls). The proportion of symptoms in these individuals was nausea 78·6%, vomiting 59·5%, diarrhoea 45·2%, and fever 19·0%. The epidemic curve showed transmission for at least 4 days. The risk of disease was associated with exposure to food (aOR 5·8) in 66·1% of cases and vomit (aOR 4·7) in 24·8% of cases. aecal samples from 11 patients and two food handlers were positive for norovirus GII.12 g.

Vomit may co-exist with other modes of transmission in norovirus outbreaks and could explain a large number of cases.

Norovirus gastroenteritis outbreak transmitted by food and vomit in a high school

Epidemiology and Infection / Volume 144 / Issue 09 / July 2016, pp 1951-1958Copyright © Cambridge University Press 2016  DOI: (About DOI), Published online: 13 January 2016

Godoy, M. Alsedà, R. Bartolomé, D. Clavería, I. Módol, P. Bach, G. Mirada And À. Domínguez