100 sick onboard Celebrity cruise ship

Up to 100 passengers have are being reported as sick from a possible Norovirus outbreak onboard the Celebrity Infinity.

vomit cruiseAccording to the Centre for Disease Control (CDC) 95 out of 2,117 passengers along with 5 crew members have been reported sick from gastrointestinal illness. The CDC has not yet confirmed that it’s Norovirus but in most outbreaks onboard it usually is. Passengers and crew have been having vomiting and diarrhea.

The CDC has also stated that 8 stool specimens from passenger and crew have been collected for testing. A CDC Vessel Sanitation Program environmental health officer and one epidemiologist are to board the 91,000 gross ton ship once it arrives in San Diego, CA on April 13. The Celebrity Infinity began the voyage on March 29th from Fort Lauderdale, Florida on a 15 night Panama Canal cruise.

It’s Norovirus and 100 sick: Toby Carvery Exeter recloses today due to “technical difficulties”

A city pub and restaurant has reclosed, two days after an outbreak of norovirus was confirmed as the cause of it temporarily shutting.

sorry-technical-difficulties-600x337In excess of 100 people are thought to have been affected by the outbreak at Toby’s Carvery at the Exeter Arms, Middlemoor.

The Exeter Arms remains closed.

A spokesperson for the chain confirmed this morning that Toby Carvery re-closed today due to “technical difficulties” – no further details were given.

Can humans get Norovirus from their dogs?

Human norovirus may infect our canine companions, according to research published online April 1 in the Journal of Clinical Microbiology, a publication of the American Society for Microbiology.

sadie.dog.powellThat raises the possibility of dog-to-human transmission, said first author Sarah Caddy, VetMB, PhD, MRCVS, a veterinarian and PhD student at the University of Cambridge, and Imperial College, London, UK. Norovirus is the leading cause of food-borne illness in the United States, according to the Centers for Disease Control and Prevention (CDC).

The research showed that some dogs can mount an immune response to human norovirus, said Caddy, who will be a junior research fellow at the University of Cambridge, beginning in August. “This strongly suggests that these dogs have been infected with the virus. We also confirmed that that human norovirus can bind to the cells of the canine gut, which is the first step required for infection of cells.”

Caddy and collaborators performed the latter research using non-infectious human norovirus particles, which consist solely of the virus’ outer protein, called the capsid. The capsid is the part of the virus that binds to host cells. By itself, it is non-infectious because it lacks genetic material. (The non-infectious capsid is the basis for a new norovirus vaccine which is being tested in clinical trials, said Caddy).

Nonetheless, it is not clear just how much of a problem canine infection and transmission may represent for humans, said Caddy. Despite dogs’ apparent susceptibility, the investigators failed to find norovirus in canine stool samples, including those from dogs with diarrhea. They found it in serum samples of only about one seventh of 325 dogs tested.

Additionally, it is not yet known whether human norovirus can cause clinical disease in dogs Assuming that dogs become infected with human norovirus as per this study, it also remains unknown whether they could shed the virus in quantities sufficient to infect humans—although clinical investigators have estimated that as few as 18 virus particles can cause human infection.

Moreover, it is yet to be determined whether dogs play a role in the epidemiology of some outbreaks of human norovirus. Some of the biggest outbreaks occur in places from which dogs are absent, such as on cruise ships and in hospitals.

Over 100 sick: Probable Norovirus shuts Toby Carvery in UK

I never knew what a carvery was until I went to the UK in 2010 with Amy and a young Sorenne.

We visited my great-uncle Keith in Newport, Wales, and I drove us to the carvery for lunch, and almost killed us because they drive on the wrong side of the road in the UK and those menacing traffic circles.

long.fin.tuna.apr.15We ate at a carvery the other night while taking a couple of days at the beach: worst meal we ever had, but the line-dancing display by the retirees at Coolangatta was awesome.

This dude (right, exactly as shown) went with a buddy in a plastic kayak to go snorkeling at Cook Island, decided to put his line out on the way (no rod, just a line), and within 10 minutes landed this long-fined tuna off the beach at Fingal Head.

He said sashimi for dinner, frozen steaks for later.

I said, better get that thing on ice.

And then I thought Amy would kill us driving back through Mt. Tamborine. There’s so much within 100km of Brisbane.

A suspected outbreak of norovirus at a popular city pub and restaurant is believed to have affected large numbers of people across the city as well as visitors and holidaymakers.

The Echo has been inundated with reports from people, including children, the elderly and an eight month pregnant woman, claiming to have visited Toby Carvery at the Exeter Arms in Rydon Lane, Middlemoor, between Monday, March 30, and Easter Sunday, April 5, and since becoming ill with sickness and diarrhea for several days.

It is thought the number of people who may have been affected could be in excess of 100.

The restaurant and hotel temporarily closed on Tuesday, April 7, after an investigation led by Environmental Health was launched.

Concerns have also been expressed that the venue failed to close sooner and remained open over the Easter weekend.

amy.mt.tamborine.apr.15A spokesman for Toby Carvery confirmed to the Echo that on Wednesday, April 1, staff became aware that a customer had been suffering from norovirus – the most common stomach bug in the UK.

The spokesman confirmed that a steam clean was subsequently carried out in the restaurant and pub on Thursday after it closed, but normal trading continued over the Easter bank holiday – one of the busiest trading periods of the year.

The spokesman confirmed that on becoming aware of the threat, restaurant officials contacted the Environmental Health department at Exeter City Council, and an officer who visited on Thursday said the restaurant had followed correct safety procedures and could continue to trade.

Environmental Health officers subsequently returned to the restaurant and pub on Tuesday, April 7, after which the restaurant issued a statement on its website announcing the voluntary closure of the restaurant and adjoining hotel until further notice.

Of those affected, one person claimed to have required hospitalisation and countless others reported battling with unpleasant sickness and diarrhoea for many days.

Around 24 staff members at an animal shelter on the outskirts of the city claim to have become ill following a staff meal at the restaurant on March 31, leaving them operating the charity with worrying low staffing numbers.

Will Jennings, from Budleigh Salterton, said he visited The Exeter Arms on the afternoon of Wednesday, April 1, and by the following evening had started to vomit violently every 10 minutes for several hours.

Mr Jennings said he has suffered with a rare autoimmune disease called Behçets Syndrome with neurological involvement for two years and, similar to the elderly and very young, is particularly vulnerable to the effects of any illness, infection or virus which can be a case of “life or death” for him.

He said he had been left “very frail” by the sickness and three more of his party of six were also taken ill with the same symptoms.

Following medical advice, he said he was rushed to hospital by ambulance in a very poorly, semi-conscious state.

“I was suffering substantial pain and dehydration,” he recalled. “I was treated with intravenous fluids, anti sickness and morphine for pain relief.”

Can norovirus get into plants? Apparently, yes

Human norovirus (NoV) is the leading cause of foodborne disease in the United States, and epidemiological studies have shown that fresh produce is one of the major vehicles for the transmission of human NoV. However, the mechanisms of norovirus contamination and persistence in fresh produce are poorly understood.

sorenne.strawberry.13The objective of this study is to determine whether human NoV surrogates, murine norovirus (MNV-1) and Tulane virus (TV), can attach and become internalized and disseminated in strawberries grown in soil.

The soil of growing strawberry plants was inoculated with MNV-1 and TV at a level of 108 PFU/plant. Leaves and berries were harvested over a 14-day period, and the viral titer was determined by plaque assay. Over the course of the study, 31.6% of the strawberries contained internalized MNV-1, with an average titer of 0.81 ± 0.33 log10 PFU/g. In comparison, 37.5% of strawberries were positive for infectious TV, with an average titer of 1.83 ± 0.22 log10 PFU/g. A higher percentage (78.7%) of strawberries were positive for TV RNA, with an average titer of 3.15 ± 0.51 log10 RNA copies/g as determined by real-time reverse transcriptase quantitative PCR (RT-qPCR).

In contrast, no or little virus internalization and dissemination were detected when TV was inoculated into bell peppers grown in soil.

strawberryCollectively, these data demonstrate (i) virally contaminated soils can lead to the internalization of virus via plant roots and subsequent dissemination to the leaf and fruit portions of growing strawberry plants and (ii) the magnitude of internalization is dependent on the type of virus and plant.

 Evidence of the Internalization of Animal Caliciviruses via the Roots of Growing Strawberry Plants and Dissemination to the Fruit

Applied and Environmental Microbiology, April 2015, Volume 81, Number 8, doi:10.1128/AEM.03867-14

DiCaprio E, Culbertson D, Li J

http://aem.asm.org/content/81/8/2727.abstract?etoc

Why I don’t eat raw shellfish: Viruses in food

The UK Advisory Committee on the Microbiological Safety of Food (ACMSF) has published its extensive review of viruses in the food chain. The ACMSF set up a group to revisit the issue of foodborne viruses in light of developments in this area. The final report considered the most important viruses associated with foodborne infections – norovirus, hepatitis A, and hepatitis E.

heston_blumenthalThe report makes a number of recommendations for government departments, including the need for more research in certain areas, and for clear advice for consumers, for example on cooking shellfish and pork products and information on washing leafy green vegetables and soft fruit. The government will respond in due course when the recommendations have been considered in detail.

Professor Sarah O’Brien, Chair of the ACMSF, said: ‘Until recently it has been difficult to assess accurately the impact of foodborne viruses on public health. However, significant advances in our ability to detect viruses in food, coupled with up- to-date estimates of the burden of illness, highlighted in the ACMSF’s latest update, show us that viruses are very important, preventable causes of foodborne illness.’

Summary

In 1994, in response to the outcomes of a joint Advisory Committee of Microbiological Safety of Food (ACMSF) and Steering Group on the Microbiological Safety of Food (SGMSF) meeting, a Working Group was set up to investigate the science and epidemiology of Foodborne Viral Infections. The Working Group assessed the risk from viruses that were believed to be the primary cause of foodborne illness. This report provides an update to this information and provides a new focus on the viruses which are currently the major route of foodborne illness.

Since the publication of the 1998 report, with the exception of two minor risk assessments on hepatitis E and avian influenza, no formal review on viruses had been performed by the ACMSF. It was decided that as significant developments had been made not only in the detection of foodborne viruses, but also in the amount of information obtained from the Infectious Intestinal Disease (IID) Study in England (published in 2000), which indicated a significant disease burden from enteric viruses in the community, it was important that an Ad-Hoc Group was convened to revisit these issues and to provide an update to the 1998 risk assessment.

norovirus-2The FVI Group first met to begin their consideration in November 2010. Over 32 months, the Group met thirteen times to discuss all aspects of viruses in the food chain from farm to fork. As a starting point for the report, the Group reviewed the recommendations from the 1998 report and gave consideration as to whether these had been adequately addressed or were still relevant. At the same time the recommendations from the 2008 World Health Organisation (WHO) Viruses in Food: Scientific Advice to Support Risk Management Activities Matrix and CODEX Criteria, and the European Food Safety Authority (EFSA) Scientific Opinion on an update on the present knowledge on the occurrence and control of foodborne viruses were reviewed.

Using this information along with data on disease burden in the community and outbreak data (from IID and IID2) the Group agreed the scope of the report and what viruses would be its main focus. It was decided that that due to their potential impact and the paucity of data in this area, norovirus, hepatitis E and hepatitis A would be the main focus of the report, although many of the recommendations would also be applicable to other enteric viruses.

During its consideration, the Group reviewed available data on commodities contaminated at source, i.e. bivalve shellfish, pork products and fresh produce and reviewed data on risks associated with infected food handlers. Environmental contamination was reviewed with consideration given to testing methods such as polymerase chain reaction (PCR), person-to-person transmission and food handlers. The Group also considered the engagement with industry and other Government departments (OGDs) regarding environmental conditions of shellfish waters and its impact on norovirus.

A review of data on issues regarding food contact surface contamination, including survivability and persistence was considered along with options for control at all stages of the food chain e.g. thermal processing, storage etc. The thermal stability of hepatitis E was considered with data presented on the increasing occurrence of the disease particularly in older UK males and the recent case control study on the association with processed pork products.

In order to obtain sentinel data the group investigated the important issue of knowledge gathering and surveillance data regarding foodborne viruses. The current limitations of the data were discussed along with what type of data was needed to provide more useful/accurate information on foodborne virus outbreaks. This review included looking at outbreaks from an Environmental Health Officer (EHO) perspective and how they prioritise what they investigate and the data they collect.

Finally, the group reviewed the consumer perspective on risk. This included looking at how risk is presented and information distributed, as this was likely to impact on any future risk assessment.

Within the report the Group has endeavoured to prioritise the recommendations by separating these into those that will inform risk assessments and those that will impact on risk assessments. Full details are provided in the report; however, key recommendations include:

A better understanding of ‘’foodborne viral disease’ (Chapter 3) is required by investigating the correlation between infective dose and genome titre. Molecular diagnostics, typing and quantification should also be used to better understand the burden of virus contamination in foodstuffs. Work is also recommended to develop the methods used to assess norovirus and hepatitis E infectivity in food samples. This would better inform surveys and could potentially be applied to routine monitoring.

Improved ‘routine surveillance and investigation of foodborne viruses’ (Chapter 5) is required with Government agencies developing a single integrated outbreak reporting scheme. A joined up approach that would also involve the annual consolidation of records would reduce the chance of underreporting outbreaks. Further to this, reliable methods for norovirus whole genome sequencing should be developed to enable virus tracking and attribution.

More research on the ‘contamination of food’ (Chapter 6) through sewage contamination is recommended. In particular work should investigate the effectiveness of sewage treatment processes in reducing norovirus concentrations, including the use of depuration on shellfish species and disinfection treatments. Similarly, research is needed to identify the most effective means of decontaminating ‘fresh produce’ post-harvest (Chapter 7).

With the emerging risk of hepatitis E in pigs, the Group recommends work is undertaken to investigate the heat inactivation of hepatitis E in ‘pork products’ (Chapter 8). Research on the effect of curing and fermentation on hepatitis E in pork products is also recommended.

The full list of conclusions and recommendation are presented at the end of each subject area and are consolidated in Chapter 12 for ease of reference.

The assessments made and conclusions reached by the Group reflect evidence oral and written drawn from the scientific community, Government departments and Agencies, EFSA and the scientific literature. The Group’s full conclusions, identified data gaps and recommendations are brought together at the end of this report. The ACMSF accepts full responsibility for the final content of the report.

14% of Norovirus outbreaks from food

Worldwide, noroviruses are a leading cause of gastroenteritis. They can be transmitted from person to person directly or indirectly through contaminated food, water, or environments.

norovirus-2To estimate the proportion of foodborne infections caused by noroviruses on a global scale, we used norovirus transmission and genotyping information from multiple international outbreak surveillance systems (Noronet, CaliciNet, EpiSurv) and from a systematic review of peer-reviewed literature. The proportion of outbreaks caused by food was determined by genotype and/or genogroup.

Analysis resulted in the following final global profiles: foodborne transmission is attributed to 10% (range 9%%–11%) of all genotype GII.4 outbreaks, 27% (25%–30%) of outbreaks caused by all other single genotypes, and 37% (24%%–52%) of outbreaks caused by mixtures of GII.4 and other noroviruses. When these profiles are applied to global outbreak surveillance data, results indicate that ≈14% of all norovirus outbreaks are attributed to food.

Norovirus genotype profiles associated with foodborne transmission, 1999–2012

Emerg Infect Dis, Volume 21, Number 4—April 2015

Verhoef L, Hewitt J, Barclay L, Ahmed S, Lake R, Hall AJ, et al

http://wwwnc.cdc.gov/eid/article/21/4/14-1073_article#suggestedcitation

Why still open? Everyone needs a pay check UK hotel guests struck down by illness

Guests at a Newquay hotel have hit out after the premises remained open despite a serious outbreak of Norovirus.

Beresford Hotel on NarrowcliffSome 30 members of a coach trip from the Sheffield area fell ill with the severe gastric virus when they visited the Beresford Hotel on Narrowcliff in February.

Guests have stated that the hotel owners, hotel owners, the Shearings Group, should have shut the establishment and stopped advertising holidays following the first outbreak so that it could be cleansed throughout. They believe this would have prevented further guests contracting the virus, especially as many are elderly and more susceptible to becoming ill.

Guests have also said they should have at least been warned about the Norovirus outbreak prior to their arrival so they could decide for themselves whether to visit or not.

Shearings has stated it took immediate action to limit the impact of the virus, such as providing information sheets advising guests to use hand gel provided and working with Environmental Health officers at Cornwall Council. The firm also offered guests the chance to stay at its sister hotel in St Ives instead.

61 sickened: Report released in Kansas Meals on Wheels Norovirus outbreak

The most likely source of a norovirus infection in Jan. in Kansas that sickened at least 61 was the Meals on Wheels kitchen in Chanute, but enough data to pinpoint a more specific source could not be obtained.

meals.on.wheelsThe outbreak was first reported Jan. 7 after several people reported gastrointestinal distress after eating Meals on Wheels in Neosho, Allen or Woodson counties.

The investigation was a joint effort between the Kansas Department of Health and Environment, Kansas Department of Agriculture and the Neosho, Allen and Woodson County health departments.

Those affected by the outbreak received meals from Meals on Wheels centers from distribution centers in Chanute, Erie, Humboldt, Iola, Moran, Neosho Falls, St. Paul, Toronto, Thayer and Yates Center, all of which receive their food from the central kitchen in Chanute.

Individual county health departments carried out interviews with affected individuals in their counties while KDHE interviewed staff and volunteers at Meals on Wheels.

According to the report, 488 clients were served by Meals on Wheels Jan. 5 and 6. Attempts were made to contact all served. A total of 159 were successfully interviewed, with 123 meeting the criteria for analysis. Of those, 61 reported illness.

How long will I barf with norovirus? Survey says, 44 hours

Norovirus infections—sometimes known as the stomach flu—typically last for the same amount of time, independent of age or the type of norovirus a person is infected with, according to a recent study by the University of Georgia College of Public Health, Emory University and the Centers for Disease Control and Prevention in the journal Epidemiology and Infection.

norovirusSymptoms from a norovirus infection last about two days, a finding that is constant between infected individuals, as well as environmental settings. The incubation period-or time until symptoms start-is also a consistent 1.5 days from time of infection. These findings differ from the authors’ expectations.

“I would have expected there to be a difference in something like a hospital setting or a difference depending on age groups,” said Andreas Handel, an assistant professor of epidemiology. “But when we analyzed the data, we didn’t see much of a difference.”

One caveat noted by the authors is that the data they analyzed was reported on the level of individual outbreaks, not individual patients. Future studies looking at individual patients are required to further test the findings.

The journal article on “Association of host, agent and environment characteristics and the duration of incubation and symptomatic periods of norovirus gastroenteritis” is available at http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9456829