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

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.

vomit.infosheet.oct.08

Ebola: Now is the time for discreet barfing

Sometimes I can handle vomit like a pro. Landing from a three-hour flight and when the plane touched the tarmac, my daughter was spewing. I had the bag and calmly departed the plane.

Image10Other times, the smell is enough  to set me off like the pie-eating scene in Stand By Me (left, exactly as shown).

And it’s much more likely to be Norovirus than Ebola.

Barf stories are now everywhere with this ebola thing, and anyone who vomits better be discreet or they will end up wrapped in plastic.

Emirates Flight 237 was surrounded by emergency service vehicles at Boston Logan Aiport as haz-mat teams boarded the plane.

The flight originated in Dubai.

None of the people on board the jet were thought to have come from West Africa.

At 9:44PM passenger Tracy Barahona tweeted: “Ok just announced that all patients of concern have been removed from plane.”

A spokesman for the airport said the five passengers were “exhibiting flu-like” symptoms.

The ill passengers are believed to be Saudi Arabian.

The first lab tests of a Kansas City, Kan., man admitted to the University of Kansas Hospital on Monday indicate that he does not have Ebola, the hospital said Tuesday.

The man will remain in a hospital isolation unit until results of confirmatory tests by the federal Centers for Disease Control and Prevention become available in the next day or two. Hospital officials are hopeful.

EFSA: Scientific Opinion on the risk posed by Salmonella and Norovirus in tomatoes

Tomatoes may be minimally processed to obtain ready-to-eat products, and these steps include selection, washing, cleaning, stem removal, cutting, packaging and storage.

tomatoEpidemiological data from the EU have identified one salmonellosis outbreak and one Norovirus outbreak associated with tomato consumption between 2007 and 2012. Risk factors for tomato contamination by Salmonella and Norovirus were considered in the context of the whole food chain.

Available estimates of the Salmonella and Norovirus occurrence in tomatoes were evaluated together with mitigation options relating to prevention of contamination and the relevance of microbiological criteria. It was concluded that each farm environment represents a unique combination of risk factors that can influence occurrence and persistence of pathogens in tomato production.

Appropriate implementation of food safety management systems including Good Agricultural Practices (GAP), Good Hygiene Practices (GHP) and Good Manufacturing Practices (GMP), should be primary objectives of tomato producers. The current lack of data does not allow the proposal of a Hygiene Criterion for E. coli at primary production of tomatoes and it is also not possible to assess the suitability of an EU-wide E. coli Process Hygiene Criterion.

There are Food Safety Criteria for the absence of Salmonella in 25 g samples of ready-to-eat pre-cut tomatoes as well as in unpasteurised tomato juice placed on the market during their shelf life. A Food Safety Criterion for Salmonella in whole tomatoes could be considered as a tool to communicate to producers and processors that Salmonella should not be present in the product.

Testing of tomatoes for Salmonella could be limited to instances where other factors indicate breaches in GAP, GHP, GMP or HACCP programmes. It is currently not possible to provide a risk base for establishing a Norovirus Food Safety Criterion for these foods.

Norovirus chef Heston Blumenthal defends $500 price tag for Fat Duck Australia pop-up

Like I’ve written before, all the hacks are headed to Australia to make a buck (I actually live here, because of my wife’s career).

heston_blumenthalAging rock stars, actors, and celebrity chefs, they’ve all done, or are doing, the tour of Australia.

Norovirus-isn’t-my-fault chef Heston Blumenthal — whose famed Bray, England restaurant Fat Duck is popping up in Australia next year — has come under fire for the hefty price point of its tasting menu. The pop-up, which will take place in Melbourne, will cost $525 AUD ($475 USD) per person, excluding beverages. Not only is it more expensive (about $75 more) than the original price in England, but Good Food AU notes that this makes it one of Australia’s “most expensive restaurants.” Blumenthal believes the price is justified: “We’re basically picking up the entire kitchen and staff from the Fat Duck and relocating across the world.” Blumenthal must also house his 50 or so British staff for six months.

Careful with those raw oysters, which sickened 550 a couple of years ago in the UK.

He also added that “the cost structure for the Duck is like no other restaurant in the world. It can take one chef days just to make one item for the menu. Dining at the Duck is four and a half hours of entertainment.” In theory that’s just over $100 an hour for a “multi-sensory gastronomic journey of history, nostalgia, emotion and memory.” The reservation line opens October 8 and will close October 26. Fat Duck Australia will pop-up from February 3, 2015 to August 15, 2015.

I won’t be going.

‘Cruise from hell’ Noro hits Australian cruise ship passengers

Passengers aboard a cruise ship bound for Fremantle say more than 100 people were struck down by a particularly violent bout of gastroenteritis.

The Sea Princess, a 15-deck ship operated by Princess Cruises, left Fremantle for Singapore on August 18 and is due back on Saturday.

vomit cruiseIt missed several stops because of a mechanical issue but passengers have been compensated for the changes.

But the norovirus outbreak on the ship led one passenger to call it “the cruise from hell”.

Another passenger, Burswood real estate agent Jim Edwards, 56, became ill about a week into the cruise and said it was the worst bout of gastroenteritis he had ever had.

He said at least 200 of the ship’s 2000 passengers had contracted the bug – double Princess Cruises’ estimate of 100.

“I couldn’t believe how strong it was,” he said.

“I’m only in my 50s but it took everything out of me and that’s why I was worried about the older people. It was knocking them down like flies.”

A Princess Cruises spokesman said more stringent sanitation procedures were implemented after the first few complaints.

Don’t touch that knob: Norovirus can spread around an entire building within just hours of contaminating one surface

A virus can spread around a whole building within two hours of coming into contact with just one surface, a new study has found, presented at the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in Washington.

knob.virusA team at the University of Arizona, Tucson found that when a virus, for example the Norovirus, contaminates a single doorknob or elevator button it spreads rapidly through entire office buildings, hotels or hospitals.

The team, led by microbiologist Charles Gerba, used bacteriophage MS-2 as a surrogate for the human Norovirus because it is similar in shape, size and resistance to disinfectants.

They placed it on a single commonly touched surface, such as a door knob or table, at the beginning of a day in office buildings, conference room and in a health care facility in Arizona.

They then tested surfaces capable of carrying infectious organisms, such as light switches, bed rails, table tops, countertops, coffee pots handles, sink tap handles, door knobs, phones and computer equipment for traces of the bacteriophage at various times between two and eight hours later.

The team found that up to 60 per cent of the surfaces sampled were contaminated with the virus within just two to four hours.

However, there is a simple solution for combating the spread, says Mr Gerba, who found using disinfecting wipes registered as effective against viruses like norovirus and flu, along with hand hygiene, reduced the spread by between 80 and 99 per cent.”

Mr Gerba concluded: “The results show that viral contamination of (surfaces) in facilities occurs quickly, and that a simple intervention can greatly help to reduce exposure to viruses.”

91 now sick from Norovirus suspected at UK pirate ship lake

A Norovirus outbreak saw a Devon holiday park temporarily close.

BTSKeithandJohnnyAWESeveral holidaymakers fell ill with suspected norovirus in the last fortnight. 

River Dart Country Park, in Ashburton, said that 91 cases of sickness and diarrhea had been reported by visitors to the outdoor activity resort since Friday, August 8.

Following an announcement that water tests were taking place, the park manager closed the site to allow “further investigation”. 

It was due to open today.

On Tuesday, managing director Mark Simpson issued a statement on the park’s website announcing he had made a decision to close the site after a discussion with the Environmental Health Agency and PHE.

I’ve been everywhere: Norovirus transmission between hands, gloves, utensils, and fresh produce during simulated food handling

Human noroviruses (HuNoVs), a leading cause of food-borne gastroenteritis worldwide, are easily transferred via ready-to-eat (RTE) foods, often prepared by infected food handlers.

mapsmaniaIn this study, the transmission of HuNoV and murine norovirus (MuNoV) from virus-contaminated hands to latex gloves during gloving, as well as from virus-contaminated donor surfaces to recipient surfaces after simulated preparation of cucumber sandwiches, was inspected. Virus transfer was investigated by swabbing with polyester swabs, followed by nucleic acid extraction from the swabs with a commercial kit and quantitative reverse transcription-PCR.

During gloving, transfer of MuNoV dried on the hand was observed 10/12 times. HuNoV, dried on latex gloves, was disseminated to clean pairs of gloves 10/12 times, whereas HuNoV without drying was disseminated 11/12 times. In the sandwich-preparing simulation, both viruses were transferred repeatedly to the first recipient surface (left hand, cucumber, and knife) during the preparation. Both MuNoV and HuNoV were transferred more efficiently from latex gloves to cucumbers (1.2% ± 0.6% and 1.5% ± 1.9%) than vice versa (0.7% ± 0.5% and 0.5% ± 0.4%). We estimated that transfer of at least one infective HuNoV from contaminated hands to the sandwich prepared was likely to occur if the hands of the food handler contained 3 log10 or more HuNoVs before gloving. Virus-contaminated gloves were estimated to transfer HuNoV to the food servings more efficiently than a single contaminated cucumber during handling. Our results indicate that virus-free food ingredients and good hand hygiene are needed to prevent HuNoV contamination of RTE foods.

American Society for Microbiology, Applied and Environmental Microbiology, Volume 80, No. 17, Septemper 2014, doi: 10.1128/AEM.01162-14

M. Rönnqvista, E. Ahoa, A. Mikkeläb, J. Rantab, P. Tuominenb, M. Rättöc and L. Maunulaa

http://aem.asm.org/content/80/17/5403.abstract?etoc

Why I don’t eat raw oysters: Norovirus genotypes implicated in two oyster-related illness outbreaks in Ireland

We investigated norovirus (NoV) concentrations and genotypes in oyster and faecal samples associated with two separate oyster-related outbreaks of gastroenteritis in Ireland. Quantitative analysis was performed using real-time quantitative reverse transcription polymerase chain reaction and phylogenetic analysis was conducted to establish the NoV genotypes present.

Raw oystersFor both outbreaks, the NoV concentration in oysters was >1000 genome copies/g digestive tissue and multiple genotypes were identified. In faecal samples, GII.13 was the only genotype detected for outbreak 1, whereas multiple genotypes were detected in outbreak 2 following the application of cloning procedures. While various genotypes were identified in oyster samples, not all were successful in causing infection in consumers. In outbreak 2 NoV GII.1 was identified in all four faecal samples analysed and NoV GII concentrations in faecal samples were >108 copies/g. This study demonstrates that a range of NoV genotypes can be present in highly contaminated oysters responsible for gastroenteritis outbreaks.

Epidemiology and Infection / Volume 142 / Issue 10 / October 2014, pp 2096-2104

P. RAJKO-NENOW, S. KEAVENEY, J. FLANNERY, A. McINTYR and W. DORÉ

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9320778&utm_source=Issue_Alert&utm_medium=RSS&utm_campaign=HYG&utm_reader=feedly