Tournaments for kids, meetings for parents, all possibilities to spread Norovirus

We’re going to a hockey tournament next weekend with its 6:30 a.m. game starts and me being grumpy coach, so there will be a lot of eating in unfamiliar spots.

dp.hockey.dec.15As a motto of faith-based food safety, I hope no one will get sick.

Health officials in New York state are investigating what caused some of the hundreds of parents and children attending a Rochester dance competition to become ill.

The Monroe County Health Department says it’s too early to determine a cause, but officials say they suspect norovirus caused several people to fall ill after attending last weekend’s event at the Rochester Riverside Convention Center.

Work crews spent Tuesday scrubbing the venue’s walls, floor and ceiling with bleach. A Rotary Club luncheon scheduled Tuesday was cancelled as a precaution.

Officials say around 700 children and adults attended the competition, some traveling from Buffalo and Canada. The number of people who reported getting sick hasn’t been released.

Health department official say norovirus causes vomiting and diarrhea that typically lasts for a couple of days.

 

Cruising and noro

I’ve never been on a cruise. Sometimes we talk about taking one, hopping from island to island and relaxing on the open seas.

And then comes another round of norovirus outbreaks. Lots of news coverage, throwbacks to the poop cruises and pictures of the CDC Vessel Sanitation program officials boarding ships.

Restaurants are linked to 64 per cent of norovirus outbreaks. CDC says that cruise ships get a lot of the attention but only account for only about 1 per cent of norovirus outbreaks.

But not everyone goes on a cruise.

In 2013, according to the Florida-Carribean Cruise Association 11.7 million North Americans (out of a total of ~530 million residents) went on cruises.

In this week’s MMWR, the good folks at the CDC released an analysis of cruise-related noro. MSMajestyOfTheSeasEdit1

From 2008 to 2014, the rate of acute gastroenteritis on cruise ships decreased among passengers from 27.2 cases per 100,000 travel days in 2008 to 22.3 in 2014, while the rate among crew members was essentially unchanged. The rate among both passengers and crew members was higher in 2012 compared with the preceding and following years, likely because of the emergence of a new norovirus strain. Among 73,599,005 passengers on cruise ships during 2008–2014, a total of 129,678 (0.18%) cases of acute gastroenteritis were reported during outbreak and nonoutbreak voyages; among 28,281,361 crew members, 43,132 (0.15%) cases were reported. Only a small proportion of those cases were part of a norovirus outbreak.

Cases of acute gastroenteritis illness on cruise ships are relatively infrequent. Norovirus, the most common causative agent of outbreaks, accounted for 14,911 cases among passengers and crew members during 2008–2014, 0.01% of the estimated number of norovirus cases in the United States during the study period. To further reduce acute gastroenteritis on cruise ships, travelers should practice good hand hygiene, especially after using the toilet and before touching the face or eating; persons experiencing diarrhea or vomiting should promptly report their illness for proper assessment, treatment, and monitoring.

Wedding ‘nightmare’ as 20 guests get Norovirus in UK

A bride and groom’s wedding celebrations turned into “a nightmare” after around 20 guests were later struck down by the winter vomiting bug.

ask_me_about_my_explosive_diarrhea_tshirt-p2354413693811905333sgf_400The Dundee couple were also affected by the outbreak of norovirus, with people advising the couple of their situation after the occasion.

Heather Albin and Steven Campbell, who were married at the Westpark Conference Centre, in Perth Road, described the aftermath of the event as a “nightmare”.

Bride Heather said: “We had an amazing day but a couple of days later we were hearing that many of our guests had been hit by acute sickness and diarrhea.”

She said that she and her new groom had also been unwell, adding: “I got it first, followed by Steve.

“At the beginning of January, around 20 of our guests had been in touch to say they and their families were feeling terrible — it’s been a nightmare.

“So many of the people who attended the wedding were affected that we wondered if it could have been something we ate at the wedding.

“However, I have now been told it is more likely to be something viral.”

3 sick from Norovirus in raw oysters in Hong Kong

The Centre for Health Protection (CHP) of the Department of Health is today (January 12) investigating a food poisoning outbreak and reminds the public to maintain personal, food and environmental hygiene to prevent food-borne diseases.

Raw oystersThe outbreak has affected three women, all aged 27. They developed vomiting, abdominal pain, diarrhoea and fever about 24 to 40 hours after having dinner in a food premises in Quarry Bay in the evening of January 3. The trio then sought medical attention and no hospitalization was required.

They have remained in stable condition.

The stool specimen of one of them tested positive for norovirus upon laboratory testing by the hospital. The CHP’s initial enquiries revealed that the trio had consumed raw oysters.

Really: Vomiting Larry is easing the burden of Norovirus in Ireland

I never saw my uncle Larry barf, but when I was young, he seemed larger than life. Great hockey player. As he died, not so much.

larry.hockey.16George Winter of The Irish Times writes in the gazetteer of human illness, and forever associated with the most common cause of acute infectious gastroenteritis in western Europe and North America, is Norwalk in the US state of Ohio.

In October 1968, 116 pupils and teachers at the town’s Bronson elementary school contracted diarrhoea and vomiting.

By 1972, electron microscopy of feces samples taken from the outbreak identified a novel agent, subsequently named Norwalk virus.

Known today as norovirus, its alias, the “winter vomiting bug”, is a misnomer, with year-round outbreaks occurring, albeit with a winter peak.

For example, data from the HSE’s health protection surveillance centre show that in April, May and June of 2015 there were 25 outbreaks involving 385 people, and by mid-November 2015 a total of 87 outbreaks had affected 1,508 people. Norovirus gastroenteritis has been a notifiable disease in Ireland since January 2004.

Infection control expert Prof Dinah Gould of Cardiff University highlights the mistaken belief that norovirus gastroenteritis is “always without serious consequences and the infection is frequently described as mild and self-limiting”.

This, she writes, ignores the fact that the illness is distressing and can last for several days. Further, while healthy individuals do not suffer long-term ill effects, there may be severe outcomes for children, the elderly or those with compromised immune systems.

According to Gould: “They can become severely dehydrated, and in severe cases may develop renal impairment.”

Viral gastrointestinal infections are acquired via the fecal-oral route: viruses shed in feces end up in someone else’s mouth, typically through food or water, although virus transfer can occur from touching contaminated surfaces.

Noroviruses are as tough as old boots and expert inducers of projectile vomiting, so can cause havoc on cruise ships and in institutional and other settings. On December 5th last year, for example, the staff canteen at Russell Investments Center’s skyscraper offices in Seattle, Washington State, was reportedly the suspected source of a norovirus outbreak affecting hundreds of employees.

In 2009 celebrity chef Heston Blumenthal was running the Fat Duck restaurant in Berkshire, and over a six-week period, 529 diners were also running within 48 hours of sampling a tainted tasting menu costing £130.

Heston’s declared speciality of “molecular gastronomy” was apposite given laboratory findings that samples of the Fat Duck’s nosh featured a striking molecular profile consistent with norovirus enrichment.

Contaminated oysters were suspected, and a 47-page UK Health Protection Agency report on the outbreak reprints the tasting menu, including an oyster and passion fruit jelly with lavender, and something called “Sound of the Sea”.

And 2014 saw inspectors telling staff at Blumenthal’s Dinner restaurant in London’s Knightsbridge to wash their hands more often following a norovirus outbreak affecting 10 dinner diners.

The importance of handwashing for the interruption of norovirus transmission is crucial considering that during an acute infection more than one billion virus particles per gram of faeces can be shed, and that healthy adults usually excrete norovirus for about 10 days, although one report found that a child shed norovirus for about 100 days.

Someone delving into the cloacal chaos wrought by norovirus is Dr Catherine Makison Booth, senior scientist at the UK government’s Health and Safety Laboratory.

Makison Booth’s invention – Vomiting Larry – gives startling insights into the infectious nature of this agent. But who is Larry?

norovirus-2The title of Makison Booth’s paper in the Journal of Infection Prevention (2014, 15: 176-180) sums it up: “Vomiting Larry: a simulated vomiting system for assessing environmental contamination from projectile vomiting related to norovirus infection.”

A system of compressed air, pistons, a water supply and a “pneumatic ram”, Larry is topped off by an authentic manikin head, complete with teeth, tongue and vocal cords.

“The first question anyone asks about Vomiting Larry is why is he called Larry and not Vomiting Victor, Puking Pete or Barfing Barry,” Makison Booth told The Irish Times.

“His name comes from his realistic manikin head, which is a commercially available device in its own right known as Airway Larry, used by medical students for practising techniques such as laryngoscopy.

“There can be as many as a thousand million viruses in the vomit and diarrhea produced by infected individuals, yet it takes only 10 to 100 viruses to cause infection in the next unaffected person.

“Currently there is no vaccine; no antiviral treatment; and most people often have limited immunity even after being infected.”

Norovirus is resistant to many cleaning products and alcohol hand gels we use today, meaning “norovirus spreads like wild- fire during outbreaks, causing the closure of hospitals, schools, cruise ships and even offshore rigs to try to curb its spread”.

 

Norovirus lasts in poop

Noroviruses, the leading cause of severe gastroenteritis worldwide, have 6 genogroups and 38 genotypes; strain GII.4 is most frequently associated with outbreaks (NEJM JW Infect Dis Mar 2013 and MMWR Morb Mortal Wkly Rep 2013; 62:55).

norovirus-2Histo-blood group antigens (HBGAs) may act as attachment factors for norovirus: People with a functional FUT2 gene (secretors) express HBGAs on mucosal epithelium; nonsecretors, who have a FUT2 mutation of guanine-to-adenine at codon 428, are presumed to be protected from norovirus infection.

The Oregon Department of Public Health and the U.S. Centers for Disease Control and Prevention have analyzed 10 selected norovirus outbreaks (9 related to strain GII.4) from November 2009 through January 2013. They studied 62 cases, 34 exposed controls, and 18 nonexposed controls. Illness duration was significantly longer in people age 70 or older than in younger patients. Norovirus was detected in stool in 42 cases (68%). Shedding of norovirus in stool, which occurred for at least 21 days in 16 of 35 cases (47%), was significantly more likely if the initial stool sample had >1010 copies of virus per gram than if it had fewer copies per gram. For GII.4 viruses, the researchers found no association between secretor status or blood type and symptomatic infection.

Prolonged shedding of Norovirus after infection

Neil M. Ampel, MD reviewing Costantini VP et al. Clin Infect Dis 2016 Jan 1.

http://www.jwatch.org/na40028/2016/01/05/prolonged-shedding-norovirus-after-infection

Chipotle served with grand jury subpoena in California norovirus outbreak

Things just got messier for Chipotle.

According to Reuters a criminal investigation linked to an August norovirus outbreak launched today. Weird that it starts with a noro outbreak.Chipotle_Brandon.jpeg

Chipotle Mexican Grill Inc said it was served with a grand jury subpoena in relation to a criminal investigation into a norovirus contamination at one of its restaurants in California in August.

The company said the subpoena required the company to produce a broad range of documents related to the norovirus incident at its restaurant in Simi Valley, California which affected nearly 100 people.

The criminal investigation is being conducted by the U.S. Attorney’s Office for the Central District of California and the U.S. Food and Drug Administration’s Office of Criminal Investigations, the company said on Wednesday.

Sounds like noro: Biathletes stricken in Slovenia

Athletes from the World Cup biathlete teams of Belarus, Austria and Canada who live in the same hotel in Slovenia, have developed serious health problems and did not take part in the competition.

pokljuka-slovenia-19th-dec-2015-silver-medalist-biathlete-marie-dorin-fa0wmyOn the eve of the Belarusian biathlon pursuit Hope Pisarev went to a hospital in Ljubljana. During the race Canadian biathlete Megan Tandy fainted and fell on a downhill track.

Austrian national team struck an unknown infection is almost at full strength, including the famous Simon Eder and Dominik Landertinger. According to team doctor Burchart Huber, the true reason is not clear, but most likely it is a virus that spreads through airborne droplets.

“We do not know what it was. Whether it was because of the food, whether because of the height at which the phase passes. One athlete throat problems, others with the stomach,” said Huber.

 

 

 

Suspected norovirus outbreak hits Holland America Line’s Veendam

Holland America Line’s Veendam was hit with a possible norovirus outbreak on its December 20-27 cruise, ending in San Diego on Sunday. Fifty-seven of 1,429 passengers or almost 4 percent of passengers were reported ill with vomiting and diarrhea as the primary symptoms, according to the U.S. Centers for Disease Control, which investigates illnesses on cruise ships.

BarfingBarbie.vomitjpgTen of 588 crew members, or 1.7 percent of the crew, also were ill during the cruise. While the CDC lists the causative agent as “unknown,” the reported symptoms mimic that of norovirus, which occurs on both land and sea in places where large numbers of people gather.

In response to the outbreak, the CDC said that Holland America Line and the crew undertook the following action:

Increased the onboard cleaning and disinfection procedures according to their outbreak prevention and response plan;

Collected stool specimens from passenger and crew gastrointestinal illness cases for testing;

Made twice daily reports of gastrointestinal illness cases to the Vessel Sanitation Program (VSP);

Consulted with the CDC on plans for their comprehensive sanitation procedures planned for the voyage disembarkation day in San Diego.

During that disembarkation, Holland America set up a planned staged disembarkation for active cases to limit the opportunity of illness transmission to other, non-infected guests and also sanitized the terminal, to protect those well passengers who were disembarking and others boarding the ship for the next cruise.

‘Floating sick bay’ Australia cruise ship rocked by Norovirus claims

Passengers aboard P&O’s newly-launched cruise liner say it is anything but a Pacific Eden, with a gastrointestinal outbreak affecting at least 60 passengers ahead of its return to Sydney on Monday.

norovirus-2The ship Pacific Eden, which docked in Sydney on Monday morning, has been accused of being a “floating disaster” and some passengers are seeking a refund.

Several passengers have contacted the Herald, claiming a norovirus gastrointestinal outbreak has affected a large number of passengers.

But a spokeswoman for P&O, which owns the ship, disputes the allegations. She said only 11 out of 1500 passengers aboard are ill, including five who were in isolation on Saturday. That number had reduced to two by Sunday.

This is about the same rate as the general population at any time, she said.

The departure of the 55,820 tonne cruise ship from Sydney on December 16 was delayed three to four hours to allow the crew to sanitise the ship after an outbreak of gastro on the previous trip. Yet the spokeswoman said she understood the previous cruise had a similar number of people who were sick with norovirus.

Yvonne Hubscher of the Sunshine Coast said she had seen children running along a deck singing, “We’re all living on a spew ship.”

She said the captain had mentioned that there had been 247 cases of norovirus on the previous trip. Many others had been sick on this trip.

Other passengers also contacted the Herald with similar allegations, including Cherie Butcherine from Dundas Valley.

vomit cruiseThe number affected by the outbreak is far higher than the 11 reported ill by a P&O spokeswoman on Sunday. It was the second outbreak of the Pacific Eden’s short life – she joined the fleet on November 25 after being purchased and refurbished by P&O.

But disease was only one of the young cruise liner’s problems. Guests who spoke to Fairfax Media also complained of mouldy bathrooms, a dearth of toilet paper, flooding, leaks and poor customer service.

“It was worse than a one-star motel, basically,” said Cherie Butcherine, who was travelling with her husband, mother and daughter Alexa. “We were just devastated to have to stay on board.

“There was food all over the floor, the bathroom was absolutely disgusting, it was covered in mould.”