50 sick: Norovirus the cause of Shropshire-area hotel illness outbreak

There’s about six new Norovirus outbreaks reported every day, but I choose this one today because I have a friend who lives in Shropshire, UK.

Deborah Hardiman of the Shropshire Star writes provisional tests carried out by Public Health England have confirmed that the group who attended the Buckatree Hall Hotel near Wellington on August 7 were struck down by the sickness bug norovirus, which was unlikely to have been spread by hotel staff.

This means that the illness that causes sickness had been spread by someone carrying the viral infection.

PHE said it was “unlikely that this is a member of staff at the hotel” due to no other reports among other guests who ate the same food falling ill.

Ann Fleming, Public Health England regional spokesperson, said: “We have just received confirmation that the samples from our laboratories have tested positive for norovirus.

“No other organisms has been detected so far.

“All the food samples have tested negative.

“There are no reports of illness in guests outside of the wedding party.”

Norovirus gets around –even without vomiting

Norovirus is a highly contagious infectious disease, which is transmitted from person-to-person via fecal-oral, or ‘vomitus-oral’ routes, or indirectly via contaminated food or environment. Airborne transmission of norovirus was implicated in an epidemiological study during an outbreak in a hotel restaurant [1], but only until recently was detection of norovirus RNA demonstrated in air samples collected in patient’s room and at the nurse’s station during hospital outbreaks [2], presumably due to projectile vomiting of patients, flushing of toilet, or during floor cleaning as described previously.

Detection of norovirus in air samples in patient without vomiting: implication of saliva testing for norovirus in immunocompromised host

Journal of Hospital Infections

25 July 2019

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DOI:10.1016/j.jhin.2019.07.011

https://www.journalofhospitalinfection.com/article/S0195-6701(19)30305-6/fulltext

In Denmark food companies caught selling fake organic products escape prosecution

Bullshit.

The systematic kind.

Dutch News reports government and organic food label inspectors identified 68 companies which have been selling or trading products labeled as organic which broke the rules, RTL Nieuws.

 In some cases the companies earned tens of thousands of euros selling non-organic coffee, meat, chocolate and vegetables as organic even though they did not meet the proper standards, RTL said. The broadcaster bases its claim on an analysis of reports made to the two watchdogs covering the sector between 2015 and 2018. In total, 58 cases involved ‘misleading’ the public and the remaining 10 were more serious fraud offences, RTL said.

‘These are not incidents,’ VU University criminologist Wim Huisman told the broadcaster. ‘This shows that there is a substantial problem and that it is happening systematically.’

“People who buy organic food pay a higher price for produce which is animal and environment friendly” (more bullshit) food scientist Gertjan Schaafsma said. ‘If there is fraud, these people are being ripped off.’

A spokesman for the NVWA told RTL that the agency does not have enough staff to tackle all the fraud involving organic food. Priority, therefore, is given to cases which have implications for food safety.

Hucksterism: Alleged treatment drink making people sick

Spectrum News reports “Miracle” or “Master” Mineral Solution claims it cures all sorts of ailments. The U.S. Food and Drug Administration (FDA) is warning consumers to stop drinking the products immediately.

These products or other sodium chlorite products are making people sick.  They have a lot of different names, including Miracle or Master Mineral Solution, Miracle Mineral Supplement, MMS, Chlorine Dioxide (CD) Protocol, and Water Purification Solution (WPS). When mixed according to package directions, they become a strong chemical that is used in bleach. 

According to the FDA, a number of distributors are making false claims saying these supplements when mixed with citric acid is an antimicrobial, antiviral, and antibacterial liquid that is a cure for autism, cancer, HIV/AIDS, hepatitis, flu, and other conditions. But the FDA isn’t aware of any research saying these products are safe or effective for treating any illness. Bottom line the FDA says: Sodium chlorite products are dangerous and you and your family should not use them.

38 sick: It was the relish at Melbourne Cricket Ground luncheon on Anzac Day

Health Times reports Australian investigators spent months trying to recreate dodgy relish that gave nearly 40 people gastro at an exclusive Melbourne Cricket Ground luncheon on Anzac Day.

Thirty-seven patrons and a staff member were left distressed and light-headed, with some fainting and going to hospital, after eating the quince and fig jam relish with barberries at the Essendon Football Club’s president lunch on April 25.

“It was a pretty dramatic foodborne outbreak,’ Victoria’s chief health officer, Brett Sutton, told reporters on Tuesday after a three-month investigation into the incident.

Rabbit, chicken and pork terrine served with the relish was initially suspected to be the culprit

But after 109 interviews trawling through everything guests and staff members ate that day, the investigation found the relish was almost certainly to blame.
“In the fashion of a true foodborne mystery, it was the relish in the (MCG’s) Olympic Room at high noon on Anzac Day,” Dr Sutton said.

The investigation took three months in part because investigators were trying to recreate the relish under various conditions, but they were unsuccessful.

“Dehydrated barberries, barberries with boiling water, the relish refrigerated for three days, the relish left out, none of it allowed sufficient growth of bacteria that would have caused that illness,’ Dr Sutton said.

“I suspect that something in that relish, barberries or the fig jam, carried a toxin at the time and the boiling water that was used in the processing wasn’t sufficient to kill it.”

Seven people were taking to hospital after being struck down by the gastro but none required admission.

159 sickened: Successive norovirus outbreaks at an event center – Nebraska, October-November, 2017

Norovirus, an extremely contagious cause of gastroenteritis, can be transmitted by infected food workers and is difficult to remove from contaminated surfaces.

What is added by this report?

An investigation into an ongoing gastrointestinal illness outbreak identified 159 persons reporting illness meeting the case definition; laboratory testing confirmed norovirus cases. Public health recommendations were not strictly followed, and transmission continued for approximately 2 weeks. Halting transmission required a coordinated approach involving thorough environmental decontamination and a strict ill employee exclusion policy.

What are the implications for public health practice?

Mitigation efforts for ongoing norovirus outbreaks in similar settings should include a comprehensive prevention strategy that addresses all possible routes of norovirus transmission.

Article Metrics

In October 2017, the Nebraska Department of Health and Human Services (NDHHS) was notified by a local health department of a gastrointestinal illness outbreak among attendees of a wedding reception at facility A, an event center. Shortly thereafter, state and local public health officials began receiving reports of similar gastrointestinal illness among attendees of subsequent facility A events. An investigation was initiated to identify cases, establish the cause, assess possible transmission routes, and provide control recommendations. Overall, 159 cases consistent with norovirus infection (three confirmed and 156 probable) were identified among employees of facility A and attendees of nine facility A events during October 27–November 18, 2017. The investigation revealed a public vomiting episode at the facility on October 27 and at least one employee involved with preparing and serving food who returned to work <24 hours after symptom resolution, suggesting that a combination of contaminated environmental surfaces and infected food handlers likely sustained the outbreak. Recommendations regarding sanitation and excluding ill employees were communicated to facility A management. However, facility A performed minimal environmental cleaning and did not exclude ill employees. Consequently, transmission continued. To prevent persistent norovirus outbreaks in similar settings, public health officials should ensure that involved facilities implement a comprehensive prevention strategy as early as possible that includes extensive sanitation and strict exclusion of ill food handlers for at least 48 hours after symptom resolution (1).

Investigation and Results

On October 30, 2017, public health officials became aware of approximately 30 persons who developed gastrointestinal illness after attending a wedding reception (event 1) on October 27 at facility A. Norovirus was suspected based on ill attendees’ reports of developing diarrhea, vomiting, abdominal cramps, and fever approximately 12–48 hours after the event. On November 6, investigators learned of similar gastrointestinal illness among attendees at five subsequent facility A events (events 2–6), at which point an Internet-based questionnaire that assessed symptom history, events attended, and food items consumed was developed. E-mail addresses for facility A employees were provided by facility management. Investigators worked with event organizers to disseminate the questionnaire to attendees of the first six events held at facility A during the investigation period, as well as four subsequent events that were also ultimately affected by the outbreak. A case-control study was performed. A probable case was defined as the occurrence of diarrhea (≥3 loose stools within 24 hours) or vomiting and at least one other symptom (nausea, abdominal cramps, diarrhea, or vomiting) in a facility A employee or an event attendee who reported illness onset 6–72 hours after attending a facility A event on or after October 27. Confirmed cases met the probable case definition and had norovirus RNA detected in a stool specimen by real-time reverse transcription–polymerase chain reaction (RT-PCR) (2). Controls were identified as facility A employees who were not ill and were exposed to facility A during the study period or event attendees who were not ill and attended an event during the study period. Estimated attack rates (ARs) were calculated per event, using host-estimated number of attendees as denominators.

Ten events that included food service provided by facility A were held at the facility during October 27–November 18, 2017. Overall, 378 persons from nine events completed questionnaires, including 18 of 25 (72%) employees and 360 of 1,383 (26%) event attendees (Table). Only one questionnaire response among 70 attendees was received for the tenth event and was thus excluded from analysis. Overall, 159 persons (six employees and 153 event attendees) reported illness meeting the probable (156) or confirmed (three) case definition (Figure); 186 controls were identified. Comparison of food items consumed by case-patients and controls was limited because the only items available at all nine events were water, ice, and drink garnishes; however, no item was significantly associated with illness. Estimated ARs for the first six events, which occurred before any public health intervention, ranged from 7% to 35% per event (median = 18.5%) (Table).

The investigation uncovered a witnessed episode of vomiting in a public area near the event space by an event attendee. The episode occurred at the beginning of the October 27 event (event 1) on carpeting in the lobby at the entrance to the event hall and might have represented the initial introduction of norovirus into facility A. Although no testing of environmental surfaces was conducted to confirm, it is possible this vomiting contaminated environmental surfaces.

On November 7, investigators learned that the carpeting where vomiting occurred on October 27 had been swept with a vacuum cleaner and inadequately sanitized; the agent used did not have efficacy against norovirus. Investigators recommended sanitizing environmental surfaces with a sodium hypochlorite (chlorine bleach) solution or a disinfectant specifically registered by the Environmental Protection Agency (EPA) as effective against norovirus*,† and excluding ill employees from work until ≥48 hours after symptom resolution (1). However, cases of gastroenteritis occurred at two events that were held on November 10 (event 7) and 11 (event 8) after these recommendations were made; estimated ARs at event 7 and event 8 were 4% (six of 150 attendees) and 15% (53 of 360 attendees), respectively, indicating ongoing transmission. Investigators subsequently learned of an employee who left work when she became ill at 10:00 a.m. on November 7, with nausea, vomiting, fever, headache, and myalgias, and returned to work preparing and serving food on November 8, <24 hours later.

Stool specimens from three ill persons were tested. Norovirus genogroup II was detected by real-time RT-PCR from all three stool specimens tested; further genetic sequencing by Nebraska Public Health Laboratory and CDC confirmed that all three specimens yielded the same norovirus genotype, GII.P12-GII.3. Two of the case-patients in whom norovirus was laboratory-confirmed attended the October 27 event (event 1), and the third attended the event on November 11 (event 8).

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Public Health Response

After initial public health recommendations to use disinfectants registered by the EPA and exclude ill employees failed to halt transmission (1), several discussions were held with facility A management during the period leading up to a planned event on November 18 (event 9). The recommendation for strict employee exclusion was reiterated on November 15, along with ideas for minimizing pressures on employees to work while ill, such as offering paid sick leave and bringing in staff members from a different location to work the event. Consideration was given to postponing the upcoming event or finding an alternative location for it. Facility A hired a professional cleaning service experienced with norovirus eradication to sanitize the facility on November 16 and 17. After thorough sanitation and strict employee exclusion were implemented, the event held on November 18 (event 9) had an estimated AR of 1% (three of 350 attendees), indicating reduced transmission (Table). No further illnesses in facility A employees or event attendees were reported to public health officials.

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Discussion

Norovirus, the most common cause of outbreak-associated acute gastroenteritis worldwide, is highly efficient at causing human disease (3). The virus is extremely contagious, with a low infectious dose capable of causing infection with as few as 18–2,800 virus particles (4,5). In addition, large numbers of virus can be shed by infected persons, even those with asymptomatic infections (1). Norovirus is resistant to many common commercial disinfectants and is able to persist on environmental surfaces for up to 2 weeks (6).

Transmission occurs through several different routes, and multiple transmission routes can coexist during norovirus outbreaks (6,7). In addition to foodborne and direct person-to-person spread, transmission can also occur through ingestion of aerosolized particles and through contact with contaminated environmental surfaces, which are believed to harbor the virus and play a role in sustaining outbreaks (8,9). Multiple outbreaks caused by foodborne sources and subsequently perpetuated by environmental contamination or person-to-person spread have been described (7,10). In addition, when contaminated food items are implicated in outbreaks, infected food handlers are often involved (1).

In this setting of successive outbreaks at the same event center, norovirus was likely transmitted through a combination of persistently contaminated environmental surfaces and ill food handlers (7). The investigation findings indicate that the initial public vomiting episode likely contaminated the carpeting at the entrance to the event hall. Inadequate sanitizing of the area and aerosolization of the virus resulting from subsequent vacuuming could both have led to further spread. Although no environmental testing was done, investigators suspect that widespread environmental contamination was likely present (9). Transmission was halted only after the facility was thoroughly cleaned and a strict ill employee exclusion policy was enforced.

The findings in this report are subject to at least two limitations. First, because the total number of attendees at each facility A event was not known, investigators had to rely on host estimations. Accordingly, calculation of exact ARs was precluded. Similarly, questionnaire distribution to individual attendees was facilitated by each event’s host. As a result, investigators had no way of knowing how many attendees successfully received the invitation to complete the Internet-based questionnaire, and accuracy of corresponding AR calculations might have been affected. Because methodology for calculating ARs was consistent across all events, the potential of adversely affecting comparison of event-specific ARs was likely limited. However, the limitation was believed to introduce enough bias to preclude a cohort analysis. Second, environmental sampling that might have helped elucidate possible transmission routes was not done. By the time public health officials learned of the outbreak’s ongoing nature, 10 days had passed since the initial public vomiting episode. Because results of environmental testing would not have changed the recommendation for extensive sanitation, such testing was not prioritized.

Mitigation efforts for ongoing norovirus outbreaks in similar settings should include a comprehensive prevention strategy that attempts to address all possible routes of norovirus transmission. In this setting, control measures that included extensive environmental decontamination and strict exclusion of all ill food handlers for ≥48 hours after symptom resolution were needed to halt the outbreak. Public health officials can also verify that facilities involved in similar persistent outbreaks are implementing recommended public health interventions.

From the duh files: Health facts aren’t enough, should persuasion become a priority?

My lab has been studying this question for over 20 years and we figured out fairly early that facts suck (to the audience, below is a video from about 2002) but I always insisted on good facts combined with good storytelling.

Aaron Carroll of the N.Y. Times writes that in a paper published early this year in Nature Human Behavior, scientists asked 500 Americans what they thought about foods that contained genetically modified organisms.

The vast majority, more than 90 percent, opposed their use. This belief is in conflict with the consensus of scientists. Almost 90 percent of them believe G.M.O.s are safe — and can be of great benefit.

The second finding of the study was more eye-opening. Those who were most opposed to genetically modified foods believed they were the most knowledgeable about this issue, yet scored the lowest on actual tests of scientific knowledge.

In other words, those with the least understanding of science had the most science-opposed views, but thought they knew the most. Lest anyone think this is only an American phenomenon, the study was also conducted in France and Germany, with similar results.

If you don’t like this example — the point made here is unlikely to change people’s minds and will probably enrage some readers — that’s O.K. because there are more where that came from.

A small percentage of the public believes that vaccines are truly dangerous. People who hold this view — which is incorrect — also believe that they know more than experts about this topic.


Many Americans take supplements, but the reasons are varied and are not linked to any hard evidence. Most of them say they are unaffected by claims from experts contradicting the claims of manufacturers. Only a quarter said they would stop using supplements if experts said they were ineffective. They must think they know better.

Part of this cognitive bias is related to the Dunning-Kruger effect, named for the two psychologists who wrote a seminal paper in 1999 entitled “Unskilled and Unaware of It.”

David Dunning and Justin Kruger discussed the many reasons people who are the most incompetent (their word) seem to believe they know much more than they do. A lack of knowledge leaves some without the contextual information necessary to recognize mistakes, they wrote, and their “incompetence robs them of the ability to realize it.”

This helps explain in part why efforts to educate the public often fail. In 2003, researchers examined how communication strategies on G.M.O.s — intended to help the public see that their beliefs did not align with experts — wound up backfiring. All the efforts, in the end, made consumers less likely to choose G.M.O. foods.

Brendan Nyhan, a Dartmouth professor and contributor to The Upshot, has been a co-author on a number of papers with similar findings. In a 2013 study in Medical Care, he helped show that attempting to provide corrective information to voters about death panels wound up increasing their belief in them among politically knowledgeable supporters of Sarah Palin.

In a 2014 study in Pediatrics, he helped show that a variety of interventions intended to convince parents that vaccines didn’t cause autism led to even fewer concerned parents saying they’d vaccinate their children. A 2015 study published in Vaccine showed that giving corrective information about the flu vaccine led patients most concerned about side effects to be less likely to get the vaccine.

A great deal of science communication still relies on the “knowledge deficit model,” an idea that the lack of support for good policies, and good science, merely reflects a lack of scientific information.

But experts have been giving information about things like the overuse of low-value care for years, to little effect. A recent study looked at how doctors behaved when they were also patients. They were just as likely to engage in the use of low-value medical care, and just as unlikely to stick to their chronic disease medication regimens, as the general public.

In 2016, a number of researchers argued in an essay that those in the sciences needed to realize that the public may not process information in the same way they do. Scientists need to be formally trained in communication skills, they said, and they also need to realize that the knowledge deficit model makes for easy policy, but not necessarily good results.

It seems important to engage the public more, and earn their trust through continued, more personal interaction, using many different platforms and technologies. Dropping knowledge from on high — which is still the modus operandi for most scientists — doesn’t work.

Everyone’s got a camera, cat edition: Australian man captures CCTV footage of cat suffocating him in his sleep

For a year in 1986-87  I wrote in the University of Guelph weekly newspaper a science column about cats.

(These are the current two, right) I was fascinated.

The next year, I became editor-in-chief.

They were the first warm-blooded pets I’d ever had that my first wife the vet student – who wrote years later she didn’t love me those 18 years but I threw off 4 good-looking daughters so she kept me around – and I named them Clark and Kent.

An Australian man said he “couldn’t breathe” while sleeping, so set up a camera to figure out what was going on.

Luis Navarro posted a series of photos on Twitter detailing the mystery he had to solve.

Using a unique Australian invention – sure your cats are fine when you’re awake but as soon as you go to sleep hell breaks loose in the kitchen, outside with the possums, anywhere

“I couldn’t breath when I slept so I installed a camera”, he tweeted.

A set of photos, still images from the camera, show Navarro’s cat staring at him in his sleep before crawling onto his face to lie down, blocking his nose and mouth in the process.

Some Twitter users responded with photos and stories of their cats doing the same thing, making it difficult for them to breathe while they slept — with others claiming Navarro’s cat was actually trying to kill him.

Doctor Rachael Stratton, a veterinary behaviourist, told 10 daily she has heard anecdotally of cats sleeping in various inconvenient places on top of people. It is often not harmful — although it can pose a problem when they try and sleep on babies in the same way

St Louis ‘porch pooper’ defecating on woman’s property

I’m thankful Australia has an abundance of public bathrooms (mainly because they are in parks that are flood areas). I was in Gerrmany a few times, impossible to find a public bathroom, the train conductor told me to just piss on the wall like everyone else.

Jasmine Payoute of KSDK writes I’ve told you countless times about porch pirates but now a new porch invader has people on the lookout.

This one is known for what he leaves behind and not what he takes.

“I’ve seen a lot, but other than animals that’s a new one,” said Angela Sanders.

It’s an act that’s usually reserved for bathrooms, but this guy decided he didn’t need that privacy.

“We woke up in the morning, my boyfriend and I, to a text letting us know somebody had defecated on our porch,” said Mary Hatches.

The dirty deed unfolded near the corner of Taft and Compton in St. Louis Sunday evening.

The poop perp was caught on camera in front of the home Mary Hatches rents.

“So I took a look at it and thankfully it cut off where I was comfortable anyway and most people would be as well,” Hatches said.

In the video, the man appears to be holding a second pair of pants as he walks past Hatches’ home to the bottom of the porch where he squats then proceeds to poop.

“One day I’ll laugh, I’m just not there yet,” Hatches said.

Not yet finding this funny, Hatches posted the video to Facebook in hopes of finding the man she calls the porch pooper.