A Six Flags water park and resort complex in up-state New York known as "Great Escapes", is the focus of a large norovirus outbreak.  Norovirus is transmitted from infected human carriers to food, water, and environmental surfaces. The US Centers for Disease Control and Prevention recognize noroviruses (and related viral strains) as the leading cause of foodborne illness in the US. The gastrointestinal illness is highly communicable and easily spread by hand to hand contact and even through the air. Outbreaks occur in resorts and other facilities when ill persons contaminate the environment, food and water through vomit and feces. Rapid and effective measures well-known to the public health community are needed to stop transmission. Many of these measures are developed by the US Public Health Service. Cruise lines have experienced many norovirus outbreaks and therefor there is much known about the pathogen and how to address it.

Untimely Responses to the Problem
According to the local health department a case of norovirus at the Great Escapes is defined as a person with norovirus symptoms at the resort on or after March 7, 2008. The health department  therefore belives the date of March 7 was the beginning of the outbreak, but did not for some unexplained reason begin an investigation for ten days. It is not known to this writer when the operator of the facility was first aware of that employees and patrons were becoming ill. We are also unaware of how or when the health department was officially notified of the problem. The official coordinated response to this outbreak began on March 17, a full 10 days after the outbreak apparently began. By March 21, there were already 200 cases. The number of reported cases eventually reached at least 435 as news of the incident spread.

Rapid tests using sophisticated molecular testing platforms are available to provide confirming results of norovirus infection in 24 hours, yet investigators over 1 week into the investigation still didn’t have a confirming diagnosis from the state lab.  The slow state lab results were an unnecessary delay, as approved private labs are available.

Early recognition of this problem is critical. Once it is known that norovirus is in the environment, investigators can implement timely and appropriate sanitation and safety precautions to combat transmission. One example of appropriate response was the closing of the food service. But this only occured after numerous employees of the kitchen reported symptoms of norovirus. The pools, food and lodging facilities are undoubtedly contaminated. Delay in the the implementation of this and other preventive measures at this public, regulated facility likely increased the potential for the exposure of large numbers of unsuspecting people to the pathogen over several days. The licensed operator’s delay in recognizing and reporting a large number of ill patrons and staff to authorities, the response of the authorities once notified, and the timeliness and effectiveness of prevention measures taken are critical questions.

Lawsuit
Four members of a family sickened by the resort have filed a lawsuit. Key issues that must be scrutinized are the delay between the start of the outbreak and notification of the health authorities, the large number of food service staff ill and whether they worked while ill, the basis for the decision to close the kitchen, and the basis for management’s decision to allow the rest of the facility to remain open..

Unanswered Questions
A detailed analysis of the cases and their relationships to the food service or other environmental exposures will be key to determining the causes of this large and serious outbreak and whether the operator responded in an effective and timely manner to protect both it’s employees and guests.

Could the large number of cases of illness been reduced if more timely and effective prevention measures were implemented at Great Escapes?

To read more, select the links below.

Health Department official statement Norovirus at Great Escapes Water Park
1st article from the Post Star. March 21st, 200 cases reported
2nd article from the Post Star, March 16th, 435 cases  reported
Channel 6 report. Lawsuits filed.

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Mr. Costa is a professor at the Walt Disney World Center for Hospitality and the Culinary Arts at Valencia College in Orlando, Florida and is the founder and owner of the consulting firm Environ Health Associates, Inc.  Mr. Costa is a registered professional sanitarian with 30 years of environmental heath practice in the academic, government and private sectors.

For our manual on Norovirus Contamination and Control send an email to rcosta1@cfl.rr.com