Tag Archives: norovirus

The burden of norovirus

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Up-to-date estimates of the burden of norovirus, a leading cause of acute gastroenteritis (AGE) in the United States, are needed to assess the potential value of norovirus vaccines in development. We aimed to estimate the rates, annual counts, and healthcare charges of norovirus-associated ambulatory clinic encounters, Emergency Department (ED) visits, hospitalizations, and deaths in the United States.

Methods

We analyzed administrative data on AGE outcomes from July 1, 2001 through June 30, 2015. Data were sourced from IBM® MarketScan® Commercial and Medicare Supplemental Databases (ambulatory clinic and ED visits), the Healthcare Utilization Project National Inpatient Sample (NIS; hospitalizations), and the National Center for Health Statistics multiple-cause-of-mortality (MCM) data (deaths). Outcome data (ambulatory clinic and ED visits, hospitalizations, or deaths) were summarized by month, age group, and setting. Healthcare charges were estimated based on insurance claims. Monthly counts of cause-unspecified gastroenteritis-associated outcomes were modeled as functions of cause-specified outcomes, and model residuals were analyzed to estimate norovirus-associated outcomes. Healthcare charges were estimated by applying average charges per cause-unspecified gastroenteritis encounter to the estimated number of norovirus encounters.

Results

We estimate 900 deaths (95% Confidence Interval [CI]: 650 – 1100), 110,000 hospitalizations (95%CI: 80,000 – 145,000), 470,000 ED visits (95% CI: 348,000 – 610,000), and 2.3 million ambulatory clinic encounters (95% CI: 1.7 – 2.9 million) annually due to norovirus, with an associated $430 – 740 million in healthcare charges.

Conclusions

Norovirus causes a substantial health burden in the United States each year, and an effective vaccine could have important public health impact.

The burden of norovirus in the United States, as estimated based on administrative data: Updates for medically attended illness and mortality, 2001-2015, 14 April 2020

Clinical Infectious Diseases

Rachel M Burke, PhD, MPH, Claire Mattison, MPH, Talia Pindyck, MD, MPH, Rebecca M Dahl, MPH, Jessica Rudd, MPH, Daoling Bi, MS, Aaron T Curns, MPH, Umesh Parashar, MBBS, MPH, Aron J Hall, DVM, MSPH

https://doi.org/10.1093/cid/ciaa438

https://academic.oup.com/cid/article/doi/10.1093/cid/ciaa438/5820114

I love the berries but not the Hep A or noro

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Foodborne enteric viruses, in particular HuNoV and HAV, are the most common cause of the berry-linked viral diseases, and outbreaks around the world, and have become an important concern for health authorities. Despite the increased importance of berry fruits as a vehicle for foodborne viruses, there is limited information concerning the fate of foodborne viruses in the berry supply chain from farm to consumer.

A comprehensive understanding of berry-associated viral outbreaks – with a focus on contamination sources, persistence, survival, and the effects of current postharvest and processing interventions and practices – is essential for the development of effective preventative strategies to reduce risk of illness.

The purpose of this paper is twofold; (i) to critically review the published literature on the current state of knowledge regarding berry-associated foodborne viral outbreaks and the efficiency of berry processing practices and (ii) to identify and prioritize research gaps regarding practical and effective mechanism to reduce viral contamination of berries.

The review found that fecally infected food handlers were the predominant source of preharvest and postharvest pathogenic viral contamination. Current industrial practices applied to fresh and frozen berries demonstrated limited efficacy for reducing the viral load. While maintaining best practice personal and environmental hygiene is a key intervention, the optimization of processing parameters (i.e., freezing, frozen storage, and washing) and/or development of alternative processing technologies to induce sufficient viral inactivation in berries along with retaining sensory and nutritional quality, is also an important direction for further research.

Outbreaks, occurrence, and control of norovirus and hepatitis A virus contamination in berries: a review, 03 February 2020

Critical Reviews in Food Science and Nutrition

Hayriye Bozkurt,Kim-Yen Phan-Thien,Floris van Ogtrop,Tina Bell &Robyn McConchie

https://doi.org/10.1080/10408398.2020.1719383

https://www.tandfonline.com/doi/abs/10.1080/10408398.2020.1719383?journalCode=bfsn20&mc_cid=4f462afa96&mc_eid=3d0743ebc0&

Super sanitation cleaning: Caribbean Princess cruise ship turned back to US after more than 300 catch gastro bug

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The Princess Cruises’ Caribbean Princess Ship left the U.S. on Feb 2 — and after more than a week at sea, was forced to turn back to the U.S. early when it was denied entry to the Caribbean.

The Caribbean Princess was set to have a 14-day trip around the Caribbean, but was forced to turn back to the U.S.

The cruise’s early return comes after it was denied entry to Trinidad and Tobago by the Government of Barbados due to the outbreak on board, according to a statement from the Ministry of Health.

Princess Cruises said in a statement to The Sun that the ship, which was on a 14-day cruise in the Caribbean, is now on its way back to the Port of Everglades in Fort Lauderdale.

The Caribbean Princess ship is scheduled to dock at 7 a.m. on Thursday, three days ahead of its previous Feb. 16 return.

A total of 299 passengers and 22 crew members of the 4,196 people on board got sick with a gastrointestinal bug, causing vomiting and diarrhea.

Princess Cruises said the cruise has “curtailed its voyage out of an abundance of caution due to guests reporting symptoms due to a mild gastrointestinal illness,” in a statement to The Sun.

The ship will undergo a “super sanitation cleaning” when it reaches the Florida port, according to a statement from the CDC.

Australia’s bromance with Heston may be losing its sheen

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It only took a decade.

In late February 2009, complaints from customers who suffered vomiting, diarrhea and flu-like symptoms began pouring into celebrity chef Heston Blumenthal’s UK restaurant, the Fat Duck.

A report by the UK Health Protection Agency concluded that 529 patrons paying a ridiculous amount of money for food-porn styled dishes were sickened with Norovirus – this at a restaurant that only seats 40 patrons per night — introduced through contaminated shellfish, including oysters that were served raw and razor clams that may not have been appropriately handled or cooked.

Investigators identified several weaknesses in procedures at the restaurant that may have contributed to ongoing transmission including: delayed response to the incident, the use of inappropriate environmental cleaning products, and staff working when ill. Up to 16 of the restaurant’s food handlers were reportedly working with Norovirus symptoms before it was voluntarily closed.

Last week it was announced that Heston Blumenthal’s scandal-plagued Australian restaurant appears doomed after its landlord and financial backer, Crown Casino, said it had moved to terminate its lease.

The company behind the Dinner by Heston restaurant appointed provisional liquidators just before Christmas. It came just days after it missed a deadline with the Fair Work Ombudsman to pay back staff the millions it owed them for underpayment.

In a statement Crown said due to the appointment of the provisional liquidator “it has taken action” to terminate the lease of restaurant owner Tipsy Cake Pty Limited.

“While this is disappointing, Crown is working to provide assistance to Tipsy Cake employees looking for employment within Crown,” a Crown spokeswoman said. “The provisional liquidator of Tipsy Cake, however, will need to deal with employee matters at the first instance.”

In December 2018, a Sunday Age investigation revealed that Dinner by Heston was dramatically underpaying staff and Tipsy Cake, the company that owned the restaurant, was based in a notorious tax haven.

The investigation revealed chefs at the Southbank eatery regularly worked 25 hours of unpaid overtime a week. That pushed pay down to as little as $15 to $17 an hour, well below the minimum rates of the award, the wages safety net.

The Fair Work Ombudsman soon after launched an investigation.

The spokeswoman said Crown would allow customers who purchased Dinner by Heston gift cards to exchange them for Crown gift cards. No timeframe was provided by Crown on when the lease of one of its high-profile tenants would end.

The move to terminate the lease creates further uncertainty for employees who had hoped that Crown may financially support the restaurant to keep it open.

Crown had provided the business – one of its marquee tenants – with a $750,000 interest free loan. Industry sources said the interest free loan could have been used as a way to lure such a high profile business to the casino, boosting its appeal to visitors

Before Christmas Fair Work Ombudsman Sandra Parker said it was disappointing that Tipsy Cake had not resolved the underpayment issue before it went into provisional liquidation.

Accounts for the Dinner by Heston restaurant show it has reported persistent losses since opening in Melbourne in 2015.

The accounts disclosed it was dependent on interest free loans from a related company run through a Caribbean tax haven and Crown Melbourne ‘’to continue operating’’.

But its opaque structure – restaurant owner Tipsy Cake is based on the volcanic Caribbean island of Nevis – made it hard to determine the true health of the business.

The ownership of companies incorporated in Nevis is never disclosed so there is no way to know who is behind companies created there.

But the company has said Blumenthal sold his shareholding more than a decade ago but remained its chef patron and “integral’’ to its operation.

Once a hack, always a hack.

RIP Neil.

Bile acids open the door to Norovirus infection

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Researchers at the Baylor College of Medicine report some people call it the ship cruise virus, but norovirus can be found in many other places. People can catch this very contagious virus from an infected person, contaminated food or water or by touching contaminated surfaces. The virus causes acute gastroenteritis – the stomach and/or the intestines get inflamed, and this leads to stomach pain, nausea, diarrhea and vomiting. Noroviruses are the leading cause of foodborne illness.

Teams of researchers around the world have been working for more than four decades to find a way to grow this virus in the lab. Success came in 2016 from the laboratory of Dr. Mary K. Estes at Baylor College of Medicine, where she and her colleagues grew, for the first time, noroviruses in laboratory cultures of human intestinal epithelial cells.

This work, published in Science, represents a major step forward in the study of human gastroenteritis viruses because it is allowing researchers to explore and develop procedures to prevent and treat infection and to better understand norovirus biology.

“In the Science paper, we showed that bile, a yellowish fluid produced by the liver that helps digest fats in the small intestine, was key to successfully culturing certain strains of norovirus in the lab,” said Victoria R. Tenge, graduate student of molecular virology and microbiology in the Estes’s lab. “The work discussed here (of which Tenge is co-first author) shows the results of our continuing investigations to identify the bile components that are involved in promoting norovirus infection.”

The researchers worked with human enteroids, a laboratory model of human intestinal cells that retains properties of the small intestine and is physiologically active.

“Mini-guts, as we call them, closely represent actual small intestine tissue, and, importantly, they support norovirus growth, allowing researchers to study how this virus causes disease,” said co-first author Dr. Umesh Karandikar, a research scientist in the Estes lab.

The researchers discovered that bile acids and ceramide in bile were necessary for viral infection.

 “Interestingly, we also discovered that bile acids stimulated the process of endocytosis in mini-guts, which was not previously appreciated. Endocytosis is a normal cellular process that cells use to acquire materials from their environment,” said corresponding author, Dr. Mary K. Estes, Cullen Foundation Endowed Professor Chair of Human and Molecular Virology at Baylor College of Medicine and emeritus founding director of the Texas Medical Center Digestive Diseases Center.

Their findings led the researchers to propose that as bile acids activate endocytosis, they create a stage that norovirus takes advantage of by riding along with it to enter the cells and subsequently replicate, causing disease.

 “This strategy works well for a food-borne virus,” said co-first author Dr. Kosuke Murakami, who was working in the Estes lab during most of this project. He is currently at the National Institute of Infectious Diseases in Tokyo. “As people ingest food, the body’s normal response is to secrete bile into the small intestine. Noroviruses contaminating food piggyback on this natural bodily response to invade cells in the small intestine, replicate and cause disease.”

The current study is published in Proceedings of the National Academy of Sciences.

Reverse zoonoses: It’s when people infect animals

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We talk a lot about Norovirus because there are a lot of outbreaks and a lot of sick people.

Dogs too.

In July 2018, recombinant norovirus GII.Pe-GII.4 Sydney was detected in dogs who had diarrhea in a kennel and in children living on the same premises in Thailand. Whole-genome sequencing and phylogenetic analysis of 4 noroviruses from Thailand showed that the canine norovirus was closely related to human norovirus GII.Pe-GII.4 Sydney, suggesting human-to-canine transmission.

Human norovirus infection in dogs, Thailand

Emerging Infectious Diseases, vol. 26, no. 2

Kamonpan Charoenkul, Chanakarn Nasamran, Taveesak Janetanakit, Ratanaporn Tangwangvivat, Napawan Bunpapong, Supanat Boonyapisitsopa, Kamol Suwannakarn, Apiradee Theamboonler, Watchaporn Chuchaona, Yong Poovorawan, and Alongkorn Amonsin 

https://wwwnc.cdc.gov/eid/article/26/2/19-1151_article?deliveryName=DM17555

Norovirus outbreak leads to shellfish harvesting ban on stretch of Virginia river

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WTVR reports health officials announced Saturday an extension of the ban on shellfish harvesting in the waters off Parrot Island in the Rappahannock River in Middlesex County.

The news comes after Virginia Department of Health officials banned the harvesting of oysters and clams in that stretch of the river on Dec. 27 following a Norovirus outbreak in Colorado linked to shellfish harvested from the area.

As a result, oysters harvested between Dec. 1, 2019 through Jan. 11, 2020 are being recalled.

The only oysters affected by the recall were shipped by Rappahanock River Oyster Company from lease numbers 18403, 18417, and 19260 in the Rappahanock River, according to the Virginia Department of Health. The company said the oysters were sold under the Emersum brand name.

Officials noted crabs and fin fish in the river are still safe to catch.

Raw is risky: 179 sick from oysters in France

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Outbreak News Today reports that French health authorities (Santé publique France) say since December 2019, 179 compulsory declarations (DO) of collective food poisoning ( toxi-infection alimentaire collective-TIAC) ​​suspected of being linked to the consumption of raw shellfish, mainly oysters.

The reports come from the majority of regions in mainland France.

Seventy-seven percent of cases occurred since December 23, with the peak of patients being observed around December 25-27.

The symptoms, mainly diarrhea and vomiting, as well as the incubation times, are compatible with infections with norovirus or other enteric viruses. Stool tests performed to date by the National Reference Center for Gastroenteritis Viruses have confirmed the presence of norovirus and other enteric viruses.

The number of TIAC suspected of being linked to the consumption of raw shellfish is significantly higher than in previous years. Each year between 25 and 120 TIAC suspected of being linked to the consumption of shellfish are reported to Public Health France, of which between 4 and 30 occurred during the December-January periods.

The norovirus barf cycle

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Jessica Grose of The New York Times writes that “two days before my 37th birthday, I received the following bone-chilling email from my daughter’s elementary school: “Dear Families, We wanted to inform you that we had an unusually high number of students across all grades suffering from symptoms of a stomach bug.”

One day before my 37th birthday, I had a parent-teacher conference in that building of horrors.

You know where this is going: I spent my birthday eve in the local E.R., getting fluids and the anti-nausea medication Zofran pumped into my veins. “You need to break the barf cycle,” the attending doctor said.

The ailment sweeping my kid’s school and my intestines was norovirus, a highly contagious stomach bug that causes nausea, vomiting and diarrhea. There are multiple strains of norovirus, so you can catch it more than once in a season — and it’s basically hanging around all winter, from November to April.

Norovirus can live on surfaces for days and, per the Centers for Disease Control and Prevention, people infected with norovirus shed billions of virus particles for two weeks or more; just a few particles can make other people sick. That’s why norovirus outbreaks have caused an elementary school in Seattle and 40 schools in Colorado to close briefly in recent weeks — officials wanted to stop the spread, and keeping sick kids away from each other and the building can help.

Norovirus outbreak at Lego event leaves more than 40 people suffering with sickness and diarrhea

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The organisers of the Bristol Brick show say they are ‘devastated’ and an investigation has been launched by the city’s health authorities.

Nearly 4,000 people visited the Action Indoor Sports centre to celebrate Lego but after the event more than 40 attendees started experiencing sickness and diarrhoea.

One Lego fan, who wishes to remain anonymous, said he was not happy with the cleanliness of the venue.

He said: “The state of the place left a lot to be desired.”

“The food wasn’t great and over the weekend, the toilets weren’t well maintained, the basins didn’t work well and there was no hand sanitiser and that sort of thing.”

“At least 40 people that I know about have been affected.”