Hepatitis A in Nanna’s berries; seen and heard

As companies and consumers check their freezers, past menus and, receipts, health officials anticipate that confirmed cases will continue to grow (The Age):

The number of cases of Hepatitis A linked to the consumption of frozen berries imported from China has climbed to at least 14.

Thirty-four government schools have advised the Victorian Education Department that some of their students have consumed berries that have been recalled because of the hepatitis A imported frozen berry outbreak.1424036630491

The number of schools affected suggests that potentially hundreds of students ate berries from one of four lines of frozen berries before they were recalled in recent days by Bairnsdale-based food company Patties Foods.

 

Another example of questioning the world of epidemiology; gotta be tough to be an epi (Business Insider Australia):

On its website, Patties Foods says “The link between our products and the reported illnesses has not yet been confirmed,” in response to its own question about meeting medical costs.

“This makes it too early to comment,” the company said.

The local-food-is-safer contingent is out – without data (Sunshine Coast Daily):

Long-time Chevallum strawberry farmer Rick Twist, co-owner of Twist Brothers, said he could not understand why people continued to risk purchasing overseas products to save a few dollars when the integrity of local produce was so much higher.

“Why the hell do people buy this stuff from those countries when their standards are so low and ours are so high?” Mr Twist said.

“Australian berries… our regulations are so tight and so strong, I think they’re the best in the world.”

And the outbreak has hit rugby (Yahoo News):

The Tigers confirmed on Tuesday that three senior players had approached club management on Monday with concerns that berries they ate may have been contaminated.

Captain Robbie Farah and veteran winger Pat Richards were later named in news reports as two players who underwent precautionary blood tests for the virus.

[Coach Jason] Taylor declined to name the trio of players but said they had shown no symptoms and the club had no confirmed cases of infection.

“It’s really simple. A couple of guys have eaten some of the berries that have been recalled, and that’s the end of the story,” Taylor said.

“We’re not overly concerned about it. We’re just being really cautious. It’s a smart move to make sure we are ticking all the boxes and all the guys are OK.

“We don’t feel that is going to come to that point (of infection) but we are doing due diligence on it.”

Some good amateur medical assessment there, Coach Taylor.

N.C. State ’stomach flu’ outbreak linked to fraternity/sorority event

The amount of norovirus-related news is overwhelming this week. A college in Virginia was closed. A cruise ship returned to port. Outbreaks at Minnesota and U.K. elementary schools.

And, maybe, possibly, an outbreak at N.C. State associated with a fraternity and sorority.

According to The Technician, there are up to 20 students experiencing nasty gastrointestinal illness symptoms following a social function between chapters of the Alpha Delta Pi sorority and the Kappa Alpha Order fraternity.10849902_719581291471357_3442145704847569295_n1-300x300

Fred Hartman, the director of public relations at NC State, said the students are exhibiting symptoms that are consistent with the stomach flu, including nausea, vomiting and diarrhea.

The sorority hosted an event Sunday night, and the university became aware that students had developed stomach ailments by Monday night, according to Hartman. No new cases were reported as of 5 p.m. Wednedsay.

The severity of the symptoms varied on a case-to-case basis, and many of the students sought treatment off campus.

The Student Health Center posted a notification to its website indicating the stomach flu had appeared on NC State’s campus on Tuesday (what is stomach flu? -ben). According to the post, symptoms of the virus (the stomach flu virus? -ben) include nausea, vomiting, diarrhea, abdominal pain/cramping, fever and/or headaches.

The virus is spread by touching contaminated surfaces before touching the mouth, consuming contaminated foods and drinks and coming in direct contact with the stool or vomit of an infected person, according to the post.

Brian Peters, the community director of the Honors Village, made a post in the NCSU Quad/Honors Village Facebook page indicating that there are reports of gastrointestinal illness going around campus, particularly in the Greek community, that is “potentially norovirus.”

Although the word norovirus never appeared in the post from the Student Health Center, the URL link to the page is: healthcenter.ncsu.edu/2015/02/norovirus-campus/.

Leah Arnett, the director of Student Health Services at NC State, deferred comments about the stomach flu outbreak to University Communications.

Justin Hammond, the director of marketing and communications in the office of the Vice Chancellor and Dean of Academic and Student Affairs, said in an email that University Communications is handling all inquiries on this information and deferred comment to Hartman.

Laine Gladstone, the president of NC State’s chapter of AD Pi also declined to comment.

Michael Wallace, the president of NC State’s chapter of Kappa Alpha Order, did not respond to multiple requests for comment by press time.

The Office of Greek Life declined to comment about the situation.

“The university is taking steps to try and help those students and to try and prevent the illness from spreading,” Hartman said.

Encouraging handwashing is a great message. If this outbreak is suspected to be norovirus, based on exposure/symptom timing and other factors, other good messages include: talking about the limitation of popular alcohol-based hand sanitizers (they don’t do much against the non-enveloped virus); keeping ill folks away from food preparation; the limitation of quaternary ammonia-based sanitizers (only chlorine is really effective); and, that the spread potential from a vomit event is about a 25 radius.

Norovirus is kind of special.

 

Norovirus on NC State campus?

There’s for sure some norovirus in the Jaykus/NoroCORE lab, but NC State Student Health Center has a message on their website suggesting that there may be be some community illnesses as well. It’s even got it’s own Twitter handle, @WolfPackNoro.
The stomach bug or stomach flu (norovirus -ben), is on campus.
 
Symptoms include nausea, vomiting, diarrhea, abdominal pain/cramping, fever and / or headache. 10849902_719581291471357_3442145704847569295_n1-300x300
 
If you are experiencing these symptoms call 919-515-7107. 
 
The virus is spread by touching contaminated surfaces or objects and then touching your mouth, eating contaminated foods or drinks, and direct contact with stool or vomit while caring for a sick person. If you become sick, take care of yourself with:
 
▪Medications. This may include fever reducing, anti-nausea, and/or anti-diarrhea medicines.
▪Oral Rehydration. Sip only clear non caffeinated liquids, such as ginger ale, water, ice chips, sport drinks, broth soups.
▪Diet. Once liquids are tolerated eat a bland diet.  This would include crackers, noodles, rice, and toast, and limit dairy.  Advance your diet as tolerated.
▪IV Fluids, as needed. Prevention is key to staying well.  
 
Washing hands is the most important thing to do to prevent getting or spreading the infection.  Also, decontaminate surfaces and objects, such a computer keyboards, door handles, and steering wheels.
 
I’d add that alcohol-based hand sanitizer, a favorite tool in outbreaks, isn’t effective against human norovirus unless it’s (VF481) and to decontaminate with chlorine-based compounds (quaternary ammonia sanitizers also aren’t all that effective against noro.
Here are some infosheets about the virus.

Another Virginia college with a norovirus outbreak

Farmville, VA has a norovirus problem. After Hampden-Sydney college closed Sunday for an outbreak-inspired deep clean, four students from neighboring Longwood University have also come down with noro, according to CBS6.

Longwood University reported that over the weekend, there were four cases of students with gastrointestinal issues.

In each case, cleaning crews disinfected the reported area with bleach. The university is continuing to monitor the situation and cleaning crews are standing by.

Risk management decision: Norovirus outbreak closes Hampden-Sydney College

Norovirus kind of sucks, unless you are a virologist. The perfect human pathogen (a term coined by my NoroCORE colleague and all-around good guy, Aron Hall) is shed at a crazy high rate of virus particles per gram of vomit or feces and sticks around in the environment for a long time. So outbreaks tend to persist.10849902_719581291471357_3442145704847569295_n1-300x300

Risk managers are faced with a  tough decision – shut down a place (school, amusement park, hotel, restaurant) for a deep clean/sanitize (with high concentrations of chlorine) or risk the chance that an outbreak stretches out over weeks. According to NBC 12, a Virginia college chose the former and will be closed until Wednesday as sanitation staff do their thing, while ill students stay isolated (and out of the classroom).

Hampden-Sydney College announced Sunday that it will remain closed through Wednesday, Feb. 4.

An update on the college’s website reads, “The Virginia Department of Health has determined that the illness on campus is norovirus. Norovirus spreads quickly person to person and causes nausea, vomiting, diarrhea, and a low grade fever. The virus is contracted by contact with infected persons or contaminated surfaces and items. The virus can remain vital for as long as two weeks.

Classes are suspended until Wednesday, February 4.

Athletic practices and competitions, extracurricular activities, and fraternity social events are suspended until Wednesday, February 4.

Administrative departments will resume normal hours on Tuesday, February 3.

It may have taken three days, but sophomore Tre Briggs just got over the norovirus. He is one of more than 300 students who fell ill after the outbreak on campus last week. “I just knew something was wrong and then that night I went to sleep and I was just vomiting all night,” Briggs said.

Managing behavior through messaging doesn’t always work, as we saw 7 years ago at Guelph:

University students’ hand hygiene practice during a gastrointestinal outbreak in residence: What they say they do and what they actually do
01.sep.09
Journal of Environmental Health Sept. issue 72(2): 24-28
Brae V. Surgeoner, MS, Benjamin J. Chapman, PhD, and Douglas A. Powell, PhD

Abstract
Published research on outbreaks of gastrointestinal illness has focused primarily on the results of epidemiological and clinical data collected postoutbreak; little research has been done on actual preventative practices during an outbreak. In this study, the authors observed student compliance with hand hygiene recommendations at the height of a suspected norovirus outbreak in a university residence in Ontario, Canada. Data on observed practices was compared to post-outbreak self-report surveys administered to students to examine their beliefs and perceptions about hand hygiene. Observed compliance with prescribed hand hygiene recommendations occurred 17.4% of the time. Despite knowledge of hand hygiene protocols and low compliance, 83.0% of students indicated that they practiced correct hand hygiene during the outbreak. To proactively prepare for future outbreaks, a current and thorough crisis communications and management strategy, targeted at a university student audience and supplemented with proper hand washing tools, should be enacted by residence administration.

Have an outbreak, lose business; norovirus leads to cancellations at Opryland

One of the consequences of being the source of an outbreak is that folks start to avoid to avoid you. Hotels seem to have persistence issues.

The Tennessean reports that a pharmaceutical company has cancelled a meeting that was to be held at Nashville’s Opryland because of noro concerns.

Gaylord Opryland 20130408-l-LLilly Diabetes, which is a part of Eli Lilly and Company, issued a statement Tuesday about pulling out of Opryland: “The health and safety of our employees is our top priority. After monitoring the situation at Opryland over the weekend, we did make the decision to cancel our meetings that were scheduled there for this week.” As of Monday, the Metro Public Health Department said preliminary lab tests indicate that three people have tested positive for the norovirus. 

Thirty ill after Peterborough school’s turkey lunch

Peterborough (that’s in Ontario, Canada) is the closest city to where I grew up.

It’s where the local CBC station (which included some excellent programming, see below) was housed; was home of the closest Walmart; and where the Petes play.

And in December a local elementary school had a Salmonella outbreak that was linked to a high school culinary program.ph_youth12

mykawartha.com reports that 30 students, staff and parents fell ill following a turkey lunch prepared by Kenner Collegiate Vocational Institute students, although the specifics of what caused the illness haven’t been identified.

According to Peterborough’s medical officer of health, Dr. Rosana Pellizzari, there must have been some kind of cross-contamination during the meal preparation process by Kenner Collegiate Vocational Institute’s culinary program students. But she says there are no food samples left over, so it’s hard to tell exactly what led to the outbreak.

“We have no smoking gun,” she says.

In all, 270 people ate at the turkey luncheon on Dec. 4.

Dr. Pellizzari says the health unit was first informed of the situation when a call came in from the mother of child who ate the lunch who had become ill.

The health unit then asked for a list of students who’d been away from school in the days following the lunch.

According to Dr. Pellizzari, many of the student who were sick were complaining of gastrointestinal issues.

“We were able to identify that many (people) were made ill by salmonella, a bacteria that’s commonly found in turkey,” she says.

Dr. Pellizzari says no major infractions were found, although the health unit did make some recommendations, all of which have since been implemented at the school.

An health unit inspector also went to another dinner with Kenner culinary students.

Cooking for a large crowd can certainly lead to cross-contamination issues. Maybe the students washed the turkey before cooking. I wonder if thermometers were used by the students (and what temp the turkey was cooked to). Frank Bryan and colleagues would have had the students recreate the day and observed everything.

 

 

 

Opryland linked to outbreak; health officials think it’s norovirus

On my first trip to Nashville in 1999, Dani’s aunt (who we were visiting) took us to the Opryland hotel. We walked around for about an hour, grabbed some ice cream and took in the vibe. The drive down Music Row was more my thing, but the hotel was pretty impressive.
According to the Tennessean, at least 10 guests of Opryland have been treated for gastroenteritis, and it looks like the cause is norovirus. Screen Shot 2015-01-16 at 8.07.49 PM

Burba Isaacs, a vendor at a hardware trade show at Gaylord Opryland Resort & Convention Center recently, said she and her husband arrived at the hotel on Jan. 7 and left on Jan. 10.

Around midnight Jan. 10, the Kentucky resident woke up “horrendously ill” with vomiting and diarrhea. She said her husband had developed similar symptoms.

“I haven’t been that sick in a long time,” Isaacs said by phone Thursday. “I have absolutely no idea (what happened).”

The hotel is trying to determine how many guests are experiencing gastrointestinal symptoms and seeking the health department’s help, hotel spokeswoman Jenny Barker said in an email to The Tennessean.

“The safety and health of our guests and employees is our top priority, and we are deeply concerned to learn of a number of guests experiencing symptoms of gastrointestinal illness,” Barker said. “We are providing health care services to all affected guests. To prevent further spread, additional precautionary sanitization measures have been implemented throughout the hotel.”
 
WSMV.com reports that health officials confirmed that at least one guest was ill with norovirus.

Norovirus outbreak, including a death, linked to Kansas Meals on Wheels; handwashing issues cited

When I was a kid I used to visit my grandparents in Campbellford,Ontario (that’s in Canada) a bunch. My grandparents lived most of their lives in Toronto (that’s also in Canada) but had retired to this town about 2hrs outside of the city.

My grandparents were into community stuff: volunteering for the hospital auxiliary, organizing charity curling bonspiels and golf tournaments and driving some of their more elderly neighbors to doctor’s appointments.Unknown-1

And my grandfather drove around some food for Meals on Wheels.

I remember being about 8 and going on his route one spring break morning. He grabbed some already-food-filled covered trays and then took a bunch of apples and oranges in bulk. This was before I knew anything about food safety; I didn’t really notice anything about bare hand contact or handwashing.

According to chanute.com, a norovirus outbreak, tragically including a death, has been linked to a Meals on Wheels service in Kansas.

It has been confirmed by the Kansas Department of Health and Environment that the source of the norovirus outbreak in the Neosho County area last week was Meals on Wheels in southeast Kansas.

KDHE Health Programs Public Information Officer Aimee Rosenow said the numbers of confirmed ill have not changed since Friday when there were 29 confirmed ill. 

Rosenow said epidemiology staff are still working on the case to narrow down the source of infection.

A Jan. 8 food safety inspection of the Chanute Senior Services of SEK facility found problems with hand washing and properly arranging food in coolers to avoid cross-contamination. Samples were also taken of all food from the batch delivered Jan. 6.

KDHE Public Health Public Information Officer Aimee Rosenow said KDHE does not have an autopsy report confirming the cause of death as Norovirus infection and cannot release the name of the deceased. 

“We do know that the patient was ill and has been served by this program,” she said.

Over the past year UNC-Chapel Hill food policy student (and frequent barfblog contributor) Ashley Chaifetz has been researching food handling practices and infrastructure at food pantries in North Carolina (as part of a USDA CAP grant on STECs). Volunteers provide a particular challenge for food safety as they may be transient and have varying food safety values.