Published Date: 2002-12-25 23:50:00
Subject: PRO/EDR> Viral gastroenteritis update 2002 - (03)
Archive Number: 20021225.6122
VIRAL GASTROENTERITIS UPDATE 2002 - (03)
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A ProMED-mail post
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[Please note that these reports have been edited to replace "flu-like",
"Norwalk-like", "bug", et alia, with the ICTV approved designation
"Norovirus" for the agent responsible for sudden onset viral
gastroenteritis. - Mod.CP]
In these updates:
[1] Health-care facilities (USA - Washington)
[2] Cruise ships (USA)
[3] Hospitals (Canada - BC)
***
[1]
Date: Fri 20 Dec 2002
From: Karen Steingart <karenst@u.washington.edu>
[The report from "The Columbian" newspaper, posted as part 2 of "Viral
gastroenteritis update 2002 - (02), was wrongly headed "British Columbia:
......etc", when in fact the Vancouver referred to in the report is located
in the southwest of Washington State in the US, far from the Canadian
border. Dr. Karen Steingart has sent the following information to clarify
the situation regarding the norovirus outbreaks in southwest Washington.
ProMED-mail regrets the misunderstanding. - Mod.CP]
Further Information on Norovirus Infection in Southwest Washington
------------------------------------------------------------------
On 1 and 2 Dec 2002, 2 assisted-living/retirement centers in Clark County,
Washington (population 360 000) reported outbreaks of gastrointestinal
illness to Southwest Washington Health District. Over the course of the
following 3 weeks, 8 similar outbreaks were reported from nursing
homes/assisted living centers, healthcare facilities, and the county jail.
A case was defined as acute onset of gastrointestinal illness, including
vomiting or diarrhea, with onset of symptoms after 30 Nov 2002 in a person
working or residing in one of the outbreak settings. We identified 354
cases, of which 326 (92 percent) were associated with 4 facilities.
The following preliminary analysis is based on cases from these 4
facilities. 8 cases were hospitalized. One of the 8, an elderly resident
with Alzheimer's disease whose main symptom was vomiting, subsequently died
of complications of pneumonia. The median age of cases was 81 years, range
16 to 105 years. Stool cultures from ill persons at one of the facilities
were negative for enteric pathogens. However, stool samples from 2 patients
at 2 different sites were positive for noroviruses by reverse
transcriptase-polymerase chain reaction performed at Washington Public
Health Laboratory. Inspections of food preparation and handling practices
at all of the facilities have been conducted and none of the inspections
has suggested a foodborne etiology. Control measures have included
excluding ill staff from work; emphasizing hand hygiene; and requiring
meticulous cleaning of environmental surfaces with 10 percent solution of
household bleach or other virucidal agent. Signs have been posted in some
of the facilities cautioning visitors who are elderly, very young, or have
underlying medical conditions to postpone their visits while the outbreak
is in progress. While the origin of the outbreaks has not been identified,
the distribution of onset dates in the cases over a period of days in
separate facilities suggests person-to-person transmission.
--
Karen R. Steingart, MD, MPH
Health Officer
Southwest Washington Health District
2000 Fort Vancouver Way
Vancouver, Washington 98663
<karenst@u.washington.edu>
******
[2]
Date: Tue 24 Dec 2002
From: ProMED-mail <promed@promedmail.org>
Source: The State/NY Daily News, Tue 24 Dec 2002 [edited]
<http://www.thestate.com/mld/thestate/news/nation/4806799.htm>
Rise in Cruise Ship Illness Forces Federal Probe
------------------------------------------------
In recent months, there have been major outbreaks of the gastrointestinal
illness involving several thousand passengers and crew members on (among
others) Holland America's Amsterdam, Disney's Magic, Carnival's
Fascination, and Celebrity Line's Constellation. The federal Centers for
Disease Control and Prevention is looking into more than 20 outbreaks on
cruise lines, triple the number last year and more than the 4 previous
years combined, according to Dan Forney, chief of the CDC's vessel
sanitation program. The health agency declares an outbreak once 3 percent
or more of a cruise ship's passengers or crew members get the stomach
illness. The virus [norovirus], which can cause vomiting, diarrhea,
abdominal cramps, chills, headache, and a low-grade fever, has spread to
many more ports of call -- on land as well as at sea.
"This is not a cruise ship virus," said Molly McPherson, director of
communications for the International Council of Cruise Lines. "It is a
virus hitting North America." McPherson said the cruise ship illnesses have
gotten more attention because the CDC requires ship companies to report
every instance in which more than 2 percent of passengers on a trip
contract a gastrointestinal illness. "When norovirus infection hits a
land-based facility, like a school, there is no such requirement.
We have
to report it," she said. Still, with more passengers than ever taking
cruises (the industry expects to tally 7.5 million passengers by the end of
this year, a 50 percent increase since 1997), the reported incidents of
norovirus illnesses have gone through the roof.
On 15 Nov 2002 the latest ship to be affected, Carnival's Conquest,
returned to port in New Orleans after a west Caribbean cruise. Officials
said about 230 of 3160 passengers contracted the infection. Boats belonging
to the Norwegian Cruise Line -- the Norwegian Dream and the Norwegian Sun -
reported 262 cases of the illness in September and October. Last month,
following a 13-night trip that began in Manhattan, 22 of 153 passengers and
15 of 159 crew members aboard the Seabourn Pride got sick, said Bruce Good,
spokesman for the Miami-based cruise line.
McPherson insisted that everything's shipshape. "It's as safe to travel on
a cruise as it's always been. We're telling people, No. 1, don't cancel,
and No. 2, don't be scared off of cruising because of this." Still, her
industry group is preparing a tip sheet that will instruct passengers on
taking extra precautions in between the eating, dancing, and relaxing.
"Practicing simple hygiene, like washing your hands frequently, will help
prevent the virus," she said. "Wash before you eat and after you eat. If
you get sick, wash your hands even more often."
[Byline: Richard T. Pienciak]
******
[3]
Date: Tue 24 Dec 2002
From: ProMED-mail <promed@promedmail.org>
Source: Canada.com, tue 24 Dec 2002 [edited]
<http://www.canada.com/victoria/news/story.asp?id={BC8874B4-B8B6-4B78-8214-DF79EF49F1EF}>
British Columbia: Virus Shuts Units at Nanaimo Hospital
-----------------------------------------------------------
At Nanaimo Regional General Hospital, 2 units are now closed after being
hit by norovirus infection. The transitional care unit reports that 9
patients and 4 staff have symptoms, while 8 patients and one staff member
have come down with the virus in the psychiatric input unit.
"It's an outbreak," Vancouver Island Health Authority (VIHA) spokeswoman
Shelby Chamberlain said on Mon 23 Dec 2002. "It's much smaller than [at]
Lady Minto [Hospital] but it's ... a small outbreak." Lady Minto on
Saltspring Island reports 33 staff and 16 patients in extended care have
had norovirus infection symptoms since 10 Dec 2002. 10. No acute-care cases
are reported. It is just one of several VIHA facilities reporting the
virus. As well, 38 patients and an unknown number of staff at Mount Tolmie
extended-care facility are showing norovirus infection symptoms.
The 2 Nanaimo hospital units are closed until the outbreak is under
control, although the psychiatric input unit will take patients when there
are no other options. The 36-bed transitional-care unit is for patients who
have been assessed and are awaiting placement in other facilities, such as
long-term care.
Regional Medical Health Officer Dr. Richard Stanwick said that labs, such
as at the B.C. Centre for Disease Control, in the last year have gained the
ability to identify noroviruses. VIHA sends samples but it takes time for
confirmation. The key concern with norovirus is dehydration, always a worry
in the more fragile such as the elderly.
Even with the hospital outbreaks, there are not a great number of norovirus
cases in Greater Victoria's general population, he said. He has received
reports from public health nurses who have not seen a spike in absences
from school, a good indicator of anything that is going around, Stanwick
said. There was one outbreak in the summer at a local cadet camp,
indicating how easily it can hit 50 percent of a group living closely
together, he said. While the norovirus outbreak in Nanaimo is new and some
local health facilities are still struggling with it, the news is better
elsewhere. Royal Jubilee, Victoria General and Saanich Peninsula acute-care
hospitals have reported no new cases, and all wards are open to new
admissions. One of Saanich Peninsula's extended-care wards is open again
and the second will reopen today. The Priory extended-care facility has
reopened and with no new cases of norovirus infection.
[Byline: Gerard Young]
--
ProMED-mail
<promed@promedmail.org>
See Also
Viral gastroenteritis update 2002 (02) 20021219.6097Viral gastroenteritis update 2002 - (01) 20021218.6088
Norwalk-like virus, cruise ship - USA (Alaska) 20020607.4432
Norwalk-like virus, cruise ship - USA (Alaska) (04) 20020803.4932
Norwalk-like virus, cruise ship - USA (Florida) 20021026.5642
Norwalk-like virus, cruise ship - USA (FL) (15) 20021212.6049
Norwalk-like virus, decontamination: RFI 20020612.4475
Norwalk-like virus, decontamination methods 20020615.4497
Norwalk-like virus, decontamination methods (02) 20020617.4519
Norwalk virus, multiple outbreaks - Canada (Ed.) (02) 20021204.5961
Norwalk virus, multiple outbreaks - Canada (Edmonton) 20021110.5765
Norwalk virus, pediatric ward - Canada (Ont.): susp. 20021205.5974
Norwalk virus, school children - Canada (BC) 20021105.5723
Viral gastroenteritis, hospital - Canada 20021208.6007
Viral gastroenteritis, hospital - Canada (05) 20021212.6044
Viral gastroenteritis, hospital - Canada (Calgary) 20021130.5933
Viral gastroenteritis, hospital - Canada (Toronto) 20021126.5903
.......................mpp/cp/pg/mpp
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