Published Date: 2003-01-01 23:50:00
Subject: PRO/EDR> Viral gastroenteritis update 2002 - (04)
Archive Number: 20030101.0005
VIRAL GASTROENTERITIS UPDATE 2002 - (04)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
[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 calicivirus presumed or confirmed to be responsible for
sudden onset viral gastroenteritis. - Mod.CP]
In these updates:
 Cruise ship - USA (Florida)
 Hospitals - Canada (Ontario)
 Country club - USA (Oregon)
Date: Fri 27 Dec 2002
From: ProMED-mail <firstname.lastname@example.org>
Source: ABC News online, Reuters report, Fri 27 Dec 2002 [edited]
Royal Caribbean Cruise Ship Hit with Illnesses
Some 80 people became ill while sailing the Caribbean on a Royal Caribbean
Cruises ship, the fifth luxury vessel to have such an outbreak in recent
weeks, a health official said on Fri 27 Dec 2002. The source of the illness
has not been identified, but its victims suffer from nausea, vomiting, and
diarrhea often associated with norovirus infection, a non-lethal virus that
affects about 180 000 Americans each year. Nearly all sufferers recover
within a few days.
More than 1000 passengers and crew on ships sailing the Caribbean from U.S.
ports have come down with gastrointestinal illnesses over the past month.
"They just came in this morning, so it is a little premature to determine
the cause," said David Forney, director of the Centers for Disease Control
division which oversees sanitation aboard cruise ships stopping at U.S.
ports. Forney said symptoms reported in the latest cases appear similar to
those in previously reported outbreaks. He said 70 guests and 10 crew
members on Royal Caribbean's "Majesty of the Seas" ship became ill. The
ship, now docked in Miami after a 4-day trip to the Bahamas, had carried
2605 passengers, Forney said.
Royal Caribbean officials were not immediately available for further
information. Health officials have collected stool samples aboard the
"Majesty of the Seas" for testing. Earlier this month, more than 100 people
on British cruise ship "Oceana", operated by P&O Cruises of London, fell
ill. Both the Holland America Line and Disney Cruise Line temporarily yanked
ships out of service in late November 2002 for disinfection.
Date: Sat 28 Dec 2002
From: ProMED-mail <email@example.com>
Source: London [Ontario] News online, via canoe.com, Sat 28 Dec 2002
Canada: Viral Gastroenteritis hits Ontario Hospitals
London's largest adult emergency department was "going crazy" yesterday with
an influx of people with symptoms reminiscent of [viral gastroenteritis],
Dr. Jane Upfold said from the South Street campus of London Health Sciences
Centre. Upfold said the majority with [viral gastroenteritis] symptoms were
"young adults -- we're not seeing a lot of elderly."
A spokesperson for St. Thomas Elgin General Hospital emergency said it was
also [busy] yesterday, primarily with [viral gastroenteritis patients]. An
official said the Dearness Home is clear of symptoms. A couple of weeks ago,
about 200 residents and staff of the city-run nursing home were ill, likely
stricken by norovirus infection.
While people use the term flu loosely, area medical officer of health Dr.
Graham Pollett notes there has been only one lab-confirmed outbreak of
influenza A at a Strathroy nursing home and one confirmed case in a London
boy. Pollett, the Middlesex-London medical officer of health, suspects most
of the [gastroenteritis patients] are experiencing norovirus infection --
not influenza, which affects the respiratory system. Norovirus-induced
illness, which affects the gastrointestinal system, usually lasts 24 to 48
hours, but sufferers are contagious for up to 72 hours after the symptoms
abate. "It's very easily transmitted, and with all the handshaking and
well-wishing going on, it's ideal for transmission," Pollett said. He said
similar outbreaks are happening across the country.
[By Mary-Jane Egan]
Date: Mon 30 Dec 2002
From: Pablo Nart <firstname.lastname@example.org>
Source: Herald and News.com (Oregon), Fri 27 Dec 2002 [edited]
Norovirus Suspected Cause of Outbreak at Country Club in Klamath Falls
State and county health officials are investigating a case of suspected food
poisoning that affected at least 60 people in Klamath Falls last weekend.
All of the people ate last Saturday [22 Dec 2002] at a company Christmas
party held at Reames Golf and Country Club. More than 60 guests became sick
within 24 to 48 hours. The symptoms were severe and sudden.
Norovirus infection, which recently became notorious for making hundreds
seriously ill on cruise ships, may be the cause, officials say. "Symptoms of
norovirus infection are fever, chills, stomachache, headache, vomiting, and
diarrhea. The incubation period is 24 to 48 hours after exposure," said
Marti Baird, community health service manager for the Klamath County Health
Department. Both county and state health officials are conducting an
investigation. Baird said fecal tests can reveal any pathogens, including
viruses or salmonella. By next Monday [30 Dec 2002?], the tests should
confirm her suspicions, she said. "This is a common and easily transmitted
virus. I think the tests will confirm that this [outbreak is due to
norovirus infection]," she said.
Dr. Paul Cieslak, manager of the community disease program of Oregon Public
Health Services, agreed with Baird. Cieslak is in charge of illness outbreak
investigations statewide. After interviewing more than 95 people who
attended the party in Klamath Falls, he said indications are the illness was
caused by norovirus infection. This type of virus comes only from another
human being, he said. "You cannot catch this virus any other way except
through human contamination. You do not catch this from animals." In many
cases where a large number of people get sick in one place at one time,
Cieslak said, the virus is spread through the food. Officials say the cause
is no secret. "It's dirty hands," said Cieslak.
Baird said she did not know whether a restaurant employee at the country
club was ill and a possible carrier of the virus. She said state health
officials from Salem are handling that part of the investigation. Cieslak
said someone carrying the virus may show no signs of illness. It is against
state law for a restaurant to have a sick person handle food. "But that
doesn't stop food contamination of this sort, because you can have the virus
and not be sick. Therefore, you can pass on the virus," said Cieslak. Baird
said that is why it is so important for food service workers to wash their
hands often. Cieslak said the ideal system is a "double hand wash system" in
which there is a sink inside the bathroom, and another sink outside the
bathroom where a food handler washes a second time where everyone else can
Reames Golf and Country Club manager Larry Baker said he directs his
employees to wash their hands, and the hand wash routine his employees have
is in compliance with safety standards. "We were just inspected 2 weeks
ago," he said. "You can catch the virus through kisses, hand shakes, and
hugs, not just from food." Baker advised anyone who feels sick to contact
the county health department.
Nearly 100 outbreaks of norovirus infection have been reported around Oregon
this year, Cieslak said. "Last year we only saw 60 outbreaks. This year is
unprecedented," he said, adding that outbreaks are occurring nationwide.
[Byline: Jennifer Bates]