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Published Date: 2003-01-08 23:50:00
Subject: PRO/EDR> Viral gastroenteritis update 2003 (01)
Archive Number: 20030108.0058

VIRAL GASTROENTERITIS UPDATE 2003 (01)
**************************************
A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[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:
[1] Winter sports lodge, Feb 2001 (USA - Wyoming)
[2] Number of confirmed cases, 2002 (England & Wales)
[3] Widespread outbreaks (Canada - Alberta)
[4] Hospitals (Canada - Ontario)
[5] Cruise ship (USA - Florida)
[6] Nursing homes (Canada - Newfoundland)
[7] Outbreaks (USA - Pennsylvania)
[8] Hospitals (USA - Massachusetts)
[9] Hospital (England - Somerset)
******
[1]
Date: Thu 2 Jan 2002
From: Pablo Nart <p.nart@virgin.net>
Source: Reuters Health online, Thu 2 Jan 2002 [edited]
<http://www.reutershealth.com/en/index.html>

USA (Wyoming): Waterborne Outbreak at Winter Sports Lodge in February 2001
--------------------------------------------------------------------------
As many as 3 dozen snowmobilers in Wyoming may have suffered a bout of
gastrointestinal illness due to a norovirus infection contracted by
drinking contaminated well water, according to a new report [to be]
published in the 15 Jan 2003 issue of the Journal of Infectious Diseases.
Norovirus is easily transmitted by person-to-person contact or through
contaminated food and water. Symptoms include vomiting, diarrhea, headache
and stomach cramps, but the ill-effects usually disappear within 48 hours.
Noroviruses are believed to be the culprits in several recent outbreaks of
illness on cruise ships.
"In February 2001, episodes of acute gastroenteritis were reported to the
Wyoming Department of Health from persons who had recently vacationed at a
snowmobile lodge in Wyoming," write Dr. Roger I. Glass of the US Centers
for Disease Control and Prevention in Atlanta, Georgia, and colleagues. The
investigators visited the lodge in question as well as 2 other neighboring
lodges. They also conducted telephone interviews with lodge guests. 22
people out of 54 who stayed at the lodge, and 13 out of 27 people who had
visited a restaurant at the lodge but stayed at a different location,
reported "acute gastroenteritis during or within 1 week of their stays,"
the study indicates. Out of 13 stool specimens collected from lodge guests
who were ill, 8 tested norovirus-positive.
In addition, Dr. Glass and colleagues discovered that 7 of 8 well water
samples at the lodge in question tested norovirus-positive. Well water
samples from the other 2 lodges were free of the virus. "Contamination of
the water supply is attributed to the geological conditions of the area and
to an overloaded sewage disposal system," the authors write.
The lodge being investigated had undergone renovations that increased the
sewage load on the septic tanks without increasing the septic system's
capacity. The wells were between 92 and 115 feet from the septic system,
which would have allowed for contamination, according to the report.
Currently US drinking water regulations do not require monitoring for
noroviruses, the researchers note. The current outbreak "illustrates the
importance of noroviruses as a cause of waterborne illness and should
encourage monitoring of (these viruses) in drinking water," the authors
conclude.
******
[2]
Date: Fri 3 Jan 2003
From: ProMED-mail <promed@promedmail.org>
Source: BBC News Online, Fri 3 Jan 2003 [edited]
<http://news.bbc.co.uk/2/hi/health/2625509.stm>

England & Wales: Confirmed Cases of Norovirus Infection at Record high
--------------------------------------------------
The number of cases of norovirus infection doubled over the last 12 months
to reach their highest ever level, official figures have revealed. There
were 3029 confirmed reports of norovirus infection during the first 10
months of 2002, according to the Public Health Laboratory Service [PHLS].
This compares with 1604 during 2001 and is higher than the previous peak
year, 1996, when 2437 cases were confirmed.
Norovirus causes sickness, diarrhoea and fever and [illness] typically
lasts from 24 to 48 hours. It typically peaks during the winter months
[hence the colloquial name "winter vomiting disease"], but experts at the
Communicable Disease Surveillance Centre of the PHLS noted that in 2002
cases did not decline during the summer.
They also noted that most of the extra cases last year were among the
elderly -- 68 percent of all cases were in people aged 65 or over.
Generally, since 1992, more than 3/4 of norovirus outbreaks reported to the
PHLS occurred either in hospitals or residential homes. The virus is easily
spread through the air when people are sick, through contaminated toilets
or in food and drink.
The PHLS said the rise in the number of confirmed cases did not necessarily
mean that incidence of the disease had increased. Increased awareness of
the virus and better diagnostic methods could also be factors in the rising
number of confirmed cases. Dr Bob Adak, consultant epidemiologist at the
PHLS, said norovirus was the most common cause of infectious diarrhoea in
[England and Wales]. Although it has unpleasant symptoms, they are
relatively short-lived. This means many people will not bother to go to the
doctor and so their cases do not appear in official statistics. One study
in 1995 estimated that there could be as many as 6000 cases a year in
England. Dr Adak said it was not clear why there were outbreaks between
July and September [2002] but not in previous years.
******
[3]
Date: Fri 3 Jan 2003
From: ProMED-mail <promed@promedmail.org>
Source: Edmonton News, via Canoe / CP, Fri 3 Jan 2003 [edited]
<http://www.canoe.ca/EdmontonNews/es.es-01-03-0016.html>

Canada: Serious Norovirus Outbreak in Edmonton and Central Alberta
------------------------------------------------
An outbreak of norovirus infection in Edmonton and central Alberta is being
called the worst of the last 20 years. Capital Health officials said there
have been 42 outbreaks affecting more than 1000 people. However, since many
people assume they just have the flu and don't get tested, health officials
suspect those numbers are just the tip of the iceberg.
"It could just be there was a buildup of susceptible people in the
population, or it could be the virus has changed itself so that it is more
infectious," said Dr. Gerry Predy, medical officer of health. On Thu 2 Dec
2002, Alberta Hospital, a mental health facility in Ponoka about 100
kilometres south of Edmonton, reported a small outbreak which officials
said was under control. However, visitors were asked to stay away so as to
help control the spread of the illness. Liz Werner of the Capital Care
Group said norovirus hits the region every year, but "this year it seems to
be wider spread, more centres have been succumbing to it."
******
[4]
Date: Fri 3 Jan 2003
From: Pablo Nart <p.nart@virgin.net>
Source: The Toronto Star online, Thu 2 Jan 2003 [edited]
<http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Artic
le_Type1&c=Article&cid=1041548528466&call_pageid=968256289824&col=968342212737>

Canada (Ontario): Norovirus Outbreak Over at Cambridge Memorial Hospital
--------------------------------------------------
The month-long norovirus outbreak at Cambridge Memorial Hospital was
declared over yesterday, while St. Mary's Hospital was to open the last of
its floors closed by a suspected outbreak that began on 20 Dec 2002 "We're
definitely pleased to see the end of it," Sarah Dickson, spokeswoman for
the Cambridge hospital said in an interview. The hospital's medicine ward,
which was used as an isolation area, had to go 5 days without any evidence
of symptoms of norovirus infection, which include severe vomiting, cramps,
and diarrhea, before an end to the outbreak could be declared. The hospital
will continue to isolate any patient who displays the symptoms, Dickson said.
At St. Mary's, spokesman Peter Sweeney said the seventh floor, a cardiac
unit where staff were hard-hit with the highly contagious illness, reopened
in mid-afternoon yesterday. The hospital took the unusual step of closing
its emergency room to ambulances and non-critical walk-in patients for 3
days just before New Year's because staff and patients throughout the
hospital had come down with Norwalk-like illness. "Closing the emergency
room really helped us get control of the situation and make adjustments,"
Sweeney said. Since the outbreak began at St. Mary's, 83 staff and 36
patients had become ill. Although people feel better within 24 to 48 hours,
the virus is contagious for 48 hours after symptoms abate, so staff
couldn't return to work immediately.
The hospital still awaits official lab confirmation that the illness is a
consequence of norovirus infection. Cathy Egan, Waterloo Region's manager
of food safety and infection control, said this year's norovirus activity
is so widespread that the Ministry of Health lab in London [Ontario] was
inundated with requests for tests and was about 3 weeks behind schedule.
Although there was still no outbreak at Grand River Hospital as of
yesterday, there have been sporadic cases. Yesterday, 2 people were
admitted to isolation. Healthy adults can usually fight off the virus at
home, but the elderly, very young children, and people with underlying
illness occasionally need rehydration in hospital. Some staff also called
in sick, but no more than usual, said Ruth
"The absentee rates for December 2002 and into January 2003 are so far on
par with what we've seen the last 2 years," hospital spokeswoman Victoria
de Wet said. "We've been encouraging staff, if they are symptomatic, to
just call in sick. It seems to be working." Ruth Schertzberg, Director of
Infection Control, said staff also worked hard cleaning the facility to
prevent an outbreak. When patients show symptoms, nurses quickly notify the
infection control department.
Egan said seven long-term care facilities reported intestinal illness.
About 20 day-care centres reported symptoms before the holidays, which are
the most current figures, since some don't reopen until Mon 6 Jan 2003. The
only lab-confirmed test from them so far identified an astrovirus.
[Astroviruses are small positive-sense single-stranded RNA viruses which
are associated with gastrointestinal illness in children. 8 serotypes of
human astroviruses are recognized. Astroviruses are classified in the
family _Astroviridae_ and are not closely related to the noroviruses, which
are included in the family _Caliciviridae_ - Mod.CP]
The Ministry of Health advises otherwise healthy people who suspect they
have the virus to call Telehealth Ontario, the province's nursing hotline,
rather than going to hospital. The hotline offers free medical advice
around the clock, although patients may have to leave a number and wait for
a call back. The number is 1-866-797-0000.
******
[5]
Date: 6 Jan 2003
From: ProMED-mail <promed@promedmail.org>
Source: The Sun Sentinel, Mon 6 Jan 2003 [edited]
<http://www.sun-sentinel.com/business/local/sfl-ccruise06jan06,0,1723688.story?coll=sfla%2Dbusiness%2Dheadlines>

USA: Outbreak of Viral Gastroenteritis on Cruise Ship Norway
--------------------------------------------------
With the cruise industry poised to enter its peak sales period, another
ship has been hit by a [viral gastroenteritis] outbreak. About 100
passengers reported various stages of a stomach flu on the Norwegian Cruise
Lines ship Norway, said company spokeswoman Susan Robison. The ship,
carrying 2200 passengers, docked at the Port of Miami on Sunday morning
after a 7-day eastern Caribbean cruise.
The outbreak is the latest [gastroenteritis] outbreak, including norovirus
infections, to hit a string of cruise ships in the past few months. While
some cruise lines canceled sailings and offered refunds, the financial
effect has been minimal so far, according to financial analysts. Industry
watchers are waiting to see how the wave of illnesses affects bookings as
the traditionally highest sales period of mid-January through February begins.
In October and November 2002, the Holland America ship Amsterdam sailed 4
times with outbreaks of norovirus infection, with 215, 26, 183, and 74
reported cases, respectively, before canceling a cruise to sterilize the ship.
In late November 2002, Disney Cruise Line alerted future passengers that a
previous cruise with had a norovirus outbreak that affected dozens. The
following week, the British vessel Oceana, operating out of Port
Everglades, reported that 114 of 1859 passengers and 3 crew had visited the
ship's infirmary to be treated for gastrointestinal illness.
Carnival Cruise line passengers also have suffered [gastroenteritis]
outbreaks, including almost 200 passengers aboard the Fascination, which
docked in Miami in early December 2002. The day after Christmas, 37
passengers ill with symptoms resembling a gastrointestinal virus on Royal
Caribbean's Miami-based Majesty of the Seas were asked to disembark a day
early in Key West.
[Byline: Tanya Weinberg]
******
[6]
Date: Mon 6 Jan 2003
From: ProMED-mail <promed@promedmail.org>
Source: The Telegram, Mon 6 Jan 2003 [edited]
<http://www.thetelegram.com/topstories/news/story.asp?id=54629&ln=ln>

Canada: More Gastroenteritis Cases in Nursing Homes in Newfoundland
--------------------------------------------------
Although most people who have fallen ill with the contagious
[gastroenteritis] virus that's been hitting seniors and staff at 2 nursing
homes in St. John's appear to be on the mend, more cases were reported on
the weekend. 30 patients at St. Clare's Mercy Hospital are now said to have
come down with the illness, in addition to the more than 240 cases reported
at the Hoyles-Escasoni complex and Salvation Army Glenbrook Lodge seniors'
home.
Officials have not confirmed whether the city is seeing an outbreak of
norovirus infection, a common food-borne illness that affects the
gastrointestinal system. But many of the symptoms -- diarrhea, abdominal
cramps, nausea and vomiting, headache and fever -- are similar. "We've had
a couple of new cases each day (but, overall cases) have been reducing in
numbers. At Glenbrook where there were 6 cases yesterday, today there was
only one new case" Jennifer Deon, spokeswoman for the St. John's Nursing
Home Board, said on Sun 5 Jan 2003. "Overall, our recovery rates are about
80 percent of the Hoyles-Escasoni complex and about 90 percent at Glenbrook
Lodge within the last couple of days, of the total numbers that have been
reported."
As of Sunday morning, at Glenbrook there were 68 reported cases among
residents (up from 59) and 54 staff had contracted the virus (up from 49).
And eight of the 12 suspected new cases reported at Hoyles-Escasoni since
Friday were confirmed to be the virus. As of Fri 3 Jan 2003, 74 residents
and 38 staff at the home had been affected. A week ago today, 40 residents
and 36 staff at Glenbrook were the first to come down with the virus, and a
handful of people had shown symptoms at Hoyles-Escasoni.
Jim Hutchinson, Director of Infection Control for the health care
corporation, stated in a news report he expects there will be many more
cases over the next few weeks before the virus [infection] runs its course.
Test results to determine whether the virus is a norovirus are not yet
available. Outbreaks of norovirus infection usually occur where a large
number of people are confined to a relatively small space. Outbreaks can
occur anywhere where there is contaminated drinking water or swimming
water, and are known to affect nursing homes, hospitals, cruise ships and
schools. According to the U.S. Centers for Disease Control and Prevention,
in many cases infected food handlers can contaminate food.
[Byline: Will Hulliard]
******
[7]
Date: Mon 6 Jan 2003
From: ProMED-mail <promed@promedmail.org>
Source: The Morning Call, Mon 6 Jan 2003 [edited]
<http://www.mcall.com/news/local/all-b1_5stomachflujan06,0,2065142.story?coll=all%2Dnewslocal%2Dhed>

USA: Pennsylvania Affected by Viral Gastroenteritis Outbreaks
---------------------------------------------------
"Viral gastroenteritis is rampant," declared Dr. Elliot Sussman, an
internist and president of Lehigh Valley Hospital and Health Network. The
disease put a serious dent in the work force at the Coffee Grinder at the
Lehigh Valley Mall in Whitehall Township. More than half of [the] 14
employees fell sick with it 2 weeks before Christmas. And Dr. David Isaac,
an emergency room physician at Easton Hospital, said so many people came to
the Wilson emergency room with vomiting and diarrhea that "we stopped
counting."
The handful of people typically admitted to area hospitals with the illness
tends to be infants, the elderly and the chronically ill. Dehydration is
the biggest threat. However, most people return to health on their own or
with fluids administered in the emergency room.
[Byline: Ann Wlazelek]
******
[8]
Date: Tue 7 Jan 2003
From: Pablo Nart <p.nart@virgin.net>
Source: Boston Herald, Tue 7 Jan 2003 [edited]
<http://www2.bostonherald.com/news/local_regional/viru01072003.htm>

USA: Outbreaks of Severe Gastroenteritis Affect Eastern Massachusetts
--------------------------------------------------
Many emergency rooms across Eastern Massachusetts are being swamped with
patients suffering from a devastating [gastroenteritis] that some doctors
say is the worst they have seen in ages. "This seems more severe than any
in the last 5 to 10 years," said Dr. Stephen Kruskall, director of the
emergency department at Leonard Morse Hospital in Natick. Patients are
becoming dehydrated from constant vomiting and diarrhea and often must be
hooked up to IVs to replenish lost fluids and electrolytes, he said. The
[illness] generally lasts 24 to 48 hours and is considered especially
contagious among people who share the same household, he said. "Other
family members can get it more easily than the garden-variety stomach
virus," he said. [Perhaps Dr. Kruskal is referring to rotavirus, the virus
usually responsible for epidemic gastroenteritis in young children. -
Mod.CP] Doctors recommend those [affected by gastroenteritis] to drink as
much clear liquid as they can hold down. Particularly good are apple and
cranberry juices, Gatorade, and Pedialyte. [ProMED-mail is not recommending
any specific proprietary product. - Mod.CP]
At Lahey Clinic in Burlington, "we've been seeing it over the past month or
month and a half," said Dr. Malcolm Creighton, Head of the emergency
department. It is characterized by nausea, vomiting, diarrhea, and
abdominal cramps," he said. The virus is being seen in kids as well as
adults, and in some cases the culprit has been identified as a norovirus,
the virus that has caused widespread outbreaks on cruise ships recently,
according to tests conducted by the state Department of Public Health (DPH).
At South Shore Hospital, "the last 2 weeks were pretty bad, especially the
first couple days of the new year, but it has slowed down a bit now," said
Dr. Robert Fitzgerald, Chief of emergency services. "Most got better with
IV fluids, but a couple had to be admitted,"he said. "A lot of our staff
were sick with the same thing."
City and state health officials said there have been a number of outbreaks
in nursing homes. "They have involved handfuls to dozens of patients," said
Roseanne Pawelec of the DPH. Dr. Anita Barry of the Boston Public Health
Commission said there have been 17 reported outbreaks of norovirus
infection in the city over the past month or so, including several at
nursing homes, hospitals and a homeless shelter. "That's pretty unusual,"
she said.
[Byline: Michael Lasalandra]
******
[9]
Date: Wed 8 Jan 2003
From: A-Lan Banks <A-Lan.Banks@derwent.co.uk>
Source: The Bath Chronicle (UK), Wed 8 Jan 2003 [edited]
<http://www.westgaz.co.uk/displayNode.jsp?nodeId=71063&command=displayContent&sourceNode=70590&contentPK=3572312>

England (Somerset): Norovirus Outbreak Closes 5 Wards in Bath Hospital
-------------------------------------------------------------------------
200 people have been laid low in the latest wave of illness caused by a
viral [gastroenteritis] outbreak at the Royal United Hospital (RUH). 5
wards at the Combe Park site were closed to new admissions last night and 3
others were subject to restrictions. The hospital was today hoping to give
2 of its 5 closed wards the all-clear as the norovirus infection is brought
under control. However, all routine operations were once again cancelled
yesterday as the [infection] continues to grip the hospital. To date, 121
patients and 79 staff have come down with [presumed norovirus infection],
which causes vomiting and diarrhoea.
The [virus infection] also hit the RUH, along with a string of other West
Country hospitals last autumn and led to the cancellation of a number of
planned operations. Nationally, cases of such "winter [vomiting illness"]
have doubled within the past 12 months to reach their highest level yet.
RUH officials say patients or visitors to the hospital may have unwittingly
brought the virus back. Visitors have been told to stay away if they have
displayed any symptoms in the previous 48 hours. Staff at the RUH are
asking staff, patients, and visitors to take extra care with hand washing
and hygiene.
--
ProMED-mail
<promed@promedmail.org>

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