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Published Date: 2004-06-10 23:50:00
Subject: PRO/EDR> Viral gastroenteritis update 2004 (20)
Archive Number: 20040610.1564

VIRAL GASTROENTERITIS UPDATE 2004 (20)
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International Society for Infectious Diseases
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In this update:

[1] & [2] Norovirus, Alaskan cruise ship - Canada (British Columbia)
[3] Norovirus, resort hotel - Canada (British Columbia)
[4] Norovirus, hospital - UK (England)
[5] Norovirus suspected, hospital - UK (Scotland)

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[1] Norovirus, Alaskan cruise ship - Canada (British Columbia)
Date: Fri 4 Jun 2004
From: ProMED-mail <promed@promedmail.org>
Source: CTV,ca, News, Fri 4 Jun 2004 [edited]
<http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/1086315299234_81724499/?hub=Canada>

Canada: Norovirus Outbreak on Outward-bound Cruise from Vancouver
--------------------------------------------------
Nearly 350 passengers and crew aboard a Princess Cruises ship that
recently left Vancouver Harbour have fallen ill with what appears to
be a norovirus infection. Shortly after leaving Vancouver for
Whittier, Alaska on Sat 29 May 2004, passengers and crew aboard the
Island Princess began getting sick. As of Wed 2 Jun 2004, 308
passengers and 40 crew members of the close to 2900 people aboard had
become ill with norovirus-like symptoms.

Norovirus causes a persistent gastrointestinal infection that is
transmitted via the "fecal-oral route" -- as a consequence of poor
handwashing after using the toilet. Symptoms usually appear about one
to 2 days after ingesting contaminated food or water. Symptoms
include severe nausea and vomiting, diarrhea and stomach cramps. An
infected patient usually recovers in 2-3 days without long-term
health effects.

The illness spreads quickly in close quarters such as cruise ships.
The virus survives for long periods on communal surfaces such as door
knobs and faucets.

Princess Cruises says onboard testing confirmed the diagnosis of
norovirus infection. The company says the ship has intensified
onboard sanitation efforts and brought in medical staff from its
sister vessels, including the Regal Princess, which is docked in
Victoria. "We're very organized in dealing with norovirus infection
now. We have procedures in place proven to be effective," said Dean
Brown, CEO of Princess Tours Division, which oversees Alaska
operations.

Norwalk outbreaks are devastating to the West Coast cruise ship
industry. 2 summers ago, hundreds of people on board Holland
America's Ryndam got sick. That cruise was scrapped, and hundreds of
refunds were handed out. With the Alaska cruise season just beginning,
tourism officials hope this outbreak won't sink what's expected to be
a buoyant season.

There is some debate about the origin of this outbreak. Princess
Cruises issued a statement saying: "We have been informed by Health
Canada that there are currently significant outbreaks throughout
British Columbia, which we suspect may be the origin of the illness
onboard." Health Canada officials dispute that, saying the source of
the outbreak isn't known. They say the only significant recent
outbreak was at Emerald Lake Lodge in Yoho National Park, hours away
in eastern B.C. For now, the Island Princess is continuing its
voyage, with the ill passengers and crew being kept in isolation
until they get better.

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[2] Norovirus, Alaskan cruise ship - Canada (British Columbia)
Date: Wed 9 Jun 2004
From: ProMED-mail <promed@promedmmail.org>
Source: Anchorage Daily News, Associated Press report, Tue 8 Jun 2004 [edited]
<http://www.adn.com/alaska/story/5169190p-5101787c.html>

Norovirus-stricken Ship Decontaminated and on Return Cruise with New
Passengers
---------------------------------------------------
The cruise ship Island Princess left Whittier early Sun 6 Jun 2004
after the vessel was scrubbed down following a norovirus outbreak
that affected more than 400 passengers and crew members. The
Princess Cruises ship is heading to Vancouver, British Columbia, with
a new set of passengers, cruise line officials said. So far, there
are no signs of another outbreak.

On the previous voyage last week, 375 passengers and 49 crew members
complained of norovirus-like symptoms, said Julie Benson, a Princess
Cruises spokeswoman. That trip was cut about 7 hours short to give
crews time to fully sanitize the Island Princess before new
passengers boarded. By the time the ship arrived at Whittier on
Friday evening, 23 passengers were still sick. They were allowed to
stay overnight on board the vessel -- isolated away from well
passengers who couldn't find rooms in the Prince William Sound town.
On Saturday, most were fit for travel, but several still were not
feeling well, so Princess made lodging arrangements for them Saturday
night.

Altogether, 2018 passengers and 896 crew members made the week-long voyage
from Vancouver to Whittier. The first signs of illness surfaced early in the
trip. Princess officials said on-board testing confirmed the presence of
norovirus infection. The virus can cause diarrhea, stomach pain and vomiting
for 24 to 48 hours. It is spread through food, water and close contact with
infected people or items they have touched.

The Centers for Disease Control and Prevention in Atlanta is
investigating the outbreak and sent a team to board the vessel in
Skagway last week. CDC spokeswoman Christine Pearson said on Sunday
that investigators had just returned and still must review ship
medical logs and other information to try to determine the source of
the virus. "They'll try to trace it back to some common link,"
Pearson said. "Our investigation could take weeks, if not months.
There's quite a bit of information we have to look at." The leading
theory is that about 10 passengers were exposed to the virus when
they traveled through an area of the Canadian Rocky Mountains where a
recent outbreak prompted Canadian officials to close a private resort
[see following report - Mod.CP]. These passengers were among the
first to become ill on board the Island Princess.

[Byline: Rachel D'Oro]

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[3] Norovirus, resort hotel - Canada(British Columbia)
Date: Wed 9 Jun 2004
From: ProMED-mail <promed@promedmail.org>
Source: Seattle Post-Intelligencer online, Associated Press report,
Wed 9 Jun 2004 [edited]
<http://seattlepi.nwsource.com/local/aplocal_story.asp?category=6420&slug=CAN%20Park%20Virus>

Canada (B.C.): Yoho National Park Hotel Reopens after Norovirus Outbreak
--------------------------------------------------
A mountain resort has been reopened after a scrubdown following an
outbreak of norovirus infection. Emerald Lake Lodge in Yoho National
Park, west of Banff National Park in the Canadian Rockies, was
reopened on Mon 7 Jun 2004 after workers completed a top-to-bottom
disinfection effort under the supervision of public health officials.

Health Canada tests of Emerald Lake's water supply have come back
negative, a boil-water order has been lifted and no new cases of the
illness have been reported since 31 May 2004. Investigators
determined a gastrointestinal illness that beset as many as 250
guests and employees during May 2004 was caused by norovirus
infection.

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[4] Norovirus, hospital - UK (England)
Date: Wed 9 Jun 2004
From: ProMED-mail <promed@promedmail.org>
Source: Macclesfield Express online, Wed 9 Jun 2004 [edited]
<http://www.macclesfield-express.co.uk/news/index/articles/article_id=13533.html>

England: Wards Closed in Macclesfield Hospital by Norovirus Outbreak
-------------------------------------------------
A contagious stomach virus has closed 3 wards at Macclesfield General
Hospital. The virus, known as a norovirus, causes projectile vomiting and
diarrhoea and by Tuesday morning [8 Jun 2004] 57 patients and an undisclosed
number of staff had been affected. The hospital are labelling it a "viral
outbreak" and say 3 general medical wards have been closed and a 4th
affected. They have refused to identify 2 nursing homes in the area that have
also been hit by the virus but say one has been cleared and the other remains
closed to new admissions.

Their attempts to bring [the outbreak] under control are being aided
by Cheshire and Merseyside Health Protection Unit, but with 4 out of
18 wards affected there is already a major disruption in hospital
activity. Outbreaks usually affect both patients and staff, sometimes
with attack rates in excess of 50 percent. The East Cheshire National
Health (NHS) Trust says 38 patients were affected as of last Fri [4
Jun 2004] and the figure had risen to 57 by this Tue [8 Jun 2004].

Medical director Dr Alan Wills has appealed to the public to limit
visits to Macclesfield Hospital. He said that patients can still
visit the Accident and Emergency departments, and the Outpatient
department is not immediately affected. No operations have yet been
cancelled, as medical -- not surgical -- wards are affected. The
virus is airborne, but can also be spread by hands. A ward has to be
clear for 48 hours before it can be reopened. The impact on [the
number of] hospital beds is severe, but the hospital says it is
coping.

Dr Wills added: "Staff on the wards, as well as cleaning and other
staff, have worked very hard over the holiday weekend to make life as
comfortable as possible for patients affected by the outbreak in
addition to their 1st illness." The decision to reopen is made in
discussions between the local infection control team and the Health
Protection Agency.

Dr Nick Phin, Consultant in Communicable Disease Control with the
Health Protection Authority, estimated that the outbreak may be over
in a week to 10 days, although people can remain infectious for more
than a week after the symptoms disappear. The last norovirus outbreak
in Macclesfield was in October 2002, when it also affected Congleton
Hospital. About 80 patients were ill in the largest outbreak in 4
years. This time Congleton has not been affected so far. Noroviruses
are the most common cause of infectious gastroenteritis in England
and Wales. Although relatively mild, the illness can occur at any age
and the incubation period is usually 24 to 48 hours.

[Byline: Peter Underwood]

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[5] Norovirus suspected, hospital (UK, Scotland)
Date: Wed 9 Jun 2004
From: ProMED-mail <promed@promedmail.org>
Source; Evening Times, Wed 9 Jun 2004 [edited]
<http://www.eveningtimes.co.uk/hi/news/5027339.html>

Scotland: Suspected Norovirus Outbreak Affects Geriatric Hospital in Glasgow
---------------------------------------------------
A hospital for elderly people in Glasgow has been forced to close a
ward after an outbreak of gastroenteritis. The north Glasgow division
of NHS Greater Glasgow has closed one of 4 wards at Lightburn
Geriatric Hospital, Carntyne. A spokeswoman said: "The division has
taken the precautionary step of closing a ward to new admissions at
Lightburn Hospital following a small outbreak of diarrhoea and
vomiting. 3 patients and 2 members of staff are currently showing
symptoms but are not giving cause for concern."

There are 26 elderly patients in the ward and new cases are not being
admitted to prevent the spread of the illness, which can transfer
between patients through the air and when another patient is
violently ill. The symptoms reported in the hospital are the same as
those cause by a norovirus, which has shut wards and hospitals across
the city in recent years. Earlier in 2004, the Royal Infirmary,
Stobhill, the Victoria Infirmary and its Mansionhouse Unit all had to
close wards after being hit by the virus. The division has sent an
infection control team to the hospital and it is working with
cleaners and nursing staff to monitor the outbreak.

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