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Published Date: 2004-12-10 23:50:00
Subject: PRO/EDR> Viral gastroenteritis update 2004 (35)
Archive Number: 20041210.3275

VIRAL GASTROENTERITIS UPDATE 2004 (35)
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A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
In this update:
[1] Norovirus, hospitals - Switzerland
[2] & [3] Norovirus, suspected, hospitals - Canada (Vancouver)
[4] Norovirus, National Parks Service advice - USA (Wyoming)
[5] Norovirus, suspected, hospitals - England (Surrey)
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[1]
Date: Mon 6 Dec 2004
From: Andreas Tietz <atietz@uhbs.ch> [edited]

Switzerland: increase in acute gastroenteritis cases in 6 cantons
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An increasing number of acute gastroenteritis cases have been reported over
the last 3 weeks in 6 cantons in Switzerland. Mainly hospitals and nursing
homes were affected.
2 hospitals, in Winterthur and Basel, have reported outbreaks of 180 and
150 cases, respectively. Mostly hospital staff have been affected. This is
consistent with the rapid detection and implementation of control measures
in patients. The source of infection is unknown, but the admission of a
sick patient is frequently observed with secondary spread. The main
containment measures are: enteric and barrier precautions, hand hygiene and
surface disinfection for patient cases, and furloughs (up to 2 days after
recovery) for affected staff. Whereas only few hospitals had to close wards
-- as recently reported in Ireland -- most facilities could continue to
care for patients without restrictions. But some affected patients may have
to wait some days for treatment such as elective surgery, or transfer to
rehabilitation.
--
Dr Andreas Tietz
University Hospitals Basel
Division of Infection Control & Hospital Epidemiology
Petersgraben 4
CH-4031 Basel
Switzerland
<atietz@uhbs.ch>
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[2]
Date: Mon 6 Dec 2004
From: ProMED-mail <promed@promedmail.org>
Soured: Canada.com, Mon 6 Dec 2004 [edited]
<http://www.canada.com/vancouver/story.html?id=3632a7c4-e96c-4cbc-a4ea-8ca55542a848>

Canada: more suspected cases of norovirus infection in Vancouver hospital
--------------------------------------------------
Last week, at least a dozen patients and more than 15 staff displayed
symptoms of norovirus infection. To protect patients, 7 cardiac surgeries
were cancelled, according to hospital officials. But on the weekend,
another 2 patients and 2 staff displayed symptoms -- usually severe
vomiting and diarrhea -- associated with the gastrointestinal virus. As a
result, another 4 surgeries -- some rescheduled after previous
cancellations -- were cancelled.
Even patients without visible symptoms of infection have seen their
non-emergency operations put on hold over concerns that their health could
be compromised if they developed the infection in a weakened post-operative
state, said Shaf Hussain, a spokesman for Providence Health Care, which
operates the hospital. Emergency surgeries are still going ahead at St Paul's.
The wards have been subject to quarantine-like protection during the
outbreak, with visitors restricted to close family members. Visitors and
staff are being required to take extra precautions -- washing hands,
wearing gloves and gowns before visits, and washing hands and not entering
other wards afterwards.
The virus causing the outbreak, which began about 10 days ago, has been
tested and found to be a gastrointestinal virus producing norovirus-like
symptoms. Such infections typically last for 24 to 28 hours. The sudden
onset and intensity of the virus is unpleasant, but only dangerous in
extreme cases, where the elderly and infants can become dehydrated.
Last month, an outbreak affecting 32 patients and staff at Richmond
Hospital as well as 8 family members forced the closure of the hospital's
cardiac, respiratory and general medicine unit for a week. At Peace Arch
Hospital's Weatherby Pavilion in White Rock, 8 of the unit's 50 long term
care patients fell ill last month in an outbreak that ended last Tuesday.
[byline: Elaine O'Connor]
******
[3]
Date: Tue 7 Dec 2004
From: ProMED-mail <promed@promedmail.org>
Source: Canada.com, Tue 7 Dec 2004 [edited]
<http://www.canada.com/vancouver/story.html?id=2996ceee-7e82-4969-b81e-68ebab902b90>

Canada: 2nd Vancouver hospital hit by norovirus infection
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A 2nd Vancouver hospital is battling an outbreak of [suspected] norovirus
infection. British Columbia's Children's Hospital yesterday joined St
Paul's in closing a ward to new patients. Visitors are also restricted to
one person at a time to see any of the 11 children -- ranging from infants
to teenagers -- isolated in ward 3M East at Children's Hospital. 2 children
were still exhibiting "explosive" vomiting and diarrhea [characteristic of
norovirus] infection, hospital officials said yesterday [Mon 6 Dec 2004].
Some inpatient surgeries at the hospital could be postponed today. 7
operations were taken off the slate yesterday.
Children's Hospital officials said that 13 patients and 30 staff members
have exhibited norovirus-like symptoms since late November. All but 2
children have recovered, but the hospital couldn't say how many staff
members are still sick. "There has been no serious illness related to this
outbreak," said Dr Eva Thomas of microbiology, virology and infection
control at Children's. "There is nothing atypical in what we are doing."
Noroviruses can remain on surfaces for up to 48 hours, Thomas said, so
"enhanced cleaning and dedicated [to one area only] staff members" have
been put in place. As well, signs remind everyone in the hospital to be
vigilant about handwashing, still considered the best way to stop the
spread of the virus. When asked if the outbreak might be related to the
privatization of cleaning services at the hospital, Thomas said: "It
[norovirus infection] happens in facilities like this. I think it's fair to
say that it is not due to diminished cleaning standards. Thomas said the
hospital is "cautiously optimistic" the worst is over. 70 hours without any
new cases is traditionally the amount of time required before a ward gets a
clean bill of health.
Meanwhile, ward 5A at St Paul's Hospital remains closed, the last of 4
wards to be closed beginning late last week due to the outbreak. 2 patients
and 2 staff members became ill on the weekend, bringing to 31 the total
number of patients and staff who showed norovirus infection-like symptoms
at St Paul's in the past week. At St Paul's, visitors to the affected wards
have been restricted to close relatives of patients, while other wards at
the hospital are off-limits to visitors of 5A. As well, visitors must wear
gloves and gowns and wash hands before and after visits.
[byline: Don Harrison]
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[4]
Date: Thu 9 Dec 2004
From: ProMED-mail <promed@promedmail.org>
Source: Casper Star Tribune, Associated Press report, Thu 9 Dec 2004 [edited]
<http://www.casperstartribune.net/articles/2004/12/08/news/wyoming/b94e6b7569e6295487256edf0002338a.txt>

USA: National Park Service advises concessionaires after outbreak
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The National Park Service has sent a health advisory notice to concessions
companies in all national parks after a gastrointestinal illness sickened
134 people at Yellowstone this summer. The outbreak, [attributed to
norovirus infection], occurred in June and early July 2004 and was
concentrated at Old Faithful and Lake. Housekeepers and concession workers
who live in dormitories were hit hardest.
Of those who became sick, 53 were visitors and 81 were employees. Many of
the workers were infected while cleaning up after sick visitors in a hotel
room or living in close quarters at a dormitory, said Charles Higgins,
director of the National Park Service's Office of Public Health. Those
situations tend to amplify the spread of the virus, he said.
The Park Service sent out advice last week to concessionaires on how best
to avoid spreading the virus. "We felt like we knew enough now to give them
some advice," Higgins said on Mon 6 Dec 2004.
The [etiologic agent] was probably the [norovirus] that has sickened
hundreds on cruise ships and caused earlier outbreaks at Yellowstone and
Grand Canyon national parks. It attacks suddenly and while not typically
life-threatening, it can make people very sick for one to 2 days. "If you
get one person ill and say you have 3 people living in a room, then you're
probably going to get 2 more," Higgins said. "Then, if they're sharing a
bathroom, you're probably automatically going to get 20 or 30 more."
Norovirus sickens an estimated 23 million people every year, according to
the Centers for Disease Control and Prevention. The virus is most commonly
spread through eating contaminated food, touching contaminated surfaces and
having direct contact with infected people. Investigators believe the virus
was not spread through food or water during the outbreak at Yellowstone but
likely from contact between people or from contaminated surfaces. Tips
offered by the Park Service include use of gloves and facial masks while
cleaning contaminated areas and making sure that those who become sick are
isolated from others.
******
[5]
Date: Thu 9 Dec 2004
From: ProMED-mail <promed@promedmail.org>
Source: ic surreyOnline.co.uk, Thu 9 Dec 2004 [edited]
<http://icsurreyonline.icnetwork.co.uk/0100news/0500dorkingleatherhead/tm_objectid=14957102&method=full&siteid=50101&headline=vomiting-disease-means-closed-wards-at-hospitals-name_page.html>

England: winter vomiting disease closes wards in Surrey hospitals
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Wards at Epsom General and St Helier, the main hospitals in the Leatherhead
area of Surrey, have been closed to new patients because of a virus
outbreak. 5 wards at St Helier and one at Epsom were forced to shut after
patients were hit by sickness and diarrhoea. Epsom and St Helier NHS Trust
confirmed the hospital wards are now closed to new admissions because of
the suspected norovirus infection. It said appropriate infection control
precautions were being taken to prevent other wards being affected.
Dr Louise Neville, infection control doctor with the Epsom and St Helier
University Hospitals NHS Trust, said: "Norovirus, sometimes called [the
winter vomiting disease virus], is a virus which causes nausea, vomiting
and diarrhoea at this time of year. It is very common in the community and
can be readily introduced to the hospital setting. Although it is
unpleasant, it is very rarely dangerous and the symptoms normally last 2 to
3 days. There is no specific treatment." She added: "We are not admitting
new patients to the affected wards and the situation is improving across
the trust."
--
ProMED-mail
<promed@promedmail.org>
[It is not without reason that norovirus infection is described as the
"winter vomiting disease." Outbreaks of norovirus infection nay be
initiated by contaminated food and water, but in most situations the
outbreaks are sustained predominantly by person to person contact and
health care facilities are at greatest risk. - Mod.CP]

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