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Published Date: 2005-01-09 23:50:00
Subject: PRO/EDR> Viral gastroenteritis update 2005
Archive Number: 20050109.0070

VIRAL GASTROENTERITIS UPDATE 2005
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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, local hospitals - Canada (Ontario)
[2] Norovirus, Caribbean cruise ship - USA (Florida)
[3] Rotavirus, suspected, nursing home for the elderly - Japan (Hiroshima)
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[1] Norovirus, local hospitals - Canada (Ontario)
Date: Fri 7 Jan 2005
From: ProMED-mail <promed@promedmail.org>
Source: The Chronicle-Journal, Thu 6 Jan 2005 [edited]
<http://www.chroniclejournal.com/story.shtml?id=25173>

Canada: norovirus outbreak affects hospitals in Ontario
-----------------------------------------------
A 2nd Northwestern Ontario hospital has declared an outbreak of norovirus
infection. Nipigon District Memorial Hospital declared an outbreak Tuesday
afternoon [4 Jan 2004]. 6 patients and 8 staff have shown symptoms of the
gastrointestinal virus since the weekend, said Bruce Sutton, the hospital's
executive director. The illness [has not been laboratory confirmed] as a
norovirus infection, but it has similar symptoms, such as nausea, vomiting,
diarrhea and abdominal cramping, he said. As of Wednesday, one patient at
the Nipigon hospital was still showing symptoms, and 2 staff members had
returned to work.
The hospital is restricting visitors to its patient care areas for both
acute and long term patients. There are some exceptions for palliative care
patients and children who are admitted. So far, public areas of the
hospital, like the labs, X-ray and physiotherapy services, are still open
to the public. The hospital is also asking people who are experiencing
norovirus-like symptoms to stay away, unless it's an emergency. Symptoms
typically last 24 to 48 hours, so Sutton is confident the outbreak is
coming to an end, he said.
The outbreak at Nipigon's hospital follows an outbreak of norovirus
infection that was confirmed at the Dryden Regional Health Centre earlier
this week [1st week of January 2005]. About 12 patients and 8 staff were
treated for norovirus infection symptoms, hospital spokesman Wade Petranik
told The Chronicle-Journal. Of those, 2 patients and 4 staff were still
showing symptoms.
Winter is the most common season for norovirus outbreaks. The virus is
spread through fecal-oral contact, most commonly through poor hand washing,
which can spread germs to other surfaces or people. It can also be
transmitted by aerosolized droplets to people who are within 3 to 4 feet of
a person experiencing active vomiting or diarrhea. It takes one or 2 days
to [exhibit] the infection after being in contact with someone who has it.
Public health nurse Diana Sadgrove, from the Thunder Bay District Health
Unit's infectious diseases department, said the best way to prevent the
spread of norovirus infection is to wash your hands thoroughly with soap
and water for at least 15 seconds. She said it's also important to stay
home from work when you're sick.
[Byline: Stephanie MacLella]
--
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[2] Norovirus, Caribbean cruise ship - USA (Florida)
Date: Sat 8 Jan 2005
From: ProMED-mail <promed@promedmail.org>
Source: The Boston Globe online, Sat 8 Jan 2005 [edited]
<http://www.boston.com/news/nation/articles/2005/01/08/virus_sickens_116_on_caribbean_cruise/>

USA: norovirus infection affects 116 during Caribbean cruise
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Nearly 120 passengers and crew members became sick with a stomach virus
aboard a ship that returned to port [Fort Lauderdale, Florida] on Sat 8 Jan
2005 after a 5-day Caribbean cruise, Royal Caribbean International
officials said. The outbreak of norovirus infection aboard the "Enchantment
of the Seas" sickened 108 passengers and 8 crew members, said company
spokesman Michael Sheehan. It was traced to a man who had symptoms 2 days
before boarding the ship on Mon 3 Jan 2005, he said.
A special cleaning of the 1950-passenger ship was expected to delay a
scheduled departure on Saturday [8 Jan 2005] for a few hours, officials said.
Symptoms of Norwalk-like viruses include nausea, vomiting and diarrhea and
last up to 48 hours. No special medical treatment is required. Such viruses
affect 23 million Americans a year and were blamed for a rash of cruise
ship illnesses more than a year ago that prompted the U.S. Centers for
Disease Control and Prevention to investigate several lines. In Sep 2004,
84 passengers aboard a cruise ship from Alaska fell ill with a norovirus
infection.
--
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[3] Rotavirus, suspected, nursing home for the elderly - Japan (Hiroshima)
Date: Sat 8 Jan 2005
From: ProMED-mail <promed@promedmail.org>
Source: Mainichi Shimbun online, Sat 8 Jan 2005 [edited]
<http://mdn.mainichi.co.jp/news/20050108p2a00m0dm001001c.html>
Japan: death of 6 patients at home for elderly attributed to rotavirus
infection
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6 people at a home for the elderly here have died after 42 residents began
suffering from vomiting and diarrhea on 30 Dec 2004, leading health
officials to suspect an outbreak of rotavirus infection. Fukuyama municipal
health officials conducted an investigation at the facility, Fukuyama
Fukujuen, a special nursing home for the elderly, on Saturday [1 Jan 2005?]
in an attempt to trace the cause of the sickness. Food poisoning was
initially suspected at the home, but an [agent] that [might have caused]
food poisoning was not found in an examination of all residents on Tue 4
Jan 2005, leading authorities to suspect an infectious [viral] disease.
The 6 patients who died, one man and 5 women, were aged between 81 and 91.
The outbreak of the illness at the home was discovered after an anonymous
caller phoned the Fukuyama municipal health center on Friday [31 Dec 2004?]
afternoon and asked whether there was any information about an apparent
food-poisoning outbreak at a home for the elderly in the city. Although
doctors who examine patients suspected of suffering from food poisoning, or
those who diagnose patients as having contracted an infectious disease, are
required to notify the nearest health center, the home had not contacted
the Fukuyama health center after the outbreak.
Fukuyama Medical Association officials said the number of patients
suffering from vomiting and diarrhea caused by a rotavirus-induced stomach
and intestine condition increased rapidly from about the beginning of
December last year [2004]. As some 100 to 200 patients a week had been
diagnosed with the condition, the medical association had issued a warning
about the virus.
Rotaviruses differ from noroviruses [usually associated with sudden-onset
gastroenteritis] in that the former are airborne viruses. Health officials
said that, judging by the symptoms of residents at Fukuyama Fukujuen, and
the way they were infected, it was likely the rotavirus was responsible for
the illnesses. In a news conference held in the predawn hours of Saturday
[8 Jan 2005?], the Director of the home, Tsuyoshi Okada, said 2 of the
patients who had died had suffered from vomiting and diarrhea, but these
symptoms had not been seen in the other 4 patients. Because of this, Okada
said he thought these patients had died of terminal conditions. The average
age of patients at Fukuyama Fukujuen is about 90, and last year [2004], 25
of the patients died. About the same number reportedly die each year from
the effects of colds and influenza.
--
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[Several aspects of this account are puzzling: The initial failure of the
care home to report the outbreak as required by the health authorities; the
anonymous phone call; the need for a pre-dawn news conference; and the
diagnosis of rotavirus infection unsupported by laboratory testing, when
norovirus infection might have been an alternate diagnosis on the basis of
symptoms alone.
Rotavirus outbreaks are most frequent in young children, babies under 2
years of age being at greatest risk. Nonetheless, outbreaks affecting the
elderly in institutionalized settings are not uncommon. The incubation
period for rotavirus infection is 2-4 days, and the characteristic syndrome
is vomiting, diarrhea and fever. Diagnosis of rotavirus infection can be
achieved rapidly by electron microscopy due to the abundance of virus
particles in the feces. Rotaviruses are normally spread by a fecal-oral
route (and not by an air-borne route as stated above) where hygiene is
inadequate. Further information confirming the diagnosis would be
appreciated. - Mod.CP]

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