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Published Date: 2005-01-23 23:50:00
Subject: PRO/EDR> Viral gastroenteritis update 2005 (03)
Archive Number: 20050123.0245

VIRAL GASTROENTERITIS UPDATE 2005 (03)
*************************************
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International Society for Infectious Diseases
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In this update:
[1] & [2] Japan - norovirus outbreaks claim more victims
[3] Chile - suspected norovirus outbreak on cruise ship
[4] USA (Florida) - norovirus outbreak on Caribbean cruise ship
[5] USA (Missouri) - norovirus outbreak traced to restaurant
[6] Dominican Republic - Canadian travel health advisory
******
[1] Japan - norovirus outbreaks claim more victims
Date: Sat 15 Jan 2005
From: Pablo Nart <p.nart@orange.net>
Source: Yahoo news, Tue 11 Jan 2005 [edited]
<http://asia.news.yahoo.com/050113/ap/d87j11ho4.html>

Japan: norovirus outbreak affects 7800 nationwide
-----------------------------------------------
A [gastroenteritis] outbreak has killed at least 12 elderly people in Japan
and infected more than 7800 other people nationwide since November 2004,
the government said on Wed 11 Jan 2005. The Health Ministry urged nursing
homes, kindergartens and schools to step up their hygiene measures to
combat the highly contagious disease. According to a government survey
published on Tue 11 Jan 2005, a total of 7821 people have shown symptoms of
[gastroenteritis] -- stomach pains, vomiting, diarrhea and fever -- since
November 2004, said Health Ministry official Atsuhiro Tamura. Of these
patients, nearly 5400 were suspected to have contracted norovirus
infection, which has been responsible for 5 of the deaths. Noroviruses are
a common cause of [gastroenteritis] in humans and are contracted primarily
by eating raw oysters [among other things] and can be spread from person to
person.
The national survey followed reports earlier this month [January 2005] that
7 residents at a nursing home in Hiroshima had died after developing flu
symptoms. 5 more deaths have since been reported in 5 other prefectures.
The illness typically lasts one or 2 days, but can be fatal in elderly
people or others in poor health.
--
Pablo Nart
<p.nart@orange.net>
******
[2] Japan - norovirus outbreaks claim more victims
Date: Sun 16 Jan 2005
From: ProMED-mail <promed@promedmail.org>
Source: Kyodo News, Thu 13 Jan 2005 [edited]
<http://www.japantoday.com/e/?content=news&cat=1&page=3>

Japan: gastroenteritis case numbers increase; fever deaths
-----------------------------------------------
A total of 7821 people, mainly in homes for the elderly, have shown
symptoms of "stomach flu" in Japan since last November [2004], of whom 12
have died, according to an interim report released by the Ministry of
Health, Labor and Welfare on Wed 12 Jan 2005.
Among the patients, 5371 are suspected to be infected with noroviruses,
known to cause stomach flu or gastroenteritis in humans, or have had the
viruses, the ministry said.
--
ProMED-mail
<promed@promedmail.org>
******
[3] Chile - suspected norovirus outbreak on cruise ship
Date: Mon 17 Jan 2005
From: Alfonso Rodriguez <ajrm_msds@yahoo.es>
Source: La Tercera news, Chile, Mon 17 Jan 2005 [translated by Mod.JGM, edited]
<http://www.tercera.cl/medio/articulo/0,0,3255_5666_108455568,00.html>

Chile: suspected norovirus outbreak on cruise ship at Valparaiso
-----------------------------------------------
The Ministry Regional Secretary (SEREMI, according to its Spanish initials)
ordered a summary sanitary procedure for the Norwegian Crown cruise liner,
because its crew did not report a diarrheal disease outbreak on time.
The SEREMI for Health Affairs in the Valparaiso region, Anibal Vivaceta,
stated that, last Friday [14 Jan 2005] when the ship was in the Puerto
Montt area, a diarrheal disease outbreak occurred, that it was not declared
to the sanitary authorities, and that therefore "there was a violation of
the maritime, airway and land border sanitary regulations." This document
establishes the minimum sanitary conditions that must be in place in ports,
airports and at land border posts with regard to national and international
health protection.
In the aforementioned outbreak, there were more than 200 persons on board
the ship who developed diarrhea, vomiting, and fever, and the duration of
the symptoms was between one and 2 days. Since this situation was not
reported, a summary sanitary procedure was performed on board when the ship
entered Valparaiso bay.
The ship was maintained under surveillance, and she was inspected by a team
including professionals from the Public Health and Sanitary Actions
departments. This team examined the affected passengers and performed an
epidemiological analysis of this information, and the likelihood of cholera
as a cause of this diarrheal disease was ruled out, since its clinical
characteristics did not match those of cholera. Clinical samples were taken
from the patients affected, and these samples were sent to the Public
Health Institute in Santiago. Afterwards, passengers were authorized to
land so they could take their previously scheduled connection flights.
Mr. Vivaceta said that, with respect to this case, "it was necessary to
implement rigorous control measures, since our country maintains a strict
sanitary barrier against cholera, amongst other diseases, and we do not
want the health of our people nor our region's tourist attractiveness to be
at risk because of the inappropriate management of a delicate situation
concerning the ship's crew or passengers.

The SEREMI added that: "Our task as sanitary authorities for strengthening
tourism is to be quite strict with the compliance of national and
international regulations. In this case, although we are almost certain
that an outbreak of norovirus infection is responsible for the disease
situation, which does not pose risks for the population outside the ship,
we must take all precautions, especially in this case where the ship
intended to avoid controls."
--
ProMED-mail
<promed@promedmail.org>
******
[4] USA (Florida) - norovirus outbreak on Caribbean cruise ship
Date: Tue 18 Jan 2005
From: Alfonso Rodriguez <ajrm_msds@yahoo.es>
Source: Yahoo News, Tue 18 Jan 2005 [edited]
<http://news.yahoo.com/news?tmpl=story&u=/afp/20050118/hl_afp/uscruisevirus_050118232621>

USA: gastroenteritis outbreak aboard Caribbean cruise ship ex Fort Lauderdale
-----------------------------------------------
An outbreak of gastroenteritis affected more than 90 passengers and crew
during a Caribbean voyage, Princess Cruises said in a statement. The
outbreak of the highly-contagious norovirus started aboard the Sun Princess
on the 2nd day of a 10-day Caribbean cruise that departed Fort Lauderdale,
Florida on 8 Jan 2005 and returned on schedule on Tue 18 Jan 2005.
The cruise line said the ship was thoroughly disinfected before sailing
again on Tuesday [18 Jan 2005] afternoon. "In our investigation to discover
the source of the illness, we found that the 1st passenger who reported ill
had falsely filled in her health status form prior to boarding," the
statement said.
Over the course of the cruise, 89 passengers and 5 crew were affected by
the illness. It is the 2nd incident of its type in less than 2 weeks on a
vessel sailing from Fort Lauderdale, after 116 passengers and crew became
sick with a stomach virus on a Royal Caribbean vessel.
--
ProMED-mail
<promed@promedmail.org>
******
[5] USA (Missouri) - norovirus outbreak traced to restaurant
Date: Wed 19 Jan 2005
From: Alfonso Rodriguez <ajrm_msds@yahoo.es>
Source: The Moberly Monitor Index news, Central Missouri, Tue 18 Jan 2005
[edited]
<http://www.moberlymonitor.com/articles/2005/01/18/news/news5.txt>

USA: norovirus outbreak in Moberlly, Missouri
-----------------------------------------------
During the week of 20 to 25 Dec 2004, the Moberly area experienced its 1st
suspected outbreak of norovirus infection, which is believed to have been
spread through a local restaurant. Noroviruses, previously known as Norwalk
virus, are a group of related viruses that cause acute gastroenteritis in
humans.
Norovirus infection in humans presents as acute-onset vomiting, watery
non-bloody diarrhea with abdominal cramps, and nausea. Low-grade fever and
headaches also occur frequently. The virus generally takes 24-48 hours to
develop after exposure, and symptoms usually last 24-48 hours. Recovery
without treatment is complete, and there are no long term after-affects.
Noroviruses are transmitted primarily from person-to-person or by the
fecal-oral route. They can also be transmitted via the environment or on
utensils, etc. A spokesperson stated that: "Noroviruses are highly
contagious, and it is thought that as few as 10 viral particles may be
sufficient to infect an individual. In other outbreaks several modes of
transmission have been documented; for example, initial foodborne
transmission followed by secondary person-to person transmission. This is
the virus that has hit the cruise ships with increased frequency over the
last couple of years. There have also been several documented cases in tour
buses of people visiting Branson."
"In the case here in Moberly, we believe that infected food workers (who
may or may not have realized they were ill) contaminated a number of food
items. Once consumed, the virus begins to replicate in the body and causes
illness. We were unable to pinpoint any one food item in this case, despite
very accurate records of what was and how many were served at the
restaurant during the time period. Added to this, we did not find out about
the outbreak until 6 Jan 2005, so submitting patient samples was not an
option. We did interview the food workers in this case, and several did
admit to being ill on 21/22 Dec 2004. Several others reported becoming ill
around Christmas Day."
The spokesperson stressed that the keys to avoiding a norovirus outbreak
are good hand-washing and not working when ill. "Norovirus is here in the
environment, and I want to stress that it is not caused by bad food, but
rather by not washing hands often enough and working when ill with
diarrhea-type symptoms. Education of food-handlers and a strict policy on
ill employees is crucial in preventing this. They are ill; it's pretty
difficult to know."
[Byline: Janet Murray, R.E.H.S./Randolph County Health Department]
--
ProMED-mail
<promed@promedmail.org>
******
[6] Dominican Republic - Canadian travel health advisory
Date: Sun 13 Jan 2005
From: ProMED-mail <promed@promedmail.org>
Source: Public Health Agency of Canada, Travel Health Advisory, Thu 20 Jan
2005 [edited]
<http://www.phac-aspc.gc.ca/tmp-pmv/2005/gastro050120_e.html>

Dominican Republic: gastrointestinal illness - travel health advisory
-----------------------------------------------
The Public Health Agency of Canada (PHAC) is aware of reports of
gastrointestinal illness (GI) in returning travelers from 2 geographical
regions in the Dominican Republic. The 1st report involves Canadian
travelers returning from Puerto Plata and the 2nd report involves American
travelers returning from Punta Cana.
PHAC consulted with Canadian tour operators and was advised of travelers
returning home with GI illness from Puerto Plata. PHAC has recommended that
Canadian medical health professionals act with increased vigilance with
regard to investigating and reporting GI illness in returning Canadian
travelers from the DR.
The Centers for Disease Control and Prevention (CDC) in the United States
notified the PHAC of a group of 20 tourists from Ohio who returned home
with GI illness from Punta Cana. To date, preliminary laboratory results
indicate norovirus (formerly referred to as Norwalk-like viruses) as being
the causative organism.
PHAC is collaborating closely with the Pan American Health Organization
(PAHO) in the Dominican Republic. An epidemiological investigation is
currently on-going and has confirmed that there is a gastrointestinal
illness outbreak occurring. While the organism has not yet been confirmed,
it appears to be viral in nature, possibly norovirus. PAHO has advised the
PHAC that multiple measures have been implemented in resorts, including
reinforcing hygiene measures related to the handling of food, water
chlorination, and education for food handlers regarding washing of hands.
The epidemiological investigation is ongoing, and PAHO will continue to
monitor the situation and the impact of the measures taken.
If you are traveling internationally, you should be aware that conditions
in other countries, both natural and man-made, may be significantly
different from those in Canada and may affect your health during travel.
Standards of hygiene may be different. Food and water may be contaminated.
The climate or environmental conditions may favor disease organisms which
do not occur in Canada. If you are planning to travel to the tropics, you
may be at risk of developing traveler's diarrhea (also known as "tourista,"
"Montezuma's revenge," etc).
Noroviruses are common forms of viral gastroenteritis seen worldwide. They
occur throughout the year, but are more common in the winter. Outbreaks are
common and generally occur where people congregate in close quarters for
extended periods (e.g., at camps, schools, nursing homes, cruise ships).
Outbreaks have been reported in Canada in a variety of settings, including
hospital emergency departments, senior's residences, day cares and schools.
Noroviruses are spread through fecal/oral exposure. Transmission may occur
through contaminated water supplies or food (e.g., contaminated shell-fish,
such as clams and oysters), and through food handled by someone who is ill
with norovirus or has been exposed to norovirus without exercising proper
hand-washing procedures. Transmission can also occur person to person if
there has been exposure to contaminated feces, or to any contaminated
surface, followed by contact with one's mouth.
The incubation period ranges from 10 to 60 hours, usually between 24 to 48
hours. Travelers can transmit the illness during the acute stage of the
illness and up to 48 hours after symptoms disappear. Generally, these
viruses cause only minor illness, with self-limiting, gastrointestinal
symptoms, such as diarrhea and vomiting lasting from one to 4 days. The
risk of dehydration is more likely to occur in the very young, the elderly
and those with weakened immune systems. There is no vaccine or specific
treatment for norovirus.
Noroviruses are very hardy, capable of surviving on practically any surface
including door handles, sinks, railings and glassware. In an outbreak
situation, an environmental cleansing with chlorine must occur to break the
cycle of transmission.
Recommendations:
----------
Canadian travelers traveling to tropical destinations, including the
Dominican Republic, are advised to refer to the Public Health Agency of
Canada's General Travel Health Advice on Gastro Intestinal Illness:
<http://www.phac-aspc.gc.ca/tmp-pmv/2001/gastro_e.html>
--
ProMED-mail
<promed@promedmail.org>

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