ProMED-mail |

Published Date: 2005-04-28 23:50:00
Subject: PRO/EDR> Viral gastroenteritis update 2005 (10)
Archive Number: 20050428.1188

VIRAL GASTROENTERITIS UPDATE 2005 (10)
**************************************
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 - hotel (Dorset, England)
[2] Norovirus - frozen raspberries (Haute-Loire, France)
*****
[1] Norovirus - hotel (Dorset, England)
Date: Sat 9 Apr 2005
From: Pablo Nart <pablo11@hotPOP.com>
Source: This is Dorset online, Sat 8 Apr 2005 [edited]
<http://www.thisisdorset.net/dorset/weymouth/news/WEYMOUTH_NEWS_NEWS1.html>

UK: Norovirus Outbreak at Hotel in Dorset
-----------------------------------------
A seafront hotel has closed again after guests were struck down by the 2nd
outbreak of a contagious virus. More than 50 guests and staff members at
the Russell Hotel on Weymouth Esplanade fell ill last week after suffering
sudden vomiting and diarrhoea symptoms. The hotel shut down at the weekend
so a deep clean could blitz the [infectious agent]. The outbreak is thought
to have been caused by norovirus infection, generally associated [with]
winter vomiting disease.
But now a coach party has been asked to leave and the doors have been
closed again until Mon 11 Apr 2005, after 14 more people displayed symptoms
of norovirus infection.
The son of an 83-year-old hotel guest said his father was taken ill soon
after he arrived in Weymouth on a tour with Failsworth Veterans Club. He
said: "We were assured it had been de-bugged and all the bedding had been
cleaned. I am annoyed that the hotel took in guests saying it was all
cleaned up -- someone needs to get their act together. These are not young
people -- they are aged around 90 years, and a virus like this leaves them
very vulnerable, it could kill them." He said the holiday turned into a
nightmare as the bug swept through the coach on the way home.
A spokesman for the Weymouth and Portland environmental health team said
the virus was extremely difficult to eradicate and a 2nd outbreak did not
mean staff were not doing their best regarding cleaning procedures. "We do
suspect that this is a norovirus, although we have not had confirmation yet."
[Byline: Emily Pykett]
******
[2] Norovirus - frozen raspberries (Haute-Loire, France)
Date: Thu 28 Apr 2005
From: ProMED-mail <promed@promedmail.org>
Ssource: Eurosurveillance Weekly, Vol. 10, Issue 4, Thu 28 Apr 2005 [edited]
<http://www.eurosurveillance.org/ew/2005/050428.asp>

France: Outbreak of Norovirus Infection Associated with Consumption of
Frozen Raspberries
---------------------------------------------------
An outbreak of gastrointestinal illness in students who ate in a secondary
school canteen in the Administrative Departement of Haute-Loire, central
France was reported to the local health authorities on 23 Mar 2005. The
school has 30 teachers and 334 students, of whom 298 ate lunch at the
school canteen. On 24 Mar 2005, using a standardised questionnaire,
students and teachers were asked about recent gastrointestinal illness, and
food and drink consumption. A case was defined as a student or teacher at
the school who had diarrhoea or vomiting accompanied by at least one other
symptom (nausea, abdominal pain, vomiting or diarrhoea) since 21 Mar 2005.
Students who reported recent gastrointestinal illness were asked to submit
stool specimens for laboratory testing. A review of food handling
procedures was carried out in the school restaurant, and samples of the
meals served on 21 and 22 Mar 2005 were tested for common foodborne pathogens.
Of the 270 students and teachers interviewed, 75 (28 percent) met the case
definition. Of the 75 cases, 69 (92 percent) reported abdominal pain, 59
(79 percent) vomiting, 53 (71 percent) nausea, 38 (51 percent) diarrhoea
and 15 (20 percent) fever. None of the ill students or teachers was
admitted to hospital, and all recovered. Duration of illness ranged from
less than 1 day to 2 days. Incubation periods, calculated as the time
interval between lunch on 21 Mar 2005 and onset of symptoms, ranged from 12
hours to 56 hours, with a mean of 36 hours and a median of 37 hours.
Consumption of raspberries with fromage blanc (a fresh cheese similar to
quark or cottage cheese), a dessert served at lunch on 21 March, was
significantly associated with illness (relative risk (RR) 3.3; 95 percent
confidence interval (CI) 1.5-7.5), and was reported by 69 of 74 cases (93
percent) for whom questionnaires were answered completely. The consumption
of fromage blanc alone was not associated with illness (RR 1.8; 95 percent
CI 0.4-9.0). 5 of the 6 stool specimens submitted by the students tested
positive for norovirus genogroup I genotype 5 (Musgrove virus, a genotype
not previously identified in France). Bacteriological cultures of the food
samples tested negative for _Escherichia coli_, _Staphylococcus aureus_,
_Clostridium sp._, _Bacillus cereus_ and salmonellae. The first analyses of
the raspberries for norovirus, from an unopened package from the same
producer as those consumed by the cases, were negative. Further analyses
are ongoing.
The raspberries, purchased deep frozen, had been mixed with the fromage
blanc in a blender while still frozen. The mixture was scooped with a spoon
into bowls by a staff member in the canteen. The staff member then used his
hands to put a frozen raspberry on each dessert. None of the staff in the
restaurant reported gastrointestinal illness in the week before the outbreak.
The Food-borne Viruses in Europe Network (FBVE,
<http://www.eufoodborneviruses.co.uk>) was informed of the outbreak on 23
Apr 2005, and an alert was sent out to the European authorities via the
European Early Warning and Response System (EWRS) on 25 Apr 2005. No other
outbreaks associated with the consumption of raspberries have been notified
in France recently.
Freezing allows viruses to survive in berries for a long time. Transmission
of viruses such as hepatitis A virus by contaminated berries has been
reported in the literature (1-3). Outbreaks of norovirus infections
attributed to raspberries have been documented in Canada in 1997 and
Finland in 2002 and 2003 (4-6).
Conclusion
----------
The investigation strongly suggests that this outbreak of gastrointestinal
illness was due to norovirus infection, with contaminated raspberries as
the most likely vehicle of infection. The absence of illness in the
restaurant staff before the outbreak, and the lack of association between
illness and the consumption of other food items prepared by the same staff,
suggest that the raspberries had been contaminated before their preparation
in the restaurant. However, the hypothesis that the raspberry desserts were
contaminated during their preparation cannot be excluded. The raspberries
had been imported from outside France. If the raspberries had been
contaminated before being frozen and packaged, similar outbreaks may occur
in other countries. If norovirus contamination of the raspberries is
confirmed, or if other outbreaks related to this product are reported, the
supplier and country of origin of the raspberries will be made available
through the Rapid Alert System for Food !
and Feed (RASFF,
<http://europa.eu.int/comm/food/food/rapidalert/index_en.htm>).
Information on other outbreaks that may be linked to consumption of
raspberries can be reported to Emmanuelle Espie at the Institut de Veille
Sanitaire in France (<e.espie@invs.sante.fr>)
References
----------
(1) Niu MT, Polish LB, Robertson BH, Khanna BK, Woodruff BA, Shapiro CN, et
al. Multistate outbreak of hepatitis A associated with frozen strawberries.
J Infect Dis 1992; 166: 518-24.
(2) CDC. Hepatitis A associated with consumption of frozen strawberries -
Michigan, March 1997. MMWR Morb Mortal Wkly Rep 1997; 46(13):288, 295.
(<http://www.cdc.gov/mmwr/preview/mmwrhtml/00047129.htm>)
(3) Reid TMS, Robinson HG. Frozen raspberries and hepatitis A. Epidemiol
Infect 1987; 98(1): 109-112.
(4) Le Guyader FS, Mittelholzer C, Haugarreau L, Hedlund KO, Alsterlund R,
Pommepuy M, Svensson L. Detection of noroviruses in raspberries associated
with a gastroenteritis outbreak. Int J Food Microbiol 2004; 97(2): 179-86.
(5) Ponka A, Maunula L, von Bonsdorff CH, Lyytikainen O. An outbreak of
calicivirus associated with consumption of frozen raspberries. Epidemiol
Infect 1999; 123(3): 469-74.
(6) Gaulin CD, Ramsay D, Cardinal P, D'Halevyn MA. [Epidemic of
gastroenteritis of viral origin associated with eating imported
raspberries]. Can J Public Health 1999;90(1):37-40. [Article in French]
[Byline: Benoit Cotterelle(1), Corinne Drougard(1), Jacqueline Rolland(2),
Monique Becamel(2), Marc Boudon(3), Stephane Pinede(3), Ousmane Traore(4),
Katia Balay(5), Pierre Pothier(5), and Emmanuelle Espie(6)
(<e.espie@invs.sante.fr>)
1 Cellule Interregionale d'Epidemiologie d'Intervention, Auvergne,
Clermont-Ferrand, France
2 Direction departementale des actions sanitaires et sociales Haute Loire,
Clermont-Ferrand, France
3 Direction departementale des services veterinaires Haute Loire,
Clermont-Ferrand, France
4 Centre Hospitalo-Universitaire, Clermont-Ferrand, France
5 Centre National de Reference des virus enteriques, Centre
Hospitalo-Universitaire, Dijon, France
6 Institut de Veille Sanitaire, St Maurice, France
--
ProMED-mail
<promed@promedmail.org>
[It is likely that the raspberries were contaminated prior to freezing
rather than after importation, for several reasons: the distinctive virus
genotype, harvesting of fruit is usually carried out by casual itinerant
labour; and washing of soft fruit prior to preservation by freezing is
difficult. - Mod.CP]

See Also