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MAINE PUBLIC
HEALTH ALERT NETWORK SYSTEM
Maine Department of Health
and Human Services
Maine Center for Disease
Control and Prevention (Maine CDC)
(Formerly Bureau of Health)
11 State House Station
Augusta, Maine 04333-0011
Phone 1-800-821-5821 / Fax 207-287-7443
2007PHADV001
TO: Long Term Care Facilities,
Hospitals, Emergency Departments, Infection Control Practitioners, Schools, Day
Care Centers, Rural Health Centers
FROM: Dora
Anne Mills, M.D., M.P.H., Public Health Director
SUBJECT: Outbreaks of Norovirus Gastroenteritis in
Maine
DATE: January
12, 2007
TIME: 8:30AM
PAGES: 3
PRIORITY: Review
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Background: Since December 1, 2006, the Maine CDC has
investigated eight reports of confirmed or suspected norovirus gastroenteritis
outbreaks from seven counties. Four of
these reports have been laboratory-confirmed. Six outbreaks occurred in long
term care facilities and one in an elementary school. One outbreak associated
with a gathering of families and friends was reported from a hospital emergency
department.
Noroviruses are the
principal cause of viral gastroenteritis in the United States. Circulation of
norovirus infections typically increases during the winter months, and
outbreaks are currently being reported also in other areas of the nation. The
Federal CDC estimates that 23 million cases of acute gastroenteritis per year
are due to norovirus infection.
Clinical Presentation: Norovirus infections are characterized by the abrupt onset of nonspecific gastrointestinal and constitutional symptoms, which usually include nausea, vomiting, diarrhea, and some stomach cramping. Additionally, some persons have low-grade fever, chills, headache, muscle aches, and malaise. In most people the illness is self-limiting with symptoms lasting for about 1 or 2 days. Dehydration is the most common complication and may require intravenous replacement fluids.
Transmission: Norovirus is very highly contagious and is transmitted in stool and vomitus. Exposure can result through direct contact with a person who is ill, by consuming food or liquids that are prepared or handled by an ill person, and through contact with surfaces or objects contaminated by vomitus or stool. The virus can persist on surfaces for prolonged periods at a wide range of temperatures. Noroviruses can also spread via a droplet route from vomitus.
Diagnosis:
In most cases of sporadic illness, specific diagnostic tests are usually not
performed once bacterial and parasitic infection is ruled out. In outbreaks and
in clusters of illness in institutional settings, a diagnosis can be made
through testing for viral RNA by reverse transcriptase polymerase chain
reaction (RT-PCR) testing of stool specimens submitted to the Maine CDC’s
Health and Environmental Testing Laboratory (HETL). PCR testing at Maine CDC is
done free of charge. To report a
possible institutional outbreak, and to obtain epidemiologic and laboratory
support, call 1-800-821-5821. Note:
In any outbreak of diarrheal illness,
stools should also be tested for bacterial and parasitic pathogens through the
routine testing processes available in that setting.
Clinical Management: No specific therapy exists for norovirus gastroenteritis. Symptomatic therapy consists of replacing fluid losses and correcting electrolyte disturbances through oral and intravenous fluid administration.
Prevention:
A. General: In the community, persons with acute gastroenteritis should be told that infection can be easily spread from person to person, and that both stool and vomit are infectious. Particular care should be taken by ill persons who prepare food for others, and with young children in diapers who may have diarrhea. Patients and their close contacts should wash their hands frequently with soap and water, and should be aware that contagion will likely continue for at least 3 days after recovery from their symptoms.
B. Food Handlers: Food handlers and preparers with gastroenteritis should not work until 2 or 3 days after they feel better. In addition, because the virus continues to be present in the stool for as long as 2 to 3 weeks after the person feels better, strict hand washing after using the bathroom and before handling food items is important in preventing the spread of this virus. Food handlers who were recently sick can be given different duties in the restaurant so that they do not have to handle food (for example, working the cash register or hosting).
C. Health Care Facilities: Transmission of norovirus infection to and from patients and staff members occurs readily, and cases of gastroenteritis should be reported to infection control professionals as soon as possible. Contact Precautions should be used when caring for diapered or incontinent persons, during outbreaks in a facility, and when there is the possibility of splashes that might lead to contamination of clothing. Persons cleaning areas heavily contaminated with vomitus or feces should wear surgical masks as well. In an outbreak setting, it may be prudent to place patients with suspected norovirus in private rooms or to cohort such patients. Environmental disinfection is particularly important in preventing and controlling outbreaks, and key personnel in all facilities should download and read the CDC Fact Sheet on Norovirus in Health Facilities (see link below). Report suspected outbreaks as soon as possible to the Maine CDC Infectious Disease Epidemiology Program at 1-800-821-5821, for assistance with diagnostic testing and control recommendations.
Other Recommendations
For More Information: Contact
the Maine CDC at 1-800 821-582
For infection control in healthcare facilities see:
http://www.cdc.gov/ncidod/dhqp/id_norovirusFS.html
http://www.cdc.gov/ncidod/dhqp/gl_environinfection.html
For general information on norovirus, see: