Heather Mazakas, Ph.D. studentWalden University

PUBH-8165-3Instructor: Dr. Raymond Thron

Winter Quarter, 2010

Purpose

The purpose of this presentation is to increase awareness about Norovirus. It reviews information on how Norovirus is spread, and offers tips for prevention.

AudienceFood handlers

Cruise shipsRestaurantsNursing homesSchoolsChild care centersSummer campsBanquet Halls

Students or others interested in learning about Noroviruses and prevention

Expected Learning OutcomesDefine NorovirusDescribe significance of NorovirusDescribe how Norovirus is transmittedList symptoms of NorovirusDescribe diagnosis and treatment of

NorovirusList methods of prevention

What is Norovirus?Virus that causes gastroenteritis, or stomach

fluGot its name from an outbreak of acute

gastroenteritis among elementary school children in Norwalk, Ohio in 1968

Also known asNorwalk-Like Viruses, or NLVsCalcivirusSmall Round Structured Viruses (SRSVs)Sapovirus, Sapporo-Like Viruses, or SLVs

(2007). Norovirus. Emerging Infectious Diseases, 13(3), 403. Retrieved from Academic Search Complete database.

SignificanceEvery year in the United states, Noroviruses

cause an estimated23 million epiosodes of gasteroenteritis50,000 hospitalizations300 deaths

Gastroenteritis is the most frequently reported illness in the US (second to the common cold)

Moeller, D. W. (2005). Environmental health (3rd ed.). Boston: Harvard University Press.United States Department of Health & Human Services. Foodborne Pathogenic Microorganisms and

Natural Toxins Handbook (2009). Retrieved January 26, 2010. Available at http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/ucm071344.htm

Outbreak statistics 1997-2000 232 outbreaks reported

Causes 57% foodborne 16% person-to-person contact 3% waterborne 23% undetermined

Common Settings 36% restaurants and catered meals 23% nursing homes 13% schools 10% vacation settings or cruise ships

Centers for Disease Control and Prevention. Norovirus: Technical Fact Sheet (2006). Retrieved January 28, 2010. Available at http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus-factsheet.htm

How is Norovirus transmitted?Through the fecal-oral route

Consuming food or beverage that is contaminated

Touching contaminated surfaces that are contaminated, such as doorknobs, railings, elevator buttons, utensils, etc.

Person to person contactHighly contagiousInfection can occur with exposure to as few

as 10 viral particlesCenters for Disease Control and Prevention. Norovirus: Q & A (2009). Retrieved January 26, 2010. Available at http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus-qa.htm

SymptomsNausea VomitingAbdominal pain Abdominal cramps Watery or loose diarrhea Weight loss MalaiseHeadache Low-grade fever

Mayo Clinic. Norovirus infection (2009). Retrieved January 12, 2009. Available at http://www.mayoclinic.com/health/norovirus/DS00942/DSECTION=symptoms

Symptoms continued

Symptoms appear 24-48 hours after being infected

Symptoms can last 12-60 hours

Chris, A. (2003). Noroviruses: When the runs can slow you down. CMAJ: Canadian Medical Association Journal, 168(1), 64. Retrieved from Academic Search Complete database.

Diagnosis and TreatmentMost commonly diagnosed based on

symptoms, can be confirmed with lab test

Treatment includes:HydrationBed restIV fluids in extreme cases

National Institute of Allergy and Infectious Diseases. Norovirus Infection (2007). Retrieved January 26, 2010. Available at http://www3.niaid.nih.gov/topics/norovirus/treatment.htm

PreventionWash hands thoroughly with soap and warm water

After using the restroomAfter changing a diaperBefore handling foodAfter smoking

Rinse raw vegetables with uncontaminated water before eating

Cook shellfish thoroughlyEmployees who are ill with gastroenteritis should

not report to workSanitize all food surfaces after each use

Accessible Journeys. Cruise Ship Illness (2005). Retrieved January 26, 2010. Available at http://www.disabilitytravel.com/cruise/cruise_ship_illness.htm

Case StudyWorld-acclaimed Fat Duck Restaurant in Bray,

Berkshire, England temporarily closed in February 2009 following an outbreak of Norovirus

More than 500 diners were affected by the outbreakInvestigation conducted by the Royal Borough of

Windsor and Maidenhead, Health Protection AgencyCause of outbreak was contaminated oysters Infected staff members also contributed to

spreading the virus

Katz, Basil.(2009 September 11). Illness at Fat Duck Tied to Shellfish and Hygiene. The New York Times. (Retrieved January 28, 2010. Available at http://dinersjournal.blogs.nytimes.com/2009/09/11/illnesses-at-fat-duck-tied-to-shellfish-and-hygiene/?scp=3&sq=fat%20duck%20norovirus&st=cse

Manos, J.. (2009). Food handler health checks would have limited Fat Duck norovirus outbreak. Occupational Health, 61(10), 30.  Retrieved January 28, 2010, from ABI/INFORM Global. (Document ID: 1887306051).

Case Study continuedRestaurant reopened in March 2009 after

making improvements to procedures and protocolsPolicy of exclusion for food handlers to wait 72

hours to report back to work following gastrointestinal illness

Ensure prompt notification of illnesses to Environmental Health Department

Improve training for staff whose first language was not English

Resulted in losses of approximately $167,000 Katz, Basil.(2009 September 11). Illness at Fat Duck Tied to Shellfish and Hygiene. The New York Times. (Retrieved January 28, 2010. Available at http://dinersjournal.blogs.nytimes.com/2009/09/11/illnesses-at-fat-duck-tied-to-shellfish-and-hygiene/?scp=3&sq=fat%20duck%20norovirus&st=cse

Manos, J.. (2009). Food handler health checks would have limited Fat Duck norovirus outbreak. Occupational Health, 61(10), 30.  Retrieved January 28, 2010, from ABI/INFORM Global. (Document ID: 1887306051).

Review of key points Norovirus is a virus that causes

gastroenteritisIt is one of the most frequently reported

illnesses in the United States It is highly contagious and can be transmitted

through contaminated food or water, or from one person to another

Symptoms include nausea, abdominal pain, abdominal cramps, diarrhea, weight loss, malaise, and low-grade fever.

Review of Key Points continuedTreatment includes hydration and bed restPrevention is the key to avoiding Norovirus

HandwashingProperly rinsing raw vegetablesSanitizing food surfacesStaying home for 72 hours following a

gastrointestinal illness

Sources for Further Reading Websites

Centers for Disease Control and Prevention. Norovirus (2009). Available at http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus.htm

Hazard Analysis & Critical Control Points (HACCP). Available athttp://www.fda.gov/Food/FoodSafety/HazardAnalysisCriticalControlPointsHACCP/default.htm

United States Department of Health & Human Services. Bad Bug Book – The Norwalk virus family (2009). Available at http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/ucm071344.htm

WHO Food Safety. Available at http://www.who.int/foodsafety/en/ Books

Goyal, Sagar (Ed.), Viruses in Foods. New York: Springer Science + Business Media, LLC (2006).

Nash, Claire. Food Safety Management Principles, Second Ed. Chadwick House Group Limited (2004)

Sources for Further Reading Continued Research Articles

Kaplan, J., Feldman, R., Campbell, D., Lookasaugh, C., & Gary, G. (1982). The Frequency of a Norwalk-Like Pattern Of Illness in Outbreaks of Acute Gastroenteritis. American Journal of Public Health, 72(12), 1329. Retrieved from Academic Search Complete database.

Surgeoner, B., Chapman, B., & Powell, D. (2009). University Students' Hand Hygiene Practice During a Gastrointestinal Outbreak in Residence: What They Say They Do and What They Actually Do. Journal of Environmental Health, 72(2), 24-28. Retrieved from Academic Search Complete database.

Review Articles Babcock, D. (2007). It's Not Just Montezuma's Revenge Anymore…. Journal

of Environmental Health, 70(4), 49-51. Retrieved from Academic Search Complete database.

Chris, A. (2003). Noroviruses: When the runs can slow you down. CMAJ: Canadian Medical Association Journal, 168(1), 64. Retrieved from Academic Search Complete database.

References(2007). Norovirus. Emerging Infectious Diseases, 13(3), 403. Retrieved from Academic Search

Complete database.

Accessible Journeys. Cruise Ship Illness (2005). Retrieved January 26, 2010. Available at http://www.disabilitytravel.com/cruise/cruise_ship_illness.htm

Centers for Disease Control and Prevention. Norovirus: Food Handlers (2006). Retrieved January 12, 2010. Available at http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus-foodhandlers.htm

Centers for Disease Control and Prevention. Norovirus (2009). Retrieved January 26, 2010. Available at http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus-qa.htm

Centers for Disease Control and Prevention. Norovirus: Technical Fact Sheet (2006). Retrieved January 28, 2010. Available at http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus-factsheet.htm

Chris, A. (2003). Noroviruses: When the runs can slow you down. CMAJ: Canadian Medical Association Journal, 168(1), 64. Retrieved from Academic Search Complete database.

CNN. Officials: Staff at top restaurant carried virus (2009). Retrieved January 30, 2010. Available at http://www.cnn.com/2009/WORLD/europe/03/20/britain.restaurant.fat.duck/

References continuedKatz, Basil.(2009 September 11). Illness at Fat Duck Tied to Shellfish and Hygiene. The New York Times.

(Retrieved January 28, 2010. Available at http://dinersjournal.blogs.nytimes.com/2009/09/11/illnesses-at-fat-duck-tied-to-shellfish-and-hygiene/?scp=3&sq=fat%20duck%20norovirus&st=cse

Manos, J.. (2009). Food handler health checks would have limited Fat Duck norovirus outbreak. Occupational Health, 61(10), 30.  Retrieved January 28, 2010, from ABI/INFORM Global. (Document ID: 1887306051).

Mayo Clinic. Norovirus infection (2009). Retrieved January 12, 2009. Available at http://www.mayoclinic.com/health/norovirus/DS00942/DSECTION=symptoms

Moeller, D. W. (2005). Environmental health (3rd ed.). Boston: Harvard University Press.

National Institute of Allergy and Infectious Diseases. Norovirus Infection (2007). Retrieved January 26, 2010. Available at http://www3.niaid.nih.gov/topics/norovirus/treatment.htm

The Fat Duck Restaurant. http://www.fatduck.co.uk/intro.html

United States Department of Health & Human Services. Foodborne Pathogenic Microorganisms and Natural Toxins Handbook (2009). Retrieved January 26, 2010. Available at http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/ucm071344.htm