Preventing Norovirus

1
Preventing Norovirus

• Heather Mazakas, Ph.D. student
• Walden University
• PUBH-8165-3
• Instructor Dr. Raymond Thron
• Winter Quarter, 2010

2
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.

3
Audience

• Food handlers
• Cruise ships
• Restaurants
• Nursing homes
• Schools
• Child care centers
• Summer camps
• Banquet Halls
• Students or others interested in learning about
  Noroviruses and prevention

4
Expected Learning Outcomes

• Define Norovirus
• Describe significance of Norovirus
• Describe how Norovirus is transmitted
• List symptoms of Norovirus
• Describe diagnosis and treatment of Norovirus
• List methods of prevention

5
What is Norovirus?

• Virus that causes gastroenteritis, or stomach flu
• Got its name from an outbreak of acute
  gastroenteritis among elementary school children
  in Norwalk, Ohio in 1968
• Also known as
• Norwalk-Like Viruses, or NLVs
• Calcivirus
• Small Round Structured Viruses (SRSVs)
• Sapovirus, Sapporo-Like Viruses, or SLVs

6
Significance

• Every year in the United states, Noroviruses
  cause an estimated
• 23 million epiosodes of gasteroenteritis
• 50,000 hospitalizations
• 300 deaths
• Gastroenteritis is the most frequently reported
  illness in the US (second to the common cold)

7
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

8
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 contact
• Highly contagious
• Infection can occur with exposure to as few as 10
  viral particles

9
Symptoms

• Nausea
• Vomiting
• Abdominal pain
• Abdominal cramps
• Watery or loose diarrhea
• Weight loss
• Malaise
• Headache
• Low-grade fever

10
Symptoms continued

• Symptoms appear 24-48 hours after being infected
• Symptoms can last 12-60 hours

11
Diagnosis and Treatment

• Most commonly diagnosed based on symptoms, can be
  confirmed with lab test
• Treatment includes
• Hydration
• Bed rest
• IV fluids in extreme cases

12
Prevention

• Wash hands thoroughly with soap and warm water
• After using the restroom
• After changing a diaper
• Before handling food
• After smoking
• Rinse raw vegetables with uncontaminated water
  before eating
• Cook shellfish thoroughly
• Employees who are ill with gastroenteritis should
  not report to work
• Sanitize all food surfaces after each use

13
Case Study

• World-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
  outbreak
• Investigation conducted by the Royal Borough of
  Windsor and Maidenhead, Health Protection Agency
• Cause of outbreak was contaminated oysters
• Infected staff members also contributed to
  spreading the virus

14
Case Study continued

• Restaurant reopened in March 2009 after making
  improvements to procedures and protocols
• Policy 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-hyg
iene/?scp3sqfat20duck20norovirusstcse 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).
15
Review of key points

• Norovirus is a virus that causes gastroenteritis
• It 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.

16
Review of Key Points continued

• Treatment includes hydration and bed rest
• Prevention is the key to avoiding Norovirus
• Handwashing
• Properly rinsing raw vegetables
• Sanitizing food surfaces
• Staying home for 72 hours following a
  gastrointestinal illness

17
Sources for Further Reading

• Websites
• Centers for Disease Control and Prevention.
  Norovirus (2009). Available at
  http//www.cdc.gov/ncidod/dvrd/revb/gastro/norovir
  us.htm
• Hazard Analysis Critical Control Points
  (HACCP). Available athttp//www.fda.gov/Food/Foo
  dSafety/HazardAnalysisCriticalControlPointsHACCP/d
  efault.htm
• United States Department of Health Human
  Services. Bad Bug Book The Norwalk virus
  family (2009). Available at http//www.fda.gov/Fo
  od/FoodSafety/FoodborneIllness/FoodborneIllnessFoo
  dbornePathogensNaturalToxins/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)

18
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.

19
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/norovir
  us-foodhandlers.htm
• Centers for Disease Control and Prevention.
  Norovirus (2009). Retrieved January 26, 2010.
  Available at http//www.cdc.gov/ncidod/dvrd/revb/g
  astro/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/norovir
  us-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/

20
References continued

• 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-hyg
  iene/?scp3sqfat20duck20norovirusstcse
• 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
  /DSECTIONsymptoms
• 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/treatme
  nt.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/FoodborneIllnes
  s/FoodborneIllnessFoodbornePathogensNaturalToxins/
  BadBugBook/ucm071344.htm