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Chadwick PR, Trainor E, Marsden GL, Mills S, Chadwick C, O'Brien SJ, Evans CM, Mullender C, Strazds P, Turner S, Weston V, Toleman MS, de Barros C, Kontkowski G, Bak A. Guidelines for the management of norovirus outbreaks in acute and community health and social care settings. J Hosp Infect 2023:S0195-6701(23)00043-9. [PMID: 36796728 DOI: 10.1016/j.jhin.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 02/17/2023]
Affiliation(s)
| | - Eamonn Trainor
- Northern Care Alliance NHS Foundation Trust, Greater Manchester, UK.
| | - Gemma L Marsden
- Healthcare Infection Society, London, UK; Royal College of General Practitioners, London, UK
| | - Samuel Mills
- British Infection Association, Seafield, West Lothian, UK; Oxford University NHS Foundation Trust, Oxford, UK
| | | | | | - Cariad M Evans
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | | | - Pixy Strazds
- Infection Prevention Society, London, UK; St Andrew's Healthcare, Northampton, UK
| | - Sarah Turner
- Infection Prevention Society, London, UK; Stockport Council, Stockport, UK
| | - Valya Weston
- Healthcare Infection Society, London, UK; Infection Prevention Society, London, UK; NHS England, London, UK
| | - Michelle S Toleman
- Healthcare Infection Society, London, UK; Cambridge University Hospitals NHS Trust, Cambridge, UK
| | | | | | - Aggie Bak
- Healthcare Infection Society, London, UK
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Küpper T, Apel C, Bertsch D, van der Giet M, van der Giet S, Graß M, Cerfontaine C, Haunolder M, Hundt N, Kühn C, Morrison A, Museo S, Timmermann L, Wernitz K, Jäger J. Analysis of local drinking water for fecal contamination in Solu-Khumbu / Mt. Everest region, Nepal. Int J Hyg Environ Health 2022; 246:114043. [DOI: 10.1016/j.ijheh.2022.114043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/12/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
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Díaz De Oleo D, McIntyre L, Randall N, Nayak R, Manning L. A socio-technical approach to food safety incident analysis using the AcciMap model in the hospitality sector. Food Control 2022. [DOI: 10.1016/j.foodcont.2022.108849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Outbreaks of Gastroenteritis Due to Norovirus in Schools and Summer Camps in Catalonia, 2017-2019. Microbiol Spectr 2022; 10:e0011922. [PMID: 35543555 PMCID: PMC9241749 DOI: 10.1128/spectrum.00119-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We studied outbreaks of acute gastroenteritis due to norovirus in schools and summer camps during 2017–2019 in Catalonia (Spain). The overall attack rate was 21.27% in schools and 33.42% in summer camps (RR 0.64 [95% CI 0.58–0.70]) and 52.63% of outbreaks occurred in cold months and 47.37% in warm months. The mean delay in reporting was 5.61 days (SD 5.58 days) and the mean duration was 6.11 days (SD 6.08 days), with a Pearson correlation coefficient of 0.84 (P < 0.001) between these variables. In outbreaks with person-to-person transmission, the aOR was higher the longer the delay in reporting: 3.07 (95% CI 1.21–7.81) when the delay was 5–8 days and 3.81 when it was >9 days (95% CI 1.42–10.23). The cold months posed a higher risk than the warm months. In common source outbreaks the risk was higher in children in secondary-higher education and in summer camps. IMPORTANCE Norovirus is the main cause of viral acute gastroenteritis outbreaks worldwide. The low infectious dose and the lack of long-term immunity in infected persons means that norovirus often causes outbreaks in institutions and closed and semiclosed centers. Norovirus gastroenteritis are usually mild, with no complications, but occasionally can result in hospital admission. Understanding the risk factors involved in a norovirus outbreak can reduce the spread, severity, and duration of the outbreak and, when a vaccine becomes available, this understanding would help us identify the population groups need to get vaccinated. Here, we show the outbreaks due to norovirus in schools and summer camps, the correlation between the delay in reporting and duration of outbreaks and the relationship of the attack rate and the size of the groups.
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Carol M, Guadalupe-Fernández V, Rius C, Soldevila N, Razquin E, Guix S, Dominguez A. A Waterborne Gastroenteritis Outbreak Caused by a GII Norovirus in a Holiday Camp in Catalonia (Spain), 2017. Viruses 2021; 13:v13091792. [PMID: 34578373 PMCID: PMC8473012 DOI: 10.3390/v13091792] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 01/26/2023] Open
Abstract
On 2 February 2017, Epidemiological Surveillance Services were notified of an outbreak of acute gastroenteritis (AGE) among schoolchildren who had taken part of a school trip from 30 January to 3 February 2017 at a holiday camp in Catalonia. A retrospective cohort study was performed to identify the causative agent, estimate the magnitude of the outbreak and identify its source, as well as to determine the route of transmission. Data collected by standardised questionnaires identified 41 episodes of AGE among 174 individuals who attended the camp. Cases had mainly symptoms of abdominal pain (73.8%), nausea (64.3%), vomiting (54.8%), diarrhoea (45.2%) and headache (42.9%). Consumption of water was associated with gastroenteritis (crude RR: 1.72, 95%CI: 1.01–2.92; adjusted RR: 1.88, 95%CI 1.03–3.56). NoV GII was detected in faeces (5 out of 13) and water samples. Additionally, faecal indicator bacteria and protozoa were detected in water samples. The outbreak showed a high attack rate and was caused by a natural water fountain not properly treated and not monitored for safety quality. There could have been a discharge of wastewater at a point close to the fountain; however, the source of contamination of the water could not be identified. Health education may be useful to eliminate risks associated with the consumption of untreated water from natural fountains.
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Affiliation(s)
- Mònica Carol
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, 08005 Barcelona, Spain;
| | - Víctor Guadalupe-Fernández
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, 08005 Barcelona, Spain;
- Correspondence:
| | - Cristina Rius
- Epidemiological Service of Public Health Agency of Barcelona (ASPB), 08023 Barcelona, Spain;
- CIBER Epidemiologia y Salud Pública (CIBERESP), Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Nuria Soldevila
- CIBER Epidemiologia y Salud Pública (CIBERESP), Instituto Salud Carlos III, 28029 Madrid, Spain
- Medicine Department, University of Barcelona (UB), 08036 Barcelona, Spain; (N.S.); (A.D.)
| | - Efrén Razquin
- Laboratory of Barcelona Public Health Agency (ASPB), 08001 Barcelona, Spain;
| | - Susana Guix
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, Section of Microbiology, Virology and Biotechnology, Institute of Nutrition and Food Safety (INSA), School of Biology, University of Barcelona (UB), 08028 Barcelona, Spain;
| | - Angela Dominguez
- CIBER Epidemiologia y Salud Pública (CIBERESP), Instituto Salud Carlos III, 28029 Madrid, Spain
- Medicine Department, University of Barcelona (UB), 08036 Barcelona, Spain; (N.S.); (A.D.)
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Okumus B. Norovirus and Coronavirus Risks in Food Service Settings: A Systematic Review for Future Research. JOURNAL OF CULINARY SCIENCE & TECHNOLOGY 2021. [DOI: 10.1080/15428052.2021.1888835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Bendegul Okumus
- Food Service and Lodging Management Department, Rosen College of Hospitality Management, University of Central Florida, Orlando, FL USA
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Doménech-Sánchez A, Laso E, Genestar E, Berrocal CI. Norovirus outbreak causing gastroenteritis in a hotel in Menorca, Spain. Enferm Infecc Microbiol Clin 2020; 39:22-24. [PMID: 32057556 DOI: 10.1016/j.eimc.2019.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/11/2019] [Accepted: 12/26/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To establish the agent responsible for a gastroenteritis outbreak in a hotel in Menorca (Spain) in September 2016. METHODS The study included epidemiological and laboratory analysis. Environmental and stool samples were examined for bacterial and viral pathogens. RESULTS One hundred and fifty-one cases were detected, 123 among the tourists staying in the hotel and 28 affecting the staff. The presence of genotypeII norovirus was discovered in the microbiological studies of patient's faeces, as well as in the surface samples of rooms and common areas. The control plan implemented allowed for control of the outbreak. CONCLUSIONS This study on a genotypeII norovirus outbreak reveals the importance of a rapid response for controlling these types of outbreaks.
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Affiliation(s)
- Antonio Doménech-Sánchez
- Saniconsult Ibérica SL, Palma de Mallorca, España; Área de Microbiología e Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), Universidad de las Islas Baleares, Palma de Mallorca, España.
| | - Elena Laso
- Saniconsult Ibérica SL, Palma de Mallorca, España
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Doménech-Sánchez A, Laso E, Pérez MJ, Berrocal CI. Efficient management of a norovirus outbreak causing gastroenteritis in two hotels in Spain, 2014. Enferm Infecc Microbiol Clin 2020; 38:431-433. [PMID: 31917027 DOI: 10.1016/j.eimc.2019.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine the aetiological agent causing a gastroenteritis outbreak in two hotels in Majorca (Spain) on August and September 2014. METHODS An epidemiological study was carried out. Environmental and stool samples were analyzed for different pathogens, including norovirus. RESULTS Epidemiological analysis detected 79 cases among the tourists hosted in the affected hotels over the period 18th August to 3rd September. They included 52 (attack rate: 6.4%) and 27 (attack rate: 3.0%) cases in hotel A and B, respectively. Seven of the staff members were also affected. Microbiological analyses detected genotype 2 norovirus in patient's stool samples, in rooms and in common areas' surfaces. The specific control plan rapidly implemented at the beginning of the outbreak, and further adapted for norovirus elimination, allowed to control the outbreak. CONCLUSIONS Our study demonstrates that the outbreak was caused by genotype 2 norovirus, and reflects the importance of a rapid analysis and response for its control.
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Affiliation(s)
- Antonio Doménech-Sánchez
- Saniconsult Ibérica SL, Palma de Mallorca, Spain; Área de Microbiología and Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), Universidad de las Islas Baleares, Palma de Mallorca, Spain.
| | - Elena Laso
- Saniconsult Ibérica SL, Palma de Mallorca, Spain
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Leone CM, Tang C, Sharp J, Jiang X, Fraser A. Presence of human noroviruses on bathroom surfaces: a review of the literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2016; 26:420-432. [PMID: 26786956 DOI: 10.1080/09603123.2015.1135312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 12/04/2015] [Indexed: 06/05/2023]
Abstract
Enteric viruses are the most common cause of acute gastroenteritis worldwide with most cases of illness attributed to caliciviruses, such as human noroviruses (HuNoV). While environmental transmission of HuNoV is reported to be low, environmental surfaces could be a source of secondary transmission. As many vomiting/fecal episodes occur in bathrooms, bathroom surfaces could be an important vehicle for transmitting HuNoV. We systematically reviewed the literature to determine the presence of HuNoV on bathroom surfaces. Our review included 22 eligible studies conducted in commercial and institutional settings. Under outbreak conditions, 11 studies reported detection rates of 20-100 %. Six studies implicated bathroom surfaces as primary sources of HuNoV infection while three reported HuNoV present on bathroom surfaces but indicated different primary sources. Under non-outbreak conditions, five studies reported detection rates of 2-17 %. Factors associated with HuNoV presence in bathrooms included population density, setting type, employee numbers, food handler knowledge, awareness, and behaviours, and cleaning/disinfecting procedures. Our review suggests bathrooms could be vehicles that transmit HuNoV under both outbreak and non-outbreak conditions.
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Affiliation(s)
- Cortney M Leone
- a Department of Food, Nutrition, and Packaging Sciences , Clemson University , Clemson , SC , USA
| | - Chaoyi Tang
- a Department of Food, Nutrition, and Packaging Sciences , Clemson University , Clemson , SC , USA
| | - Julia Sharp
- b Department of Mathematical Sciences , Clemson University , Clemson , SC , USA
| | - Xiuping Jiang
- a Department of Food, Nutrition, and Packaging Sciences , Clemson University , Clemson , SC , USA
| | - Angela Fraser
- a Department of Food, Nutrition, and Packaging Sciences , Clemson University , Clemson , SC , USA
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Leshem E, Gastañaduy PA, Trivedi T, Laufer Halpin A, Pringle J, Lang F, Gregoricus N, Vinjé J, Behravesh CB, Parashar U, Hall AJ. Norovirus in a United States virgin islands resort: outbreak investigation, response, and costs. J Travel Med 2016; 23:taw040. [PMID: 27296584 DOI: 10.1093/jtm/taw040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/06/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND During 8-20 April 2012, an outbreak of gastrointestinal illness occurred among guests and employees of a resort hotel in St. Thomas, US Virgin Islands. We describe outbreak characteristics, and estimate indirect (non-medical) costs to travellers. METHODS Employees who met the case definition were interviewed and provided stool samples. Samples were tested for norovirus by real-time reverse-transcription polymerase chain reaction. Guests were asked to complete a survey aimed to identify and characterize cases, and to estimate quality adjusted vacation days (QAVD) lost. RESULTS Overall, 66 persons (20 employees and 46 guests) met the probable case definition. The first reported illness onset occurred in a hotel employee on 8 April, while the first reported onset in a guest occurred on 13 April. An employee suffered a public diarrhoea incident on 13 April in the central kitchen, followed by illness onset in the next day among employees that assisted with the clean-up. On 15 April, after 10 guests reported ill, the hotel implemented an outbreak response protocol instructing ill employees to take a 3-day leave, and obtain medical clearance prior to resuming work. Ill guests were advised to self-isolate, and rapid cleaning of public areas and guest rooms where suspected contamination occurred was implemented. We estimated that 65 QAVDs were lost by 43 guests (1.5 days/guest). Using an approximate cost of $450 per vacation day, we estimated indirect illness cost at $675 per guest case. Seven (64%) of 11 cases' stool specimens were positive for norovirus genotype GII.4 Den Haag. CONCLUSIONS A norovirus outbreak in a resort hotel resulted in substantial indirect costs and loss of vacation days to ill travellers. We recommend outbreak control measures including exclusion of ill employees, until ≥48-72 h after resolution of symptoms, self-isolation of ill guests and appropriate cleaning in hotel-associated norovirus outbreaks.
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Affiliation(s)
- Eyal Leshem
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention Atlanta, GA, USA.,Internal Medicine C', Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Paul A Gastañaduy
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention Atlanta, GA, USA
| | - Tarak Trivedi
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,The CDC Experience Applied Epidemiology Fellowship, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alison Laufer Halpin
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention Atlanta, GA, USA.,Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeshua Pringle
- The CDC Experience Applied Epidemiology Fellowship, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Francine Lang
- The United States Virgin Islands Department of Health, St Thomas, US Virgina Island
| | - Nicole Gregoricus
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jan Vinjé
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Casey Barton Behravesh
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Umesh Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aron J Hall
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
Norovirus, an RNA virus of the family Caliciviridae, is a human enteric pathogen that causes substantial morbidity across both health care and community settings. Several factors enhance the transmissibility of norovirus, including the small inoculum required to produce infection (<100 viral particles), prolonged viral shedding, and its ability to survive in the environment. In this review, we describe the basic virology and immunology of noroviruses, the clinical disease resulting from infection and its diagnosis and management, as well as host and pathogen factors that complicate vaccine development. Additionally, we discuss overall epidemiology, infection control strategies, and global reporting efforts aimed at controlling this worldwide cause of acute gastroenteritis. Prompt implementation of infection control measures remains the mainstay of norovirus outbreak management.
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Affiliation(s)
- Elizabeth Robilotti
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Stan Deresinski
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Benjamin A Pinsky
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
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12
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Thomas S, Luxon BA. Vaccines based on structure-based design provide protection against infectious diseases. Expert Rev Vaccines 2014; 12:1301-11. [DOI: 10.1586/14760584.2013.840092] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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