A norovirus outbreak at a long-term-care facility: the role of environmental surface contamination

BACKGROUND

The role of environmental surface contamination in the propagation of norovirus outbreaks is unclear. An outbreak of acute gastroenteritis was reported among residents of a 240-bed veterans long-term-care facility.

OBJECTIVES

To identify the likely mode of transmission, to characterize risk factors for illness, and to evaluate for environmental contamination in this norovirus outbreak.

METHODS

An outbreak investigation was conducted to identify risk factors for illness among residents and employees. Stool and vomitus samples were tested for norovirus by reverse transcription polymerase chain reaction (RT-PCR). Fourteen days after outbreak detection, ongoing cases among the residents prompted environmental surface testing for norovirus by RT-PCR.

RESULTS

One hundred twenty-seven (52%) of 246 residents and 84 (46%) of 181 surveyed employees had gastroenteritis. Case-residents did not differ from non-case-residents by comorbidities, diet, room type, or level of mobility. Index cases were among the nursing staff. Eight of 11 resident stool or vomitus samples tested positive for genogroup II norovirus. The all-cause mortality rate during the month of the outbreak peak was significantly higher than the expected rate. Environmental surface swabs from case-resident rooms, a dining room table, and an elevator button used only by employees were positive for norovirus. Environmental and clinical norovirus sequences were identical.

CONCLUSION

Extensive contamination of environmental surfaces may play a role in prolonged norovirus outbreaks and should be addressed in control interventions.

Assessment of an aerosol treatment to improve air quality in a swine concentrated animal feeding operation (CAFO)

Poor air quality within swine concentrated animal feeding operations (CAFOs) poses a threat to workers, the surrounding community, and farm production. Accordingly, the current study was conducted to evaluate a technology for reducing air pollution including particulate matter (PM), viable bacteria, and ammonia within such a facility. The technology consists of an acid-oil-alcohol aerosol applied daily. Its effectiveness was evaluated by comparing air quality from before to after treatment and between treated and untreated sides of a barn separated by an impervious partition. On the untreated side, air quality was typical for a swine CAFO, with mean PM2.5 of 0.28 mg/m3 and PM(TOT) of 1.5 mg/m3. The treatment yielded a reduction in PM concentration of 75-90% from before to after treatment. Effectiveness increased with time, application, and particle size (40% reduction for 1 microm and 90% for >10 microm). Airborne bacteria levels (total bacteria, Enterobacteriaceae, and gram-positive cocci) decreased one logarithmic unit after treatment. In contrast, treatment had no effect on ammonia concentrations. These findings demonstrate the effectiveness of an intervention in yielding exposure and emission reductions.

Prevalence of norovirus among visitors from the United States to Mexico and Guatemala who experience traveler's diarrhea

Traveler's diarrhea (TD) is the most common infectious illness acquired by visitors to developing nations. The purpose of this study was to utilize molecular diagnostic techniques to determine the prevalence of norovirus (NoV) in TD occurring among visitors from the United States to Guatemala and Mexico. Stool samples (n = 54) were collected from 34 TD cases and analyzed for NoV by reverse transcription-PCR and oligoprobe confirmation. The overall prevalence of NoV was 65%. Interestingly, all NoV-positive stool samples were identified as genogroup I NoVs, and time spent at travel destinations was found to be an important factor in determining the frequency of infection (P = 0.003). Eleven NoV-positive stool samples also tested positive for enterotoxigenic Escherichia coli, indicating that dual infections with this leading bacterial cause of TD were very common. Results of this study suggest that NoV infection is a frequent occurrence among travelers to Mexico and Guatemala who experience episodes of TD. In addition, the simple molecular detection method utilized here will serve to facilitate more in-depth epidemiological studies of this emergent viral pathogen in travelers and other at-risk populations.