Widespread environmental contamination with Norwalk-like viruses (NLV) detected in a prolonged hotel outbreak of gastroenteritis

A protracted outbreak of Norwalk-like virus (NLV)-associated gastroenteritis occurred in a large hotel in North-West England between January and May 1996. We investigated the pattern of environmental contamination with NLV in the hotel during and after the outbreak. In the ninth week, 144 environmental swabs taken from around the hotel were tested for NLV by nested RT-PCR. The sites were categorized according to the likelihood of direct contamination with vomit/faeces. The highest proportion of positive samples were detected in directly contaminated carpets, but amplicons were detected in sites above 1.5 m which are unlikely to have been contaminated directly. The trend in positivity of different sites paralleled the diminishing likelihood of direct contamination. A second environmental investigation of the same sites 5 months after the outbreak had finished were all negative by RT-PCR. This study demonstrates for the first time the extent of environmental contamination that may occur during a large NLV outbreak.     

一起诺瓦克样病毒性胃肠炎的流行病学调查

目的探讨2004年广州市番禺区一起由诺瓦克样病毒引起的学校胃肠炎疫情暴发特征. 方法采用现场流行病学调查方法,对该起疫情进行调查分析. 结果该起疫情共报告病例30例 ,其中3例患者的粪便或肛拭标本检出诺瓦克病毒抗原. 结论本次胃肠炎暴发疫情由诺瓦克样病毒引起,传染来源尚未查明.     

Waterborne outbreak of Norwalk-like virus gastroenteritis at a tourist resort,Italy

In July 2000, an outbreak of gastroenteritis occurred at a tourist resort in the Gulf of Taranto in southern Italy. Illness in 344 people, 69 of whom were staff members, met the case definition. Norwalk-like virus (NLV) was found in 22 of 28 stool specimens tested. The source of illness was likely contaminated drinking water, as environmental inspection identified a breakdown in the resort water system and tap water samples were contaminated with fecal bacteria. Attack rates were increased (51.4%) in staff members involved in water sports. Relative risks were significant only for exposure to beach showers and consuming drinks with ice. Although Italy has no surveillance system for nonbacterial gastroenteritis, no outbreak caused by NLV has been described previously in the country.     

A gastroenteritis outbreak due to norovirus associated with a Colorado hotel

Describing the system components of norovirus outbreaks is important in understanding how to prevent future outbreaks. Investigation of these components includes environmental, epidemiologic, and laboratory perspectives. This study describes how an investigation from these three perspectives was conducted and the significance of each component in understanding norovirus outbreaks. On May 23, 2000, members of a professional group attending two meetings at a local hotel in Englewood, Colorado, began to complain of gastrointestinal illness. Sixty-nine illnesses were reported among 133 attendees. Eight hotel employees also complained of illness. Staff from the Tri-County Health Department and the Centers for Disease Control and Prevention investigated the outbreak. Three stool specimens collected from ill attendees contained norovirus. While the epidemiologic component did not identify a specific vehicle of transmission, the environmental investigation revealed food-handling practices, food handler perceptions, and hotel policies that may have contributed to disease transmission.     

An outbreak of food-borne gastroenteritis in two hospitals associated with a Norwalk-like virus.

Two connected outbreaks of gastroenteritis in separate hospitals associated with a small round structured virus morphologically indistinguishable from the Norwalk virus are described. The virus was most probably introduced on chicken sandwiches prepared by a member of the kitchen staff who was incubating the disease.     

An outbreak of Norwalk-like gastroenteritis associated with contaminated drinking water at a caravan park

Abstract: During the 1989 Christmas holiday period, a large outbreak of gastroenteritis occurred among persons staying at a caravan park in southern New South Wales. Review of local hospital records found that 77 per cent of patients presenting with infective diarrhoea between 29 December and 3 January had stayed at the caravan park. In a retrospective cohort study we compared rates of illness among caravan park patrons exposed to different water sources. Stools were tested for pathogens and convalescent sera for viral antibodies. Rain and reticulated river water sampled from the caravan park were tested for bacteria and viruses. Of 351 persons interviewed at the caravan park, 305 (87 per cent) reported an illness characterised by diarrhoea, vomiting and abdominal pain. Of 196 persons who used reticulated river water for drinking or ablutions, 175 (89 per cent) became ill compared with 47 of 72 persons (65 per cent) who did not use this water (relative risk 1.4, 95 per cent confidence interval 1.2 to 1.6). The outbreak was probably caused by a 27–28 nm small round structured virus found in the stool from one ill person. High levels of faecal coliforms in the reticulated river water and enterovirus in sediment samples suggest that the outbreak was caused by sewage contaminating the reticulated river water through a break in the pipe directly over the underground water tanks. To prevent such outbreaks, poor water and sewerage system layouts should be avoided and nonpotable water should be clearly labelled. Where feasible, all camping-ground water should stem from town supplies.     

Practical lessons from the management of an outbreak of small round structured virus (Norwalk-like virus) gastroenteritis

An outbreak of viral gastroenteritis caused illness in 92 people during October 2000. All the cases had an association with one hotel and 80% of cases identified had attended one of two buffet meals on 18th October 2000. Cohort analysis did not implicate any particular foodstuff in this outbreak. All bacteriological tests on food samples were negative. Small round structured virus (SRSV)/Norwalk-like virus (NLV) particles were seen by electron microscopy in 6 out of 27 stool samples submitted for analysis. This paper describes the outbreak and in particular the lessons learned from the management and control of it. These include practical points with regard to the outbreak control team, liaison with the microbiology laboratory, handling data, agreeing a case definition, and occupational health issues. All can be applied elsewhere by those responsible for managing outbreaks at a local level.     

Molecular epidemiology of Norwalk-like virus (NLV) outbreaks occurring in Kyushu Japan between 1988 and 1993

In nine outbreaks that occurred in the Kyushu district between 1988 and 1993, we determined the nucleotide sequences of Norwalk-like virus (NLV) gene fragments amplified by RT-PCR and molecular-epidemiologically analyzed the NLV epidemics. It is known that the NLV strains isolated from nine outbreaks of acute gastroenteritis, were divided into five clusters consisting of two genogroups. Described by the year of outbreaks, the genogroup-1 (Norwalk-like virus group) was prevalent in 1988, 1989, and 1992, the genogroup-2 (snow mountain-like virus group) was detected in 1988, 1989, and 1993. Especially it was revealed that various strains of NLV were prevalent in the Kyushu district from 1988 to 1989. Epidemics of the Norwalk-like strain continued to be prevalent in 1992 (FP/7/92), and the strains very close to OSAP 18 continued to be prevalent in 1993 (FP/8/93, FP/9/93). Although the strains belonging to Norwalk virus (KY89) in the genogroup-1 and belonging to P1B (OSAP 18) in the genogroup-2 were detected for a prolonged period from 1988 to 1992/1993, the homology in these strains was very close, and this study shows that a high homogeneity was conserved in these strains. It was revealed that various strains of NLV were prevalent in the Kyushu district from 1988 to 1989.     

An outbreak of calicivirus associated gastroenteritis in an elderly persons home. A possible zoonosis?

An outbreak of gastroenteritis caused by calicivirus began amongst residents and staff of an old persons home 24 hours after the proprietor's dog had been sick. Serological evidence suggests that the calicivirus isolated from one of the cases may be capable of infecting dogs as well as man. The virus strain responsible for this outbreak differs antigenically from those associated with two other outbreaks in the U.K. and one in Japan. The characteristic morphology of calicivirus is lost if stool is stored at -70 degrees C.     

An outbreak of Campylobacter jejuni gastroenteritis linked to meltwater contamination of a municipal well

A large outbreak of Campylobacter jujuni gastroenteritis attributed to contamination of an unchlorinated municipal water system was investigated. Unlike most previous summer outbreaks, this one began in early spring and was attributed to meltwater entering one or more municipal wells. 241 suspected cases were documented, but retrospective information from local health care workers suggested a much larger outbreak. 45 laboratory-confirmed cases participated in a case-control study which showed a significant association between infection and amount of town water consumed. Stool specimens from 29 patients were studied with detailed serotyping by the method of Lior, with eight known serotypes and one previously unknown one identified. It is concluded that intensive surveillance of water quality during periods of spring runoff is essential, and that timely reporting of disease outbreak patterns in emergency department settings is necessary to protect the public's health.     

Foodborne outbreak of gastroenteritis due to Norovirus and Vibrio parahaemolyticus

Vibrio parahaemolyticus and Norovirus have been recognized as the cause of sporadic cases or outbreaks of diarrhoeal illness in association with the ingestion of raw or improperly cooked seafood. This report describes a foodborne outbreak of gastroenteritis caused by both Norovirus and Vibrio parahaemolyticus following the consumption of raw seafood in a restaurant in Terrassa (Catalonia, Spain) in September 2005. Measures are needed to reduce contamination of raw seafood. Consumers can reduce the risk of foodborne illness by avoiding consumption of raw or undercooked food.     

A large hotel outbreak of Norwalk-like virus gastroenteritis among three groups of guests and hotel employees in Virginia

A large outbreak of acute gastroenteritis occurred among three different groups of guests and the employees of a Virginia hotel within a 2-week period in November 2000. At least 76 of the hotel's guests and 40 hotel employees had acute gastroenteritis during this period. All tested ill persons were infected with the same strain of Norwalk-like virus, as shown by cloning and sequencing of virus detected in stool specimens from the three guest groups and the employees. Epidemiologic investigation suggested food as the probable source for the guests. Most of the employees, including those sick, did not eat in the hotel, suggesting that environmental contamination and person-to-person transmission could have contributed to the outbreak. The disease continued to spread in the hotel, passing from one guest group to another, by food, environmental contamination, and/or by person-to-person transmission through infected employees and guests. The study describes procedures implemented to control the outbreak and makes recommendations for future outbreak control.     

Managing the challenge of an acute gastroenteritis outbreak caused by a Norwalk-like virus in a 239 bed long-term care facility

Outbreak management in long-term care facilities (LTCFs) highlights the differences between the ’ideal’ and ’real’ practicalities of implementing appropriate control measures. Infection control practitioners must develop workable strategies in an environment where it may not be possible to adopt traditional outbreak management procedures.This paper documents events during a large, prolonged outbreak of Norwalk-like virus, genotype II, affecting residents and staff of a 239 bed LTCF in Queensland. Diagnosis was confirmed from one faecal specimen. The case rate was 37 per cent with a total of 76 residents and 25 staff and volunteers meeting the criteria set in the case definition. Three peaks of infection were noted. Implementing standard mechanisms to isolate and cohort affected residents was not possible due to psychosocial and environmental factors in the setting. In addition, staffing shortages already in existence were compounded due to illness.The lack of facility-specific outbreak policies and procedures contributed to the slow resolution of the outbreak. An education programme focused on developing a collaborative, problem solving relationship among all disciplines. The result was the development of specific gastroenteritis outbreak management guidelines that reflect the realities of managing an outbreak event in a LTCF. This article outlines the management issues, solutions and outcomes associated with this outbreak.