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  • Norovirus outbreaks-various reports

    What are noroviruses?
    Noroviruses are a group of viruses that cause the ?stomach flu,? or gastroenteritis (GAS-tro-en-ter-I-tis), in people. The term norovirus was recently approved as the official name for this group of viruses. Several other names have been used for noroviruses, including:
    • Norwalk-like viruses (NLVs)
    • caliciviruses (because they belong to the virus family Caliciviridae)
    • small round structured viruses.
    Viruses are very different from bacteria and parasites, some of which can cause illnesses similar to norvirus infection. Viruses are much smaller, are not affected by treatment with antibiotics, and cannot grow outside of a person?s body.

    What are the symptoms of illness caused by noroviruses?

    The symptoms of norovirus illness usually include nausea, vomiting, diarrhea, and some stomach cramping. Sometimes people additionally have a low-grade fever, chills, headache, muscle aches, and a general sense of tiredness. The illness often begins suddenly, and the infected person may feel very sick. The illness is usually brief, with symptoms lasting only about 1 or 2 days. In general, children experience more vomiting than adults. Most people with norovirus illness have both of these symptoms.

    What is the name of the illness caused by noroviruses?

    Illness caused by norovirus infection has several names, including:
    • stomach flu ? this ?stomach flu? is not related to the flu (or influenza), which is a respiratory illness caused by influenza virus.
    • viral gastroenteritis ? the most common name for illness caused by norovirus. Gastroenteritis refers to an inflammation of the stomach and intestines.
    • acute gastroenteritis
    • non-bacterial gastroenteritis
    • food poisoning (although there are other causes of food poisoning)
    • calicivirus infection
    How serious is norovirus disease?

    Norovirus disease is usually not serious, although people may feel very sick and vomit many times a day. Most people get better within 1 or 2 days, and they have no long-term health effects related to their illness. However, sometimes people are unable to drink enough liquids to replace the liquids they lost because of vomiting and diarrhea. These persons can become dehydrated and may need special medical attention. This problem with dehydration is usually only seen among the very young, the elderly, and persons with weakened immune systems. There is no evidence to suggest that an infected person can become a long-term carrier of norovirus.


    How do people become infected with noroviruses?

    Noroviruses are found in the stool or vomit of infected people. People can become infected with the virus in several ways, including:
    • eating food or drinking liquids that are contaminated with norovirus;
    • touching surfaces or objects contaminated with norovirus, and then placing their hand in their mouth;
    • having direct contact with another person who is infected and showing symptoms (for example, when caring for someone with illness, or sharing foods or eating utensils with someone who is ill).
    Persons working in day-care centers or nursing homes should pay special attention to children or residents who have norovirus illness. This virus is very contagious and can spread rapidly throughout such environments.
    When do symptoms appear?
    Symptoms of norovirus illness usually begin about 24 to 48 hours after ingestion of the virus, but they can appear as early as 12 hours after exposure.

    Are noroviruses contagious?

    Noroviruses are very contagious and can spread easily from person to person. Both stool and vomit are infectious. Particular care should be taken with young children in diapers who may have diarrhea.How long are people contagious?
    People infected with norovirus are contagious from the moment they begin feeling ill to at least 3 days after recovery. Some people may be contagious for as long as 2 weeks after recovery. Therefore, it is particularly important for people to use good handwashing and other hygienic practices after they have recently recovered from norovirus illness.

    Who gets norovirus infection?

    Anyone can become infected with these viruses. There are many different strains of norovirus, which makes it difficult for a person?s body to develop long-lasting immunity. Therefore, norovirus illness can recur throughout a person?s lifetime. In addition, because of differences in genetic factors, some people are more likely to become infected and develop more severe illness than others.

    What treatment is available for people with norovirus infection?

    Currently, there is no antiviral medication that works against norovirus and there is no vaccine to prevent infection. Norovirus infection cannot be treated with antibiotics. This is because antibiotics work to fight bacteria and not viruses.
    Norovirus illness is usually brief in healthy individuals. When people are ill with vomiting and diarrhea, they should drink plenty of fluids to prevent dehydration. Dehydration among young children, the elderly, the sick, can be common, and it is the most serious health effect that can result from norovirus infection. By drinking oral rehydration fluids (ORF), juice, or water, people can reduce their chance of becoming dehydrated. Sports drinks do not replace the nutrients and minerals lost during this illness.

    Can norovirus infections be prevented?

    Yes. You can decrease your chance of coming in contact with noroviruses by following these preventive steps:
    • Frequently wash your hands, especially after toilet visits and changing diapers and before eating or preparing food.
    • Carefully wash fruits and vegetables, and steam oysters before eating them.
    • Thoroughly clean and disinfect contaminated surfaces immediately after an episode of illness by using a bleach-based household cleaner.
    • Immediately remove and wash clothing or linens that may be contaminated with virus after an episode of illness (use hot water and soap).
    • Flush or discard any vomitus and/or stool in the toilet and make sure that the surrounding area is kept clean.
    Persons who are infected with norovirus should not prepare food while they have symptoms and for 3 days after they recover from their illness (see food handler information sheet). Food that may have been contaminated by an ill person should be disposed of properly.



  • #2
    Norovirus outbreaks-various reports

    Be prepared for vomiting virus

    Apr 20 2006

    Ellesmere Port Pioneer


    HEALTH chiefs have advised people of the steps to take if they are hit by the winter vomiting virus.

    The Health Protection Agency says it is aware of several outbreaks of viral gastroenteritis - stomach bugs - reported across Cheshire and Merseyside since the beginning of the year.

    One-hundred outbreaks have been reported from hospitals, homes for the elderly, schools and nurseries since January.

    Viral gastroenteritis can occur at any-time of the year but is particularly common over the winter. A similar number of outbreaks were reported for the same timeframe last year.

    Dr John Reid, director of the Cheshire and Merseyside Health Protection Unit, said: 'Viral gastroenteritis is most commonly caused by noroviruses or winter vomiting viruses.


    'They cause an illness which usually starts with sudden vomiting and some people also suffer diarrhoea. People usually make a full recovery within one or two days, although the very young and elderly sometimes require admission to hospital for severe dehydration. There are no long-term side effects.'

    He added: 'There is no specific treat-ment for norovirus. The illness needs to run its course.

    'It is important to drink plenty of fluids to prevent dehydration. This is particularly important for babies and older people to prevent dehydration.'

    'Outbreaks can happen where people are gathered together in groups, such as hospitals, nursing homes and schools. Outbreaks may be difficult to control because the infection is easily spread from one person to another.

    'People should wash their hands regularly with soap and warm water if they are in contact with someone who is ill or soiled articles. Soiled surfaces should be thoroughly cleaned.'

    Health officials are advising people to not visit hospitals or other healthcare establishments if they are suffering from vomiting or diarrhoea until they have been completely free from symptoms for 48 hours.

    They say parents of affected children should keep their children off school or nursery for 48 hours after their symptoms have finished because the virus can still be in the system.

    Affected people should also avoid food preparation until three days after symptoms are gone.

    The latest local, sport (incl. Chester FC) and events news in Chester and around Cheshire. Including breaking, live blogs, video and indepth coverage on all the things that matter, from the Cheshire Live team.

    Comment


    • #3
      Norovirus outbreaks-various reports

      Archive Number 20060603.1547
      Published Date 03-JUN-2006
      Subject PRO/EDR> Norovirus - Canada (Calgary)

      NOROVIRUS - CANADA (CALGARY)
      *****************************
      A ProMED-mail post
      <http://www.promedmail.org>
      ProMED-mail is a program of the
      International Society for Infectious Diseases
      <http://www.isid.org>

      Date: Sat 3 Jun 2006
      From: Pablo Nart <pablo.nart@terra.es>
      Source: Calgary Herald, Fri 2 Jun 2006 [edited]
      <http://www.canada.com/calgaryherald/news/archives/archives_paper.html?pubdate=2006%2F06%2F02&x=16&y= 2>


      Calgary experienced an unprecedented number of norovirus outbreaks
      this May, with nearly a dozen identified instances of the stomach bug
      that is more common in the winter months.

      Calgary Health Region (CHR) officials announced on Friday [2 Jun
      2006] that they confirmed 11 outbreaks of Norovirus affecting 192
      people in May in settings that range from long-term care homes to
      restaurants. Experts say they normally see only a handful of
      norovirus -- which causes nausea, vomiting and diarrhea -- during the
      spring and summer months.

      "This is unusual," said Dr. Judy MacDonald, deputy medical officer of
      health for CHR, who wanted to alert the public to the outbreaks,
      although they are usually not serious. "We've seen what I would call
      unprecedented norovirus activity in May."

      Officials say the higher-than-usual number of cases may be linked to
      the summer travel season, noting that some cruise ships and trains
      have recently had problems with norovirus outbreaks.

      The virus is also thought to occur in 2-year cycles, with 2004 being
      the last year with a significant number of outbreaks in Calgary.
      Indeed, the month with the largest number of outbreaks was November
      2004 when Calgary's downtown Drop-In Centre saw 140 clients and staff
      infected with the [virus]. Parts of the facility were quarantined for
      nearly 3 weeks.

      On Friday, CHR officials did not identify any facilities affected by
      the most recent outbreaks. Although there were 11 confirmed outbreaks
      of norovirus in May 2006, MacDonald says that is likely a fraction of
      the number of cases that are actually in Calgary. She noted that the
      number of Calgarians calling the CHR's healthlink number complaining
      of gastrointestinal illnesses has increased in recent weeks.

      --
      Pablo Nart
      <pablo.nart@terra.es>

      [Noroviruses are enteric viruses belonging to the family
      _Caliciviridae_. Sudden-onset acute viral gastroenteritis is most
      often caused by noroviruses; indeed, they are more frequent causes of
      infective gastroenteritis than _Salmonella_ or _Campylobacter_.
      Noroviruses are spread mainly by fecal-oral transmission and to some
      extent by the aerosols generated during the vomiting which often
      accompanies norovirus infection. These features coupled with a low
      infective dose explain the rapid spread of norovirus infection in
      closed communities. However, norovirus outbreaks may also be
      associated with point-source outbreaks such as contaminated drinking
      or recreational water supplies. Food-borne outbreaks are also common
      and have involved many types of foods, ice-cubes and shellfish being
      among the most common. The epidemiology of norovirus outbreaks is
      complex. The 2-year periodicity of outbreaks of norovirus infection
      described in the above report is not a regular feature. Human
      noroviruses can be grouped into 2 genogroups (GI and GII) and at
      least 14 GI and 17 GII genotypes. Human noroviruses cannot be
      propagated in cell-culture systems which complicates analysis.

      However, expression of recombinant VP1 in insect cells results in the
      formation of virus-like particles (VLPs). An antibody ELISA using
      polyclonal antisera raised against these VLPs has been used to
      determine cross-reactivity. Considerable antigenic diversity was
      detected. Antisera reacted strongly with homologous VLPs; however, a
      number of novel cross-reactivities among different genotypes was
      noted. For example, GI/11 antiserum showed a broad-range
      cross-reactivity, detecting 2 GI and 10 GII genotypes. Likewise,
      GII/1, GII/10 and GII/12 antisera showed a broad-range
      cross-reactivity, detecting several other distinct GII genotypes. For
      further details see: Genetic and antigenic diversity among
      noroviruses. Hansman GS, et al; J Gen Virol. 2006 Apr;87 (Pt
      4):909-19). - Mod.CP]

      Comment


      • #4
        Norovirus outbreaks-various reports

        Linking healthcare associated norovirus outbreaks: a molecular epidemiologic method for investigating transmission
        Ben A Lopman, Chris Gallimore, Jim J Gray, Ian B Vipond , Nick Andrews, Joyshri Sarangi, Mark H Reacher and David W Brown

        Background Noroviruses are highly infectious pathogens that cause gastroenteritis in the community and in semi-closed institutions such as hospitals. During outbreaks, multiple units within a hospital are often affected, and a major question for control programs is: are the affected units part of the same outbreak or are they unrelated transmission events? In practice, investigators often assume a transmission link based on epidemiological observations, rather than a systematic approach to tracing transmission. Here, we present a combined molecular and statistical method for assessing: 1) whether observed clusters provide evidence of local transmission and 2) the probability that anecdotally|linked outbreaks truly shared a transmission event. Methods 76 healthcare associated outbreaks were observed in an active and prospective surveillance scheme of 15 hospitals in the county of Avon, England from April 2002 to March 2003. Viral RNA from 64 out of 76 specimens from distinct outbreaks was amplified by reverse transcription-PCR and was sequenced in the polymerase (ORF 1) and capsid (ORF 2) regions. The genetic diversity, at the nucleotide level, was analysed in relation to the epidemiological patterns. Results Two out of four genetic and epidemiological clusters of outbreaks were unlikely to have occurred by chance alone, thus suggesting local transmission. There was anecdotal epidemiological evidence of a transmission link among 5 outbreaks pairs. By combining this epidemiological observation with viral sequence data, the evidence of a link remained convincing in 3 of these pairs. These results are sensitive to prior beliefs of the strength of epidemiological evidence especially when the outbreak strains are common in the background population. Conclusion The evidence suggests that transmission between hospitals units does occur. Using the proposed criteria, certain hypothesized transmission links between outbreaks were supported while others were refuted. The combined molecular/epidemiologic approach presented here could be applied to other viral populations and potentially to other pathogens for a more thorough view of transmission.


        <table class="smalltext" cellpadding="0" cellspacing="0"><tbody><tr><td>Published</td> <td width="25"> </td> <td>11 July 2006</td> </tr> </tbody></table>
        Abstract (provisional)

        The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

        Background
        Noroviruses are highly infectious pathogens that cause gastroenteritis in the community and in semi-closed institutions such as hospitals. During outbreaks, multiple units within a hospital are often affected, and a major question for control programs is: are the affected units part of the same outbreak or are they unrelated transmission events? In practice, investigators often assume a transmission link based on epidemiological observations, rather than a systematic approach to tracing transmission. Here, we present a combined molecular and statistical method for assessing: 1) whether observed clusters provide evidence of local transmission and 2) the probability that anecdotally-linked outbreaks truly shared a transmission event.


        Methods
        76 healthcare associated outbreaks were observed in an active and prospective surveillance scheme of 15 hospitals in the county of Avon, England from April 2002 to March 2003. Viral RNA from 64 out of 76 specimens from distinct outbreaks was amplified by reverse transcription-PCR and was sequenced in the polymerase (ORF 1) and capsid (ORF 2) regions. The genetic diversity, at the nucleotide level, was analysed in relation to the epidemiological patterns.


        Results
        Two out of four genetic and epidemiological clusters of outbreaks were unlikely to have occurred by chance alone, thus suggesting local transmission. There was anecdotal epidemiological evidence of a transmission link among 5 outbreaks pairs. By combining this epidemiological observation with viral sequence data, the evidence of a link remained convincing in 3 of these pairs. These results are sensitive to prior beliefs of the strength of epidemiological evidence especially when the outbreak strains are common in the background population.


        Conclusions
        The evidence suggests that transmission between hospitals units does occur. Using the proposed criteria, certain hypothesized transmission links between outbreaks were supported while others were refuted. The combined molecular/epidemiologic approach presented here could be applied to other viral populations and potentially to other pathogens for a more thorough view of transmission. Here, we present a combined molecular and statistical method for assessing: 1) whether observed clusters provide evidence of local transmission and 2) the probability that anecdotally-linked outbreaks truly shared a transmission event.


        Methods
        76 healthcare associated outbreaks were observed in an active and prospective surveillance scheme of 15 hospitals in the county of Avon, England from April 2002 to March 2003. Viral RNA from 64 out of 76 specimens from distinct outbreaks was amplified by reverse transcription-PCR and was sequenced in the polymerase (ORF 1) and capsid (ORF 2) regions. The genetic diversity, at the nucleotide level, was analysed in relation to the epidemiological patterns.


        Results
        Two out of four genetic and epidemiological clusters of outbreaks were unlikely to have occurred by chance alone, thus suggesting local transmission. There was anecdotal epidemiological evidence of a transmission link among 5 outbreaks pairs. By combining this epidemiological observation with viral sequence data, the evidence of a link remained convincing in 3 of these pairs. These results are sensitive to prior beliefs of the strength of epidemiological evidence especially when the outbreak strains are common in the background population.


        Conclusion
        The evidence suggests that transmission between hospitals units does occur. Using the proposed criteria, certain hypothesized transmission links between outbreaks were supported while others were refuted. The combined molecular/epidemiologic approach presented here could be applied to other viral populations and potentially to other pathogens for a more thorough view of transmission.



        Comment


        • #5
          Norovirus outbreaks-various reports

          14 ILL WITH NOROVIRUS SYMPTOMS
          July 18, 2006

          (Where is the 14th???)

          Thirteen patients from Castle Peak and Tung Wah Hospitals and a Pamela Youde Nethersole Eastern Hospital staff member have come down with diarrhoea or vomiting, the Hospital Authority says. Some have tested positive for Norovirus.

          The six women, aged 19 to 65, and seven men, aged 48 to 85, are being treated in isolation while the staff member is on sick leave. Their condition is stable.

          Infection control measures have been stepped up. The cases have been reported to the authority's Head Office and Centre for Health Protection.


          Source: http://www.news.gov.hk/en/category/h...718en05002.htm

          Comment


          • #6
            Re: Riverboat passengers to be treated for flu-like symptoms

            Sounds like a Norovirus. Quite common to have large outbreaks among people in closed spaces like cruise ships and schools. Nausea, vomiting, diarrhea of short duration are common.

            Comment


            • #7
              Norovirus outbreaks-various reports

              Published: 11/17/2006 2:47 PM Updated: 11/17/2006 2:51 PM

              By: Cindy Hadish - The Gazette<!--End Header --> <!--Last Updated: 20061117T144603-0600-->MANCHESTER , IA - State health officials were investigating the source of an outbreak today at Lambert Elementary in the West Delaware School District.

              Four staff members and 166 of about 500 students of the Manchester school called in sick this morning, according to the Iowa Department of Public Health.

              Symptoms reported included vomiting and diarrhea, which could mean any number of illnesses, health department spokesman Kevin Teale said, including flu or a food-borne illness.

              Department personnel will use a questionnaire to try and pinpoint the cause of the illness.

              Manchester is about 30 miles north of Cedar Rapids.

              Health officials determined norovirus, a highly contagious virus, caused an outbreak that sickened more than half the students at Longfellow Elementary in Iowa City in March.

              "We are in this breathing space before it happens. We do not know how long that breathing space is going to be. But, if we are not all organizing ourselves to get ready and to take action to prepare for a pandemic, then we are squandering an opportunity for our human security"- Dr. David Nabarro

              Comment


              • #8
                Norovirus outbreaks-various reports

                Sonoma County Schools Hit by Outbreak of Gastrointestinal Illness

                Posted Wednesday November 22, 2006:

                Students and staff members at two Sonoma County schools have been infected by a fast-spreading gastrointestinal illness.
                Thirty-seven students and two staff members at Yulupa and Strawberry schools have come down with the symptoms of norovirus over the past week.
                The outbreak has prompted the district to cancel one teacher's parent conferences, move another out of a classroom and send letters home to parents, advising them of what precautions to take.
                Health officials say the norovirus outbreak has been working its way through five Santa Rosa long-term care homes for the elderly, infecting 199 residents and staff members.
                Norovirus lasts 48 hours and causes nausea and vomiting.
                It can be dangerous for the elderly, but not for children.

                Comment


                • #9
                  Norovirus outbreaks-various reports



                  Volume 13, Number 1?January 2007

                  Dispatch

                  Gastroenteritis Caused by Norovirus GGII.4, the Netherlands, 1994?2005

                  J. Joukje Siebenga,*? Harry Vennema,* Erwin Duizer,* and Marion P.G. Koopmans*?
                  *National Institute for Public Health and the Environment, Bilthoven, the Netherlands; and ?Erasmus University, Rotterdam, the Netherlands
                  Suggested citation for this article
                  Abstract
                  From 1994 through 2005, gastroenteritis outbreaks caused by norovirus generally increased in the Netherlands, with 3 epidemic seasons associated with new GGII.4 strains. Increased percentages of GGII.4 strains during these epidemics, followed by a sharp decrease in their absolute and relative numbers, suggest development of immunity.

                  Noroviruses (NoVs) cause large outbreaks of gastroenteritis in settings of close human contact such as hospitals, institutions, military bases, and cruise ships, as well as sporadic cases. In recent years, human NoVs have increasingly been recognized as a common cause of gastroenteritis. Since the introduction of rapid molecular detection techniques, a high proportion of acute gastroenteritis outbreaks have been attributed to NoVs (1?3). We describe trends in occurrence of NoV in the Netherlands, with a focus on the predominant GGII.4 strains.
                  The Study

                  Surveillance of viral gastroenteritis outbreaks was initiated just over a decade ago at the National Institute for Public Health and the Environment in the Netherlands (RIVM). Outbreaks were typically reported by the municipal health service or the food inspection services to the RIVM, and samples were collected in close collaboration with these agencies. To determine the role of NoV and possible differences between different NoV strains in gastroenteritis outbreaks, a minimal set of epidemiologic data (setting, date of onset, number of persons affected, most probable mode of transmission, and number of hospitalizations) was collected for reported outbreaks. These data were supplemented with results of molecular biologic detection and typing techniques to enable more in-depth analysis of surveillance data.
                  Preliminary typing of strains was performed by sequencing region A (280 nt in the polymerase gene) of the virus. A systematic selection of strains was also typed by sequencing region C (277 nt in the capsid gene) (1,2). Because NoV activity is much higher in winter months, seasons were analyzed from July through June, rather than per calendar year.
                  <table align="right" border="0" cellpadding="5" cellspacing="0" width="150"> <tbody><tr> <td bgcolor="#d8eceb">
                  Figure
                  </td> </tr> <tr> <td bgcolor="#d8eceb"></td> </tr> <tr> <td bgcolor="#d8eceb">Figure. A) Number of norovirus outbreaks reported per month in the Netherlands, 1994?2005. B) Total no. of outbreaks per season...
                  </td> </tr> </tbody></table> From December 18, 1993 to December 26, 2005, a total of 1,032 gastroenteritis outbreaks were reported to the RIVM. Samples from 942 outbreaks were received and analyzed. Of these, 695 (74%) outbreaks met our inclusion criteria for a NoV outbreak (>25% of samples positive by reverse transcription?PCR). Overall, we observed an increasing trend in the number of reported outbreaks per year (Figure, panel A). In the 1995?96, 2001?02, 2002?03, and 2004?05 seasons, more NoV outbreaks were reported (66, 90, 154, and 161, respectively). GGII virus strains were predominant in all years and caused 577 (91%) of 631 outbreaks with known genotypes, compared with 36 (6%) of 631 outbreaks caused by GGI or GGIV viruses and 18 (3%) of 631 outbreaks caused by mixed infections with viruses of different genotypes (Table).
                  GGII.4 strains have been detected since 1995, with the highest proportions observed in years with high numbers of outbreaks. In the epidemic seasons of 1995?96, 2002?03, and 2004?05 the percentages of outbreaks caused by GGII.4 were 82%, 83%, and 89%, respectively, compared with an overall average of 68% (Figure). In seasons after these epidemics, the percentage caused by GGII.4 decreased to 39% in 1996?97, 55% in 2003?04, and 32% in the first half of 2005?06. Multiple NoV genotypes co-circulated throughout the years of the study, but in postepidemic years, outbreaks caused by non-GGII.4 strains were more common (Figure, panel C). The high number of outbreaks in 2001?02 may be partially explained by emergence of a new variant of GGII.4 in the spring of 2002 (4), which caused uncharacteristically high numbers of outbreaks between April and June. The epidemic increases in the number of outbreaks and seasonality of outbreaks were mainly attributable to GGII.4. Strains with genotypes other than GGII.4 were found at similar levels throughout the year (data not shown).
                  A total of 548 (79%) outbreaks were reported in healthcare settings (hospitals and residential institutions) compared with 102 (15%) in nonhealthcare settings; for 45 (6%) outbreaks no data were available (Table). A total of 407 (81%) of 502 outbreaks with genotyping information in healthcare settings were caused by GGII.4 NoV strains (Table). In the nonhealthcare settings, GGII.4 was significantly less prevalent (39 [43%] of 91, p<0.0001), resulting in a relative risk at least 2.17? higher for acquiring a GGII.4 infection in a healthcare setting than in other settings.
                  A mode of transmission was reported for 272 (39%) outbreaks. Data confirmed that the main transmission route was person to person (60%, 163/272) (Table) (5,6). GGII.4 strains were found in 73% of person-to-person outbreaks compared with 44% of food-related outbreaks (p<0.0001). When outbreaks for which no genotype was known were counted as non-GGII.4 strains, the relative risk of finding GGII.4 in an outbreak caused by person-to-person transmission was 2.3? greater than finding it in a foodborne outbreak or relative to other genotypes. Multiple GGII NoV strains were found in 18 outbreaks (3 foodborne, 1 waterborne, 4 person-to-person, and 10 with unknown modes of transmission).
                  Conclusions

                  Detailed molecular epidemiologic data from long-term surveillance on NoV outbreaks are rare because NoV molecular detection techniques became available only in the mid-1990s. In our 12-year surveillance study, we observed large differences in the magnitude of the annual winter peak of NoV infection. All epidemic peaks were associated with predominance of GGII.4 strains. Although this finding has been observed in studies covering a shorter period (3,5?7), our data suggest an increase in infections with GGII.4 in recent years, particularly in healthcare settings. However, the number of outbreaks reported in healthcare settings is likely overrepresented in our study because of mandatory reporting of illness in such settings. An actual increase in the number of outbreaks cannot be proven based on passive surveillance data alone, but an increase is strongly suggested by increased prevalence of GGII.4 in recent years and supported by reported shifts in the predominant GGII.4 variant associated with large numbers of outbreaks (8).
                  The overall dominance of GGII.4 suggests that this genotype is more transmissible than other genotypes in healthcare settings, where close contact of many persons favors person-to-person transmission. Transmission may also be affected by poorer hygiene or greater susceptibility to infection. Increased transmissibility could result from increased levels of shedding of GGII.4 or altered stability of virus particles outside the host compared with other genotypes. Alternatively, changes in circulating viruses may lead to differences in host cell binding or immune recognition, thereby changing the dynamics of infection or size of the population at risk.
                  Our group and other researchers have reported the emergence of distinct GGII.4 lineages in 1995?96, 2002, and 2004 (2,4,9,10). This suggests that the changing phenotype of GGII.4 strains results in increased numbers of outbreaks (10). A detailed characterization of GGII.4 strains is ongoing to determine the molecular mechanisms involved in observed epidemiologic patterns. The marked decrease in the percentage of GGII.4 strains during seasons after epidemic seasons caused by variant strains suggests that populations may acquire immunity against these predominant strains.
                  The value of this surveillance dataset will increase with its continuation, as well as with its expansion as part of a European surveillance network (www.eufoodborneviruses.co.uk). Future research will be directed at understanding the molecular basis for observed changes in the epidemiology of NoV and control of its spread.
                  Acknowledgments

                  We thank E. de Bruin and B. van de Veer for technical assistance, L. Verhoef for assistance with statistical analysis, and A. Kroneman for assistance with databases.
                  This study was supported by the European Commission DG Research Quality of Life Program, Sixth Framework (SP22-CT-2004-502571).
                  Ms Siebenga is a PhD student at Erasmus University, Rotterdam, the Netherlands, and works at the National Institute for Public Health, Bilthoven, the Netherlands. Her research interests include the molecular epidemiology and evolution of noroviruses.
                  References

                  1. Vinje J, Koopmans MP. Molecular detection and epidemiology of small round-structured viruses in outbreaks of gastroenteritis in The Netherlands. J Infect Dis. 1996;174:610?5.
                  2. Vinje J, Altena SA, Koopmans MP. The incidence and genetic variability of small round-structured viruses in outbreaks of gastroenteritis in The Netherlands. J Infect Dis. 1997;176:1374?8.
                  3. Fankhauser RL, Noel JS, Monroe SS, Ando T, Glass RI. Molecular epidemiology of "Norwalk-like viruses" in outbreaks of gastroenteritis in the United States. J Infect Dis. 1998;178:1571?8.
                  4. Lopman B, Vennema H, Kohli E, Pothier P, Sanchez A, Negredo A, et al. Increase in viral gastroenteritis outbreaks in Europe and epidemic spread of new norovirus variant. Lancet. 2004;363:682?8.
                  5. Blanton LH, Adams SM, Beard RS, Wei G, Bulens SN, Widdowson MA, et al. Molecular and epidemiologic trends of caliciviruses associated with outbreaks of acute gastroenteritis in the United States, 2000?2004. J Infect Dis. 2006;193:413?21.
                  6. Bon F, Ambert-Balay K, Giraudon H, Kaplon J, Le Guyader S, Pommepuy M, et al. Molecular epidemiology of caliciviruses detected in sporadic and outbreak cases of gastroenteritis in France from December 1998 to February 2004. J Clin Microbiol. 2005;43:4659?64.
                  7. Gallimore CI, Green J, Lewis D, Richards AF, Lopman BA, Hale AD, et al. Diversity of noroviruses cocirculating in the north of England from 1998 to 2001. J Clin Microbiol. 2004;42:1396?401.
                  8. Kroneman A, Vennema H, van Duijnhoven Y, Duizer E, Koopmans M. High number of norovirus outbreaks associated with a GGII.4 variant in the Netherlands and elsewhere: does this herald a worldwide increase? Eurosurveillance Weekly. 2005;10:51?2.
                  9. Noel JS, Fankhauser RL, Ando T, Monroe SS, Glass RI. Identification of a distinct common strain of "Norwalk-like viruses" having a global distribution. J Infect Dis. 1999;179:1334?44.
                  10. Bull RA, Tu ET, McIver CJ, Rawlinson WD, White PA. Emergence of a new norovirus genotype II.4 variant associated with global outbreaks of gastroenteritis. J Clin Microbiol. 2006;44:327?33.
                  Figure

                  Figure. A) Number of norovirus outbreaks reported per month in the Netherlands, 1994?2005. B) Total no. of outbreaks per season...
                  Table

                  Table. Outbreaks of gastroenteritis caused by noroviruses per mode of transmission and setting, the Netherlands, 1994?2005
                  Suggested Citation for this Article

                  Siebenga JJ, Vennema H, Duizer E, Koopmans MPG. Gastroenteritis caused by norovirus GGII.4, the Netherlands, 1994?2005. Emerg Infect Dis [serial on the Internet]. 2007 Jan [date cited]. Available from http://www.cdc.gov/ncidod/EID/13/1/144.htm

                  Comment


                  • #10
                    Re: Gastroenteritis Caused by Norovirus GGII.4, the Netherlands, 1994?2005

                    J. Joukje Siebenga,*? Harry Vennema,* Erwin Duizer,* and Marion P.G. Koopmans*?
                    *National Institute for Public Health and the Environment, Bilthoven, the Netherlands; and ?Erasmus University, Rotterdam, the Netherlands
                    Vol. 13, No. 1 ? January 2007




                    Figure. A) Number of norovirus outbreaks reported per month in the Netherlands, 1994?2005. B) Total no. of outbreaks per season and fraction of GGII.4 outbreaks reported in the Netherlands. Total no. is indicated by the solid line, no. of GGII.4 outbreaks by the dotted line (values on left y-axis), bars indicate percentage of GGII.4 outbreaks of the total no. (values on right y-axis), and arrows indicate epidemic seasons. Seasons run from July through June. C) Total no. of genotypes (Gts) circulating per season. Shading of the bar indicates the percentage of GGII.4, ranging from white (0%?20%), in steps of 20%, to black (80%?100%).
                    This page posted December 15, 2006
                    This page last reviewed December 15, 2006

                    Comment


                    • #11
                      Re: China: Speculation

                      While Beijing doctors are busy treating patients with flu and colds, hospitals in Guangzhou, capital of south China's Guangdong province, are seeing a rise in the number of patients with diarrhea. The number of patients diagnosed with gastroenteritis has increased by 20 percent over the same period last year, said Lu Jianhua, director of the emergency departmen in the city's First People's Hospital. Similar increment is also found in other Guangzhou-based hospitals, including the Red Cross Hospital, the People's Hospital and the Third Affiliated Hospital of Guangzhou Medical College. The phenomenon has caused some to worry over a possible outbreak of norovirus, which has infected over 60,000 people in Japan, but doctors say the phenomenon is not unusual, and the number of gastroenteritis patients usually rises at this time of year. "Most patients are infected by rotavirus, and the virus has taken advantage of the warm weather in the past few days," said LiZengqing, a pediatrician in Guangzhou People's Hospital. Local disease prevention officials said the cases are not connected, and they have not registered any massive outbreak of gastro-viral infections. "The patients may have been infected after dining in restaurants with poor sanitation, or have eaten undercooked hot-pot food, which is local people's favorite dish in winter," said Wang Zhengwei, a doctor in the Third Affiliated Hospital of Guangzhou Medical College. Doctors have advised local residents not to eat raw or undercooked foods and refrain from eating too much in the holiday season.
                      http://visz.rsoe.hu/alertmap/woalert...t=dis&lang=eng
                      "In the beginning of change, the patriot is a scarce man (or woman https://flutrackers.com/forum/core/i...ilies/wink.png), and brave, and hated and scorned. When his cause succeeds, the timid join him, for it then costs nothing to be a patriot."- Mark TwainReason obeys itself; and ignorance submits to whatever is dictated to it. -Thomas Paine

                      Comment


                      • #12
                        Norovirus outbreaks-various reports

                        Article on previous outbreak:
                        Norwalk virus strikes Preeceville and Yorkton<script src="http://m1.2mdn.net/879366/flashwrite_1_2.js"></script>



                        Pamela Cowan, The Leader-Post
                        Published: Friday, January 05, 2007
                        Visitors are being restricted at the Preeceville Lions Lodge and the Yorkton Regional Hospital because of outbreaks of the volatile Norwalk virus.

                        The Norwalk virus struck the long-term facility in Preeceville on Monday and First West, a medical ward at the Yorkton Regional Hospital, on Wednesday.

                        "You have to take strict isolation precautions and hopefully contain it because it can spread it so easily," said Joe Kirwan, CEO of the Yorkton-based Sunrise Health Region.

                        As a precaution, visitors at Yorkton's hospital are limited to just fathers on the obstetrics ward, parents on the pediatrics ward and immediate family members on the intensive care and palliative care units.

                        "If this thing gets out of hand, we'll have to lock the whole hospital down," Kirwan said. "We've had more outbreaks this year than we've ever seen. It just doesn't seem to want to quit."

                        An eight-day outbreak occurred at the Yorkton Regional Hospital in September. Later that month the virus struck the Yorkton and District Nursing Home for 19 days and the Canora Gateway Lodge for 13 days.

                        The virus hit Norquay's long-term care facility for 10 days in October and St. Anthony's Hospital in Esterhazy suffered a seven-day outbreak. In November visiting restrictions were enforced at the Yorkton Regional Health Centre during a 12-day outbreak. Since September, there have also been eight alerts at facilities in the Sunrise Health Region, Kirwan said.

                        Throughout the province, the Norwalk virus peaked about a month ago, but the number of diagnosed cases in 2006 was almost four times the yearly average, said Dr. Ross Findlater, Saskatchewan's chief medical health officer.

                        As of last Friday, there were 831 positive cases of Norwalk virus in the province, he said.

                        "That's high," Findlater said. "In 2004 there were 189 and in 2005 there were 231.

                        "At one point about two months ago, I asked which health regions hadn't had any cases and there were only one or two."

                        It's hard to pinpoint why Norwalk was so prevalent in 2006 but it could mean the genetic makeup of the virus has changed, he said.

                        "One of the factors in the big numbers this fall is likely that the outbreaks in facilities have been detected and a lot of testing was done around those outbreaks, particularly at the beginning," he said. "It's also a problem in other parts of Canada and the U.S. so it's not something unique to Saskatchewan."

                        Thorough handwashing and infection control procedures in hospitals and long-term facilities can stem the spread of the Norwalk virus, Findlater said.
                        Since there isn't a specific treatment for the Norwalk virus, there isn't any benefit to going quickly to a doctor to be tested, he said.

                        Although institutional outbreaks have been publicized, Norwalk virus has been in communities as well, said Findlater, who added that the disease has a low mortality rate and people usually recover within 48 hours.

                        "The important thing in a community setting if you have diarrhea and vomiting is to make sure that you're drinking enough to replace the liquid you're losing, stay home and let somebody else do the food preparation," he said.
                        ? The Leader-Post (Regina) 2007
                        "In the beginning of change, the patriot is a scarce man (or woman https://flutrackers.com/forum/core/i...ilies/wink.png), and brave, and hated and scorned. When his cause succeeds, the timid join him, for it then costs nothing to be a patriot."- Mark TwainReason obeys itself; and ignorance submits to whatever is dictated to it. -Thomas Paine

                        Comment


                        • #13
                          Norovirus outbreaks




                          <TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR vAlign=top><TD>BY REX BOWMAN
                          TIMES-DISPATCH STAFF WRITER
                          </TD><TD align=right>Jan 20, 2007
                          </TD></TR></TBODY></TABLE>


                          <!-- NO VIDEO CHILDREN -->Three dozen Radford University students were treated at a local hospital yesterday after a mysterious illness brought on stomach cramps, vomiting and diarrhea.

                          <SCRIPT language=JavaScript type=text/javascript><!--if (hasPhoto) document.write('
                          ');//--></SCRIPT><SCRIPT language=JavaScript type=text/javascript><!--if (typeof mgSiteID!='undefined' & mgSiteID=='RTD'){ DisplayOasAd("Top,Top1,Top2,Top3,Middle,Middle1,Mi ddle2,Middle3,Left,Left1,Left2,Left3,Right,Right1, Right2,Right3!Left3");}// --></SCRIPT><SCRIPT language=JavaScript1.1 src="http://ads.mgnetwork.com/RealMedia/ads/adstream_jx.ads/timesdispatch.com/news/1149192752640.htm/1658565448@Top,Top1,Top2,Top3,Middle,Middle1,Middl e2,Middle3,Left,Left1,Left2,Left3,Right,Right1,Rig ht2,Right3!Left3"></SCRIPT><NOSCRIPT></NOSCRIPT>
                          School spokesman Rob Tucker said three of the students were admitted to the Carilion New River Valley Medical Center for evaluation. The others were released after treatment.

                          The New River Valley Health District is trying to find the cause of the illness and could have results back from a Roanoke laboratory as early as today.

                          Bobby Parker, spokesman for the health district, said investigators don't know yet if the sickness is a foodborne illness or due to surface contaminants or a norovirus.

                          In the meantime, as a precaution, the school has closed two of the four restaurants in the campus' Dalton Hall food court.

                          Tucker said investigators interviewed six students and determined that a significant number of them had eaten at the two restaurants in the past two days.

                          The school also posted a note on its Web site notifying students and parents of the illness and encouraging students with symptoms to report to the school health center.

                          Parker said sick students started showing up at the hospital Thursday night. Yesterday's first case of sickness was reported at 2 a.m., and by noon 18 students had been treated at the hospital, Tucker said.

                          The number doubled to at least three dozen by yesterday evening, Parker said.
                          The health district is urging students to wash their hands and follow standard hygienic practices, Parker said, adding that the illness does not seem to be overly debilitating. "It's not as serious as one might imagine."

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                          • #14
                            Norovirus outbreaks

                            [CENTER]Health officials begin tracking highly contagious stomach bug

                            Thousands of patients stricken with nausea, vomiting and diarrhea have visited emergency rooms during the last six weeks in a wave of gastrointestinal illness that has swept cities across North America.

                            Federal health authorities are so concerned that they will conduct a telephone conference call with disease trackers from across the nation to gauge the impact of an outbreak blamed on norovirus, an intestinal germ that travels easily from person-to-person. Dr. Marc-Alain Widdowson, a norovirus specialist at the U.S. Centers for Disease Control and Prevention, said the current outbreak of illness appears to be the worst since 2002-2003.

                            “But the bottom line is we don’t really know why,” said Widdowson, who speculated that the virus circulating may be a different strain, one that is more easily transmitted or one that spawns more severe symptoms.

                            Large numbers of patients with stomach virus symptoms began showing up at Geisinger South Wilkes-Barre emergency room in early January, according to the hospital’s marketing coordinator Betsy DalSanto. She said about 20 percent of patients seen in the hospital’s emergency room over the last week were suffering from severe stomach virus.

                            “The emergency department will see the person and get them stable, but they are not doing diagnostic tests to confirm norovirus,” DalSanto said. She said she doesn’t believe the emergency room was instructed to test for norovirus.

                            While some patients suffering from the virus may be given fluids to treat dehydration, only the elderly, very young or those with other serious illnesses are hospitalized, DalSanto said.

                            The emergency room at Geisinger Wyoming Valley Medical Center in Plains Township has also seen a surge in patients with nausea, vomiting, diarrhea, stomach cramps and low-grade fever, according to hospital spokeswoman Anne Green. She said over the last two weeks, the hospital has been treating between four to eight stomach virus patients per day, an unusually high number, but tests are not being done to determine whether they are suffering from the extremely contagious norovirus.

                            Norovirus typically strikes nursing homes, day care centers, hospitals and other group settings in the winter and cruise ships all year-round, according to the San Jose Mercury News. It can be transmitted through close contact with infected people or by eating contaminated food.

                            The Pennsylvania Department of Health, along with other state health departments, has begun tracking norovirus outbreaks at the request of the CDC. The department said the norovirus infection is a common cause of winter stomach flu and issued a list of precautions for Pennsylvania residents Friday morning. Spokesman Richard McGarvey said the department has not found any serious problems in the Wyoming Valley.

                            “Luzerne County didn’t have any large outbreaks, just scattered cases, and none of the big outbreaks that shut down particular areas,” McGarvey said.

                            A Hilton hotel outside Washington has been closed for a top-to-bottom scrubbing after 15 employees and more than 100 guests were sickened by the highly contagious norovirus, a hotel spokesman said Friday. Hotel officials first heard reports of sick guests Wednesday and contacted Fairfax County health authorities, said Jim Cree, the director of sales and marketing at the hotel near Dulles International Airport. Officials confirmed it was norovirus Thursday night, he said.

                            The current wave of outbreaks in the United States could be linked to a new strain of the virus discovered by European health officials, who first noted it striking cruise ships last spring. Twenty-eight cruise ship outbreaks were reported to the CDC in 2006, double the number in the previous year, according to the Mercury News.

                            The Queen Elizabeth 2 has become the first cruise ship in 2007 to suffer a serious outbreak of norovirus illness, with about 16 percent of passengers sickened since the ship left Southampton, England, on Jan. 2. Staff members from the CDC boarded the ship Friday when it docked in Acapulco, Mexico, to survey passengers and inspect cleaning procedures. As of Friday afternoon, 263 passengers and 27 crew members had shown signs of norovirus, according to the Kansas City Star.

                            Although there is no medicine to prevent or cure norovirus, the state Department of Health recommends people suffering from symptoms to drink plenty of fluids and stay home to avoid spreading the illness.


                            &#169;The Citizens Voice 2007
                            Last edited by Sally Furniss; April 7, 2007, 05:21 AM. Reason: remove ad

                            Comment


                            • #15
                              Norovirus outbreaks-various reports

                              [CENTER]Health officials begin tracking highly contagious stomach bug
                              Thousands of patients stricken with nausea, vomiting and diarrhea have visited emergency rooms during the last six weeks in a wave of gastrointestinal illness that has swept cities across North America.

                              Federal health authorities are so concerned that they will conduct a telephone conference call with disease trackers from across the nation to gauge the impact of an outbreak blamed on norovirus, an intestinal germ that travels easily from person-to-person. Dr. Marc-Alain Widdowson, a norovirus specialist at the U.S. Centers for Disease Control and Prevention, said the current outbreak of illness appears to be the worst since 2002-2003.

                              “But the bottom line is we don’t really know why,” said Widdowson, who speculated that the virus circulating may be a different strain, one that is more easily transmitted or one that spawns more severe symptoms.

                              Large numbers of patients with stomach virus symptoms began showing up at Geisinger South Wilkes-Barre emergency room in early January, according to the hospital’s marketing coordinator Betsy DalSanto. She said about 20 percent of patients seen in the hospital’s emergency room over the last week were suffering from severe stomach virus.

                              “The emergency department will see the person and get them stable, but they are not doing diagnostic tests to confirm norovirus,” DalSanto said. She said she doesn’t believe the emergency room was instructed to test for norovirus.

                              While some patients suffering from the virus may be given fluids to treat dehydration, only the elderly, very young or those with other serious illnesses are hospitalized, DalSanto said.

                              The emergency room at Geisinger Wyoming Valley Medical Center in Plains Township has also seen a surge in patients with nausea, vomiting, diarrhea, stomach cramps and low-grade fever, according to hospital spokeswoman Anne Green. She said over the last two weeks, the hospital has been treating between four to eight stomach virus patients per day, an unusually high number, but tests are not being done to determine whether they are suffering from the extremely contagious norovirus.

                              Norovirus typically strikes nursing homes, day care centers, hospitals and other group settings in the winter and cruise ships all year-round, according to the San Jose Mercury News. It can be transmitted through close contact with infected people or by eating contaminated food.

                              The Pennsylvania Department of Health, along with other state health departments, has begun tracking norovirus outbreaks at the request of the CDC. The department said the norovirus infection is a common cause of winter stomach flu and issued a list of precautions for Pennsylvania residents Friday morning. Spokesman Richard McGarvey said the department has not found any serious problems in the Wyoming Valley.

                              “Luzerne County didn’t have any large outbreaks, just scattered cases, and none of the big outbreaks that shut down particular areas,” McGarvey said.

                              A Hilton hotel outside Washington has been closed for a top-to-bottom scrubbing after 15 employees and more than 100 guests were sickened by the highly contagious norovirus, a hotel spokesman said Friday. Hotel officials first heard reports of sick guests Wednesday and contacted Fairfax County health authorities, said Jim Cree, the director of sales and marketing at the hotel near Dulles International Airport. Officials confirmed it was norovirus Thursday night, he said.

                              The current wave of outbreaks in the United States could be linked to a new strain of the virus discovered by European health officials, who first noted it striking cruise ships last spring. Twenty-eight cruise ship outbreaks were reported to the CDC in 2006, double the number in the previous year, according to the Mercury News.

                              The Queen Elizabeth 2 has become the first cruise ship in 2007 to suffer a serious outbreak of norovirus illness, with about 16 percent of passengers sickened since the ship left Southampton, England, on Jan. 2. Staff members from the CDC boarded the ship Friday when it docked in Acapulco, Mexico, to survey passengers and inspect cleaning procedures. As of Friday afternoon, 263 passengers and 27 crew members had shown signs of norovirus, according to the Kansas City Star.

                              Although there is no medicine to prevent or cure norovirus, the state Department of Health recommends people suffering from symptoms to drink plenty of fluids and stay home to avoid spreading the illness.


                              &#169;The Citizens Voice 2007
                              Last edited by Sally Furniss; April 7, 2007, 05:20 AM. Reason: remove ad

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