NOROVIRUS INFORMATION FOR CRUISE LINE PERSONNEL

WALDEN UNIVERSITYENVIRONMENTAL HEALTH 6165, SECTION 5

Adonnica RowlandAugust 8, 2010

AREAS WE WILL DISCUSS

History of the Virus Virus Transmission Symptoms Prevention Additional Information

Sources Q and A/ Open

Discussion

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WHAT IS NOROVIRUS?

Numerous Strands of the virus exists Family of unclassified viruses When a new strand is identified, it is named

according to the location in which it was found Causes gastroenteritis and food poisoning Has the ability to effect many people in a short time period making

closed areas, such as cruise ships ideal locations in which the virus can easily be transmitted(U.S. Food and Drug Administration, 2009)

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(U.S. Food and Drug Administration, 2009)

NOROVIRUS

1. ( Ohwaki, Nagashima, Aoki, Aoki, Yano, 2009) 2. ( US Food and Drug Administration, 2009)

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VIRUS SYMPTOMS Nausea Frequent, violent vomiting Diarrhea Fever

(U.S. Food and Drug Administration, 2009)

Headache Fatigue Onset of virus is usually within 12-48 hours after exposure All symptoms usually reside in three days

(Atmar, Opekun, Gilger, Estes, Crawford, Neill, Graham, 2008)

Responsible for approximately 7% of diarrheal fatalities in the US. (Apelt, Hartberger, Campe, Loscher, 2010)

5(Atmar, Opekun, Gilger, Estes, Crawford, Neill, Graham, 2008)(Apelt, Hartberger, Campe, Loscher, 2010)(U.S. Food and Drug Administration, 2009)

EPIDEMIOLOGY OF THE VIRUS

Outbreaks occur year-round In 2006 Norovirus caused of

624 food borne illness outbreaks, resulting in 11,879 cases

(CDC, 2009) 6

MODES OF TRANSMISSION Hand-to-mouth transmission

(Liu, Yuen, Hsiao, Jaykus, Moe, 2010)

Fecal-oral route Contaminated surfaces Particles in the air from infected person (i.e. droplets from a

sneeze) The virus is present in vomit and stool of people who are infected

(Heijne, et al., 2009)

Foods and beverages Direct contact with infected person

(Dreyfuss, 2009)

7(Dreyfuss, 2009)(Liu, Yuen, Hsiao, Jaykus, Moe, 2010)(Heijne, et al., 2009)

RISK OF INFECTION

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(Atmar, Opekun, Gilger, Estes, Crawford, Neill, Graham, 2008)

DIAGNOSIS, TREATMENT AND RECOVERY

Stool samples blood testing (case confirmation and study purposes) Symptoms usually last 24-48 hours, and reside 1 to 3 days Virus may remain in system for a duration of 2 to 8 weeks, with

virus shedding occurring up to 13-56 days Adequate hydration critical for infected persons With the acceptation of becoming dehydrated, or infections in

persons with compromise immune systems, the virus itself is not life threatening(Atmar, Opekun, Gilger, Estes, Crawford, Neill, Graham, 2008)

No treatment or vaccinations available(U.S. Food and Drug Administration, 2009)

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(Atmar, Opekun, Gilger, Estes, Crawford, Neill, Graham, 2008)(U.S. Food and Drug Administration, 2009)

PREVENTIVE MEASURES FOR CREWMEMBERS

Wash hands with soap and water after bathroom visits Sanitize surfaces where food will be prep, or cooking and eating

utensils are stored(Liu, Yuen, Hsiao, Jaykus, Moe, 2010)

Thoroughly wash and store fruits, vegetables and shellfish at proper room temperature

Heat cooked foods to proper temperature and ensure they remain at proper temperature until they are consumed(Dreyfuss, 2009)

Do not allow symptomatic persons to handle food, beverages or utensils

Clean up stool or vomit, and sanitize object or surface that these bodily secretions may come into contact with

(Heijne, et al., 2009)

10(Dreyfuss, 2009)(Heijne, et al., 2009)(Liu, Yuen, Hsiao, Jaykus, Moe, 2010)

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The Center for Disease Control and Prevention website has a information on Norovirus, including a section solely for food handlers.

CDC (2010) Norovirus-Foodhandlers. Available at: http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus-foodhandlers.htm.

The following article discusses the practices to prevent outbreaks, and the spread of Norovirus

Li, D, Schaffner, D.W. (2009) Norovirus: What is it and why should we care?. Visions., 21(1). Retrieved July 12, 2010 at: http://njaes.rutgers.edu/pubs/visions/vis-21-1.pdf.

This article discuss methods for reducing outbreaks and managing virus transmission when an outbreak occurs aboard a cruise ship.

Rooney, R.M., Cramer, E.H., Mantha, S., Nichols, G., Bartram, J.K., Farber, J.M., Benembarek, P.K. (2004). A review of outbreaks of foodborne disease associated with passenger ships: Evidence for risk management. Public Health Rep., 119(4), 427-434. Retrieved July 12, 2010 at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497653/?tool=pubm ed.

Resources for Further Reading

REFERENCES Apelt, N., Hartberger, C., Campe, H., Löscher, T. (2010).The prevalence of

Norovirus in returning international travelers with diarrhea. BMC Infectious Diseases., 10:131. Retrieved July 22, 2010 at: http://www.biomedcentral.com/content/pdf/1471-2334-10-131.pdf.

Atmar, R.L., Opekun, A.R., Gilger, M.A., Estes, M.K., Crawford, S.E., Neill, F.H., Graham, D.Y. (2008). Norovirus shedding after experimental human infection. Emerg Infect Dis., 14(10), 1553–1557. Retrieved July 12, 2010

at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2609865/pdf/080117_finalR.p df.

CDC. (12 June, 2009). Surveillance for foodborne disease outbreaks --- United States, 2006. MMWR., 58(22),609-615. Retrieved August 1, 2010 at: .http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5822a1.htm.

Dreyfuss, M.S. (2009). Is norovirus a foodborne or pandemic pathogen? Foodborne Pathogens and Disease., 6(10), 1219-1228. Retrieved July 20, 2010 at: http://www.liebertonline.com/doi/pdf/10.1089/fpd.2009.0320.

April 19, 2023

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REFERENCES CONTINUED Heijne, J.C-M., Teunis, P., Morroy, G., Wijkmans, C., Oostveen, S, Duizer, e.,

Kretzschmar, M., Wallinga, J. (2009) Enhanced hygiene measures and Norovirus transmission during an outbreak. Emerging Infectious Diseases., 15(1), 24-30. Retrieved August 2, 2010 at:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660689/pdf/08-

0299_finalR.pdf.

Liu, P., Yuen, Y., Hsiao, H.M., Jaykus, L.A., Moe, C. (2010). Effectiveness of liquid soap and hand sanitizer against Norovirus on contaminated hands. Appl Environ Microbiol., 76(2),394-399. Retrieved July 12, 2010 at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805232/pdf/1729-09.pdf.

Ohwaki, K., Nagashima, H., Aoki, M., Aoki, H., Yano, E. (2009) A foodborne Norovirus outbreak at a hospital and attached long-term care facility. Jpn. J. Infect. Dis., 62, 450-454. Retrieved August 2, 2010 at: http://www.nih.go.jp/niid/JJID/62/450.pdf.

U.S. Food and Drug Administration. (2009). Bad Bug Book: Foodborne pathogenic microorganisms and natural toxins handbook. The Norovirus family. Retrieved July 12, 2010 at:

http://www.fda.gov/food/foodsafety/foodborneillness/foodborneillnessfoodbornepathogensnaturaltoxins/badbugbook/ucm071344.htm. 13

MY CONTACT INFO

Adonnica Rowland

Email: rowlanda@waldenu.edu

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