Food Poisoning, Foodborne Illness Information and Research : International Food Safety Network : BarfBlog

From Katie Filion on assignment in New Zealand:

I have virtually no athletic capabilities, but during my elementary school days I was quite the track star. OK, maybe not a star, but I was good enough to make the track and field team.  I remember winning a few races, but usually a day at the track resulted in an embarrassing sunburn. Students at Arden Elementary school in British Columbia weren’t so lucky, with more than one hundred students sent home from the track meet with Norwalk-like virus, reports Comox Valley Echo.

Dr. Jordan Tinney, superintendent of the school said the health department was contacted and the symptoms are consistent with Norwalk. The virus affected no other schools at the track meet.

Dr. Charmine Enns, Comox Valley medical health officer, said,

 "Norwalk or Norovirus is ubiquitous. It's in all of our communities. It's easily transmitted because people have very little warning that they're going to get sick."

Enns stressed that gastro-intestinal illnesses of any type could be thwarted with good hygiene, especially hand washing.

While lab diagnosis had not been sought out, Enns said she was confident the students had been struck with Norwalk.

She explained,

"Typically if it walks like a duck and quacks like a duck then it probably is a duck. And it's quacking and walking like Norovirus."

Arden Elementary has been thoroughly sanitized and nearly all students have returned to classes.



 

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Ottawa County Health Department officials closed Hope College on Friday after a four-day Norovirous outbreak that has left more than 400 staff and students sick.

“Earlier Sunday, the college said the number of reported cases of the flu-like illness causing vomiting and diarrhea for 24 to 48 hours climbed to 180, but many students felt those numbers self-reported to the health department are low.”

A Facebook page for the campus community called "Hope College: The Great Plague of 2008," was created by a freshman student to find out how many people have been affected by the sickness.  About a third of the campus community registered at the site, 14% of who said they are sick or had been.

Health officials strongly urged students to remain on campus, but not to congregate, to help stop the spread of infection.  However many students chose to leave campus once the closure was announced.  At the earliest, campus is scheduled to reopen on Wednesday.  During the closure, a campus cleaning crew will be sanitizing common surfaces.

Norovirous is highly contagious virus that is the leading cause of gastroenteritis in the United States.
No specific treatment is available for Norovirus. In most healthy people, the illness usually is self-limiting and resolves in a few days.

The CDC recommends frequent handwashing, especially after using the bathroom or before preparing food.  Contaminated surfaces and materials should be thoroughly disinfected.  Infected individual should not prepare food while they have symptoms and for 3 days after they recover from their illness.

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As I was beginning the listening section of an introductory French exam today, several students suddenly jumped up. Desks were screeching and I thought there must have been a cockroach or mouse in the room (both things have happened to me in the past at other universities). But no. A student in the front row was only vomiting on the floor and some of his neighbors happened to get hit. The students were all very cool and helpful – getting water and paper towels for the sick classmate. I sent the sick one home but he cleaned up most of his mess. I notified administration, sprayed the floor with some chemical spray, wiped up, and directed the students to another classroom. I went and washed my hands and facilities came within the next 15 minutes to mop the floors.

But what’s the protocol for handling other people’s puke? When I told Doug what happened he reminded me that if the student was sick with a virus like Noro, the germs could be aerosolized and make the rest of us ill. This particular student believed it was a problem with medicine, but to be safe … Washoe County Nevada Health Department suggests:

•    Staff should wear disposable gloves and aprons when cleaning up after ill guests, especially when handling vomit, diarrhea, or other bodily wastes. It is recommended that persons who clean areas substantially contaminated by feces and/or vomitus wear masks because spattering or aerosols of infectious material might result in disease transmission. Use of cleaning cloths and other items used to clean toilets should only be used for that purpose and should not be used from room to room. Do not use these items to clean other surfaces. Effective virucides should be used in bathrooms and high hand-contact areas in guest rooms such as taps, faucets, door and drawer handles, door latches, toilet or bath rails, telephones, rails on balconies, light and lamp switches, thermostats, remote controls, curtain pulls and wands, covers on guest information books, alarm clock buttons, hair dryers, irons, and pens.
•    Staff should promptly bag and clean soiled linens or dispose of them as infectious waste. Linens soiled with vomit or feces should be washed in a hot wash and dried at high temperature (drier temperature >170º F).
•    When responding to a Public Vomiting Incident (PVI), the area within at least a 25-foot radius should be cleaned and disinfected using the above procedures.
•    Staff should wash hands thoroughly using soap and water and then dry them thoroughly after completing the clean-up procedure and again after completing the disposal procedure.

A teacher named “Koko” blogged that when this happened in her classroom in China, she used dirt to cover the vomit, made sure it was dry, then swept, threw out the waste, and mopped afterwards. She made her students participate in the cleaning.

 

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Cryptosporidium and norovirus continue to be problems in public swimming pools, but many other kinds of illnesses can also be contracted from contaminated pool water. Including giardia, E. coli, and Shigella; collectively, all these diseases are known as recreational water illnesses (RWIs).  The Centers for Disease Control and Prevention (CDC) defines RWIs as illnesses that are spread by swallowing, breathing, or having contact with contaminated water from swimming pools, spas, lakes, rivers, or oceans.  The main culprit for RWIs is poop in the pool.

Poop needs to be removed as soon as it’s spotted in the pool.  If it’s formed stool, swimmers should exit the pool and the poop must be fished out of the pool without breaking it apart.  Breaking the stool apart will release any harmful bacteria within it.  Bacteria can still leech out of formed stool, but the sooner it’s removed the less likely that bacteria will escape.  The pool must be properly treated before any swimmers can be allowed back into the pool.  The CDC recommends raising the chlorine content of the water to 2.0 ppm (parts per million) for 30 minutes.

Diarrhea is a much more severe problem.  Diarrheal accidents are much more likely than formed stool to contain germs.  In this case, swimmers must exit the pool while the pool is treated.  As much as possible of the fecal matter should be removed using a net or scoop.  The chlorine will need to be raised to 20 ppm for 13 hours or 10 ppm for 26 hours.  In most cases of diarrhea, the pool must be closed for an extended period of time.

Of course poop in the pool is a problem in private pools as well as commercial pools.  Parents soon forget that their kiddie pool in the backyard must be treated in a similar manner when there is poop in the pool.  In the case of small pools in the backyards, most do not have filters, so the entire pool must be emptied and scrubbed out with a strong bleach detergent.

Poop in the pool is a major health hazard.  Luckily there are proven ways for pool managers to combat RWIs.  Preventative measures include asking people suffering from diarrhea or infants with diapers to refrain from using the pool.  Have a safe summer and help keep poop out of the pool.

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A Six Flags water park and resort complex in up-state New York known as "Great Escapes", is the focus of a large norovirus outbreak.  Norovirus is transmitted from infected human carriers to food, water, and environmental surfaces. The US Centers for Disease Control and Prevention recognize noroviruses (and related viral strains) as the leading cause of foodborne illness in the US. The gastrointestinal illness is highly communicable and easily spread by hand to hand contact and even through the air. Outbreaks occur in resorts and other facilities when ill persons contaminate the environment, food and water through vomit and feces. Rapid and effective measures well-known to the public health community are needed to stop transmission. Many of these measures are developed by the US Public Health Service. Cruise lines have experienced many norovirus outbreaks and therefor there is much known about the pathogen and how to address it.

Untimely Responses to the Problem
According to the local health department a case of norovirus at the Great Escapes is defined as a person with norovirus symptoms at the resort on or after March 7, 2008. The health department  therefore belives the date of March 7 was the beginning of the outbreak, but did not for some unexplained reason begin an investigation for ten days. It is not known to this writer when the operator of the facility was first aware of that employees and patrons were becoming ill. We are also unaware of how or when the health department was officially notified of the problem. The official coordinated response to this outbreak began on March 17, a full 10 days after the outbreak apparently began. By March 21, there were already 200 cases. The number of reported cases eventually reached at least 435 as news of the incident spread.

Rapid tests using sophisticated molecular testing platforms are available to provide confirming results of norovirus infection in 24 hours, yet investigators over 1 week into the investigation still didn't have a confirming diagnosis from the state lab.  The slow state lab results were an unnecessary delay, as approved private labs are available.

Early recognition of this problem is critical. Once it is known that norovirus is in the environment, investigators can implement timely and appropriate sanitation and safety precautions to combat transmission. One example of appropriate response was the closing of the food service. But this only occured after numerous employees of the kitchen reported symptoms of norovirus. The pools, food and lodging facilities are undoubtedly contaminated. Delay in the the implementation of this and other preventive measures at this public, regulated facility likely increased the potential for the exposure of large numbers of unsuspecting people to the pathogen over several days. The licensed operator's delay in recognizing and reporting a large number of ill patrons and staff to authorities, the response of the authorities once notified, and the timeliness and effectiveness of prevention measures taken are critical questions.

Lawsuit
Four members of a family sickened by the resort have filed a lawsuit. Key issues that must be scrutinized are the delay between the start of the outbreak and notification of the health authorities, the large number of food service staff ill and whether they worked while ill, the basis for the decision to close the kitchen, and the basis for management's decision to allow the rest of the facility to remain open..

Unanswered Questions
A detailed analysis of the cases and their relationships to the food service or other environmental exposures will be key to determining the causes of this large and serious outbreak and whether the operator responded in an effective and timely manner to protect both it's employees and guests.

Could the large number of cases of illness been reduced if more timely and effective prevention measures were implemented at Great Escapes?

To read more, select the links below.

Health Department official statement Norovirus at Great Escapes Water Park
1st article from the Post Star. March 21st, 200 cases reported
2nd article from the Post Star, March 16th, 435 cases  reported
Channel 6 report. Lawsuits filed.

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Mr. Costa is a professor at the Walt Disney World Center for Hospitality and the Culinary Arts at Valencia College in Orlando, Florida and is the founder and owner of the consulting firm Environ Health Associates, Inc.  Mr. Costa is a registered professional sanitarian with 30 years of environmental heath practice in the academic, government and private sectors.

For our manual on Norovirus Contamination and Control send an email to rcosta1@cfl.rr.com

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Today's New York Times has a great article on viruses, inspired by writer Natalie Angier's post-New Year's Eve norovirus encounter.

In it she writes that viruses are:

infectious parasitic agents tiny enough to pass through a microfilter that would trap bacteria and other microbes, tiny enough to fit millions on board a single fleck of spit. All viruses have at their core compact genetic instructions for making more viruses, some of the booklets written in DNA, others in the related nucleic language of RNA. Our cells have the means to read either code, whether they ought to or not. Encasing the terse viral genomes are capsids, protective coats constructed of interlocking protein modules and decorated with some sort of docking device, a pleat of just the right shape to infiltrate a particular cell. Rhinoviruses dock onto receptors projecting from the cells of our nasal passages, while hepatitis viruses are shaped to exploit portholes on liver cells.

I've been a big fan of viruses for a long time.  I read a book in high school (Level 4: Virus Hunters of the CDC) which led me into molecular biology and genetics, where virology became my favourite undergraduate course. Angier succinctly summarizes why I think viruses are so cool:

They depend on our cells to manufacture every detail of their offspring, to print up new copies of the core instruction booklets, to fabricate the capsid jackets and to deliver those geometrically tidy newborn virions to fresh host shores. Through us, viruses can transcend mere chemistry and lay claim to biology.

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