1. April 15, 2010 Marcy McMillian Effie Boothe
Norovirus Infection
April 15, 2010
Marcy McMillian
Effie Boothe

2. What is norovirus? Also known as Viral infection
Norwalk-like virus
Caliciviruses (family Caliciviridae)
Small round structured viruses
Viral infection
Not improved with antibiotics
Live only in human host
Most common cause of gastroenteritis outbreaks
- Vol 58, No 22;
Gastroenteritis is an inflammation of the lining of the stomach and intestines. Norovirus is the official name; also called NLV, caliciviruses, small-round structured viruses.
No vaccine; antibiotic use contraindicated.
Suspected cause of >50% of all gastroenteritis outbreaks in nursing homes and LTCFs

3. Symptoms Nausea Vomiting Diarrhea Abdominal cramping
Incubation hours
Duration 1-2 days
Norovirus is not as commonly seen children, and in adults vomiting the most common symptom. Incubation is ~ hrs but typically hrs. Other symptoms may include low grade fever, chills, headache, muscle aches, and general feeling of tiredness. Onset of symptoms is sudden in most cases.

4. How is norovirus spread?
Found in stool or vomitus
Infection spreads by
Consuming contaminated food or liquids
Touching contaminated surfaces or objects
Person-to-person contact
Day care centers and nursing homes more vulnerable to both spread and effects of illness
Insensible contact to orifices such as mouth should be avoided as a matter of practice.
Person to person is the direct contact with another person who is affected, or sharing foods or eating utensils with someone who is ill.

5. Treatment No vaccine or antibiotic available Supportive care
--fluids
--rest
Hospitalization may occur in vulnerable groups
IV rehydration may be indicated
Mild dehydration can be treated with non-caffeine and non-alcoholic fluids
Oral rehydration fluids examples: Infalyte, Kao Lectrolyte, Naturalyte, Oralyte, and Pedialyte.

6. Outbreak Data

7. Enteric Outbreaks 2005-2010 N=255 * * Norovirus # of outbreaks year
All other outbreaks
# of outbreaks * *
year
* Preliminary data

8. Norovirus by Transmission Mode

9. Norovirus by Setting
School/Daycare
LTCF

10. Norovirus Outbreaks 2005-2010 N=112
LTCF
All other outbreaks
# of outbreaks * *
year
* Preliminary data

11. Median Number ill from Norovirus Outbreaks by Year
LTCF
Median # ill
All other settings
ill all noro ill LTCF noro
19 37
19=median # ill for all noro; 37 = median ill in LTCF; 4273 total ill; 1344 ill in LTCF (LTCF represents 31% of ill cases) * *
year
* Preliminary data

12. Hospitalizations by Setting
86 hospitalizations from

13. Prevention and Control

14. Prevention and control of norovirus
Frequent handwashing
Wash fruits/vegetables, steam oysters
Cohort patients
Disinfect using bleach-based cleaner
Exclude food workers and HCWs for 48 hrs after symptoms end
Handwashing after tolieting and diaper change, and before preparing or eating food.
Immediately clean washables with hot water and soap
Flush or discard vomitus/stool

15. TDOH response to norovirus
Evaluation of trends
CDC recommendations
Laboratory capacity for identification increased
1. We know much more about the incidence and characterizations of viral gastroenteritis, as Marcy has demonstrated in her talk.
2. The Healthcare Infections Control Practice Advisory Committee is studying its draft on
Guideline for prevention and Management of Norovirus Gastroenteritis Outbreaks in healthcare Settings.
3. In a few minutes Amy Woron will talk new developments in viral detection at the TDOH State Lab.

16. …additional TDOH responses
Statewide annual review
Fact sheet for long term care facilities
Development of viral gastroenteritis fact sheet for Tennessee HDs
1. Education is a leading way to communicate advances in management of diseases.
2. CEDS is preparing a viral gastroenteritis fact sheet for nursing homes and long term care facilities, similar to what has been done by some other states.
3. Daniel Gholston has been instrumental in collaborating with Davidson County health care workers on the control and prevention of GE, and he will share what Nashville has done.

17. Conclusions Norovirus is a serious illness
Illness can spread quickly in congregate settings
Important to educate LTCF and other partners about prevention and control

18. Thank You! 615-741-7247 Effie Boothe: Effie.Boothe@tn.gov
Marcy McMillian: