1. Norovirus Kimberlee Wilson and Kayla Pierson

2. Norovirus -History  First described as the “winter vomiting disease” in 1929  Virus was first seen by an electron microscope in 1972 in some feces from an outbreak  In 2002 Norovirus became the official genus name  Also known as the “stomach bug”  Number one reason children see the doctor for diarrhea  It is thought that gastroenteritis has always been caused by the Norovirus  First described as the “winter vomiting disease” in 1929  Virus was first seen by an electron microscope in 1972 in some feces from an outbreak  In 2002 Norovirus became the official genus name  Also known as the “stomach bug”  Number one reason children see the doctor for diarrhea  It is thought that gastroenteritis has always been caused by the Norovirus

3. Norovirus -What is it?  As the name suggests, it is a Virus  It is genetically diverse with single stranded RNA  It is non-enveloped, which is odd because it is so virulent to temperature and cleaning products  The virus when visualized by EM is 26 to 34nm in diameter; small, round, with an amorphous surface and ragged outer edge  It is able to specifically bond to complex carbohydrates outside most cells known as histo-blood group antigens and specific strains of the virus have affinity for specific blood groups and these antigens act as receptors for Norovirus  As the name suggests, it is a Virus  It is genetically diverse with single stranded RNA  It is non-enveloped, which is odd because it is so virulent to temperature and cleaning products  The virus when visualized by EM is 26 to 34nm in diameter; small, round, with an amorphous surface and ragged outer edge  It is able to specifically bond to complex carbohydrates outside most cells known as histo-blood group antigens and specific strains of the virus have affinity for specific blood groups and these antigens act as receptors for Norovirus Norovirus in an EM Image courtesy of John Marshall

4. Norovirus -What’s happening to your body?  Norovirus causes inflammation of the GI track  This causes nausea, vomiting and diarrhea  Once infected it only takes 12-38 hours for symptoms to start developing  Only takes 10-100 particles to cause infection  Even once symptoms are gone you can still spread norovirus for up to two days and up to two weeks in stool  Norovirus causes inflammation of the GI track  This causes nausea, vomiting and diarrhea  Once infected it only takes 12-38 hours for symptoms to start developing  Only takes 10-100 particles to cause infection  Even once symptoms are gone you can still spread norovirus for up to two days and up to two weeks in stool

5. Who and how do you get it?  ANYONE can get norovirus and is especially dangerous for young children and the elderly  You can get norovirus from someone who is infected, by touching their feces, vomit, soiled laundry or surfaces they have touched and then putting you hand in your mouth  It can also be transited through contaminated food and water  Humans are the only known reservoirs of the virus  ANYONE can get norovirus and is especially dangerous for young children and the elderly  You can get norovirus from someone who is infected, by touching their feces, vomit, soiled laundry or surfaces they have touched and then putting you hand in your mouth  It can also be transited through contaminated food and water  Humans are the only known reservoirs of the virus Photo provided by CDC

6. Norovirus -How many cases?  #1 MOST COMMON FOOD BORN ILLNESS  In the US each year, it causes 19-21 million illnesses and contributes to 56,000-71,000 hospitalizations and 570-800 deaths.  In 2013 there were 1,951 confirmed cases of Norovirus in long term facilities in Oregon, that was 63% of all various outbreaks reported  #1 MOST COMMON FOOD BORN ILLNESS  In the US each year, it causes 19-21 million illnesses and contributes to 56,000-71,000 hospitalizations and 570-800 deaths.  In 2013 there were 1,951 confirmed cases of Norovirus in long term facilities in Oregon, that was 63% of all various outbreaks reported Burden of Norovirus in the United States (CDC)

7. Norovirus -How do you know if you have it?  In the lab  RT-qPCR assay (real-time reverse transcription-polymerase chain reaction) is used which analyzes the specimen by primers that detect specific genome and can give a number of viral load  The virus can not be cultured, so they must test on people who are already infected  The specimen is usually found in stool  Before they would detect norovirus with an electron microscope, which was expensive and time consuming  In the lab  RT-qPCR assay (real-time reverse transcription-polymerase chain reaction) is used which analyzes the specimen by primers that detect specific genome and can give a number of viral load  The virus can not be cultured, so they must test on people who are already infected  The specimen is usually found in stool  Before they would detect norovirus with an electron microscope, which was expensive and time consuming

8. Norovirus -What do you do?  There are currently no known vaccines or medications for Norovirus, seek medical attention if:  Symptoms last for more than 5 days  You develop a high fever  You become severely dehydrated  Drink plenty of fluids and wash your hands very frequently  There are currently no known vaccines or medications for Norovirus, seek medical attention if:  Symptoms last for more than 5 days  You develop a high fever  You become severely dehydrated  Drink plenty of fluids and wash your hands very frequently

9. Norovirus -How do we get rid of it?  Norovirus is very difficult to kill  It can survive freezing temperatures, high chlorine levels and heat up to 60 degrees Celsius (140’ F)  Must use bleach based cleaners on surfaces  Wash hands frequently, very few hand sanitizers kill norovirus  Wash fruit before serving it  Stay away from people while infected and for at least 2 days after symptoms are gone  There are many strains of Norovirus, being infected once does not prevent future infections  Norovirus is very difficult to kill  It can survive freezing temperatures, high chlorine levels and heat up to 60 degrees Celsius (140’ F)  Must use bleach based cleaners on surfaces  Wash hands frequently, very few hand sanitizers kill norovirus  Wash fruit before serving it  Stay away from people while infected and for at least 2 days after symptoms are gone  There are many strains of Norovirus, being infected once does not prevent future infections

10. Norovirus -A First Hand Experience  Belen Davis is an R.N. in a memory care assisted living in McMinnville, and last spring there was a norovirus outbreak at this facility. She said it came into the facility first by an employee that had children at home who were sick with norovirus. “In a memory care assisted living it is different than other assisted livings when these sort of things happen, because in memory care a lot of the residents are similar to small children, meaning everything goes in their mouths and they do not usually remember to wash their hands or to stay away from other residents who are sick.” Belen stated that as soon as the first resident was sick for about a month a half after every day a new resident or a few would get sick as well. Employees were also getting sick, so they had to implement proper procedure for infection control for them as well. Many employees wore masks and gowns when doing resident care, especially if they were dealing with any bodily fluids or waste. Belen stated that the employees who followed procedure, including herself, did not get sick. But the residents and employees that did would complain of stomach pain, and experienced frequent diarrhea and vomiting. Because of this, many were also dehydrated so they encouraged everyone to be drinking a lot of water and had caregivers going around with a water cart every couple of hours. Belen said that she had to report to the Yamhill County Health Department when this happened and they had to send in several fecal samples so that they could confirm that it was norovirus, and it did come back as such.

11. Norovirus -Why should you care?  Norovirus is the number one cause of gastroenteritis  It spreads quickly through medical institutions like care homes, rehab facilities, hospitals and also places like day cares and schools  It is important to understand the importance of proper handwashing techniques  Norovirus is the number one cause of gastroenteritis  It spreads quickly through medical institutions like care homes, rehab facilities, hospitals and also places like day cares and schools  It is important to understand the importance of proper handwashing techniques

12. References Belen Davis Norovirus 2015 [Personal interview]. (2016, February 9). Hahn, D. (n.d.). Norovirus. Retrieved February 10, 2016, from http://www.austincc.edu/microbio/2421d/nv.htm http://www.austincc.edu/microbio/2421d/nv.htm Kitzhaber, J. A. (2014). Norovirus Outbreak Detection and Management. OREGON STATE PUBLIC HEALTH DIVISION. Retrieved February 10, 2016, from https://public.health.oregon.gov/DiseasesConditions/CommunicableDisease/Outbreaks/Gastroenteritis/ Documents/Noro-Outbreak-Detection-Mgmt-Tool.pdf https://public.health.oregon.gov/DiseasesConditions/CommunicableDisease/Outbreaks/Gastroenteritis/ Documents/Noro-Outbreak-Detection-Mgmt-Tool.pdf N. (2010). GUIDELINES FOR THE PUBLIC HEALTH MANAGEMENT OF GASTROENTERITIS OUTBREAKS DUE TO NOROVIRUS OR SUSPECTED VIRAL AGENTS IN AUSTRALIA. Retrieved February 10, 2016, from http://www.health.gov.au/internet/publications/publishing.nsf/Content/cda- cdna-norovirus.htm-l~cda-cdna-norovirus.htm-l-2http://www.health.gov.au/internet/publications/publishing.nsf/Content/cda- cdna-norovirus.htm-l~cda-cdna-norovirus.htm-l-2 Norovirus. (2015, December 10). Retrieved February 10, 2016, from http://www.cdc.gov/norovirus/index.html http://www.cdc.gov/norovirus/index.html Belen Davis Norovirus 2015 [Personal interview]. (2016, February 9). Hahn, D. (n.d.). Norovirus. Retrieved February 10, 2016, from http://www.austincc.edu/microbio/2421d/nv.htm http://www.austincc.edu/microbio/2421d/nv.htm Kitzhaber, J. A. (2014). Norovirus Outbreak Detection and Management. OREGON STATE PUBLIC HEALTH DIVISION. Retrieved February 10, 2016, from https://public.health.oregon.gov/DiseasesConditions/CommunicableDisease/Outbreaks/Gastroenteritis/ Documents/Noro-Outbreak-Detection-Mgmt-Tool.pdf https://public.health.oregon.gov/DiseasesConditions/CommunicableDisease/Outbreaks/Gastroenteritis/ Documents/Noro-Outbreak-Detection-Mgmt-Tool.pdf N. (2010). GUIDELINES FOR THE PUBLIC HEALTH MANAGEMENT OF GASTROENTERITIS OUTBREAKS DUE TO NOROVIRUS OR SUSPECTED VIRAL AGENTS IN AUSTRALIA. Retrieved February 10, 2016, from http://www.health.gov.au/internet/publications/publishing.nsf/Content/cda- cdna-norovirus.htm-l~cda-cdna-norovirus.htm-l-2http://www.health.gov.au/internet/publications/publishing.nsf/Content/cda- cdna-norovirus.htm-l~cda-cdna-norovirus.htm-l-2 Norovirus. (2015, December 10). Retrieved February 10, 2016, from http://www.cdc.gov/norovirus/index.html http://www.cdc.gov/norovirus/index.html