2What is norovirus? Also known as Viral infection Norwalk-like virusCaliciviruses (family Caliciviridae)Small round structured virusesViral infectionNot improved with antibioticsLive only in human hostMost 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
3Symptoms Nausea Vomiting Diarrhea Abdominal cramping Incubation hoursDuration 1-2 daysNorovirus 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.
4How is norovirus spread? Found in stool or vomitusInfection spreads byConsuming contaminated food or liquidsTouching contaminated surfaces or objectsPerson-to-person contactDay care centers and nursing homes more vulnerable to both spread and effects of illnessInsensible 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.
5Treatment No vaccine or antibiotic available Supportive care --fluids--restHospitalization may occur in vulnerable groupsIV rehydration may be indicatedMild dehydration can be treated with non-caffeine and non-alcoholic fluidsOral rehydration fluids examples: Infalyte, Kao Lectrolyte, Naturalyte, Oralyte, and Pedialyte.
10Norovirus Outbreaks 2005-2010 N=112 LTCFAll other outbreaks# of outbreaks**year* Preliminary data
11Median Number ill from Norovirus Outbreaks by Year LTCFMedian # illAll other settingsill all noro ill LTCF noro19 3719=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
12Hospitalizations by Setting 86 hospitalizations from
14Prevention and control of norovirus Frequent handwashingWash fruits/vegetables, steam oystersCohort patientsDisinfect using bleach-based cleanerExclude food workers and HCWs for 48 hrs after symptoms endHandwashing after tolieting and diaper change, and before preparing or eating food.Immediately clean washables with hot water and soapFlush or discard vomitus/stool
15TDOH response to norovirus Evaluation of trendsCDC recommendationsLaboratory capacity for identification increased1. 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 onGuideline 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 reviewFact sheet for long term care facilitiesDevelopment of viral gastroenteritis fact sheet for Tennessee HDs1. 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.
17Conclusions Norovirus is a serious illness Illness can spread quickly in congregate settingsImportant to educate LTCF and other partners about prevention and control