1. N OROVIRUS I NFORMATION F OR C RUISE L INE P ERSONNEL W ALDEN U NIVERSITY E NVIRONMENTAL H EALTH 6165, S ECTION 5 Adonnica Rowland August 8, 2010

2. A REAS W E W ILL D ISCUSS History of the Virus Virus Transmission Symptoms Prevention Additional Information Sources Q and A/ Open Discussion 2

3. W HAT IS N OROVIRUS ? 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) 3

4. N OROVIRUS 1. ( Ohwaki, Nagashima, Aoki, Aoki, Yano, 2009) 2. ( US Food and Drug Administration, 2009) 4

5. V IRUS S YMPTOMS 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)

6. E PIDEMIOLOGY OF THE V IRUS Outbreaks occur year-round In 2006 Norovirus caused of 624 food borne illness outbreaks, resulting in 11,879 cases 1270 FBDO Outbreaks Reported 624 Outbreaks caused by Norovirus 11,879 cases of Norovirus 2006 ( CDC, 2009) 6

7. M ODES OF T RANSMISSION 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 (Liu, Yuen, Hsiao, Jaykus, Moe, 2010) (Heijne, et al., 2009)

8. R ISK OF INFECTION Once a case occurs, more people are likely to become ill because Norovirus is: Numerous modes of transmission increase chances of contamination Virus can be spread from both symptomatic, and asymptomatic persons Highly Transmissible from person to person 8 (Atmar, Opekun, Gilger, Estes, Crawford, Neill, Graham, 2008)

9. D IAGNOSIS, T REATMENT AND R ECOVERY 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) 9 (Atmar, Opekun, Gilger, Estes, Crawford, Neill, Graham, 2008) (U.S. Food and Drug Administration, 2009)

10. P REVENTIVE M EASURES FOR C REWMEMBERS 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)

11. 11 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. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497653/?tool=pubm Resources for Further Reading

12. 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. 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..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. September 2, 2014 12

13. R EFERENCES C ONTINUED 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.pdfhttp://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. 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/foodborneillnessfoodbo rnepathogensnaturaltoxins/badbugbook/ucm071344.htm. http://www.fda.gov/food/foodsafety/foodborneillne 13

14. M Y C ONTACT I NFO Adonnica Rowland Email: rowlanda@waldenu.edu 14