1. University Norovirus Outbreak 31st October 2008 Tui Shadbolt B.Hlth.Sc, MVS Coordinator Health Protection MidCentral Public Health Service

2. Roadmap Notification of the outbreak CIMS Resources Food Hall joint visit Epidemiology Practical interventions Conclusions

3. Notification - !#%?&*!@# University Medical Centre 9:30am Heaps of students reporting Gastro type symptoms Appeared to be mostly from the Halls of residence Seen 8 already and there was a queue out the door Two specimens available already Medical Officer of Health on Leave Medical Officer of Health in Whanganui Friday – last week on call for the year Assignment due Monday for block course

4. Intelligence gathering 9000 people visit the campus daily Total of 750+ people live on campus 550 people in 10 catered hostels 205 people live in self catering hostels 5 food outlets Core caterer serves 2000+ customers a day - main supplier of food to campus University has separate drinking water supply Say 40/750 ill (~5%) but what is the background rate? It’s exam time! Not from same course/school according to doctor Friday afternoon so resourcing issues

5. Coordinated Incident Management Structure (CIMS) Structure for Uni OB 2008 response Incident Controller Tui Shadbolt HPO Operations Brett Munro HPO H&S Manager Planning & Intel Tui Shadbolt HPO Logistics Chris Bland HPO Uni Liaison H&S Media & Communications DHB Dennis Geddis Health and Safety Medical officer of Health advisor Patrick O’Connor

6. Initial case definition established A person who lives, works, studies or had recently visited the University campus who was reporting vomiting and diarrhoea in the previous 7days – ongoing

7. Resources available ESR Canterbury PH 3 HPO’s 1 MOH covering from Whanganui but visiting PN Good knowledge of campus Bulk distribution centre for region at PN Hosp A handy pre planned meeting Norovirus Guidelines - different setting but same bug

8. Generating hypotheses on limited info Probable point source due to large numbers clustered in time Catered hostels indicated by doctor - ? food source What about the water?

9. The 10:30am pre planned meeting “change of focus” Health and Safety manager Cryptosporidiosis off the menu Acute Gastroenteritis new dish in discussion Indoctrinated H&S Manager into the world of the Norovirus guidelines Planned likely response Medical Center update 30+ cases by 10:30 with more queued up and reports of many ill in hostels Identified key issue EXAM WEEK!!

10. Resource Shopping List Bulk Signage Bulk Handsanitiser Bulk Electrolytes Bulk Vomit bowls Bulk Biohazard bins Bulk Bottled water Bulk Case Logs for Hostels Bulk Questionnaires

11. The environmental assessment Foodhall inspection –EHO, and 2 HPO’s –A Grade Premises registered by PNCC –Large Food-hall up to 500+ meals per sitting –Multiple Kiosks (4) with extensive menus –Discussed Staff illness –No leftovers –Menus for the last week collected Review of drinking water sampling

12. The Uni Food Hall

13. What was our gut feeling based on evidence gathered Reports of Food handlers with Ds & Vs Weekend of the 25 th and 26 th FH 1 cared for family with D and V’s (FH1 no symptoms) Tuesday 28 th FH 1 worked rostered shift at campus 1 preparing salads and sandwiches including food sent to campus 2 Campus 2 Wednesday 29 th FH2 onset D & V’s 6am at work Campus 1 Wednesday 29 th FH3 onset 6:30am at home Campus 1 FH4 onset 6pm at home This is what happened on the Thursday 30 th and Friday the 31 st

14. Sick food handlers

16. Control measures Food Hall –Robust staff sickness policies –Strong reminder regarding thorough hand hygiene practices –Importance of hygiene measures due to the possibility of asymptomatic carriage –Decontamination advice (NV guidelines) –Discussion around provision of meals to students in catered accommodation while sick

17. Infection Control Measures Outbreak signage Self care messages, Hand hygiene promotion and NV fact sheets via University intranet Discouraging movement of affected students to common areas i.e. Exams, food hall Handsanitiser at all entry and exit points Disposable vomit bags and provision of biohazard bins Briefing for cleaning staff, hostel managers, catering staff Additional cleaning implemented in foodhall and affected hostels Two Acute Gastro Clinics run daily on campus (away from Med Centre) Communication to all After hours clinics in PN re the above clinics for cases

18. Uni Personal and Pastoral cares Bottled water to affected cases Electrolyte sachets to affected cases Food delivered to common rooms in hostels for collection by students three times a day Case logs for each hostel and twice daily check of those known to be ill Affected students encouraged to apply for aegrotat/impaired performance rather than present to Exams Separate Exam hall for those affected who felt they had to sit exams Daily meeting PHU/Uni Clear demarcation of contaminated areas requiring a terminal clean

19. Conclusion Six Lab confirmed cases Norovirus (including FH2) 288 notified probable cases Onset for the majority of cases was over a 48 hour period Questionnaires of limited value due to wrong menu being supplied Daily Case logs gave us a quick result to measure burden of disease Concurrently investigated with two other outbreaks in rest homes Strains were indistinguishable

20. Was it a busy year YearTotal OBsNumber of NV OBs Probable Cases 20071513314 20082014694 200924211241 20103510221 20114213282

21. Thank you Questions?