A large hotel outbreak of Norwalk-like virus gastroenteritis among three groups of guests and hotel employees in Virginia

Love, S.; Jiang, Xi; Barrett, E.; Farkas, Tibor; Kelly, Simon P.

doi:10.1017/s0950268802007161

Cited by 31 publications

(21 citation statements)

References 27 publications

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“…Outbreaks of norovirus can be particularly ferocious in closed or semiclosed communities, such as transport vehicles and a variety of public venues (114,115). Sudden and widespread outbreaks can escalate without warning in nursing and residential homes, schools, hotels, and prisons (114,(116)(117)(118).…”

Section: Norovirusmentioning

confidence: 99%

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Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

2014

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SUMMARY There is increasing interest in the role of cleaning for managing hospital-acquired infections (HAI). Pathogens such as vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), multiresistant Gram-negative bacilli, norovirus, and Clostridium difficile persist in the health care environment for days. Both detergent- and disinfectant-based cleaning can help control these pathogens, although difficulties with measuring cleanliness have compromised the quality of published evidence. Traditional cleaning methods are notoriously inefficient for decontamination, and new approaches have been proposed, including disinfectants, steam, automated dispersal systems, and antimicrobial surfaces. These methods are difficult to evaluate for cost-effectiveness because environmental data are not usually modeled against patient outcome. Recent studies have reported the value of physically removing soil using detergent, compared with more expensive (and toxic) disinfectants. Simple cleaning methods should be evaluated against nonmanual disinfection using standardized sampling and surveillance. Given worldwide concern over escalating antimicrobial resistance, it is clear that more studies on health care decontamination are required. Cleaning schedules should be adapted to reflect clinical risk, location, type of site, and hand touch frequency and should be evaluated for cost versus benefit for both routine and outbreak situations. Forthcoming evidence on the role of antimicrobial surfaces could supplement infection prevention strategies for health care environments, including those targeting multidrug-resistant pathogens.

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Section: Norovirusmentioning

confidence: 99%

“…Sudden and widespread outbreaks can escalate without warning in nursing and residential homes, schools, hotels, and prisons (114,(116)(117)(118). CDC reported an outbreak of norovirus in a primary school that affected over 100 staff members and pupils (117).…”

Section: Norovirusmentioning

confidence: 99%

Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

2014

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“…It can be transmitted through small infectious droplets (aerosols) after a vomiting episode (6,7) and can survive for a very long time in the environment (5,8). Most norovirus outbreaks are seen in settings where clusters of vulnerable, susceptible persons live closely together, such as nursing homes, hospitals, and daycare centers (4), and in settings in which turnover of susceptible persons is high, such as hotels and cruise ships (9,10).…”

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confidence: 99%

Enhanced Hygiene Measures and Norovirus Transmission during an Outbreak

Heijne¹,

Teunis²,

Morroy³

et al. 2009

Emerg. Infect. Dis.

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Control of norovirus outbreaks relies on enhanced hygiene measures, such as handwashing, surface cleaning, using disposable paper towels, and using separate toilets for sick and well persons. However, little is known about their effectiveness in limiting further spread of norovirus infections. We analyzed norovirus outbreaks in 7 camps at an international scouting jamboree in the Netherlands during 2004. Implementation of hygiene measures coincided with an 84.8% (95% predictive interval 81.2%-86.6%) reduction in reproduction number. This reduction was unexpectedly large but still below the reduction needed to contain a norovirus outbreak. Even more stringent control measures are required to break the chain of transmission of norovirus. G astroenteritis is one of the most common causes of illness (1). Recent fi ndings indicate norovirus is the most common cause of gastroenteritis (2,3). Of all gastroenteritis outbreaks reported in the Netherlands during 2002, 54% were caused by norovirus (4). Norovirus is predominantly transmitted through the fecal-oral route, either indirectly through contaminated food or surfaces or directly from person to person (5). It can be transmitted through small infectious droplets (aerosols) after a vomiting episode (6,7) and can survive for a very long time in the environment (5,8). Most norovirus outbreaks are seen in settings where clusters of vulnerable, susceptible persons live closely together, such as nursing homes, hospitals, and daycare centers (4), and in settings in which turnover of susceptible persons is high, such as hotels and cruise ships (9,10).Norovirus infection can cause serious medical complications, such as dehydration, in persons with underlying illness (11). No antiviral treatment exists for norovirus infection, and although norovirus vaccines are in development (12), none are available yet. Early studies suggested that norovirus outbreaks could be contained by rapid implementation of enhanced hygiene measures, such as washing hands, thoroughly cleaning contaminated surfaces, avoiding contact between sick and healthy persons, and requesting caretakers and cleaning staff to wear gloves and aprons (13-16). However, in nursing homes or on cruise ships, norovirus can cause consecutive outbreaks, even after implementation of strict hygiene protocols (9,17,18). No quantitative estimates exist of the results of such enhanced hygiene measures on reducing further transmission of norovirus. To our knowledge, the effect of enhanced hygiene measures has not been investigated in randomized controlled trials or in statistical analyses of outbreaks.We investigated the effect of enhanced hygiene measures on reducing norovirus transmission during an outbreak. We measured the effectiveness of enhanced hygiene measures as the relative reduction in the reproduction number-defi ned as the average number of secondary cases caused by 1 typical case-in the absence of and after enhanced hygiene measures. The value of this reproduction number provides crucial information about transmissi...

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“…They are members of the family Caliciviridae, having a single-stranded RNA genome with positive polarity ϳ7.5 kb long. Noroviruses frequently cause outbreaks of gastroenteritis in settings where people congregate, such as hospitals, hotels, cruise ships, and schools (4,12,19,21). Transmission occurs fecal-orally via aerosols, fomites, food, or water, and the attack rate is high, with the virus affecting all age groups (5).…”

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confidence: 99%

Mutation in a Lordsdale Norovirus Epidemic Strain as a Potential Indicator of Transmission Routes

Dingle

2004

J Clin Microbiol

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An increase in norovirus outbreaks was reported internationally during 2002 and 2003 and was also observed in Oxfordshire (United Kingdom) hospitals. To understand their epidemiological relationships, viruses from 22 outbreaks (15 from one hospital) were subjected to nucleotide sequencing. The 3-terminal 3,255 nt or complete genomes were determined for 49 viruses. All outbreaks were caused by a genogroup II norovirus related to the Lordsdale virus (GII 4), common in healthcare settings. The norovirus mutation rate was sufficiently high that the 3,255-nucleotide sequences allowed separate and potentially connected outbreaks to be identified, since all outbreaks with identical sequences were temporally or geographically linked. The high mutation rate was further indicated by four mutations and three microheterogeneities in 3,255 nucleotides during 17 days of norovirus shedding by an immunocompromised patient. The data suggested that multiple virus introductions from the community, occasional transmission among wards, and one instance of ongoing environmental contamination had occurred. The accumulation, or lack, of mutations within an outbreak was also used to indicate the predominant transmission route. In an outbreak where person-to-person spread was thought to predominate, six mutations were detected throughout the genome, whereas one mutation was detected when point source infection was suspected. This norovirus epidemic strain differed from its closest previously described relative by 11.4 to 13.6% in the outer P2 domain of the capsid, which also had a single-amino-acid insertion. Alterations to the capsid structure compared to previous noroviruses may explain the increased number of outbreaks during 2002 and 2003.

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A large hotel outbreak of Norwalk-like virus gastroenteritis among three groups of guests and hotel employees in Virginia

Cited by 31 publications

References 27 publications

Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

Enhanced Hygiene Measures and Norovirus Transmission during an Outbreak

Mutation in a Lordsdale Norovirus Epidemic Strain as a Potential Indicator of Transmission Routes

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