Norovirus: What you Need to Know

Jan 2013

WHAT IS IT?
Norovirus is a highly contagious gastrointestinal illness, most easily spread in crowded and close environments. Though it is commonly referred to as the “stomach flu”, it is not related to the influenza virus. Norovirus is responsible for 21 million illnesses and contributes to roughly 70,000 hospitalizations each year. Its peak season is usually the month of January, although a virulent new strain originating in Australia is causing an unusually high volume of illnesses this year across the world.

HOW DO I CATCH IT?
Norovirus spreads very quickly throughout close quarters and contained environments. Viral particles shed in stool and vomitus of an infected individual. The virus can be found in stool even before a person gets sick, and up to two weeks after they recover. The estimated infectious dose is said to be as low as 18 viral particles, while over 100 billion viral copies per gram of feces are shed 2-5 days after the initial infection has occurred. The most common routes of transmission occur through the fecal-to-oral route, ingesting aerosolized vomitus, or through indirect exposure to contaminated surfaces. Viral particles can also be spread through foods or liquids contaminated by an infected food handler.

COMMON SYMPTOMS
The virus causes acute gastroenteritis, or swelling of the stomach and intestines. The most common symptoms are  diarrhea, vomiting, nausea, and stomach pain. Additional symptoms such as fever, headaches, and body aches are related to the inability to stay adequately hydrated. It is important to monitor and regulate fluid intake for persons infected, as dehydration is a major concern, especially for young children and the elderly.

PREVENTION
Currently, there is no vaccine for Norovirus, however research in this area is currently underway. There are simple steps you can take to reduce your risk of infection:

· Wash your hands: Thorough hand-washing for at least 20 seconds is vital to prevention, especially after using the bathroom, changing a diaper, and before-and-after preparing and eating food. The act of hand washing has been shown to reduce the amount of microbes via mechanical removal of the loosely adherent microorganisms. Alcohol-based hand sanitizers alone are not an adequate substitute for washing hands with soap and water.

· Avoid contaminated food and water: Be mindful of who is preparing your food. Throw out any food that has been prepared by someone with diarrhea. Avoid eating raw shellfish and be sure to thoroughly wash produce before consumption.

· Disinfection: Be sure to clean and disinfect soiled areas after getting sick. Not all disinfectants are effective against norovirus. The CDC recommends using a chlorine bleach based solution with a concentration of 1000-5000 ppm. Leave the cleaning solution on the soiled surface for at least 5-10 minutes if possible. A list of registered disinfectants is available here.

· Wash laundry thoroughly: Viral contamination can occur via fomites, therefore it is important to disinfect soiled clothes. CDC recommends washing soiled items separately using the maximum cycle length followed by machine drying.

· Stay home: If you are sick, avoid unnecessary contact with other people. You may be contagious up to three days after your symptoms end.

Fungal Meningitis Outbreak

Nov 2012

A rare, but serious form of fungal meningitis has been spreading across the Country over the past several weeks, leaving 5 dead and 35 additional infections in five states including Tennessee, North Carolina, Florida, Virginia and Maryland.

Officials at the Center’s for Disease Control and Prevention (CDC) have linked the outbreak to an injectable steroid medication produced by a pharmaceutical company in Framingham, Massachusetts called the New England Compounding Center. Officials suggest the drug may have been shipped to 23 states, although it was licensed in all 50. The company has subsequently conducted voluntary recalls of the drug after being notified of the problem.

According to officials, all patients had received a treatment for chronic back pain known as a lumbar epidural steroid injection. The medication used in this treatment, methylprednisolone acetate, was found to contain fungal spores of the Aspergillus genus, responsible for the infection. The infection is not contagious and is not spread through person to person contact.

Health officials warn more infections are likely to arise due to the scope of the procedure. The incubation for the infection could range from a few days to four weeks, and that anyone who has received the spinal epidural injection experiencing symptoms including headaches, dizziness, fever, loss of balance, slurred speech, and stroke or stroke-like symptoms should notify their doctors of their prior treatment.

*The type of epidural medication related to the outbreak is not the same type of medication given to women receiving an epidural for childbirth.

Update:
According to CDC surveillance, the scope of the current outbreak has been expanded to 16 states with 20 fatalities and an overall case count of 257 as of October 18th. The states with the largest proportion of cases are Tennessee, Michigan, and Virginia. Additionally, the CDC has identified fungal infections associated with medications used for injections in peripheral joint space including the knee, shoulder, and ankles are related to the initial outbreak stemming from the compounding facility. Officials warn that patients who received these types of injections are not believed to be at risk for fungal meningitis; however they may be at risk for serious peripheral joint infections. As a cautionary measure, FDA officials are urging physicians to follow-up with patients who received any injectable medication from the New England Compounding Center (NECC) after May 21, 2012. These medications could include an ophthalmic drug that is injected or used in conjunction with eye surgery, as well as a cardioplegic solution purchased from or produced the NECC.

FDA officials raided the NECC facility on Tuesday after confirming the presence of a fungus known as Exserohilum rostratum in unopened medication vials of preservative-free methylprednisolone acetate. Additional testing on other NECC injectables is ongoing.

West Nile Virus

Summer 2012

If you’ve turned on your television or computer over the past month, you’re probably aware of the current outbreak of West Nile Virus (WNV) across the country, most notably in the Southwest.

According to the Centers for Disease Control and Prevention (CDC) to date, there have been 1,993 confirmed cases of WNV and 87 deaths. Additionally, of the cases reported, 54% were reported as severe.

In the National Capitol Region (NCR), including DC, MD, and VA, there have been 20 confirmed cases and 1 death, however many more cases are likely to develop due to the favorable weather conditions for mosquito breeding.

While the risk of infection is relatively low, health officials do suggest taking simple precautions to protect you and your loved ones. Using insect repellent with active ingredients registered by the Environmental Protection Agency such as DEET or Picaridin whenever you plan on being outside, especially between dusk and dawn will help to ensure protection from mosquitoes.

If you are opposed to using or allergic to insect repellent , covering yourself with a protective layer of clothing will help to reduce your risk. Use mosquito nets to cover infant carriers to reduce your child’s risk of infection. Avoiding exposure to open-air environments between peak mosquito activity (dusk to dawn) is one of the most effective ways of preventing WNV.

Hanta Virus Outbreak

 A less publicized, but much more severe vector-borne disease has surfaced recently in one the nation’s most popular national parks in California.

According to reports by the National Park Service (NPS), over 10,000 visitors who stayed in  Curry Village at Yosemite National Park may have been exposed to fecal dust particles of deer mice that tested positive for Hantavirus.

So far, there have only been 6 confirmed cases and two deaths reported, although officials fear that that number is likely to increase due to the long incubation period (2-6 weeks) between infection and initial symptoms.

Health officials suggest that individuals who were at Yosemite during the dates listed should be tested and treated if necessary.

Integrated Pest Management (IPM)

IPM is a process involving common sense and sound solutions for treating and controlling pests such as rodents and insects.

The IPM is a simple three step approach including 1) inspection, 2) identification, and 3) treatment.

The National Pest Management Association (NPMA) provides free resources and tips regarding pest control to reduce your risk of contact with pests and the diseases they carry. A few simple tips include:

• Empty containers with stagnant water (bird baths, buckets) in your yard that can provide a breeding ground for mosquitoes.

• Keep windows properly screened.

• Seal cracks and holes in the foundation (mice can fit through holes less than inch in diameter).

• Repair leaky pipes.

These are some of the many tips for controlling pests in the home. For more free tips and other resources, click here.