Download `Flu Near You` Wants To Track Influenza Trends in US

Sticky, icky virus: How to clean a 1,000-foot cruise ship
Maggie Fox NBC News
Thomas Layer / AP
Passengers from a motorcycle tour group prepare to board the Royal Caribbean International's Explorer of the Seas, docked at St.
Thomas, U. S. Virgin Islands.
Royal Caribbean cruise officials are busy scrubbing and sanitizing a giant cruise ship after nearly 650 passengers and crew got sick
with suspected norovirus this week. But it won’t be easy to get the ship spic and span for the next batch of tourists.
The norovirus is sticky and hard to kill, and it gets everywhere.
Ask the people who found the virus in light fixtures and on mantelpieces in a British hotel after an outbreak, or the flight attendants
who all got sick after a single passenger threw up on a jet, or the soccer players who got sick after a teammate threw up near — not on,
but near — a grocery bag.
Now translate that to a monster liner with 15 decks, four pools, six whirlpools, 15 bars, clubs and lounges — including a casino — and
shops.
“Any surface that you can disinfect, you probably should,” said Benjamin Lopman, a viral disease expert at the Centers for Disease
Control and Prevention.
The Explorer of the Seas ship turned back partway through a 10-day cruise from Cape Liberty, N.J., to the Caribbean island of St.
Maarten after patients started getting sick, with vomiting and diarrhea — classic symptoms of norovirus. It's a big vessel, carrying
1,165 crew and 3,050 passengers who are being encouraged to stay in their cabins as much as possible to reduce the risk of infection.
Cleanup means going over every square inch. Workers will spray railings, handles and elevator buttons with bleach. They’ll soak
carpets in disinfectant and even clean bedside Bibles. The CDC Manual for keeping cruise ships clean is 267 pages long.
“There’s one particular incident where a food handler vomited into a sink and then cleaned the sink, but subsequently used it for food
preparation,” says Lopman. Thousands of people got sick in that outbreak, he says.
That’s why there are now clear guidelines on what cleaner to use, how much to use and how long to let it sit to make sure it kills all
the germs. The virus is extremely infectious, easily spread, sticks to surfaces and can survive liberal sloshing with alcohol-based hand
sanitizer. It takes just a few tiny particles to infect someone and people can spread it both before they start feeling sick and after they
feel better. “It can spread in food, it can spread in water and even on contaminated surfaces,” says Dr. Susan Rehm, medical director
of the National Foundation for Infectious Diseases.
“Noroviruses are perhaps the perfect human pathogens,” CDC’s Aron Hall writes in the Journal of Infectious Diseases.
The viruses live in just the right zone to infect people, sticking to serving spoons at buffet tables, lingering on plates even after they’ve
been through the dishwasher, floating into the air when someone vomits suddenly and even settling on fresh laundry.
“Once you get it onto a surface or get it onto a food source, it is pretty easily transmitted,” said Allison Aiello, a professor of
epidemiology at the University of North Carolina.
The number one disinfectant is bleach, but there are other products listed by the Environmental Protection Agency as well. The key is
to use them right.
“Bleach is a good product,” Aiello added. “But you have to let it sit for the right amount of time.” Just wiping with bleach won’t do it.
And some surfaces are more challenging than others — think carpets or wood, neither of which comes out looking too good after
being doused with bleach.
Just a few pieces of virus can make someone sick, and people infected with norovirus will spew out millions of bits of virus.
Outbreaks have been traced to casinos, schools nursing homes and basketball tournaments. In one widely reported case, seven girls on
a school soccer team got infected after another team member threw up in a bathroom near a shopping bag holding their lunch.
In 2008, several sick members of a tour group threw up on a flight from Boston to Los Angeles and ended up infecting other
passengers on the flight. On another flight, staff got sick for six days after a passenger vomited. “Over the course of a week, people
were still getting sick from this one contamination episode,” Lopman said.
One outbreak linked to a Kentucky middle school basketball tournament in February 2012 put two children into the hospital and made
more than 240 people sick. “Three persons from three separate teams had experienced illness onset before the tournament, and one
had vomited courtside in a crowded gymnasium on the first night of the tournament,” a CDC team wrote in a report on the outbreak.
And it’s not just among kids. In December 2010, 24 players or team staffers from 13 different NBA teams got sick, a different CDC
team reported.
Cruise ships create a perfect storm for the virus. “Unfortunately, it is in close settings, whether it be a school, a church, a cruise ship,
where people are close together where viruses like norovirus tend to spread rapidly,” Rehm said.
And if your cabinmate is sick, it’s almost impossible to avoid getting sick, too.
Royal Caribbean officials say they'll clean the vessel three times. It's due back in its home port in New jersey Wednesday, and was
scheduled to go back out again Friday for a nine-day Caribbean cruise.
Several investigations have linked outbreaks with public vomiting — someone suddenly throws up, and many of the people standing
nearby end up infected later. And people might not even know — for instance, in a public restroom. “If you step into the bathroom
right after someone got sick it would be in the air,” said Aiello.
Lopman says one investigation at a British hotel showed just how far the viral particles could float. Researchers swabbed the hotel
after an outbreak several years ago. “They found virus in the light fixtures, on door handles, on fireplace mantles,” he said. “There
were surfaces around 6 feet off the ground where you found norovirus.”
But the main culprit is dirty hands. All the experts recommend thorough washing with soap and water, especially after using the
restroom, and perhaps an extra dollop of hand sanitizer just to be sure. And one of the biggest battles is over food preparation and
health care workers coming to work while infected.
“Someone who is sick shouldn’t be preparing food,” Lopman said. And because the virus still spreads after someone feels better, they
should stay home for 24 to 48 hours after they feel better.
“Clearly it is challenging, particularly in industries where there is no paid sick leave,” Lopman notes.
MERS virus spread in hospitals should be focus of
prevention, MDs urge
Journal editorial draws parallels to role hospitals played in the spread of SARS
The Canadian Press Posted: Jan 28, 2014 11:07 AM ET Last Updated: Jan 28, 2014 11:07 AM ET
The spread of MERS coronavirus infections in hospitals in affected countries is a significant but underappreciated problem, infection
control experts wrote in a journal editorial.
"The concentration of vulnerable patients, the frequent movement of patients, and the many daily contacts make health- care facilities
the perfect breeding ground for MERS-CoV transmission," the authors warned Monday in the journal Annals of Internal Medicine.
"Focus on the health-care setting may prevent continued human-to-human transmission among at-risk patients."
Until doctors and scientists solve where MERS is coming from, they can't effectively reduce that risk, infectious disease specialists
say. (Reuters)
The authors are three specialists who travelled to Saudi Arabia last spring to investigate a large outbreak of MERS in a hospital at AlAhsa in the eastern part of the country. One of the three is Dr. Allison McGeer, head of infection control at Toronto's Mount Sinai
Hospital.
Their publication came on the same day as the World Health Organization confirmed a doctor in Saudi Arabia had succumbed to the
virus earlier this month.
The man, a Bangladeshi who practised in a Riyadh hospital, is not known to have had contact with a MERS patient or with the types
of animals — bats and camels — suspected of being involved in the spread of the disease. He had not recently travelled outside the
country.
As it remains unclear how people are contracting MERS, authorities would not be able to rule out the possibility the doctor caught the
virus outside the hospital. But the possibility remains that he was infected while treating a patient who was not recognized as having
been infected with MERS.
The editorial drew parallels to the role hospitals played in the spread of SARS — also a coronavirus — during the 2003 outbreak.
McGeer was a key figure in Toronto's battle against that frightening new disease and she actually contracted the virus in the early days
of the outbreak.
The authors cited a study published last fall that noted 30 of the first 161 known MERS patients were health-care workers. Since then
at least two more health-care workers have become infected with the virus.
Just over a third of the health-care worker cases have been described as asymptomatic — showing no signs of illness. But a number of
health-care workers have required intensive care treatment and at least three have died.
Health-care workers make up about 18 per cent of confirmed MERS cases so far. The WHO said Monday that there have been 180
confirmed cases to date; 77 of those patients have died.
In the SARS outbreak, health-care workers made up about 20 per cent of cases globally. In Canada, health-care workers comprised 43
per cent of probable and suspect SARS cases.
"I think there's a tendency to look at this and say 'Well, SARS was much worse.' And it's true. It's much better than SARS from a
perspective of health-care workers," said McGeer.
"But there is still clearly too much serious illness and death in health-care workers. And to my mind until we solve where this is
coming from, we can't effectively reduce that risk."
'Sizable outbreak'
Michael Osterholm, an infectious diseases expert who has been following the MERS outbreak closely, said he believes people haven't
grasped the scale of MERS health-care infections, perhaps because the outbreak to date has remained in countries on the Arabian
Peninsula.
Toronto's large SARS outbreak really drove home for western countries the risk the new disease posed, said Osterholm, who is the
director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.
"If we had a situation where we had a sizable outbreak in the western world, where 17 to 20 per cent of the cases where in health-care
workers, I think you'd be seeing a very different attitude towards the concern about health-care workers and MERS."
The editorial was published in conjunction with a report on the disease course and symptoms of 12 MERS patients treated in the
intensive care units of two Saudi hospitals. Three of the 12 were health-care workers.
The Daily Beast
Gideon Resnick
Photo by Getty
01.12.14
‘Flu Near You’ Wants To Track Influenza Trends in
U.S., Save Lives
As the U.S. enters flu season, one website hopes to help reduce the yearly influenza-related deaths. And it
needs you to help.
Thousands of multi-colored dots light up a map of the United States, each one representing a person who has provided feedback about
their health to the website Flu Near You.
The site, which launched in 2011 has been tracking self-reported trends in the presence of flu-like systems from its estimated 80,000
participants. 40,000 of them actively respond to weekly email updates according to Director of the Global Health Threats Division of
the Skoll Global Threats Fund Mark Smolinski, one of the collaborative administers of the site.
Flu Near You was created in partnership with the Boston Children’s Hospital’s HealthMap, an expansive globe-spanning project that
tracks outbreaks of infectious diseases. Participants who register on Flu Near You are sent a weekly email that asks whether they have
had a flu shot and whether they have experienced any symptoms from a provided list of ten potential answers including fever, fatigue
and sore throat.
After the responses are accrued, different color dots are attributed to each corresponding zip code in which the participants live. Blue
indicates no reported symptoms, orange represents some symptoms and red is an indication of an influenza-like illness, based on the
CDC definition of the flu. In the week ending in January 5, 80.9% of respondents reported that they had no symptoms, while 19.1%
said they had some and the remaining 3.3% reported they had an influenza-like illness.
As flu season wages on, typically reaching its peak during January and February, Smolinski wants the site to examine the ongoing
trends in 2014, particularly observing the overall success rate of vaccinations.
“Can we understand more about the impact of vaccines?” Smolinski said in a phone interview. “I get a flu shot every year and nobody
ever comes back and asks me whether I have the flu. So by participating in something like Flu Near You, where you actually
document whether you had a vaccine or not, and then when that’s matched up with the symptoms, we may be able to start getting real
numbers about how effective the vaccine is each year.”
Flu Near You also provides locations where people can get flu shots based on their zip codes, in an attempt to reduce the yearly
influenza-related deaths in the United States, which the CDC estimates is sometimes as high as 49,000. Smolinski wants the site to
serve as an informational tool for citizens, demonstrating where the outbreaks of disease are occurring, providing comparison between
self-reported statistics against Google Flu Trends and CDC data as well as the locations of available resources for treatment.
“It’s these respiratory diseases that really worry us
because they can spread around the world.”
During the 2012 flu season, one which resulted in over 22,000 deaths in the United States between the end of September and the end
of the year alone, Smolinski saw the participation in Flu Near You grow exponentially. He partially credits this activity boon to the
website’s appearance on CNN.
Smolinski doesn’t only want the site to gain attention, but rather to keep a consistent set of participants every year in order to provide
a viable and accurate health resource.
“The reality is the system will be the most useful if people remain in the system,” Smolinski said. “Getting big hits and people joining
it is good for awareness, but the utility of the tool is really to keep them long-term.”
In order to accomplish this, Smolinksi hopes to incentivize people to consistently use the site by integrating it into the workplace and
even getting younger people like Girl Scout and Boy Scout troupes to participate.
As the first flu deaths of the season are being reported in the U.S. and a patient in Canada became the first North American to die from
avian flu , Smolinski’s tool may be more important than ever.
“It’s these respiratory diseases that really worry us because they can spread around the world,” Smolinski said of influenza. “So why
aren’t we trying to do more to really learn everything we can about this disease we experience every year?”
"Google Flu Trends" Found to Be Nearly on Par with CDC Surveillance Data
Searching for flu symptoms online is a reasonable proxy for actually having them
May 17, 2010 By Katie Moisse
Seasonal flu epidemics account for as many as half a million deaths worldwide each year. And the rapid spread of new strains can
cause many more (the 2009 H1N1 flu pandemic alone killed more than 16,000 people, according to the World Health Organization.)
Quickly detecting a regional rise in flu-like symptoms such as coughs, sore throats or high fevers can help public health officials take
steps to dampen the impact. However, it can take days—even weeks—for trends spotted in clinics to be reported more broadly.
Before visiting a clinic, many flu sufferers visit Web sites for information about symptoms and remedies—a tendency that Google
engineers took advantage of to create a real-time flu tracker called ‘Google Flu Trends.’
"We're constantly looking for trends in our search results, and ways to use them to do something useful," says Jamie Yood,
communications lead for Google Flu Trends.
By comparing the popularity of the 50 million most common Google search queries in the U.S. with flu-like illness rates measured by
the U.S. Centers for Disease Control and Prevention’s (CDC) national surveillance program, the Flu Trends team narrowed down the
pool to 45 search terms (relating to symptoms, complications and remedies) that correlated with the agency's data on the prevalence of
flu symptoms. "It shows the trends—whether flu-like illness rates are going up or down in certain regions," says Yood.
"Oscar nominations" and "March madness" queries also peaked during flu season, but didn't make the cut, Yood jokes.
The CDC's national surveillance program is based on weekly reports from 3,000 health clinics that count the number of patients with a
fever and a cough or a sore throat. But it takes up to two weeks for these numbers to be compiled into meaningful and publicly
available information about flu trends, Yood says. Google Flu Trends is updated daily, and according to data from the 2007–2008 flu
season, it can bridge the CDC's two-week lag, potentially buying officials critical extra time to devise a public health response and
curtail the virus’s general spread.
Google collaborated with the CDC to validate the flu tracker. "They were really excited about the idea of having another source of
information that could help with early detection," Yood says of the agency. Together, Google and the CDC published their search
query–based flu-tracking model in Nature in February 2009.
But Google Flu Trends doesn't replace the CDC's national surveillance program, Yood stresses. Although it matches CDC-detected
trends to within 95 percent, it's less accurate at estimating actual rates of laboratory-confirmed flu, according to a study presented May
17 at the American Thoracic Society 2010 International Conference in New Orleans.
Focusing on flu outbreaks in the U.S. between 2003 and 2008, Justin Ortiz from the Division of Pulmonary and Critical Care
Medicine at the University of Washington and colleagues from CDC and PATH, a Seattle-based nonprofit health organization, found
that Google Flu Trends deviated greatest from CDC surveillance figures for laboratory-confirmed flu rates during the 2003–2004 flu
season, which saw a high number of flu-related deaths in children and, as a result, was a hot topic in the media. During periods of
intense media interest or unexpected flu activity, Google Flu Trends might be less accurate in estimating flu rates because of the
heightened public interest and increased search activity, the researchers concluded.
"Still, Google Flu Trends provides an excellent public health service, because it's fast and cheap and requires very little infrastructure,"
Ortiz says.
Google Flu Trends was launched in the U.S. in November 2008. Here, it tracks flu-like illness at the state level, but work is under way
to narrow monitoring down to individual cities. The effort has since expanded to track flu-like illness in 20 countries, with results in
38 languages.