Download Health Department:Public Health Advisory:Countywide Increase in

Dutchess County Department of
Health
Public Health Update*
Subscribe to Public Health Updates at: http://www.co.dutchess.ny.us/CountyGov/Departments/Health/16586.htm
Marcus J. Molinaro
Michael C. Caldwell, MD, MPH
County Executive
Commissioner of Health
Countywide Increase in Viral Gastrointestinal Illness (Update)
Date: February 14, 2012 - 1:00 pm
Please Distribute to: Day Cares, School Nurses, Colleges, Senior Housing, Nursing Homes, Emergency
Medicine, Pediatrics, Primary Care, Infectious Diseases, Internal Medicine, Family Medicine, Laboratory
Medicine, and Infection Control.
SUMMARY:
•
Dutchess County Department of Health continues to receive increased reporting of vomiting and diarrhea
throughout the region further indicating the presence of Norovirus-like virus.
•
• DCDOH strongly recommends:
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-Increase diligence to handwashing (oversee if needed for younger children).
•
-Thorough disinfection of areas affected by vomit and/or diarrhea with a bleach solution (5 tablespoons of
bleach/gallon). Individuals need to wear gloves and avoid using mops (use disposable items).
•
-UPDATED: All affected individuals should remain at home until symptoms have
especially those who work in daycare, medical, or food
establishments.
•
resolved for 72 hours,
Report any outbreaks (e.g. daycare, school, nursing homes) to 845.486.3402.
Dutchess County Department of Health continues to receive an unusually high number of reports of
gastroenteritis illness (diarrhea and/or vomiting) in schools, daycares, and community settings (please see
Public Health Advisory dated 02/07/2012 - attached for reference).
To reduce the spread of this outbreak, the Department of Health is strongly encouraging individuals to increase
handwashing efforts, caution individuals when cleaning up vomit and diarrhea to adhere to disinfection
standards and to utilize personal protective equipment, and to stay home if they are experiencing vomiting
and/or diarrhea until 72 hours after these symptoms have stopped.
Dutchess County Department of Health is asking for your assistance by incorporating these prevention
strategies into your setting as soon as possible. Please continue to report any outbreaks to the Department at
845-486-3402.
*Health Alert-conveys the highest level of importance; warrants immediate action or attention; Health Advisory- provides important information for a specific incident
or situation; may not require immediate action; Health Update- provides updated information regarding an incident or situation; unlikely to require immediate action.
Dutchess County Department of Health
387 Main Street, Poughkeepsie NY 12601 • (845) 486-3400 • Fax (845) 486-3447 • TTY (845) 486-3417
The following information is a summary from the Centers for Disease Control and Prevention at www.cdc.gov:
Clinical Presentation
The incubation period for norovirus-associated gastroenteritis in humans is usually between 24 and 48 hours, but cases
can occur within 12 hours of exposure. Norovirus infection usually presents as acute-onset vomiting, watery non-bloody
diarrhea with abdominal cramps, and nausea. Low-grade fever also occasionally occurs, and vomiting is more common in
children. Dehydration is the most common complication, especially among the young and elderly, and may require medical
attention. Symptoms usually last 24 to 60 hours. Recovery is usually complete and there is no evidence of any serious
long-term sequelae.
Virus Transmission
Noroviruses are transmitted primarily through the fecal-oral route (either by consumption of fecally contaminated food or
water) or by direct person-to-person spread. Environmental and fomite contamination may also act as a source of infection.
Good evidence exists for transmission due to aerosolization of vomitus that presumably results in droplets contaminating
surfaces or entering the oral mucosa and being swallowed.
Noroviruses are highly contagious. During outbreaks, several modes of transmission have been documented; for example,
initial foodborne transmission in a restaurant, followed by secondary person-to-person transmission to household contacts.
Although presymptomatic viral shedding may occur, shedding usually begins with onset of symptoms and may continue for
2 weeks after recovery. It is unclear to what extent viral shedding over 72 hours after recovery signifies continued
infectivity.
Diagnosis of Norovirus
Human. In the last 10 years, diagnosis of norovirus illness in outbreaks has improved with the increasing use of
reverse transcriptase polymerase chain reaction (RT-PCR). Currently, 27 state public health laboratories have the
capability to test for noroviruses by RT-PCR. RT-PCR can be used to test stool and emesis samples, as well as to detect
the presence of noroviruses on environmental swabs in special studies. Identification of the virus can be best made from
stool specimens taken within 48 to 72 hours after onset of symptoms, although good results can be obtained by using
RT-PCR on samples taken as long as 5 days after symptom onset. Virus can sometimes be found in stool samples taken
as late as 2 weeks after recovery.
Environmental. Assays to detect virus in food need to be adapted for each food substance; these have been only
rarely used, with the exception of assays to detect virus in shellfish. Water can be tested for noroviruses by using RT-PCR
to detect virus when large volumes of water are processed through specially designed filters.
Prevention
Prevention of foodborne norovirus disease is based on the provision of safe food and water. Noroviruses are relatively
resistant to environmental challenge: they are able to survive freezing, temperatures as high as 60�C, and have even
been associated with illness after being steamed in shellfish. Moreover, noroviruses can survive in up to 10 ppm chlorine,
well in excess of levels routinely present in public water systems.
In addition, DCDOH offers the following recommendations to help reduce the spread:
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Wash hands thoroughly and frequently especially after going to the bathroom and before handling food
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Use of gloves should be used when cleaning diarrhea and/or vomit (use of masks is recommended for vomit)
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When cleaning vomit, the CDC recommends the use of paper towels, not a mop. Disinfect the area with a bleach
solution (5 tablespoons of household bleach in a gallon of water). Also, disinfect areas of “high-touch” such as door knobs,
telephones, railings, faucet levers, etc
•
Do not share personal items
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Avoid drinking untreated water
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Cook shellfish thoroughly before eating
***People who experience symptoms should not attend work or handle food ***
For further information on Norovirus, you can contact the DCDOH’s Division of Communicable Diseases at (845)
486-3402 or go to the following websites: Center for Disease Control http://www.cdc.gov