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Iredell County Health Department
February 2012
Volume 2, Issue 1
CD CONNECT
Inside this issue:
NOROVIRUS
•
Norovirus Information and Prevention
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Antimicrobial Resistance (AMR)
•
Vaccines for Healthcare Personnel
•
Food-borne Illnesses
What is it?
Noroviruses (genus Norovirus, family Caliciviridae) are a group of related,
single-stranded RNA, non-enveloped viruses that cause acute gastroenteritis
in humans. The most common symptoms of acute gastroenteritis are diarrhea,
vomiting, and stomach pain. Norovirus is the official genus name for the
group of viruses previously described as “Norwalk-like viruses” (NLV).
Norovirus is the leading cause of foodborne-disease outbreaks in the United States and a common cause of outbreaks in
long-term care facilities, schools, restaurants, and other group settings. The CDC estimates that over 20 million cases of
gastroenteritis are caused by norovirus annually. Common foods associated with norovirus outbreaks include leafy green
vegetables and raw shellfish; however, any food served raw or handled after prepared can be contaminated.
Noroviruses spread from person to person, through contaminated food or water, and by touching contaminated surfaces.
Healthcare Prevention:
•
Clean patient care and waiting areas with household bleach 1:10 in water (must be mixed fresh daily) or EPA
registered product that is effective against norovirus. A list of these products can be found at
http://www.epa.gov/oppad001/list_g_norovirus.pdf. Note: Many disinfectants used in healthcare settings are not
effective against norovirus.
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The CDC recommends that healthcare workers stay home for 48 hours after symptoms resolve since the virus can
still be spread to others during this time.
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Encourage frequent hand washing with soap and water, especially before and after each patient contact; hand
sanitizers are not effective against norovirus. Noroviruses can continue to be spread for days or even weeks after
symptoms have resolved.
•
Although norovirus is not a reportable disease, report suspected outbreaks of the virus to the health department
within 24 hours so an investigation can be completed and preventive measures enforced to prevent further spread in
the community.
Management:
There are no specific medications to treat norovirus, but infected people should drink plenty of liquids to replace fluid
lost through vomiting and diarrhea. Prevention is the priority with norovirus.
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Antimicrobial Resistance (AMR)
FACTS:
• Antimicrobial resistance was the focus of World Health Day in
2011 and is recognized as the greatest risk to human health on the
plant.
• MRSA kills more Americans annually than emphysema,
HIV/AIDS, Parkinson’s, and homicide combined
• Antibiotic Resistant infections add more than eight million
additional hospital days in the U.S. annually and the Institute of
Medicine estimates that the U.S. annual cost of infections by
antibiotic-resistant bacteria is $4 to $5 billion
• About $1.1 billion is spent annually on unnecessary adult upper
respiratory infection antibiotic prescriptions
• Society could be faced with treatable diseases becoming
untreatable, as in the days before antibiotics were developed
CAUSES AND PREVENTION:
Inappropriate antimicrobial use:
• Encourage patients to complete antibiotics as prescribed and not to take other people’s prescriptions
• Patients may associate getting better with taking an antibiotic whether indicated or not: educate patients regarding
unnecessary antibiotic use for viral infections; it is estimated that 50% of antibiotics prescribed in office settings and
in hospitals are unnecessary or inappropriate
Confined Animal Feeding Operations (CAFOs):
• CAFOs add human antibiotics to feed to accelerate growth and prevent diseases common in overcrowded and unsanitary living conditions
• According to the FDA, 80% of antibiotics produced in the U.S. are used in animal agriculture, mostly for nontherapeutic purposes
• Studies have suggested that hog farms are the source of a new strain of MRSA
• Support the Preservation of Antibiotics for Medical Treatment Act (PAMTA, H.R. 965); this bill was reintroduced
in 2011 after not passing the first time it was introduced.
Vaccines for Healthcare Personnel: CDC Recommendations
Healthcare Personnel: Includes all who may come into contact with patients (volunteers, housekeeping, etc)
Hepatitis B: If potential for exposure to blood or body
fluids
Influenza: All workers annually
MMR: 2 doses of vaccine or lab evidence of immunity.
Those born before 1957 generally considered immune,
but CDC recommends proof of immunity, especially if an
outbreak of disease occurs in the community
Varicella: 2 doses of vaccine, physician diagnosed
disease, or laboratory evidence of immunity
Tdap: One dose for all workers, regardless of interval
since last tetanus-containing vaccine
Meningococcal: For microbiologists routinely exposed
to N. meningitidis
Get Vaccinated to Protect Your Patients! For more information http://www.cdc.gov/vaccines/spec-grps/hcw.htm
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Common Food-borne Illnesses
Iredell County Confirmed and Probable Food-borne Reports 2011:
Salmonellosis: 43
E. Coli-shiga toxin producing: 7
Campylobacter: 16
Cryptosporidiosis: 1
Streptococcus, Group A: 8
Listeriosis: 1
Disease Name
Incubation Period
Clinical syndrome
Confirmation
Salmonellosis (038)
6 hrs-10 days;
usually 6-48 hrs
Diarrhea, often with fever
and abdominal cramps
Isolation of salmonella from a clinical
specimen
Campylobacter (050)
2-10 days; usually
2-5 days
Diarrhea (often bloody),
abdominal pain, fever
Isolation of campylobacter from a clinical
specimen
Streptococcus,
Group A (061)
1-4 days
Fever, pharyngitis, scarlet
fever, upper respiratory
infection
Isolation of group A streptococcus
(streptococcus pyogenes) by culture from a
normally sterile site (usually blood or CSF)
E-coli-shiga toxin
producing (STEC)
(053)
1-10 days; usually
3-4 days
Diarrhea (often bloody),
abdominal cramps (often
severe, little or no fever
Isolation of E. coli from a clinical
specimen*
Mary Gantt, RN, BSN
Community Services
Supervisor
* Escherichia coli 0157:H7 may be assumed to be shiga toxinproducing. For all other isolates, Shiga toxin production or the
presence of Shiga toxin genes must be determined to be considered
STEC.
The information in this newsletter is not intended to be a
complete guide for communicable disease investigation and
response; visit the CDC website at www.cdc.gov for detailed
disease information.
Iredell County Health Department
Statesville Location:
318 Turnersburg Hwy
Statesville, NC, 28625
Phone: 704-878-5300
CD Program Mgr: 704-878-5334
STD Program Mgr: 704-878-5300 ext. 2316
Fax for CD Reports: 704-871-3474
Mooresville Location:
610 East Center Ave.
Mooresville, NC, 28115
Phone: 704-664-5281 Fax: 704-664-9737
Our Mission:
To promote and protect community, personal,
and environmental health.
Iredell County does not discriminate on the basis of race, color,
national origin, sex, religion, age, or disability in employment
or the provision of services.
References:
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Centers for Disease Control and Prevention: http://www.cdc.gov/
ncidod/dvrd/revb/gastro/norovirus.htm
Centers for Disease Control and Prevention (2011, February 16).
Guide to confirming a diagnosis in foodborne disease
“North Carolina Division of Public Health Communicable Disease
Manual:” http://www.epi.state.nc.us/epi/gcdc/manual/toc.html.
Union of Concerned Scientists: http://www.ucsusa.org/
food_and_agriculture/solutions/wise_antibiotics/pamta.html