Norovirus infection secondary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The CDC currently does not conduct active surveillance to monitor outbreaks of gastroenteritis caused by noroviruses. The National Outbreak Reporting System (NORS) is a web-based system that was launched by the CDC in 2009 to collect information on outbreaks of foodborne, waterborne, and enteric diseases that spread from person-to-person, animals, environmental surfaces, and other or unknown ways. Public health agencies can report all outbreaks of gastroenteritis, including norovirus illness. The CDC also developed CaliciNet in 2009. It is a network of public health and food regulatory laboratories that submit norovirus sequences identified from outbreaks into a national database.
Secondary Prevention
The CDC currently does not conduct active surveillance to monitor outbreaks of gastroenteritis caused by noroviruses. Outbreaks are reported to the CDC's Viral Gastroenteritis Section, Respiratory and Gastroenteric Viruses Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD) when states send specimens for testing or sequencing, or outbreaks are reported directly by states to the electronic database (eFORS) maintained by the Foodborne Diarrheal Diseases Branch.[1]
Reporting
Currently, health departments are not obliged to report individual cases of norovirus illness to a national surveillance system. They may not know about such cases because most hospitals and doctor’s offices do not have capability to test for norovirus. The virus usually remains undiagnosed until an outbreak occurs. It is the responsibility of the health care providers to report all suspected outbreaks of norovirus, to the appropriate health department.[2]
Definition of a Norovirus Outbreak
An outbreak of norovirus is defined as an occurrence of two or more similar illnesses resulting from a common exposure. Health departments are encouraged to report all suspected and confirmed norovirus outbreaks through the National Outbreak Reporting System (NORS) and CaliciNet.[3]
Surveillance Systems
NORS
CDC launched the National Outbreak Reporting System (NORS) in 2009. NORS is a web-based platform to collect information on outbreaks of diseases transmitted via water, food and contact with person, animals and environmental surfaces, or other unknown ways. Public health agencies are to report all gastroenteritis outbreaks, including those mediated by norovirus, through this web-based platform. This system gives us a clear perspective of the most commune geographical sites, routes of virus transmission and specific food or water sources involved. Subsequently, this aids to identify and develop the best strategies to prevent spread of the virus and occurrence of an outbreak.[4][5]
CaliciNet
The CDC developed CaliciNet in 2009. It is a network of public health and food regulatory laboratories that submit norovirus sequences identified from outbreaks into a national database. The information is used to link norovirus outbreaks that may be caused by common sources (such as food), monitor trends, and identify emerging norovirus strains. As of February 2012, public health laboratories in 25 states have been certified by the CDC to participate in CaliciNet. States that are not yet certified may contribute through designated CaliciNet outbreak support centers, including the the CDC.[6]
Other Surveillance Systems
The CDC is using the New Vaccine Surveillance Network (NVSN) and the Fooborne Diseases Active Surveillance Network (FoodNet) to perform norovirus testing on patients with gastroenteritis. This will help generate new estimates of norovirus illness and monitor trends over time.[7]
Responding to Norovirus Outbreaks
Prompt response, investigation, and reporting of norovirus outbreaks are critical for identifying causes of outbreaks and the primary mechanisms by which the virus spreads. Collection of appropriate specimens also depends on a rapid response.
Typical Responsibilities During an Outbreak
- State, Local, and Territorial Health Departments: They are the leading agencies of the norovirus outbreaks who investigate the outbreak by interviewing patients, collecting stool specimens, and performing diagnostic testing.
- Food Regulatory Agencies: They consisted of the FDA, USDA, and State Authorities. When there an association between food contamination and the illnesses are found these agencies become involved. They perform food testing for specific foods, such as shellfish and coordinate recalls of foods involved in outbreaks.
- The CDC: The CDC's responsibility during outbreaks is to coordinate multi-state outbreak investigations, provide epidemiologic consultation and tools and test specimens and provide other laboratory support.
Using Kaplan Criteria for Suspected Norovirus Outbreaks
When it is not possible to get laboratory confirmation of norovirus, health departments can use Kaplan Criteria to determine if the outbreak was likely caused by norovirus.
The Kaplan Criteria are:
- A mean (or median) illness duration of 12 to 60 hours
- A mean (or median) incubation period of 24 to 48 hours
- More than 50% of people with vomiting
- No bacterial agent found.
When all four criteria are present, it is very likely that the outbreak was caused by norovirus. However, about 30% of norovirus outbreaks do not meet these criteria. If the criteria are not met, it does not mean that outbreak was not caused by norovirus.[8]
Outbreak on Cruises
Recommendations for Cruise Staff Members
- Implement additional disinfection measures and cleaning procedures.
- Advise passengers and crew who are ill to stay in their cabins until they are well for 24 hours after their last episode of diarrhea or vomiting.
- Report numbers of cases of illness to CDC on a daily basis.
- Discontinue certain high-risk activities during a cruise.[9][10]
Role of Vessel Sanitation Program
VSP monitors and evaluates GI illnesses aboard ships to determine the cause of the outbreaks and to make recommendations for control. It takes following steps to accomplish the goal.
- Estimates the magnitude of GI illnesses among passengers and crew.
- Monitors the spread and distribution of GI illnesses among both passengers and crew members.
- Assists in assessment of changes in sanitation practices, infectious agents, and types of diseases.
- Evaluates the effectiveness of prevention and control strategies.
- Provides lab support to confirm the cause of the illness.[11]
References
- ↑ https://www.cdc.gov/norovirus/reporting/index.html
- ↑ https://www.cdc.gov/norovirus/reporting/index.html
- ↑ https://www.cdc.gov/norovirus/trends-outbreaks/responding.html#:~:text=An%20outbreak%20of%20norovirus%20is,to%20be%20caused%20by%20norovirus.
- ↑ https://www.cdc.gov/norovirus/reporting/index.html#:~:text=Public%20health%20agencies%20can%20report,make%20data%20easy%20to%20visualize.
- ↑ https://www.cdc.gov/media/releases/2014/p0603-norovirus.html
- ↑ https://www.cdc.gov/norovirus/reporting/calicinet/index.html
- ↑ https://www.cdc.gov/norovirus/reporting/index.html
- ↑ https://www.cdc.gov/norovirus/trends-outbreaks/responding.html
- ↑ Isakbaeva ET, Widdowson MA, Beard RS, Bulens SN, Mullins J, Monroe SS; et al. (2005). "Norovirus transmission on cruise ship". Emerg Infect Dis. 11 (1): 154–8. doi:10.3201/eid1101.040434. PMC 3294347. PMID 15705344.
- ↑ https://www.cdc.gov/nceh/vsp/pub/healthycruising/tips.htm
- ↑ https://www.cdc.gov/nceh/vsp/desc/aboutvsp.htm