Gastrointestinal Flu: Norovirus in Health Care and Long-Term Care Facilities

Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 10/2008; 47(9):1202-8. DOI: 10.1086/592299
Source: PubMed


Noroviruses, recognized as the leading global cause of viral gastroenteritis and a major contributor to food-borne illness,
present a growing challenge in health care and long-term care facilities. The virus spreads easily and by multiple routes.
A visitor to a ward might initiate an outbreak by person-to-person contact, vomiting staff members or patients can disseminate
the virus by airborne means, and contaminated surfaces, such as doorknobs and computer keyboards, can sustain an epidemic.
In addition, although self-limited in healthy hosts, the virus can cause increased morbidity in more-vulnerable people. The
GII.4 strain of the virus now dominates in multiple recent worldwide epidemics as well as in health care and long-term care
facilities. Much like the influenza virus, norovirus appears to evolve by antigenic drift and evading the immune system, causing
waves of global epidemics. Previous attempts at controlling outbreaks, both in the community and in closed facilities, provide
guidance about the vigilance and action required by the health care community to diminish the clinical impact of norovirus

Full-text preview

Available from:
  • Source
    • "Human noroviruses are the cause of 80–90% of reported outbreaks of nonbacterial gastroenteritis worldwide [1]. The viruses are transmitted mainly through the fecal-oral route, including consumption of contaminated food and water [2] [3] [4]. Yet, numerous outbreaks occurring in public settings, such as cruise ships, nursing homes, hospitals, and daycare centers, strongly indicate that food is rarely the main vehicle; rather, high persistence, infectivity, and transmissibility collectively implicate contaminated surfaces as a main reservoir for the spread of NoVs [5] [6] [7]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We evaluated the virucidal efficacy of light-activated fluorinated TiO2 surface coatings on human norovirus and several surrogates (bacteriophage MS2, feline calicivirus (FCV), and murine norovirus (MNV)). Inactivation of viruses on surfaces exposed to a common fluorescent lamp was monitored and the effects of UVA intensity, temperature, and fluoride content were assessed. Destruction of RNA and capsid oxidation were evaluated for human norovirus inocula on the F-TiO2 surfaces, while contact with the F-TiO2 surface and exposure to residual UVA radiation of 10μWcm(-2) for 60min resulted in infectivity reductions for the norovirus surrogates of 2-3 log10. Infectivity reductions on pristine TiO2 surfaces in identical conditions were over 2 orders of magnitude lower. Under realistic room lighting conditions, MS2 infectivity declined below the lower detection limit after 12h. Reductions in RNA were generally low, with the exception of GII.4, while capsid protein oxidation likely played a larger role in infectivity loss. Inactivation of norovirus surrogates occurred significantly faster on F-TiO2 compared to pristine TiO2 surfaces. The material demonstrated antiviral action against human norovirus surrogates and was shown to effectively inhibit MS2 when exposed to residual UVA present in fluorescent room lighting conditions in a laboratory setting.
    Full-text · Article · Aug 2014 · Journal of Photochemistry and Photobiology B Biology
  • Source
    • "The relative proportions of outbreak-causing pathogens identified by Rhinehart et al. are similar to our findings. Differences may be explained partly by the emergence of norovirus and C. difficile as pathogens causing HAI-outbreaks [20], [21]. Furthermore Rhinehart et al only analysed data from acute care hospitals, whereas the national mandatory HAI surveillance system in Germany includes all healthcare settings, including long-term care facilities. "
    [Show abstract] [Hide abstract]
    ABSTRACT: BackgroundIn August 2011, the German Protection against Infection Act was amended, mandating the reporting of healthcare associated infection (HAI) outbreak notifications by all healthcare workers in Germany via local public health authorities and federal states to the Robert Koch Institute (RKI).ObjectiveTo describe the reported HAI-outbreaks and the surveillance system’s structure and capabilities.MethodsInformation on each outbreak was collected using standard paper forms and notified to RKI. Notifications were screened daily and regularly analysed.ResultsBetween November 2011 and November 2012, 1,326 paper forms notified 578 HAI-outbreaks, between 7 and 116 outbreaks per month. The main causative agent was norovirus (n = 414/578; 72%). Among the 108 outbreaks caused by bacteria, the most frequent pathogens were Clostridium difficile (25%) Klebsiella spp. (19%) and Staphylococcus spp. (19%). Multidrug-resistant bacteria were responsible for 54/108 (50%) bacterial outbreaks. Hospitals were affected most frequently (485/578; 84%). Hospital outbreaks due to bacteria were mostly reported from intensive care units (ICUs) (45%), followed by internal medicine wards (16%).ConclusionThe mandatory HAI-outbreak surveillance system describes common outbreaks. Pathogens with a particular high potential to cause large or severe outbreaks may be identified, enabling us to further focus research and preventive measures. Increasing the sensitivity and reliability of the data collection further will facilitate identification of outbreaks able to increase in size and severity, and guide specific control measures to interrupt their propagation.
    Full-text · Article · May 2014 · PLoS ONE
  • Source
    • "quaternary ammonium compounds) and solvents (e.g. alcohol) (Said et al. 2008; 02/understanding-the-physiology-of-healthcare-pathogens- for-environmental-disinfection.aspx. Accessed on February 4, 2014). "
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the antiviral efficacy of oregano oil and its primary active component, carvacrol, against the nonenveloped murine norovirus (MNV), a human norovirus surrogate. Along with an observed loss in cell culture infectivity, the antiviral mechanisms of action were determined in side-by-side experiments including a cell-binding assay, an RNase I protection assay and transmission electron microscopy (TEM). Both antimicrobials produced statistically significant reductions (P ≤ 0·05) in virus infectivity within 15 min of exposure (c. 1·0-log10 ). Despite this, the MNV infectivity remained stable with increasing time exposure to oregano oil (1·07-log10 after 24 h), while carvacrol was far more effective, producing up to 3·87-log10 reductions within 1 h. Based on the RNase I protection assay, both antimicrobials appeared to act directly upon the virus capsid and subsequently the RNA. Under TEM, the capsids enlarged from ≤35 nm in diameter to up to 75 nm following treatment with oregano oil and up to 800 nm with carvacrol; with greater expansion, capsid disintegration could be observed. Virus adsorption to host cells did not appear to be affected by either antimicrobial. Our results demonstrate that carvacrol is effective in inactivating MNV within 1 h of exposure by acting directly on the viral capsid and subsequently the RNA. This study provides novel findings on the antiviral properties of oregano oil and carvacrol against MNV and demonstrates the potential of carvacrol as a natural food and surface (fomite) sanitizer to control human norovirus.
    Full-text · Article · May 2014 · Journal of Applied Microbiology
Show more