Norovirus infection secondary prevention

Revision as of 17:56, 8 December 2015 by YazanDaaboul (talk | contribs)
Jump to navigation Jump to search

Norovirus infection Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Norovirus infection from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice

History and Symptoms

Physical Examination

Laboratory Findings

Treatment

Medical Therapy

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Norovirus infection secondary prevention On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Norovirus infection secondary prevention

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Norovirus infection secondary prevention

CDC on Norovirus infection secondary prevention

Norovirus infection secondary prevention in the news

Blogs on Norovirus infection secondary prevention

Directions to Hospitals Treating Norovirus infection

Risk calculators and risk factors for Norovirus infection secondary prevention

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.

Reporting

Currently, state, local, and territorial health departments are not required 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 is usually diagnosed only when an outbreak happens.

Health care providers should report all outbreaks of acute gastroenteritis, including suspected outbreaks of norovirus, to the appropriate state, local or territorial health department.

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.

Surveillance Systems

NORS

NORS 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, through this web-based system. This information is used to determine where norovirus outbreaks commonly occur, how the virus is spread, and specific food or water sources involved. In turn, this helps with identifying the best ways to prevent and control norovirus illness and outbreaks.

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.

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.

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
  • Serve as the lead agencies in most investigations of norovirus outbreaks
  • Interview patients, collect stool specimens, and may perform diagnostic testing
Food Regulatory Agencies (FDA, USDA, and State Authorities)
  • Collaborate with health departments when a link between contaminated food and illness are identified
  • Perform food testing for specific foods, such as shellfish
  • Coordinate recalls of foods involved in outbreaks
The CDC Helps With Investigations and Control of Norovirus Outbreaks by:
  • Coordinating multi-state outbreak investigations
  • Providing epidemiologic consultation and tools
  • Testing specimens and providing 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:

  1. A mean (or median) illness duration of 12 to 60 hours
  2. A mean (or median) incubation period of 24 to 48 hours
  3. More than 50% of people with vomiting
  4. 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.

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.

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.

References


Template:WikiDoc Sources