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{{Norovirus infection}} {{CMG}}
{{Norovirus infection}}  
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==Overview==
The [[CDC]] currently does not conduct active [[disease surveillance|surveillance]] to monitor [[outbreak]]s of [[gastroenteritis]] caused by [[norovirus]]es. 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==
==Secondary Prevention==
[[CDC]] currently does not conduct active [[disease surveillance|surveillance]] to monitor [[outbreak]]s of [[gastroenteritis]] caused by [[norovirus]]es. [[outbreak|Outbreaks]] are reported to CDC's Viral Gastroenteritis Section, Respiratory and Gastroenteric Viruses Branch, Division of Viral Diseases, National Center for Immunization and Respiratoiry 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.
The [[CDC]] currently does not conduct active [[disease surveillance|surveillance]] to monitor [[outbreak]]s of [[gastroenteritis]] caused by [[norovirus]]es. [[outbreak|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.<ref>https://www.cdc.gov/norovirus/reporting/index.html</ref>


===Reporting===
===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.<ref>https://www.cdc.gov/norovirus/reporting/index.html</ref>
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===
===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.<ref>https://www.cdc.gov/norovirus/trends-outbreaks/responding.html#:~:text=An%20outbreak%20of%20norovirus%20is,to%20be%20caused%20by%20norovirus.</ref>
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===
===Surveillance Systems===
====NORS====
====NORS====
 
[[Centers for Disease Control and Prevention|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.<ref>https://www.cdc.gov/norovirus/reporting/index.html#:~:text=Public%20health%20agencies%20can%20report,make%20data%20easy%20to%20visualize.</ref><ref>https://www.cdc.gov/media/releases/2014/p0603-norovirus.html</ref>
NORS was launched by CDC in 2009 to collect information on outbreaks of foodborne, waterborne, and enteric disease 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====
====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.<ref>https://www.cdc.gov/norovirus/reporting/calicinet/index.html</ref>
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 CDC.


====Other Surveillance Systems====
====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.<ref>https://www.cdc.gov/norovirus/reporting/index.html</ref>
CDC is using New Vaccine Surveillance Network (NVSN) and Fooborne Diseases Active Surveillance Network (FoodNet) to do norovirus testing on patients with gastroenteritis. This will help generate new estimates of norovirus illness and monitor trends over time.


===Responding to Norovirus Outbreaks===
===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.
Prompt response, investigation, and reporting of norovirus outbreaks are critical for identifying the cause of outbreak and the primary way the virus was spread. Collection of appropriate specimens also depends on a rapid response.


====Typical Responsibilities During an Outbreak====
====Typical Responsibilities During an Outbreak====
=====State, Local, and Territorial Health Departments=====


*Serve as the lead agencies in most investigations of norovirus outbreaks
*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]].
*Interview patients, collect stool specimens, and may perform diagnostic testing
*Food Regulatory Agencies: They consisted of the [[Food and Drug Administration|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.
=====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
 
=====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=====
=====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.
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:
The Kaplan Criteria are:


*A mean (or median) illness duration of 12 to 60 hours,
#A mean (or median) illness duration of 12 to 60 hours
*A mean (or median) incubation period of 24 to 48 hours,
#A mean (or median) [[Incubation period|incubation]] period of 24 to 48 hours
*More than 50% of people with vomiting, and
#More than 50% of people with vomiting
*No bacterial agent found.
#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.
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.<ref>https://www.cdc.gov/norovirus/trends-outbreaks/responding.html</ref>


=====Detecting Norovirus in Food, Water, and Environmental Specimens=====
==Outbreak on Cruises==
===Recommendations for Cruise Staff Members===


To recover and detect norovirus in food, laboratory methods must be adapted for each type of food. Such methods are generally available only in research and academic settings. So, no standardized, validated laboratory tests for detecting norovirus in food are available, except for shellfish.
*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.<ref name="pmid15705344">{{cite journal| author=Isakbaeva ET, Widdowson MA, Beard RS, Bulens SN, Mullins J, Monroe SS | display-authors=etal| title=Norovirus transmission on cruise ship. | journal=Emerg Infect Dis | year= 2005 | volume= 11 | issue= 1 | pages= 154-8 | pmid=15705344 | doi=10.3201/eid1101.040434 | pmc=3294347 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15705344  }} </ref><ref>https://www.cdc.gov/nceh/vsp/pub/healthycruising/tips.htm</ref>


Water can be tested for norovirus by processing large volumes of water (10-100L) through specially designed filters.
===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.  


Swabs of objects, such as doorknobs and handrails, and surfaces, such as kitchen counters, can also be tested for norovirus. However, obtaining virus from swabs is highly variable. Results should be interpreted with caution and in the context of the available epidemiologic evidence.
*Estimates the magnitude of GI illnesses among passengers and crew.
==Recommendations for Cruise Staff Members in Case of an Outbreak==
*Monitors the spread and distribution of GI illnesses among both passengers and crew members.
* Implement additional disinfection measures and cleaning procedures.
*Assists in assessment of changes in [[sanitation]] practices, infectious agents, and types of diseases.
* 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.
*Evaluates the effectiveness of [[Prevention (medical)|prevention]] and control strategies.
* Report numbers of cases of illness to CDC on a daily basis.
*Provides lab support to confirm the cause of the illness.<ref>https://www.cdc.gov/nceh/vsp/desc/aboutvsp.htm</ref>
* Discontinue certain high-risk activities during a cruise.
 
== References ==
==References==
{{Reflist|2}}
{{Reflist|2}}


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[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
 
[[Category:Needs overview]]
[[Category:Needs overview]]
[[Category:Viral diseases]]
[[Category:Viral diseases]]

Latest revision as of 18:02, 8 March 2021

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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:

  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.[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

  1. https://www.cdc.gov/norovirus/reporting/index.html
  2. https://www.cdc.gov/norovirus/reporting/index.html
  3. https://www.cdc.gov/norovirus/trends-outbreaks/responding.html#:~:text=An%20outbreak%20of%20norovirus%20is,to%20be%20caused%20by%20norovirus.
  4. https://www.cdc.gov/norovirus/reporting/index.html#:~:text=Public%20health%20agencies%20can%20report,make%20data%20easy%20to%20visualize.
  5. https://www.cdc.gov/media/releases/2014/p0603-norovirus.html
  6. https://www.cdc.gov/norovirus/reporting/calicinet/index.html
  7. https://www.cdc.gov/norovirus/reporting/index.html
  8. https://www.cdc.gov/norovirus/trends-outbreaks/responding.html
  9. 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.
  10. https://www.cdc.gov/nceh/vsp/pub/healthycruising/tips.htm
  11. https://www.cdc.gov/nceh/vsp/desc/aboutvsp.htm


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