Hostname: page-component-f554764f5-nt87m Total loading time: 0 Render date: 2025-04-12T10:24:45.609Z Has data issue: false hasContentIssue false
  • English
  • Français

A Norovirus Outbreak at a Long-Term-Care Facility: The Role of Environmental Surface Contamination

Published online by Cambridge University Press:  21 June 2016

Henry M. Wu ,
Mary Fornek ,
Kellogg J. Schwab ,
Amy R. Chapin ,
Kristen Gibson ,
Edna Schwab ,
Charles Spencer  and
Kelly Henning
Henry M. Wu*
Affiliation:
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Mary Fornek
Affiliation:
Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
Kellogg J. Schwab
Affiliation:
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Amy R. Chapin
Affiliation:
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Kristen Gibson
Affiliation:
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Edna Schwab
Affiliation:
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
Charles Spencer
Affiliation:
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
Kelly Henning
Affiliation:
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
*
Drexel University College of Medicine, Mailstop 461, 245 N. 15th St., Philadelphia, PA 19102[email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

The role of environmental surface contamination in the propagation of norovirus outbreaks is unclear. An outbreak of acute gastroenteritis was reported among residents of a 240-bed veterans long-term-care facility.

Objectives:

To identify the likely mode of transmission, to characterize risk factors for illness, and to evaluate for environmental contamination in this norovirus outbreak.

Methods:

An outbreak investigation was conducted to identify risk factors for illness among residents and employees. Stool and vomitus samples were tested for norovirus by reverse transcription polymerase chain reaction (RT-PCR). Fourteen days after outbreak detection, ongoing cases among the residents prompted environmental surface testing for norovirus by RT-PCR.

Results:

One hundred twenty-seven (52%) of 246 residents and 84 (46%) of 181 surveyed employees had gastroenteritis. Case-residents did not differ from non-case-residents by comorbidities, diet, room type, or level of mobility. Index cases were among the nursing staff. Eight of 11 resident stool or vomitus samples tested positive for genogroup II norovirus. The all-cause mortality rate during the month of the outbreak peak was significantly higher than the expected rate. Environmental surface swabs from case-resident rooms, a dining room table, and an elevator button used only by employees were positive for norovirus. Environmental and clinical norovirus sequences were identical.

Conclusion:

Extensive contamination of environmental surfaces may play a role in prolonged norovirus outbreaks and should be addressed in control interventions.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 10 , October 2005 , pp. 802 - 810
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1.Green, KY, Belliot, G, Taylor, JL, et al.A predominant role for Norwalk-like viruses as agents of epidemic gastroenteritis in Maryland nursing homes for the elderly. J Infect Dis 2002;185:133–146.CrossRefGoogle ScholarPubMed
2.Green, KY, Ando, T, Balayan, MS, et al.Taxonomy of the caliciviruses. J Infect Dis 2000;181(suppl 2):S322–S330.Google Scholar
3.Schwab, KJ, Estes, MK, Atmar, RL. Norwalk and other human caliciviruses: molecular characterization, epidemiology and pathogenesis. In: Cary, JW, Linz, JE, Bhatnager, D, eds. Microbial Foodborne Diseases: Mechanisms of Pathogenicity and Toxin-Synthesis. Lancaster, PA: Tech-nomic Publishing; 2000:460–493.Google Scholar
4.Keswick, BH, Satterwhite, TK, Johnson, PC, et al.Inactivation of Norwalk virus in drinking water by chlorine. Appi Environ Microbiol 1985;50:261–264.Google Scholar
5.Anonymous. Outbreaks of gastroenteritis associated with noroviruses on cruise ships: United States, 2002. MMWR 2002;51:1112–1115.Google Scholar
6.Love, SS, Jiang, X, Barrett, E, Farkas, T, Kelly, S. A large hotel outbreak of Norwalk-like virus gastroenteritis among three groups of guests and hotel employees in Virginia. Epidemiol Infect 2002;129:127–132.Google Scholar
7.Cheesbrough, JS, Green, J, Gallimore, CI, Wright, PA, Brown, DW. Widespread environmental contamination with Norwalk-like viruses (NLV) detected in a prolonged hotel outbreak of gastroenteritis. Epidemiol Infect 2000;125:93–98.Google Scholar
8.Kuusi, M, Nuorti, JP, Maunula, L, et al.A prolonged outbreak of Norwalk-like calicivirus (NLV) gastroenteritis in a rehabilitation centre due to environmental contamination. Epidemiol Infect 2002;129:133–138.CrossRefGoogle Scholar
9.Marks, PJ, Vipond, IB, Carlisle, D, Deakin, D, Fey, RE, Caul, EO. Evidence for airborne transmission of Norwalk-like virus (NLV) in a hotel restaurant. Epidemiol Infect 2000;124:481–487.Google Scholar
10.Evans, MR, Meldrum, R, Lane, W, et al.An outbreak of viral gastroenteritis following environmental contamination at a concert hall. Epidemiol Infect 2002;129:355–360.Google Scholar
11.Chadwick, PR, McCann, R. Transmission of a small round structured virus by vomiting during a hospital outbreak of gastroenteritis. J Hosp Infect 1994;26:251–259.CrossRefGoogle ScholarPubMed
12.Green, J, Wright, PA, Gallimore, CI, Mitchell, O, Morgan-Capner, P, Brown, DW. The role of environmental contamination with small round structured viruses in a hospital outbreak investigated by re-verse-transcriptase polymerase chain reaction assay. J Hosp Infect 1998;39:39–45.Google Scholar
13.Khanna, N, Goldenberger, D, Graber, P, Battegay, M, Widmer, AF. Gastroenteritis outbreak with norovirus in a Swiss university hospital with a newly identified virus strain. J Hosp Infect 2003;55:131–136.CrossRefGoogle Scholar
14.Anonymous. Norovirus activity: United States, 2002. MMWR 2003;52:41–45.Google Scholar
15.Milazzo, A, Tribe, IG, Ratcliff, R, Doherty, C, Higgins, G, Givney, R. A large, prolonged outbreak of human calicivirus infection linked to an aged-care facility. Commun Dis Intell 2002;26:261–264.Google Scholar
16.Marx, A, Shay, DK, Noel, JS, et al.An outbreak of acute gastroenteritis in a geriatric long-term-care facility: combined application of epidemiological and molecular diagnostic methods. Infect Control Hosp Epidemiol 1999;20:306–311.Google Scholar
17.Rodriguez, EM, Parrott, C, Rolka, H, Monroe, SS, Dwyer, DM. An outbreak of viral gastroenteritis in a nursing home: importance of excluding ill employees. Infect Control Hosp Epidemiol 1996;17:587–592.CrossRefGoogle Scholar
18.Lew, JF, Glass, RI, Gangarosa, RE, Cohen, IP, Bern, C, Moe, CL. Diarrheal deaths in the United States, 1979 through 1987: a special problem for the elderly. JAMA 1991;265:3280–3284.Google Scholar
19.Gangarosa, RE, Glass, RI, Lew, JF, Boring, JR. Hospitalizations involving gastroenteritis in the United States, 1985: the special burden of the disease among the elderly. Am J Epidemiol 1992;135:281–290.Google Scholar
20.Kaplan, JE, Schonberger, LB, Varano, G, Jackman, N, Bied, J, Gary, GW. An outbreak of acute nonbacterial gastroenteritis in a nursing home: demonstration of person-to-person transmission by temporal clustering of cases. Am J Epidemiol 1982;116:940–948.Google Scholar
21.Schwab, KJ, Estes, MK, Neill, FH, Atmar, RL. Use of heat release and an internal RNA standard control in reverse transcription-PCR detection of Norwalk virus from stool samples. J Clin Microbiol 1997;35:511–514.Google Scholar
22.Chapin, AR, Carpenter, CM, Dudley, WC, et al.Prevalence of norovirus among visitors from the United States to Mexico and Guatemala who experience traveler's diarrhea. J Clin Microbiol 2005;43:1112–1117.CrossRefGoogle ScholarPubMed
23.Sambrook, J, Russell, DW. Appendix 8: commonly used techniques in molecular cloning. In: Argentine, J, ed. Molecular Cloning: A Laboratory Manual, ed. 3. Cold Spring Harbor, NY: Cold Spring Harbor Laboratory Press; 2001:A8.1–A8.55.Google Scholar
24.Gulati, BR, Allwood, PB, Hedberg, CW, Goyal, SM. Efficacy of commonly used disinfectants for the inactivation of calicivirus on strawberry, lettuce, and a food-contact surface. J Food Prot 2001;64:1430–1434.CrossRefGoogle Scholar
25.Anonymous. Influenza Virus Surveillance: Philadelphia Department of Public Health, Division of Disease Control; March 3,2005. Philadelphia: Philadelphia Department of Public Health, Division of Disease Control; 2005.Google Scholar
26.Patterson, W, Haswell, P, Fryers, PT, Green, J. Outbreak of small round structured virus gastroenteritis arose after kitchen assistant vomited. Commun Dis Rep CDR Rev 1997;7:R101–R103.Google Scholar
27.Cheesbrough, JS, Barkess-Jones, L, Brown, DW. Possible prolonged environmental survival of small round structured viruses. J Hosp Infect 1997;35:325–326.Google Scholar
28.Ho, MS, Glass, RI, Monroe, SS, et al.Viral gastroenteritis aboard a cruise ship. Lancet 1989;2:961–965.Google Scholar
29.Jiang, X, Wang, J, Graham, DY, Estes, MKDetection of Norwalk virus in stool by polymerase chain reaction. J Clin Microbiol 1992;30:2529–2534.CrossRefGoogle ScholarPubMed
30.Wyn-Jones, AP, Pallin, R, Dedoussis, C, Shore, J, Sellwood, J. The detection of small round-structured viruses in water and environmental materials. J Virol Methods 2000;87:99–107.Google Scholar
31.Shieh, Y, Monroe, SS, Fankhauser, RL, Langlois, GW, Burkhardt, W 3rd, Baric, RS. Detection of norwalk-like virus in shellfish implicated in illness. J Infect Dis 2000;181 (suppl 2) :S360–S366.Google Scholar
32.Schwab, KJ, Neill, FH, Fankhauser, RL, et al.Development of methods to detect “Norwalk-like viruses” (NLVs) and hepatitis A virus in delicatessen foods: application to a food-borne NLV outbreak. Appi Environ Microbiol 2000;66:213–218.Google Scholar
33.Brown, CM, Cann, JW, Simons, G, et al.Outbreak of Norwalk virus in a Caribbean island resort: application of molecular diagnostics to ascertain the vehicle of infection. Epidemiol Infect 2001;126:425–432.CrossRefGoogle Scholar
34.Hoebe, CJ, Vennema, H, Husman, AM, van Duynhoven, YT. Norovirus outbreak among primary schoolchildren who had played in a recreational water fountain. J Infect Dis 2004;189:699–705.Google Scholar
35.Taku, A, Gulati, BR, Allwood, PB, Palazzi, K, Hedberg, CW, Goyal, SM. Concentration and detection of caliciviruses from food contact surfaces. J Food Prot 2002;65:999–1004.Google Scholar
36.Barker, J, Vipond, IB, Bloomfield, SF. Effects of cleaning and disinfection in reducing the spread of norovirus contamination via environmental surfaces. J Hosp Infect 2004;58:42–49.CrossRefGoogle ScholarPubMed
37.Thornton, S, Davies, D, Chapman, F, et al.Detection of Norwalk-like virus infection aboard two U.S. Navy ships. Mil Med 2002;167:826–830.Google Scholar
38.Vipond, IB, Barker, J, Bloomfield, SF, Caul, EO. Molecular epidemiology for detecting Norwalk-like viruses in clinical cases and associated environment contamination. J Hosp Infect 2002;50:237–238.CrossRefGoogle ScholarPubMed
39.Okhuysen, PC, Jiang, X, Ye, L, Johnson, PC, Estes, MK. Viral shedding and fecal IgA response after Norwalk virus infection. J Infect Dis 1995;171:566–569.Google Scholar
40.Sattar, SA. Microbicides and the environmental control of nosocomial viral infections. J Hosp Infect 2004;56(suppl 2):S64–S69.CrossRefGoogle Scholar