Health Advisory
GASTROINTESTINAL ILLNESS AMONG RESIDENTS OF LONG TERM CARE FACILITIES

Background

Delaware Division of Public Health (DPH) would like to alert the medical community about an increase in gastrointestinal illnesses noted in long term care facilities in Delaware. Gastrointestinal illness usually increases during the winter months. Investigation has determined that the length of illness has been relatively short at (24-48 hours) and involves nausea, vomiting and diarrhea which could indicate a viral pathogen. DPH has received reports from two facilities. These reports are being investigated and infection control recommendations have been provided to each facility.

Laboratory Findings

Norovirus has been detected from specimens submitted to the DPH Laboratory (DPHL) from both of the facilities involved.

Transmission

Norovirus is transmitted by the fecal-oral route. Contact or airborne transmission from fomites has been suggested to explain the rapid spread in hospital settings. Persons are considered communicable during the acute stage of disease and up to 48 hours after cessation of diarrhea. Community outbreaks have been caused by food and water vehicles. Secondary transmission among close contacts is common. The incubation period is between 24 to 48 hours (median in outbreaks 33 to 36), but some cases can occur within 12 hours of exposure.

DPH Recommended Infection Control Measures

• Increase handwashing and use of alcohol based sanitizers among patients, staff and visitors
• Strict contact precautions
• Increase terminal cleaning throughout the facility
• Consider cancelling group activities and communal dining
• Cancel outside appointments when possible
• Restrict residents to units - if possible cohort ill residents
• If possible, do not have patient care givers float from unit to unit
• Meal service utilizing disposable products - residents to eat in rooms
• Consider cancelling visitation (except for humanitarian circumstances)
• Increase surveillance for ill patient care givers and/or food service workers and have a low threshold for excluding ill employees
• Collect stools for testing (see below for Norovirus testing at the Division of Public Health Laboratory)
• Maintain recommendations until 2 full incubations periods have passed without any new cases (generally 4 days)

DPH Bureau of Epidemiology provides recommendations on an individual basis based upon each facility’s special needs or situation. For more information on Norovirus, please visit the CDC website at: http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus.htm

Laboratory Testing

The DPH Laboratory has the capability to test for Norovirus and other viral pathogens. Arrangements for laboratory testing must be made through DPH Bureau of Epidemiology.

For More Information

For further information, contact DPH, Bureau of Epidemiology at 302-744-4541 or 1-888-295-5156 to report possible clusters and seek guidance with infection control recommendations, to arrange for laboratory testing, or to ask questions.