Health Alert
INCREASING CLUSTERS OF NOROVIRUS CASES

The Delaware Division of Public Health (DPH) is issuing this health alert to provide healthcare providers with information regarding an increase in clusters of norovirus cases, recommendations for infection control at healthcare facilities (both acute and long-term care), and guidance for testing patients with gastroenteritis.

Summary

Over the past few weeks, DPH has received reports of gastroenteritis clusters from several healthcare facilities in Delaware. Norovirus outbreaks in acute or long-term care settings can be prolonged; sometimes lasting months. Strict control measures (including isolation of symptomatic patients, discouraging visitation, exclusion of affected staff, and restricting new admissions into affected units) are disruptive and costly but are often required to curtail outbreaks.

Background

According to the Centers for Disease Control and Prevention (CDC), healthcare facilities, including nursing homes and hospitals, are the most commonly reported settings for norovirus outbreaks in the United States (US). Approximately 59% of norovirus outbreaks in the US have occurred in long-term care facilities and 4% in hospitals. Noroviruses are a group of viruses that cause gastroenteritis marked by an acute onset of severe vomiting, watery diarrhea, and nausea, which occurs 12 to 48 hours after exposure to the virus and lasts 24 to 72 hours after onset of symptoms. Noroviruses spread very rapidly and are highly contagious. Young children, the elderly, and people with other medical conditions are at highest risk for severe or prolonged infection. Norovirus illness often occurs during the winter months. Shedding of the virus (peak: 2-5 days after onset) occurs primarily in stool but also in vomitus and is transmitted by contaminated food/water, person-to-person, fomites, and aerosols (from vomiting). There is no specific therapy for norovirus infections available except for supportive care.

Healthcare facilities (including long-term care facilities and acute care hospitals) and other institutional settings such as daycares and schools are particularly at risk for outbreaks because of increased person-to-person contact.

Infection Control Recommendations

Specific infection control recommendations for acute care and long-term care facilities are available at: http://www.dhss.delaware.gov/dhss/dph/epi/files/norovirusguidelines.pdf

Laboratory Testing

For any patient in a sensitive situation (works in or is in a hospital, long-term care facility, food establishment, daycare, or school where the organism can be readily spread) with signs and symptoms of gastroenteritis, healthcare providers are strongly encouraged to order:

• Norovirus PCR testing &
• Stool culture (for identification of bacterial pathogens)

Reporting

Notify DPH, Bureau of Epidemiology (24/7) of any gastroenteritis clusters at 1-888-295-5156. DPH will coordinate specimen testing for norovirus and other enteric pathogens with the Delaware Public Health Laboratory (http://dhss.delaware.gov/dph/lab/labs.html).

Additional Information

• CDC info: http://www.cdc.gov/norovirus/index.html; http://www.cdc.gov/features/dsnorovirus/
• Norovirus information for healthcare providers: http://www.cdc.gov/norovirus/hcp/index.html
• DPH Norovirus FAQ: http://www.dhss.delaware.gov/dhss/dph/files/norwalkfaq.pdf
• Delaware Division of Public Health, Bureau of Epidemiology (24/7): 1-888-295-5156
• Delaware Public Health Laboratory: 302-223-1520

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