Norovirus - USA: (OR, WA) reusable bag link

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Interesting. 


--- On Thu, 5/10/12, ProMED-mail <promed@promed.isid.harvard.edu> wrote:

From: ProMED-mail <promed@promed.isid.harvard.edu>
Subject: PRO/EDR> Norovirus - USA: (OR, WA) reusable bag link
To: promed-edr@promedmail.org
Date: Thursday, May 10, 2012, 12:59 PM

NOROVIRUS - USA: (OREGON, WASHINGTON) REUSABLE BAG LINK
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A ProMED-mail post
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Date: Wed 9 May 2012
Source: CIDRAP (Center for Infectious Disease Research & Policy) News
[summ., edited]
<http://www.cidrap.umn.edu/cidrap/content/fs/food-disease/news/may0912noro.html>


Reusable grocery bag fingered in norovirus outbreak
---------------------------------------------------
The role of fomites in norovirus outbreaks has been difficult to pin
down, but Oregon health officials today [9 May 2012] described how a
reusable grocery bag left in a bathroom where a patient was sick
spread the virus to members of a girls' soccer team and their
chaperones. The outbreak came to the attention of the Oregon Public
Health Division when they learned that a group of girls and their
chaperones got sick after participating in a soccer tournament in King
County, Washington state. Officials noted that the outbreak was
unusual, because the index patient had no contact with her teammates
after she got sick, and the public health investigation didn't find
links to other illnesses at the team's hotel, the tournament, or the
restaurants where they had dined [see: Repp KK, Keene WE: A
point-source norovirus outbreak caused by exposure to fomites. J
Infect Dis 2012; 205(11): 1639-41; available at
<http://jid.oxfordjournals.org/content/205/11/1639.full>].

The initial case-patient started feeling ill in the evening and went
to a chaperone's room, where the girl started vomiting and having
diarrhea in the bathroom after midnight. The next morning the girl was
driven home to Oregon by the chaperone, who later became ill. Neither
of the 2 had rejoined the group the following day, which was Sunday.
Other group members, however, got sick on Tuesday after they had
returned home. In total, 9 of the 21-member team delegation got sick.
During the investigation, interviews with the girls and chaperones
revealed that eating sealed packaged cookies during a Sunday lunch was
significantly associated with illness. 7 of 11 members at the lunch
got sick. The cookies and other lunch supplies had been bought in
Oregon and stored at the hotel.

Upon further questioning, group members told public health officials
that the items had been stored in a reusable open-top grocery bag that
had been stored in the hotel bathroom where the 1st girl repeatedly
vomited and had diarrhea. The girl said she never touched or handled
the grocery bag. Hours after the sick girl had departed for home, the
grocery bag was taken to another hotel room, where its contents --
packaged cookies, chips, and grapes -- were eaten for lunch. 3 stool
specimens from sick patients were positive for norovirus genotype
GII.2. Two of 10 swabs taken from the grocery bag 2 weeks after the
team meal was consumed were positive for genogroup GII norovirus,
though they were insufficient for sequencing.

Looking back at the investigation, Repp and Keene said incubation time
suggested most members of the group were exposed during the Sunday
lunch, but the 1st girl's illness was puzzling, because she didn't
have direct contact with teammates or the food after she started
vomiting and having diarrhea. "Only when we learned about the bag in
the bathroom did a coherent story emerge," they wrote. Aerosolized
virus in the hotel bathroom probably settled on the grocery bag and
its contents, and touching the bag and consuming its contents appeared
to facilitate transmission. "Incidentally, this also illustrates one
of the less obvious hazards of reusable grocery bags," the authors
noted. The event confirms the potential for aerosol contamination of
fomites in norovirus outbreaks, which has been suspected, but
difficult to prove in other outbreak settings such as cruise ships and
nursing homes, they wrote.

A take-home message from the event is, of course, not storing food in
bathrooms and where aerosol exposure may have occurred. It's important
to disinfect not only exposed surfaces, but also objects that may have
been in the area, Repp and Keene concluded.

[Byline: Lisa Schnirring]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[In an accompanying editorial to the Repp and Keene paper, AJ Hall
wrote that this report is a fascinating example of how unique
situations can lead to a norovirus outbreak. The chain of events in
this outbreak demonstrates how this tenacious virus finds a way to
move from host to host, even when those hosts have no direct contact
with one another. The report shows that not only can noroviruses be
aerosolized and dispersed onto fomites, exposure to contaminated
fomites can lead to disease. However he cautioned that such results
should be interpreted with caution, because the diagnostic procedures
detect viral RNA, which doesn't always indicate presence of infectious
virus (Hall AJ: Noroviruses: the perfect human pathogens? (Editorial)
J Infect Dis 2012; 205(11):1622-4; available at
<http://jid.oxfordjournals.org/content/205/11/1622>).

Washington and Oregon states can be seen on the HealthMap/ProMED-mail
interactive map at <http://healthmap.org/r/1hcI>. A map showing the
location of King County in Washington State can be accessed at
<http://www.countymapsofwashington.com/>. - Mod.CP]

[see also:
Norovirus - Canada: (QC) ex Cuba (HO) tourism-related
20120125.1021637
2011
----
Norovirus, strain characterisation 20110714.2134
2008
----
Norovirus, strain characterisation 20080111.0146
2007
----
Norovirus - USA (multistate): new strain 20070310.0849]
.................................................cp/mj/mpp
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