Norovirus increasing

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Norovirus cases appear to be increasing -- and not just on cruise shipsBY MARTHA BRANNIGAN

mbrannigan@MiamiHerald.com

 

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Cruise ships are getting a tidal wave of bad publicity from Norovirus -- including back-to-back outbreaks on voyages of Royal Caribbean's Freedom of the Seas, the world's largest cruise ship.

 

Drowned out amid the recent spate of outbreaks is that the nasty stomach bug is hitting hard on land these days, too. It's probably on a doorknob or handrail near you.

 

Five nursing homes in Miami-Dade have had bouts of Norovirus since the end of October, according to the Miami-Dade County Health Department. Juan Suarez, a regional environmental epidemiologist at the agency, estimates that an average of 20 to 30 -- ''maybe 40'' -- people at each facility took ill. Broward health officials say they have seen one suspected outbreak at a nursing home in recent weeks.

 

The Centers for Disease Control in Atlanta say the Norovirus family of viruses seems to be on the rise lately, though it has data only for cruise ships and food-borne outbreaks. Cruise ships are required to log gastrointestinal incidents, and the CDC gets involved when outbreaks strike 2 percent of the passengers or crew.

 

''Informal reports suggest there has been an increase in Norovirus outbreaks around the country,'' said Dr. Marc-Alain Widdowson, a CDC medical epidemiologist. ``It's not a cruise-ship virus. Cruise ships are just sentinels of what's happening on land.''

 

''Norovirus is the second most common illness other than the common cold,'' said Suarez. ``But it's not diagnosed very often.''

 

Most cases of non-cruise Norovirus stay under the radar since the illness doesn't have to be reported to health officials on an individual basis. Victims typically get miserably sick -- symptoms include nausea, vomiting, diarrhea, cramping and chills -- for a day or two, then recover, although the virus can kill the elderly and frail.

 

Generally, the bug gets the spotlight only when it shows up in a group setting -- such as a cruise, a nursing home, a school or a restaurant.

 

Case in point: The Dinosaur Barbeque in Syracuse, N.Y. At the popular biker bar and restaurant, some 960 patrons were hit during the busy Thanksgiving weekend. The hangout was shuttered for four days while workers gave it a thorough washing.

 

''We'll never be able to say definitively what caused it,'' said Gary Sauda, Onondaga County, N.Y., director of environmental health. ``An employee was ill the same time.''

 

Around Roanoke, Va., seven nursing homes and assisted-living centers, a doctor's office and a high school sports team have been hit in recent weeks.

 

South Dakota's state health department took the unusual step of issuing a Norovirus warning on Dec. 4. ''Since Thanksgiving, we've been seeing an increase in nursing homes in the state and outbreaks associated with parties, such as wedding parties,'' said Dr. Lon Kightlinger, the state's epidemiologist.

 

Public health officials in Oregon and California and the U.S. Food and Drug Administration are recalling certain frozen oysters shipped from Central Fisheries Co. in Korea after a batch tested positive for Norovirus.

 

''Food, water and ice are all efficient ways to get fecal material into somebody's mouth,'' said Dr. William E. Keene, an epidemiologist for the state of Oregon, which has seen a rash of Norovirus outbreaks in recent months. ''Food that gets handled but not cooked is a good source.'' Salads can be a culprit.

 

Named after Norwalk, Ohio, where the first known outbreak was documented at an elementary school in 1968, the virus is unusually hardy. It can also be spread on surfaces such as doorknobs, countertops, paper or glass, and it takes only a few viral particles to wreak havoc. It can be ingested through aerosolized vomit, too, experts say.

 

Norovirus used to be called winter vomiting disease, because it seems to favor cold weather, when people crowd indoors.

 

''It's very common, and when you get it in a closed society like a cruise ship or a nursing home or a prison, it's very easy to spread back and forth,'' said Dr. Roberta Hammond, the state's food and waterborne diseases coordinator. ``We don't keep data just because it is so common.''

 

Hand-washing with soap and water is the best defense against contracting it from surfaces. Health officials say alcohol gels won't purge it.

 

This is a particularly active year for Norovirus aboard cruise ships. So far in 2006, the CDC has logged outbreaks of Norovirus-like illness on 33 cruises, compared with 18 cruises during all of 2005. The most recent case was reported Monday. Holland America's Zaandam, which arrived in San Diego, logged 64 passengers and four crew members with symptoms.

 

''Noroviruses love cruise ships. There's lots of available food handled by lots of people. There are tongs and ice,'' said the CDC's Widdowson.

 

After 338 passengers and 43 crew members took ill on the Nov. 26-Dec. 3 voyage of Freedom of the Seas, Royal Caribbean scrubbed the ship. CDC experts boarded Dec. 3 to conduct an epidemiological and environmental health investigation of the outbreak.

 

Yet on her next voyage, some 97 of 3,907 passengers and 11 of 1,400 crew showed gastrointestinal symptoms matching Norovirus. Another ship, Princess Cruises' Sun Princess, which arrived in Port Everglades Sunday, logged 119 cases of Norovirus.

 

Now the Freedom of the Seas is taking extra precautions. At the urging of the CDC, the ship's voyage was delayed two days until today so an extra team of cleaners could disinfect the ship.

 

Health officials say the key is keeping sick people isolated from others, and most importantly, away from food and beverages others will eat.

 

Screening passengers remains a tough problem. ''In some cases, cruise ships are asking passengers [boarding ships] if they've been sick in the last three days, so they're trying,'' said David Forney, chief of CDC's vessel sanitation program. ``But people plan cruises months in advance. If they have diarrhea two days before, guess what? They're going to go anyway. Especially if they're coming from Milwaukee with 10 inches of snow.''

 

Michael Sheehan, a spokesman for Royal Caribbean, said passengers who get Norovirus during a cruise get credits for days spent isolated in cabins. Medical consultation is free in cases of Norovirus.

 

Passengers who call ahead to cancel claiming the sickness are handled on a ''case-by-case basis,'' Sheehan said.

 

Jennifer de la Cruz, a spokeswoman for Carnival Cruise Lines, which saw a big outbreak of the bug in November on a transatlantic crossing of the Liberty, said if a passenger cancels citing Norovirus-like symptoms, the line will credit toward a future cruise with medical documentation.

 

And if a passenger shows up at port ready to embark on a cruise and admits being ill, she said, ``We'll give them full credit for a future cruise, so there's no downside.''