Blaming consumers: Cruise ship edition

Jim Walker of Cruise Law News writes the Centers for Disease Control (CDC) reports that there was a gastrointestinal outbreak on the Crown Princess during its recent cruise, from October 25th to November 8, 2017. The Princess cruise ship departed Quebec, Canada on October 25th for a two-week cruise to Canadian and U.S. ports. The cruise ship arrived in Fort Lauderdale, Florida on November 8th and will begin its Caribbean season.

According to the CDC report, 184 passengers and 12 crew members became ill with gastro-like symptoms which included diarrhea.  

During the period from 2010 to the current date, Princess Cruises experienced the most outbreaks on its cruise ships calling on U.S. ports, according to the CDC. Princess reported twenty-one (21) cases to the CDC during this time period.

The Crown Princess alone has suffered through six (6) norovirus outbreaks since 2010 to the present. Before the current GI outbreak, the last norovirus outbreak on the Crown Princess was from January 3 – 18, 2016 and, before that, from October 18 to November 16, 2014. Earlier, there was a norovirus and e-coli outbreak from February 5 to 12, 2014. It also experienced back-to-back norovirus outbreaks from January 29 to February 4, 2012 and February 4 to February 9, 2012.

The cruise line with the second most outbreaks is Holland America Line with 18 cases of GI sicknesses reported to the CDC since 2010. HAL suffered norovirus outbreaks on the Nieuw Amsterdam, and two outbreaks each on the Voendam and the Noordam this year.  

So why is Princess Cruises far more prone to norovirus outbreaks than Carnival cruise lines, for example?

The cruise industry always blames the passengers for bringing the virus aboard, rather than its food handlers, or contaminated food or water. So are Princess Cruises customers the sickest and the least hygienic cruisers around? Are guests of HAL the second most unhygienic cruisers? Do they wash their hands the least of any cruisers? This seems like absurd arguments to make.

Whoever is to blame, the crew members, of course, always pay the price, by having to wipe and scrub and spray everything in sight for long 16+ hour days to try to disinfect a ship longer than three football fields.

Irrespective of the blame-game, don’t call us if you get sick on a cruise. Proving where the virus came from, or that the cruise line was negligent, is virtually impossible to prove, especially since the CDC conducts no epidemiological analysis and sometimes can’t even figure out whether the outbreak is due to norovirus, e-coli or something as exotic as Shigella sonnei or Cyclospora cayetanensis.

For example, The New Zealand Herald reports, a passenger on a cruise ship plagued with a vomiting and diarrhoea bug says he only learnt previous guests had been struck down with the same thing once they set sail.

Sydney man Walter Gibian and his wife Elisabeth left Sydney on October 30 on a 12-day Celebrity Solstice cruise travelling from Sydney to Auckland via the South Island so they could see New Zealand. Gibian had worked in New Zealand in 1980s and loved it so booked the cruise to see the East Coast.

The ship had left Melbourne when the captain announced to guests that passengers on an earlier cruise had norovirus and asked guests to take extra precautions including washing their hands regularly and using hand sanitiser.

any notification before they left and by this time it was too late to do anything about it as they were well on their way to New Zealand.

“It think people should be told and given the option that if you don’t like being exposed to this virus you are allowed to get off. But we found out when we were sea.”

Halfway into the 12-day cruise passengers started falling ill and Elisabeth came down with the bug on Saturday night. She was then isolated to her cabin for 48 hours.

“They (passengers) are sick all right. But of course the ship won’t tell us how many are sick, but my wife got sick on Saturday night. They are taking all sorts of precautions but it is still happening. They keep telling me, they are doing their utmost and they are doing their best but the fact is it is not effective.”

It was the ice: 144 students sickened in Taiwan, 2015

On 5 March 2015, Taiwan Centers for Disease Control was notified of more than 200 students with gastroenteritis at a senior high school during excursion to Kenting. We conducted an outbreak investigation to identify the causative agent and possible vehicle of the pathogen.

Methods

We conducted a retrospective cohort study by using a structured questionnaire to interview all students for consumed food items during their stay at the resort. Students were defined as a gastroenteritis case while having vomiting or diarrhea after the breakfast on 4 March. We inspected the environment to identify possible contamination route. We collected stool or vomitus samples from ill students, food handlers and environmental specimens for bacterial culture for common enteropathogens, reverse transcription polymerase chain reaction (RT-PCR) for norovirus and enzyme-linked immunosorbent assay (ELISA) for rotavirus. Norovirus PCR-positive products were then sequenced and genotyped.

Results

Of 267 students enrolled, 144 (54%) met our case definition. Regression analysis revealed elevated risk associated with iced tea, which was made from tea powder mixed with hot water and self-made ice (risk ratio 1.54, 95% confidence interval 1.22–1.98). Ice used for beverages, water before and after water filter of the ice machine and 16 stool and vomitus samples from ill students were tested positive for norovirus; Multiple genotypes were identified including GI.2, GI.4 and GII.17. GII.17 was the predominant genotype and phylogenetic analyses showed that noroviruses identified in ice, water and human samples were clustered into the same genotypes. Environmental investigation revealed the ice was made by inadequate-filtered and un-boiled water.

Conclusions

We identified the ice made by norovirus-contaminated un-boiled water caused the outbreak and the predominant genotype was GII.17. Adequately filtered or boiled water should be strongly recommended for making ice to avoid possible contamination.

Ice-associated norovirus outbreak predominantly caused by GII.17 in Taiwan, 2015

BNC Public Health, 2017, 17:870, Hao-Yuan Cheng, Min-Nan Hung, Wan-Chin Chen, Yi-Chun Lo, Ying-Shih Su, Hsin-Yi Wei, Meng-Yu Chen, Yen-Chang Tuan, Hui-Chen Lin, Hsu-Yang Lin, Tsung-Yen Liu, Yu-Ying Wang, Fang-Tzy Wu https://doi.org/10.1186/s12889-017-4869-4

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4869-4

100 sickened: Why I hate text and always told students to check e-mail: Missed e-mail leads to Norovirus outbreak

Back around 2002, when my lab and responsibilities were growing exponentially, the hardest thing to teach any new student was this: check your e-mail.

Every 5 minutes.

(It would have been every minute, but the IT nerds at the university said no one needs that, it can wait. Which is why they’re on university timelines.)

We were on-call for grocery stores, ran the national food safety hotline, and whether I was golfing or hanging with the kids, I was always accessible.

I hate text.

I hate Facebook.

Hate is a strong word, but apt in this situation.

Chapman says now, there’s a whole generation that missed e-mail.

But since I had it from the late 1980s, it was always crucial.

And still is.

Radio-Canada reports that an email miscommunication led to an outbreak of norovirus that affected more than 100 people at a long-term care facility in Rouyn-Noranda in early August.

Patients and staff at the home were served peach and raspberry compote on Aug. 2 and 4.

A few hours later, 26 people showed symptoms of gastroenteritis.

Over the next 10 days, between Aug. 4 and 14, 61 patients and 48 employees at the facility fell ill.

The Centre intégré de santé et de services sociaux (CISSS) in the Abitibi-Témiscamingue region had been notified that the raspberries were subject to a recall because they were suspected of being contaminated with norovirus.

The Canadian Food Inspection Agency emailed the facility about the recall on July 20, according to access to information requests obtained by Radio-Canada.

But that email was only sent to one person and that person didn’t relay the information to the kitchen staff.

The facility wouldn’t say why the message didn’t get to the kitchen.

The interim head of IT services for the facility, Stéphane Lachapelle, says more people have been added to its mailing list.

 

Rapid detection of human norovirus in frozen raspberries

Raspberries have lately caused several human norovirus (HuNoV) outbreaks in Europe.

In this study, we developed and evaluated for HuNoV reverse transcription (RT)-PCR detection in frozen raspberries extraction methods that have equal sensitivity but are less time-consuming than widely used methods based on polyethylene glycol (PEG) precipitation and chloroform–butanol purification.

One method was applied to stored frozen raspberries linked to previous HuNoV outbreaks and berries on sale. In the virus elution-based Method 1, sparkling water eluted viruses most efficiently from the berries. Method 2, based on direct nucleic acid extraction with minor PEG supplement, yielded the highest number of positive findings (4 out of 9) at low virus concentration level of 100 genome copies HuNoV genogroup II per 25 g raspberries. Both methods showed approximately equal sensitivity to a method including PEG precipitation and chloroform–butanol purification. Two naturally contaminated berry samples linked to HuNoV outbreaks in 2006 and 2009 were still positive for HuNoV genogroup I, but all berry products purchased from a local store remained negative for HuNoV. In conclusion, this study presents two efficient and rapid methods which can be used in urgent HuNoV outbreak investigations, since the results of the virus analysis are available in a few hours.

Norovirus at the hotel California

As I gracefully age, I realize a few truths: my brain can’t take any more hits to the head, my childhood buddy Wayne will always be a better hockey player than me, and the Eagles suck.

I had one of those grade 10 English teachers who made us analyze contemporary music lyrics as poetry so he and his beard could sleep while students offered daft analysis (and lesbian seagull played while we meditated).

Some kid did Hotel California and got an A. I did Led Zeppelin’s Kasmir because it went on forever and meant nothing.

I got a D.

Adam Racusin of 10 News reports a group of people in the health care industry are suing the world famous Hotel del Coronado.

A lawsuit filed last week claims nearly 90 people got sick after attending a dining event at the hotel.

According to the suit, several of the attendees were confirmed to have been infected with norovirus.

The suit claims “an investigation by the California Department of Public Health confirmed that the source of the norovirus outbreak was a dessert table containing food items that were prepared, served, and monitored by defendants in accordance with the contract between Defendants and Healthgrades.”

The dining event was part of a three-day symposium sponsored by Healthgrades, an online site for information about physicians and hospitals.

45 sick: Norovirus outbreak linked to Hawaiian restaurant

One of Waikiki’s newest restaurants underwent a thorough cleaning after several diners got sick.

Herringbone Waikiki voluntarily closed Thursday after a string of illnesses was traced back to the restaurant.

A sign on the door read, “Unfortunately we will not open this evening and apologize for any inconvenience.”

The Hawaii Department of Health says it’s an outbreak of norovirus, which is a foodborne illness.

So far, up to 45 people have fallen ill, and officials say that number will rise.

According to a department report posted online, on Saturday, Oct. 7, at around 11:30 a.m, “three customers ordered and shared the toss salad. All three showed symptoms of nausea, vomiting, abdominal cramps and diarrhea.”

On Monday, diners who got sick called Herringbone and the health department.

An inspector was dispatched Tuesday and observed good personal hygiene practices. No employees were sick.

Me teaching Chapman how to golf: Norovirus everywhere

The University of North Carolina-Chapel Hill Panhellenic Council has postponed sorority recruitment due to an outbreak of norovirus-like symptoms for a “significant section of the Greek community,” according to an email sent to students Thursday.

The council said it has taken the recommendation of Campus Health and the Orange County Health Department to cancel at least Thursday and Friday’s planned events.

“Please go to Campus Health immediately if you are showing any symptoms,” the Panhellenic Council said in an email.

In Australia as we welcomed the first day of spring, hundreds of people have been struck down by gastroenteritis with New South Wales Health urging affected people to stay home and follow medical advice.

There were 39 gastro outbreaks in NSW institutions between August 20 and 26, including 22 in childcare centres, 10 in aged-care homes, five in hospitals and two in schools.

NSW Health said at least 348 people were affected by the bug in these outbreaks, which is more than double the previous five-year weekly average number of outbreaks for August.

And the bug finally has a name.

Director Communicable Diseases, NSW Health, Vicky Sheppeard said it appeared the outbreaks were caused by viral gastroenteritis including rotavirus and norovirus which spread easily.

“If your work involves handling food or looking after children, the elderly or patients, do not return to work until 48 hours after symptoms have stopped.

“The best defence against gastroenteritis is to wash your hands thoroughly with soap and running water for at least 10 seconds before handling and eating food, and after using the toilet, changing nappies or assisting someone who has diarrhoea or vomiting.”

10 seconds? In the U.S. it’s 20. How can all these scientists come up with different recommendations when looking at the same data. Values. And I agree with 10.

Winter has been a bad season for gastro in Australia; 1900 people attended NSW emergency departments with the bug in early August.

Brisbane has also been affected by an outbreak, with 51 childcare centres hit in the eight weeks to August 14.

NSW Health said all children should receive the rotavirus vaccine for free as part of the National Immunisation Program.

These figure come after NSW Health data showed there were 35,670 confirmed flu cases in NSW last month, making it the worst month on record for flu cases in NSW.

University students’ hand hygiene practice during a gastrointestinal outbreak in residence: What they say they do and what they actually do
01.sep.09
Journal of Environmental Health Sept. issue 72(2): 24-28
Brae V. Surgeoner, MS, Benjamin J. Chapman, PhD, and Douglas A. Powell, PhD
http://www.neha.org/JEH/2009_abstracts.htm#University_Students%92_Hand_Hygiene_Practice_During_a_Gastrointestinal_Outbreak_in_Residence:_What_They_Say_They_DO_and_What_They_Actually_Do 
Abstract
Published research on outbreaks of gastrointestinal illness has focused primarily on the results of epidemiological and clinical data collected postoutbreak; little research has been done on actual preventative practices during an outbreak.

In this study, the authors observed student compliance with hand hygiene recommendations at the height of a suspected norovirus outbreak in a university residence in Ontario, Canada. Data on observed practices was compared to post-outbreak self-report surveys administered to students to examine their beliefs and perceptions about hand hygiene. Observed compliance with prescribed hand hygiene recommendations occurred 17.4% of the time.

Despite knowledge of hand hygiene protocols and low compliance, 83.0% of students indicated that they practiced correct hand hygiene during the outbreak. To proactively prepare for future outbreaks, a current and thorough crisis communications and management strategy, targeted at a university student audience and supplemented with proper hand washing tools, should be enacted by residence administration.

 

Sick food handlers are a food safety risk

A while back I was awarded a contract to teach food safety in correctional institutions. I clearly remember an incident when I was talking about not going to work when you are ill as this poses a food safety risk and I went to explain why. Then this massive looking dude about the size of Terry Crews jumps out of his seat yelling at me. Apparently he had worked in the food service industry and had to support a family of five without having any sick time. So, when he was sick he went to work. Thereafter it was blur as 5 correctional officers jumped in the room to detain my friend as I soiled myself from fear…

Heather Williams writes

We put a lot of trust in the people who prepare and serve our food. We expect that our food is safe to eat and handled appropriately. In the United States, we have standards for food safety and many regulations in place. Why wouldn’t we trust those who prepare and serve our food? Unfortunately, a significant number of food workers have admitted to working while knowingly being sick. There are many reasons someone might do this. Some do it for financial reasons, others for sense of duty, and then there are some who fear they may lose their job if they do not cover their shift. Could foodborne illness cases dramatically decrease if food workers could have sick leave, which would allow them monetary compensation for identifying their illness and not passing it on to other unsuspecting patrons? Let’s explore this.
Restaurants Are a Primary Source of Foodborne Outbreaks
According to the Center for Disease Control and Prevention (CDC), an estimated 48 million people become ill in the United States each year from foodborne infection. Approximately 128,000 are hospitalized and foodborne illness claims about 3,000 lives each year. Over half of all foodborne outbreaks reported to the CDC can be linked back to eating in restaurants or delicatessens.
In one study, a group of investigators gathered data from FoodNet. This resource is also known as the Foodborne Diseases Active Surveillance Network, a central database where participating sites report information regarding foodborne illness. In a study analyzing 457 foodborne disease outbreaks, 300 were restaurant related. 98% of the 300 had only one contributing factor causing the outbreak. The most common contributing factor resulting in 137 outbreaks was “handling by an infected person or carrier of pathogen.” This is a significant number considering one lapse can have such high statistical repercussions.
The purpose of the study was to identify the contributing factors in restaurant-linked foodborne disease outbreaks. 75% of the outbreaks investigated were linked to Norovirus and Salmonella. These infections were predominately linked back to transmission by food workers. Significant resources are devoted to preventing contamination of food products before they make it to the point of service. Restaurants must ensure that staff have adequate training and understanding for how to handle the food once it becomes in their custody. Food worker health and hygiene were primary factors in contributing to foodborne illness.

The rest of the story can be found be here:

http://www.unsafefoods.com/2017/08/29/sick-leave-reduce-foodborne-illness/

 

Norovirus…again

I have never been on a cruise ship; just the thought of masses of people in close quarters on open water makes me want to barf. Large norovirus outbreaks are associated with settings where people live in close quarters and can easily infect each other, such as cruise ships, dormitories, and hospitals. Contaminated food, water, an infected person are all potential sources of norovirus. Viral contamination of environmental surfaces (fomites) may persist during and after outbreaks and contribute to further illnesses. The source of the Sun princess cruise ship outbreak is currently unknown. 

A norovirus outbreak has struck at least 91 passengers on a Sun Princess cruise ship.
The affected people were treated for gastro after the ship docked in Brisbane on Thursday morning.
A Queensland Health spokesman told Daily Mail Australia: ‘Metro North Public Health Unit is aware of at least 91 cases of gastro on board a cruise ship that berthed in Brisbane this morning.
‘We have been advised that on-board testing has found norovirus to be the cause of the illness.’
It comes after 140 passengers came down with gastro in February after a Sun Princess cruise returned from a 14-day trip around New Zealand.
A fortnight before that, there was another outbreak on the vessel during a previous cruise.

Norovirus, you don’t want it

Norovirus, one of the leading causes of acute gastroenteritis, is highly contagious and attempts to mitigate the bug can be extremely difficult. Moreover, trying to investigate the source of a norovirus outbreak can be frustrating and laborious for public health types.

I can still recall the pain I exhibited when I was infected with norovirus in Mexico, projectile vomiting, diarrhea, and horrible stomach cramps. Being religious, I think I recited the rosary 16 times for the pain to stop.…..then the week after, bit by 2 wild dogs on the resort….nice trip. 

A quickly spreading norovirus outbreak that’s sickened more than 200 people kept a Maumee doughnut shop closed for the third day in a row Thursday.
Initial investigations show patients had similar symptoms and had eaten food from Mama C’s Donuts at 924 Conant St. Illnesses were tracked to patrons who ate there Friday through Monday.
Health officials said at least 214 cases were reported in Lucas County, and Wood County officials said they are investigating if about a dozen norovirus cases were caused by doughnuts the store provides to businesses there.
Toledo-Lucas County Health Department spokesman Shannon Lands said Mama C’s voluntarily closed for cleaning on Tuesday. It was expected to remain closed Thursday.
Many Toledo area residents had stories of how they or family members were affected.
John Pointer of Port Huron, Mich., was one of the lucky ones.
He said he left his granddaughter’s 8th birthday party in Perrysburg before the doughnut cake was served, and so avoided the illness. Fifteen party guests, including the birthday girl, weren’t so lucky, he said.
“Everybody at the party got sick,” he said.
Delray Busch’s 3-year-old daughter Corrigan started vomiting around 12:45 a.m. Tuesday after eating a doughnut Sunday. Corrigan was feeling much better Wednesday, Ms. Busch said, adding she was thankful that the illness was brief and her 2-month-old didn’t show signs of catching it.
The South Toledo resident said she’s been eating at Mama C’s for two years and will be back.
“They are great to our community,” she said. “I will absolutely keep supporting our small businesses.”
A Wood County Health Department spokesman said that the department had confirmed that Grounds for Thought in Bowling Green sells Mama C’s products, and that the department on Wednesday was trying to determine if any other businesses are supplied by the store.
“All of those doughnuts have been taken off the shelf,” said Alex Aspacher, spokesman for the department.
Symptoms of norovirus include vomiting, diarrhea, stomach pain, fever, and body aches.