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.

Barf spreads and why I work at home: How quickly one sick employee can infect an entire workplace

Using tracer viruses, researchers found that contamination of just a single doorknob or tabletop results in the spread of viruses throughout office buildings, hotels, and health care facilities. Within 2 to 4 hours, the virus could be detected on 40 to 60 percent of workers and visitors in the facilities and commonly touched objects, according to research presented at the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), an infectious disease meeting of the American Society for Microbiology.

phageThere is a simple solution, though, says Charles Gerba of the University of Arizona, Tucson, who presented the study.

“Using disinfecting wipes containing quaternary ammonium compounds (QUATS) registered by EPA as effective against viruses like norovirus and flu, along with hand hygiene, reduced virus spread by 80 to 99 percent,” he says.

Norovirus is the most common cause of acute gastroenteritis in the United States, according to the Centers for Disease Control and Prevention (CDC). Each year, it causes an estimated 19-21 million illnesses and contributes to 56,000-71,000 hospitalizations and 570-800 deaths. Touching surfaces or objects contaminated with norovirus then putting your fingers in your mouth is a common source of infection.

In the study, Gerba and his colleagues used bacteriophage MS-2 as a surrogate for the human Norovirus, as it is similar in shape, size and resistance to disinfectants. The phage was placed on 1 to 2 commonly touched surfaces (door knob or table top) at the beginning of the day in office buildings, conference room and a health care facility. After various periods of time (2 to 8 hours)  they sampled 60 to 100 fomites, surfaces capable of carrying infectious organisms (light switches, bed rails, table tops, countertops, push buttons, coffee pots handles, sink tap handles, door knobs, phones and computer equipment), for the phages.

norovirus“Within 2 to 4 hours between 40 to 60% of the fomites sampled were contaminated with virus,” says Gerba.

In the intervention phase cleaning personal and employees were provided with QUATS disinfectant containing wipes and instructed on proper use (use of at least once daily). The number of fomites on which virus was detected was reduced by 80% or greater and the concentration of virus reduced by 99% or more.

There are 90 different EPA-registered quat-based formulations available under 1500 different brand names that are formulated to kill Norovirus on solid surfaces. These are available as wipes or ready-to-use liquids or concentrates for use by professional maintenance teams. 

“The results shown that viral contamination of fomites in facilities occurs quickly, and that a simple intervention can greatly help to reduce exposure to viruses,” says Gerba.

“One time one of my kids came out with crap on his hands”; posting grades for fast outlet playgrounds

About once a month we take our kids to Chick-Fil-A and let them run wild in the play area. It’s a treat that keeps Jack behaving relatively well for a few hours beforehand – and Dani and I like the food there. Our kids get exposed to lots of dirty places (child care at the gym; preschool; Marbles, a kids museum with lots of hands-on stuff) and we spend a lot of time washing hands. At Chick-Fil-A, we do a bunch of handwashing after visiting the play area and before jumping into our meals. The staff also disinfects the whole room using a bunch of different sanitizers every night. Not risk elimination, but definitely reduction.

A Toronto (that’s in Canada) city councilor wants public health officers to inspect not just the kitchens and processes in food establishments, but add sanitation of playgrounds to the list as well.

The councilor, Paul Ainslie, cites an awesome example of some of the risks and challenges in an interview with the Toronto Sun.

The father of three said he’s had concerns about the cleanliness of those indoor playgrounds, often in fast-food restaurants, for a while.

“I’ve had concerns for a long time about the play tubes and kids going in and once and a while someone comes out and says a kid crapped his diaper and they go find the manager,” Ainslie said. “One time one of my kids came out with crap on his hands.
“I just became very concerned about the cleanliness of them and how they are being taken care of.”

The Ward 43, Scarborough East councillor stressed some restaurants do a great job keeping their play areas clean but not all of them.

Toronto Public Health officials said Thursday that currently there is “no legislation governing the disinfection of indoor playgrounds in eating establishments.”

The move would also have the medical officer of health to come up with a checklist for eating establishments who operate an indoor play area to ensure it is a health environment for kids.

Playgrounds, particularly outdoor ones (with sand or surface bark) have been linked to outbreaks in the past. Pathogens can stick around and persist in soil (especially something hardy like Salmonella) and on fomites like slides (norovirus).