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VOLUME 2
Norovirus Surveillance Protocol
A Norovirus outbreak is highly contagious, and poses a major threat to force readiness…2
ISSUE 2 APRIL 2010
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Ask the Doctor…
Measures to take in case of suspected Norovirus outbreaks …3
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Filth Flies: More than a nuisance?
By visiting these food sources they pick up a number of bacteria and viruses of human health concern …………3
Bug
bytes
A publication of Navy Environmental and Preventive Medicine Unit 2
W
elcome to this edition of Bug Bytes. Each time I write the forward to this newsletter it seems that a new challenge has tested the Public Health and Preventive Medicine professionals reading this publication. This edition is certainly no exception.
Helping You Promote Public Health In January the US government, working alongside allied forces and non-governmental agencies, answered the call to fulfill a humanitarian assistance and disaster response effort in Haiti following the devastating earthquake there. Within 96 hours, NEPMU-2 gathered personnel and equipment assigned to one of our Forward Deployable Preventive Medicine Teams and readied them for deployment. Their efforts and accomplishments were specifically commended in opening ceremony speeches by both RADM Cullison (Deputy Surgeon General of the Navy) and RDML Stocks (FFC Surgeon and JTF Haiti Surgeon) at the recent Navy and Marine Corps Public Health Center Conference. We join those Navy Medicine leaders in saluting the Team and other public health professionals that participated in those relief efforts. Their outstanding performance in the sustainment of the force health protection of our forces and in assisting the Haitian government with their immense recovery effort was indeed spectacular. T.L. Wagner CDR MC USN OIC NEPMU-2
HM1 (SW/AW) Ryan Predum, of Forward Deployed Preventive Medicine Unit Haiti, delivers food, toys, and smiles to children at a local orphanage in Port-Au-Prince, Haiti.
NEPMU 2 Forward Deployable Preventive Medicine Unit Excels in Haiti LT Benjamin Espinosa The NEPMU 2 Forward Deployable Preventive Medicine Unit (FDPMU) returned to Norfolk March 19 after seven weeks in Haiti supporting the disaster relief efforts of Operation Unified Response. The unit deployed to assess, prevent and control public health threats to operational forces already in place. In Haiti, potentially deadly diseases like malaria and dengue fever are ever-present, so the FDPMU started by educating the service members on the dangers they faced. “A large part of our activities included educating forces on methods of personal protection," said Lt. Anthony Hanley, FDPMU entomologist. "This training included education on proper use of DEET, mosquito netting, policing camps of trash and structures where mosquitoes can breed, and strict adherence to anti-malaria prophylaxis."
The unit's robust microbiology lab rapidly diagnosed many of the other diseases endemic to Haiti. Upon arrival, FDPMU personnel responded to a gastrointestinal disease outbreak at one of the forward operating bases in Port-au-Prince. Another accomplishment of the unit was addressing vital air and water quality issues, which helped to provide clean drinking water for the local population. The Industrial Health component also provided guidance and sampling concerning occupational health risks to ensure the safety of deployed personnel. The unit came away from the experience proud to have been a part of a humanitarian mission to a nation in desperate need of a helping hand.
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Did you know?
What is Norovirus?*
-Gastrointestinal (GI) infections
Noroviruses are a group of viruses that cause the “stomach flu,” or gastroenteritis. The average incubation period for norovirusassociated gastroenteritis is 12 to 48 hours. Illness is characterized by acute-onset vomiting, watery, non-bloody diarrhea with abdominal cramps, and nausea. Dehydration is the most common complication and may require intravenous replacement fluids. Symptoms usually persist for 24 to 60 hours.
are caused by viruses, bacteria, or parasites. -There are seven organisms that commonly cause GI and diarrhea (Norovirus, E.coli, Salmonella enteritidis, Campylobacter, Shigella, Giardia, and Cryptosporidium). -Norovirus infection is a frequent cause of severe, dehydrating diarrhea. - A patient with norovirus can infect 50-70% of all persons within 4 meter radius through aerosol droplets. - One vomit contains in excess of 30 million viral particles. Ingestion of as few as 10 and 100 viral particles may be enough to cause infection. - The main cause for all the Norovirus outbreaks is poor hygiene. - In rare cases filth fly larvae infest living human tissue, this is called facultative myiasis. - Many flies are coprophagous, meaning they feed on feces.
Consume food, water, and ice only from US-approved sources:
"Boil it, cook it, peel it, or forget it.”
Noroviruses are highly contagious, as few as 10 virus particles are sufficient to cause infection. Noroviruses are transmitted primarily through the fecal-oral route by ingesting fecally contaminated food or water. Noroviruses can also spread via a droplet route from vomitus. These viruses are relatively stable in the environment and can survive freezing and heating to 60°C (140°F). In close living conditions, transmission can additionally occur through hand transfer of the virus to the oral mucosa via contact with environmental surfaces that have been contaminated with either feces or vomitus. * Reference: CDC Technical Factsheet on Noroviruses
Norovirus: as few as 10 particles may be enough to cause diarrhea.
Norovirus Surveillance Protocol LT Chris Coetzer A Norovirus outbreak is highly contagious, and poses a major threat to force readiness in confined spaces onboard ships and at recruit training depots. In 2009, USS Farragut ‘lost’ a third of its crew to Norovirus. Currently all surface vessels of the 2nd and 3rd Fleet, as well as MCRD Parris Island and MCRD San Diego are part of the Norovirus surveillance protocol. Units have received Norovirus kits to collect stool swabs (not stool cups) for PCR testing. Turnaround time for testing for Norovirus at NEPMU-2 is 72 hrs. In 2008 there were 7 very large GI outbreaks that were not reported in NDRSi (Navy Disease Reporting System internet). Whatever the setting, outbreak reporting is important and stool samples should be tested to confirm the nature of the infection.
Doctor’s Orders: measures to take in the case of suspected Norovirus outbreaks Dr. Jennifer Espiritu We’ve received some questions about Norovirus, and wanted to put some frequently asked questions and their answers out here for your reading pleasure! We tried to step away from the medical-speak.
Q: How can I prevent myself from getting Norovirus? Frequent hand washing with soap and water is the most effective means of prevention. The recommended procedure is to apply soap and water, rub your hands together vigorously for 20 seconds and then thoroughly rinse your hands under a stream of water. Alcohol based hand sanitizers can supplement regular hand washing, but are only effective if your hands are not visibly soiled. The best option is to wash your hands with running water and soap as described above, dry them, then follow up with sanitizers. Frequent cleaning of commonly used surfaces with a bleach based solution can also be helpful.
Q: How long will it take for me to get sick once I eat something with the virus on it and what are the symptoms? The time in-between eating something with the virus on it and getting sick (the incubation period) ranges from 12 to 48 hours. After that period, Norovirus-caused gastroenteritis normally presents without warning and you’ll have nausea and vomiting, watery and non-bloody diarrhea, and abdominal cramps. The disease normally lasts 48-60 hours and resolves completely. Occasionally, a very low fever may be present.
The Giardia parasite can survive the normal amounts of chlorine used to purify community water. Newsletter Editors LT Chris Coetzer LTJG Matthew Montgomery
Q: What will make me better? Treatment is symptomatic so we give you medicines for what ails you (anti-nausea drugs, diarrhea drugs, and sometimes Motrin), and also involves rest and fluid replacement. I recommend very bland diets like the BRAT diet – bannanas, rice, apple sauce, and toast, until you feel like you can tolerate heavier and/or spicier foods like steak and lasagna. Severe dehydration is possible, particularly with the very young and very old and some people find watered down sports drinks helpful. If you have any specific questions you’d like answered, about Norovirus or otherwise, please email the NEPMU2 Threat Assessment Department.
Web: Recommendations by Country, Norovirus Outbreak Response Guide E-mail: NEPMU2NorforlkThreatAssessment@med.navy.mil
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Courses available at NEPMU2: T R A I N I N G
GET YOUR ANSWERS HERE EMAIL NEPMU-2 click on the links below Fleet/FMF -Entomology -Environmental Health -Industrial Health
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Training
3311Assessment M Maarrcchh 22001100 Threat EPM Senior Enlisted Leader
RESOURCE LINKS NMCPHC (NEHC) Navy and Marine Corps Public Health Center Instructions Navy Medicine Publications PrevMed Topic Page NMCPHC (NEHC) supported page of Preventive Medicine topics and resources CHPPM U.S. Army Center for Health Promotion and Preventive Medicine
Supplies Fly Control - CDC Light Trap (NSN 3740-00-134-9229) - Indoor Fly Traps (NSN 3740-01-412-9363) - Fly Terminator Pro (NSN 3740-01-561-9678) DEET Lotion NSN 6840-01-284-3982 Standard Military Bed Net NSN 7210-00-266-9736
Sunscreen with DEET NSN 6840-01-228-2188
C O R N E R
Food Safety Managers (B-322-2101): 26-27 April, 17-18 May, 28-29 June Lab Identification of Malaria (B-322-2210): 19 May Shipboard Pest Management (B-322-1075): 4 May, 6 July Food Safety Managers Course
Description: This course includes basic food microbiology, causes and prevention of foodborne illnesses, sanitary standards; health standards for food service personnel, food inspection and storage, and pest control. Target Audience: HM and CS For further info contact Jeff Bolden: (NEPMU2Norfolk-EducationandTraining@med.navy.mil)
Make Food Safety Part of Your Plan for Operational Success LTJG Chahn Chess Food safety is a practice oriented at keeping a food-borne outbreak from occurring. A food-borne outbreak is an incident in which two or more people experience the same illness after eating the same food. Each year in the United States there are 76 million food-borne illnesses, 325,000 of these cases will require hospitalization and 5,000 will result in death. The most common causes for these outbreaks are foods held at improper temperatures, inadequately cooked food, contaminated food equipment, food supplied by an unsafe source, and poor personal hygiene.
These risk factors are easily mitigated. Food should be cooked at the proper temperature for the required amount of time and kept out of the temperature danger zone (41-135°F), which is the temperature range most conducive to bacterial growth. Additionally, proper sanitation and hygiene are a must. This Next Issue includes not using the same utensils for 15 July 2010 different types of food preparation, washing hands, using gloves, and wearing clean appropriate work attire. Ensuring food safety is very manageable and essential to maintaining a healthy force.* *Send your questions to NEPMU-2 Environmental Heath.
Filth Flies: More than a nuisance? LTJG Matthew Montgomery Although most people may think of filth flies as just a nuisance pest, they actually represent a threat to troop health as well. “Filth fly” is an ambiguous term that covers members of the families Calliphoridae, Muscidae, Sarcophagiade and Phoridae among others. They earn this title for their propensity to infest all manners of filth: garbage, feces, corpses, and other decaying organic matter. Filth Fly life stages
By visiting these food sources they pick up a number of bacteria and viruses of human health concern, such as hepatitis, cholera, dysentery, E. coli, typhoid, Salmonella, and even anthrax. Filth flies typically aren’t content to remain in one place and are constantly seeking and investigating new food sources. When they land on a potential host (e.g. our food and bodies) they can mechanically transmit the aforementioned pathogens via their mouthparts, vomitus, feces, and setae (i.e. hairs). The most effective means of managing filth fly populations is to deny them a food source through proper sanitation. This entails keeping garbage and sewage a good distance from areas with troops present. Further control can be accomplished through bait-traps and sticky traps, some of which can be used indoors. (See Supplies)
Lt. Hanley, FDPMU entomologist, fills a fly trap with fly bait and pesticide during relief operations in Haiti.
Contact us: Phone (757) 953-6600 DSN 377 Fax (757) 953-7212 1887 Powhatan St, Norfolk, VA 23511 Website: http://www.med.navy.mil/sites/nmcp/Partnerships/nepmu2/Pages/default.aspx
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