That Nasty Little Norwalk Virus

THE NORWALK VIRUS THRIVES ANYWHERE THAT PEOPLE GATHER.

AND IT SPREADS RAPIDLY VIA FOOD, WATER, HUMAN CONTACT AND SOMETIMES BY AIR.

WHEN PEOPLE GET NOROVIRUS, AS IT'S KNOWN, THEY USUALLY THINK THEY'RE EXPERIENCING WHAT WE TEND TO CALL A STOMACH FLU.

YOU KNOW THE FEELING – YOU WAKE UP WITH NAUSEA, DIARRHEA - MAYBE A HEADACHE AND FEVER.

IT CAN BE DEBILITATING, BUT IT GOES AWAY AFTER A FEW DAYS IF YOU ARE YOUNG AND HEALTHY.

THE PROBLEM IS THAT NURSING HOMES ARE ON THE FRONT LINES OF NORWALK OUTBREAKS.

AND THE OUTBREAKS APPEAR TO BE ON THE RISE AS NEW STRAINS OF THE VIRUS DEVELOP.

OVER 77% OF THE CASES IN NH LAST YEAR OCCURRED IN LONG-TERM CARE FACILITIES – AND IN ELDERLY PATIENTS WITH WEAKENED IMMUNE SYSTEMS.

SYMPTOMS CAN BE SEVERE

MONTERO: The risk of dying from Norwalk is in general low – basically people who have severe illnesses or elderly people who is quite fragile have a lot of chronic diseases has a chance of dying. ……

THAT'S JOSE MONTERO, NEW HAMPSHIRE'S CHIEF OF DISEASE CONTROL AT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES.

HE SAYS HE CAN'T RECALL ANY REPORTS OF PEOPLE IN THE STATE DYING FROM NORWALK INFECTIONS.

BUT HE ADDS THAT DOESN'T MEAN IT HASN'T HAPPENED.

OUTBREAK NUMBERS ARE SKETCHY AT BEST IN THE U.S. – AND THEY'RE BELIEVED TO BE UNDERESTIMATED.

BUT DATA OBTAINED FROM THE STATE SHOW A SHARP SPIKE IN OUTBREAKS STARTING IN 2002.

AND COMPARED TO THE PREVIOUS DECADE, THE NUMBERS HAVE REMAINED HIGH SINCE.

MONTERERO: Surveillance for GI illnesses in general and specifically for Norwalk is something that is tricky. The disease is not reportable so we rely on facilities to notify us when something is happening. Now there are cycles and years that we see an increase and years they decrease with no particular scientific explanation.

IN 2002, 40 OUTBREAKS WERE RECORDED IN NEW HAMPSHIRE – THAT’S TWENTY TIMES HIGHER THAN IN 2001 WITH JUST 2 DOCUMENTED OUTBREAKS.

DATA OUT OF EUROPE, ASIA AND CRUISE SHIP COMPANIES SHOW A SIMILAR SPIKE TO NEW HAMPSHIRE’S IN 2002.

AND STUDIES REVEALEDA NEWER STRAIN OF NORWALK - THE GII.4 (G-TWO-FOUR) TYPE EMERGED WORLDWIDE THAT YEAR.

IN GENERAL, ONLY A SMALL DOSE IS NEEDED TO CAUSE ILLNESS.

THE VIRUS IS STABLE SO IT CAN STICK AROUND AND SPREAD TO OTHERS UP TO TWO WEEKS AFTER SYMPTOMS DISAPPEAR.

A NURSING HOME IN SALEM WAS ONE OF MANY HIT WITH AN OUTBREAK THIS YEAR.

RAYMOND MILLIARD IS THE EXECUTIVE DIRECTOR OF SALEMHAVEN.

Milliard: When it hit our facility we started to backtrack when to where the source was. One of the nurses noted that one of the visitors had complained about symptoms prior to their visit. Looking back at it the resident they visited we believe was the first resident to have the outbreak here at the facility.

TO MAKE MATTERS WORSE THE OUTBREAK TOOK PLACE IN A UNIT OF PATIENTS SUFFERING FROM DEMENTIA.

AND IT HAPPENED ON A WEEKEND.

Milliard:…. and when we came in on Monday morning we realized we had something bigger than a typical flu outbreak. We notified the Departments of health and human services and our local health department and both were helpful to us here at Salem with lots of guidance and support.

THE FACILITY WAS NEARLY INCAPACITATED.

FORTY OF THE 110 ELDERLY RESIDENTS GOT SICK AND SO DID ABOUT 20 % OF THE STAFF.

WITH EMPLOYEES CALLING IN SICK, THE SITUATION GOT MUCH MORE DIFFICULT.

MARJORIE D’ALBA, THE NURSE AND MANAGER OF THE SPECIAL CARE UNIT, BECAME ILL ON A THURSDAY – BEFORE ANYONE KNEW IT WAS A NOROVIRUS.

D’ALBA: “I called in on that Friday and was off whole weekend – so I was past it by Monday. Some of symptoms I had were extreme headache, nausea, stomach cramps, eventually it works through your whole system…….

ALL 16 RESIDENTS IN D’ALBA’S UNIT HAVE DEMENTIA – AND SOME BECAME ILL AGAIN AFTER RECOVERING.

D’ALBA: In the dementia unit they didn’t understand what was going on. You put them on clear liquids. They didn’t know why they couldn’t have food. Some still on restricted diets. It was difficult. We had to separate them.

TODAY, MOST HEALTHCARE FACILITIES CAN’T TEST FOR THE VIRUS THEMSELVES.

AND BY THE TIME STATE LABS OR THE CENTERS FOR DISEASE CONTROL RECEIVE SAMPLES, A WHOLE FACILITY CAN BE DOWN.

SAFEHAVEN'S DIRECTOR MILLIARD SAYS AFTER THEIR OUTBREAK THE STAFF FEELS BETTER PREPARED TO FACE THE FUTURE..

MALLIARD: We took appropriate measures. Masks gloves gowns all those things. We got extra staff. We did little things. We limited movement for staff … We cancelled main dining room services and visitation, outside entertainment. We cleaned…. punch clocks touch computer screens – surfaces – telephone keyboard. The Department of Health and Human Services and our local health department did recommend that we use this as a springboard board for a plan for a pandemic - like a bird flu – and it is a great model. We didn’t lose a resident, we had one hospitalized – everyone made it through.

Most methods for eliminating bacterial foodborne illnesses don’t affect Norovirus.

It can even survive freezing and chlorinization.

The Centers for Disease Control says that better detection, tracking and prevention strategies are needed as new virus strains become more common.

Researchers have begun work on a potential rapid detection test, but so far, a vaccine for the Norwalk virus hasn’t been discovered..

For NHPR News, I’m Dianne Finch.