University Norovirus Outbreak
31st October 2008
Tui Shadbolt B.Hlth.Sc, MVS
Coordinator Health Protection
MidCentral Public Health Service
Roadmap
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Notification of the outbreak
CIMS
Resources
Food Hall joint visit
Epidemiology
Practical interventions
Conclusions
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Notification - !#%?&*!@#
University Medical Centre 9:30am
Heaps of students reporting Gastro type symptoms
Appeared to be mostly from the Halls of residence
Seen 8 already and there was a queue out the
door
Two specimens available already
Medical Officer of Health on Leave
Medical Officer of Health in Whanganui
Friday – last week on call for the year
Assignment due Monday for block course
Intelligence gathering
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9000 people visit the campus daily
Total of 750+ people live on campus
550 people in 10 catered hostels
205 people live in self catering hostels
5 food outlets
Core caterer serves 2000+ customers a day - main
supplier of food to campus
University has separate drinking water supply
Say 40/750 ill (~5%) but what is the background rate?
It’s exam time!
Not from same course/school according to doctor
Friday afternoon so resourcing issues
Coordinated Incident Management
Structure (CIMS)
Structure for Uni OB 2008 response
Health and Safety
Medical
officer of
Health
advisor
Patrick
O’Connor
Incident Controller
Media &
Communications
DHB Dennis
Geddis
Tui Shadbolt HPO
Uni Liaison
H&S
Operations
Brett Munro HPO
H&S Manager
Planning & Intel
Tui Shadbolt HPO
Logistics
Chris Bland HPO
Initial case definition established
• A person who lives, works, studies or had
recently visited the University campus who
was reporting vomiting and diarrhoea in
the previous 7days – ongoing
Resources available
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ESR
Canterbury PH
3 HPO’s
1 MOH covering from Whanganui but visiting PN
Good knowledge of campus
Bulk distribution centre for region at PN Hosp
A handy pre planned meeting
Norovirus Guidelines - different setting but same bug
Generating hypotheses on
limited info
• Probable point source due to large
numbers clustered in time
• Catered hostels indicated by doctor - ?
food source
• What about the water?
The 10:30am pre planned meeting
“change of focus”
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Health and Safety manager
Cryptosporidiosis off the menu
Acute Gastroenteritis new dish in discussion
Indoctrinated H&S Manager into the world of the
Norovirus guidelines
• Planned likely response
• Medical Center update 30+ cases by 10:30 with
more queued up and reports of many ill in
hostels
• Identified key issue EXAM WEEK!!
Resource Shopping List
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Bulk Signage
Bulk Handsanitiser
Bulk Electrolytes
Bulk Vomit bowls
Bulk Biohazard bins
Bulk Bottled water
Bulk Case Logs for Hostels
Bulk Questionnaires
The environmental assessment
• Foodhall inspection
– EHO, and 2 HPO’s
– A Grade Premises registered by PNCC
– Large Food-hall up to 500+ meals per
sitting
– Multiple Kiosks (4) with extensive menus
– Discussed Staff illness
– No leftovers
– Menus for the last week collected
• Review of drinking water sampling
The Uni Food Hall
What was our gut feeling based on
evidence gathered
Reports of Food handlers with Ds & Vs
Weekend of the 25th
and 26th FH 1 cared for
family with D and V’s
(FH1 no symptoms)
Campus 2 Wednesday
29th FH2 onset D & V’s
6am at work
Tuesday 28th FH 1
worked rostered shift
at campus 1 preparing
salads and sandwiches
including food sent to
campus 2
Campus 1 Wednesday
29th FH3 onset 6:30am
at home
Campus 1 FH4 onset 6pm
at home
This is what happened on the Thursday 30th and Friday the 31st
Onset Date
14/11/2008
13/11/2008
12/11/2008
11/11/2008
10/11/2008
9/11/2008
8/11/2008
7/11/2008
6/11/2008
5/11/2008
4/11/2008
3/11/2008
2/11/2008
1/11/2008
31/10/2008
30/10/2008
29/10/2008
140
28/10/2008
Number of Cases
Epidemic Curve, Massey Uni Norovirus Outbreak,
28/10/2008-14/11/2008
Sick food
handlers
120
100
80
60
40
20
0
29
/1
0
30 /2 0
/1 08
0
31 /2 0
/1 08
0/
2
1/ 00
11 8
/2
2/ 0 0
11 8
/2
3/ 0 0
11 8
/2
4/ 0 0
11 8
/2
5/ 0 0
11 8
/2
6/ 0 0
11 8
/2
7/ 0 0
11 8
/2
8/ 0 0
11 8
/2
9/ 0 0
11 8
10 /20
/1 08
1
11 /2 0
/1 08
1
12 /2 0
/1 08
1
13 /2 0
/1 08
1/
20
08
Number of Cases
Disease onset between catered & self-catered hostels compared to
reported cases who lived off campus
90
80
70
60
50
Self Catered
40
Catered
30
Community
20
10
0
Reported date of onset
Control measures
• Food Hall
– Robust staff sickness policies
– Strong reminder regarding thorough hand
hygiene practices
– Importance of hygiene measures due to the
possibility of asymptomatic carriage
– Decontamination advice (NV guidelines)
– Discussion around provision of meals to
students in catered accommodation while sick
Infection Control Measures
• Outbreak signage
• Self care messages, Hand hygiene promotion and NV
fact sheets via University intranet
• Discouraging movement of affected students to common
areas i.e. Exams, food hall
• Handsanitiser at all entry and exit points
• Disposable vomit bags and provision of biohazard bins
• Briefing for cleaning staff, hostel managers, catering staff
• Additional cleaning implemented in foodhall and affected
hostels
• Two Acute Gastro Clinics run daily on campus (away from Med Centre)
• Communication to all After hours clinics in PN re the
above clinics for cases
Uni Personal and Pastoral cares
• Bottled water to affected cases
• Electrolyte sachets to affected cases
• Food delivered to common rooms in hostels for
collection by students three times a day
• Case logs for each hostel and twice daily check of
those known to be ill
• Affected students encouraged to apply for
aegrotat/impaired performance rather than present to
Exams
• Separate Exam hall for those affected who felt they had
to sit exams
• Daily meeting PHU/Uni
• Clear demarcation of contaminated areas requiring a
terminal clean
Conclusion
• Six Lab confirmed cases Norovirus (including
FH2)
• 288 notified probable cases
• Onset for the majority of cases was over a 48
hour period
• Questionnaires of limited value due to wrong
menu being supplied
• Daily Case logs gave us a quick result to
measure burden of disease
• Concurrently investigated with two other
outbreaks in rest homes
• Strains were indistinguishable
Was it a busy year
Year
Total OBs
Number of NV
OBs
Probable
Cases
2007
15
13
314
2008
20
14
694
2009
24
21
1241
2010
35
10
221
2011
42
13
282
• Thank you
• Questions?