(South Wales Evening Post)

Welsh opera diva Katherine Jenkins needed hospital treatment after being hit by the Norovirus stomach bug. The usually fit and healthy singer, aged 29, from Neath, was diagnosed with the illness – known as the winter sickness bug.

Katherine was sent home to recuperate and was forced to cancel several engagements. Friends said she had swapped her glittering dresses and heels for pyjamas and slippers as she recovered at her London flat. The former teacher has had to pull out of the iTunes concert in London. But Katherine was able to twitter from her sickbed and apologise to fans who missed her personal appearances promoting her number one album Believe.

She wrote: “Still feeling pretty awful (Norovirus apparently) and just wanted 2 say sorry 2 all those who were coming to iTunes. A hospital visit last night has made a big difference and I feel I am coming out the other side of it. I hate letting you all down.”

Katherine works out in the gym every day and did a 10k run for the Kidney Wales Foundation in September. A friend said: “She’s usually the picture of health but this bug has really hit her and she says she’s feeling a bit green. She was so concerned she went to hospital for a check-up but it is nothing too serious.”

The blonde mezzo-soprano scored a number one with her latest album – her seventh release.

Six wards are shut to try and prevent the winter vomiting bug which has affected Teesside’s James Cook and North Tees hospital…. From BBC News. Full story

This site may contain information about: virus. The blog is also related to: virus.

An outbreak of the winter vomiting virus affects patients on three wards at a Northumberland hospital…. From BBC News. Full story

This site may contain information about: virus. For a different topic see compare 2 cities. The blog is also related to: virus.

 I travel a fair bit on cruise ships as a speaker, and I know a number of my readers enjoy this form of holiday – after all many of us met when you came to one of my talks onboard! The fear of any traveller is being ill while away and the Norovirus has been a real challenge over the past couple of years with many ships, and passengers succumbing to outbreaks. Now a new report in the journal Clinical Infectious Diseases last week on a combined research project from Boston University School of Medicine, Carney Hospital, Cambridge Health Alliance and Tufts University School of Medicine, has worrying news for us.

They have found that widespread poor compliance with regular cleaning of public bathrooms on cruise ships may predict subsequent norovirus infection outbreaks. This is the first study of environmental hygiene on cruise ships where outbreaks of acute gastroenteritis often occur because of the close proximity of such a large group of people. Recent studies into outbreaks of gastroenteritis have confirmed that 95 percent of cruise ship outbreaks are caused by norovirus. It should be said that all this research was done on 66 ships monitored by the United States Centers for Disease Control and Prevention so is US based, but I think we can learn a lesson from it.

 The problem seems to be mainly around how thoroughly everything in a public bathroom is cleaned and disinfected as only 37 percent of the 273 randomly selected onboard bathrooms were thoroughly cleaned daily. The most neglected area for cleaning was any handles on stall doors, or entrance and the researchers found that the stand of cleaning did not vary by cruise line and did not meet the Center for Disease Control and Prevention Vessel Sanitation Program inspection scores. Washing your hands is of course essential, but this is no help if the bathroom doors are not clean. The solution as ever is preventive action so carry antibacterial gel and handwipes and do not touch the doors with your bare hands – use a barrier such as a handwipe of tissue to cut down the possibility of infection.

It’s not generally realised that one of the biggest sources of infection in public areas are the handrails – whether on a ship, or anywhere else. Avoid using them if you can, and if you have to put your bare hand on them then always use an antibacterial wipe of gel before touching food or drink, or your own face. The good news is that although the thoroughness of disinfection cleaning was 30 percent on more than half of the ships, near-perfect cleaning was documented on several vessels, so it can be done and is being done on s hips that maintain high standards of cleaning and monitoring.

A hospital ward in Hampshire closes after an outbreak of the norovirus winter vomiting bug…. From BBC News. Full story

This site may contain information about: virus. The blog is also related to: virus.

PHILADELPHIA, Nov. 12 (UPI) –

U.S. researchers found norovirus — stomach flu — RNA detectable in groundwater for more than 18 months.

To better understand the risks of waterborne norovirus transmission, researchers at Emory University’s Center for Global Safe Water examined how long norovirus remains infectious in water.

Common symptoms of norovirus gastroenteritis include diarrhea, vomiting and stomach cramping.

Noroviruses are highly contagious and easily spread through several different ways such as eating foods or drinking liquid contaminated with a norovirus. Treatment for norovirus gastroenteritis consists of managing the symptoms while the body fights off the infection.

Outbreaks of norovirus are associated with contaminated groundwater, surface water and recreational water and causes serious morbidity and economic losses.

The researchers presented the finding at the American Public Health Association’s annual meeting in Philadelphia.

See the full post at Norovirus detectable in groundwater

Along with the dangers of cruise ship accidents are the possibility of contracting communicable diseases. Because huge ocean carriers are intermittently isolated and in contact with foreign populations, bacteria and viruses can thrive. There may be rare instances in which the cruise line can be held liable for cruise passengers getting sick, but travelers should take their own precautions.

Swift cruise ship outbreaks of H1N1 influenza and norovirus are in the news and shipboard cases have been discovered in locations as distant from one another as Australia and Alaska. Passengers and/or crew were quarantined and ship surfaces disinfected.

If you believe your cruise line did not respond properly to reports of infectious disease, a maritime attorney can help When selecting a maritime personal injury attorney you’ll want to ask critical questions such as: how long have you been practicing law; do you have experience with cruise ship accident cases; what is the biggest settlement or verdict you have won?

Whocanisue.com has the largest directory of trained personal injury attorneys on the Web! Find an experienced personal injury lawyer in your area now!

Browse our library and learn more about cruise ship accidents.

Come immagino altri a San Felice, anch’io ho partecipato allo studio osservazionale sulla grave epidemia che ha colpito San Felice lo scorso giugno, avviata dal Dipartimento di Medicina, S.S.D. Gastroenterologia degli Spedali Civili di Brescia, responsabile il Prof. Alberto Lanzini, studio che giudico positivamente in quanto più se ne sa e meglio è su questa brutta vicenda.

Nei giorni scorsi ricevo a casa questa busta con tanto di timbro ASL di Brescia con un nuovo questionario che compilerò al più presto:

Cliccare per documento completo (PDF)

All’interno della lettera trovo una serie di pagine tra i quali il foglio informativo di ASL sulle finalità dello studio che letteralmente riporta:

Progetto di Studio

Gastroenterite acuta virale e incidenza/storia naturale di sindrome dell’intestino irritabile post-infettiva e di morbo celiaco: studio osservazionale prospettico di coorte su epidemia da Norovirus.

……

La sindrome dell’intestino irritabile è una condizione clinica abbastanza diffusa caratterizzata da dolore e/o fastidio alla pancia associati ad alterazioni del modo di scaricarsi.

Il morbo celiaco è una intolleranza alimentare che colpisce solo soggetti geneticamente predisposti e che consiste nella perdita della tolleranza al glutine (una proteina che si trova in molti cereali (frumento, grano duro, segale, orzo, farro).

Per entrambe queste condizioni ci sono ipotesi che correlano un episodio di gastroenterite infettiva con il loro esordio.

……

Subito mi  viene un dubbio in merito al mio post del 14 settembre in cui riportavo casi di transaminasi alte a distanza di mesi tra i coinvolti nella grave epidemia da Norovirus e quindi inizio qualche ricerca.

Premetto che non sono un medico, anzi, da normale cittadino di medicina ne capisco poco se non nulla, ma cercando velocemente in rete trovo ad esempio questo articolo sull’International Journal of Gastroenterology and Hepathology (anche in PDF) in cui all’interno letteralmente c’è scritto:

Therefore, norovirus infection has to be included among the conditions that are associated with increased numbers of IELs (eg, coeliac disease, …).

che tradotto in italiano recita:

Quindi, l’infezione da norovirus deve essere inclusa tra le condizioni associate alla crescita del numero di IEL (es. celiachia, …).

Opps, mi dico, già un particolare torna.

Quindi provo a fare un passo in più e provo a verificare se la celiachia o la sindrome dell’interstino irritabile provocano l’innalzamento delle transaminasi.

Andando sul sito della Associazione Italiana Celiachia ho trovato una risposta del Prof. Umberto Volta il quale dice letteralmente che:

… l’ ipertransaminasemia senza una causa eziologica nota sia un possibile segno di presentazione di celiachia ed il suo manifestarsi è imputabile ad un aumentato passaggio di antigeni alimentari attraverso la barriera intestinale (con incrementata permeabilità nella celiachia) ed al loro successivo arrivo attraverso il circolo portale al fegato con conseguente citonecrosi epatica. Abbiamo dimostrato con numerosi contributi scientifici che la dieta aglutinata stretta normalizza i valori delle transaminasi nel giro di 3-6 mesi.

E il prof. Volta non è l’ultimo arrivato essendo co-autore dello studio “Anti tissue transglutaminase antibodies as predictors of silent coeliac disease in patients with hypertransaminasaemia of unknown origin“, pubblicato su Digest Liver Dis 2001; 33:420-425 (U. Volta et al.) in cui proprio all’inizio dell’abstract dice:

Unexplained hypertransaminasaemia can be regarded as an extraintestinal presentation of coeliac disease.

Oppss, anche questo torna!

E così potrei citare tracce che ho trovato di correlazione tra sindrome dell’intestino irritabile (che in termini medici viene definito con l’acronimo IBS) e ipertransaminasemia.

A questo punto però io non capisco quello che a mio personale avviso è un duplice atteggiamento di ASL che da una parte risponde tramite il Direttore Sanitario Dott. Vassallo dicendomi in pratica che non ci sono indicazioni diverse rispetto al decorso benigno, dall’altra parte invece presenta evidentemente dei dubbi a cui con questo studio vuole cercare di dare qualche risposta.

Ora, so che verrò accusato di allarmismo, ma ripeto che la mia intenzione è solamente essere da stimolo, perché ho la netta sensazione che si stiano sottovalutando aspetti medici e ritengo siano temi di indagine a cui andare a fondo con decisione anche perché ci sono persone che continuano ad avere problemi dopo l’epidemia e nessuno sta dando risposta.

Anzi, giro subito queste mie perplessità al Prof. Lanzini.

Sie müssen ziemlich feige sein, denn einzeln tun sie uns nichts. Erst, wenn sich mindestens zehn von ihnen zusammen schließen, fallen sie über uns her. Wir haben keine Waffen gegen sie. Wir können sie nur töten, wenn wir uns regelmäßig und gründlich die Hände waschen. Wenn wir unsere Umgebung möglichst gut desinfizieren. Wenn wir Speisen auf 95°C abkochen.

Mancher nennt sie Kreuzfahrerviren, denn sie lieben Kreuzfahrtschiffe. Gefährdet sind aber auch alle anderen Orte, an denen massenhaft Alte und Kranke zusammen kommen. Deren Körper ist nämlich schwächer, so dass der auftretende Flüssigkeitsverlust zu Komplikationen, wenn nicht sogar zum Tode führen kann.

Wir können sie nicht mit bloßem Auge sehen. Wenn sie uns gekriegt haben, merken wir das aber. Man stelle sich vor: Der Kreuzfahrer steht sterbenselend an der Reeling und weiß nicht, welchen Körperteil er am besten darüber hängen soll, den Kopf oder den Allerwertesten, denn überall kommt es raus, und zwar ununterbrochen. Irgendwann wünscht der Kreuzfahrer sich nur noch, zu sterben. Diesen Wunsch vergisst er zwar spätestens nach zwei Tagen, aber irgendwie ist doch die schöne Kreuzfahrt ruiniert. Den anderen beim Reihern zuzusehen versaut einem nämlich die Aussicht. Und nur, weil die kleine Küchenhilfe sich vermutlich mal wieder nicht die Hände gewaschen hat… Ich an Stelle des Kreuzfahrers wäre jedenfalls sauer. Ist ja auch teuer, so was.

Genug geträumt, zurück in den Alltag.

Vor allen Fahrstühlen auf unserer Etage liegen Wischlappen. Sie sind mit einer gelb-grünen Flüssigkeit getränkt. Aus dem Fernsehen kenne ich ähnliche Bilder, Ortseingänge, die abgesperrt sind, Leute, die mit den Schuhen in Desinfektionslösung treten müssen… Quarantäne. Nur deshalb ahne ich, dass irgendetwas nicht stimmt.

Wie üblich gehe ich zunächst in den Tagesraum. Gähnende Leere. Nur Frau N., eine körperlich hinfällige, geistig aber rege Mittsechzigerin, sitzt an ihrem Platz. „Wo sind denn alle?“, frage ich, während wir uns die Hand schütteln. „Weiß nicht.“, antwortet sie. Ich vermute eine Gruppenbeschäftigung auf einer anderen Etage und suche meine Kollegen.

Sportlich nehme ich den Weg über die Treppe. Nachher fällt mir auf, dass vor dem Zugang zum Treppenhaus kein grüner Lappen lag. Überhaupt kein Lappen. Ups, denke ich, beruhige mich aber gleich: Wird schon gut gehen. Weiter geht es, treppauf, treppab.

Nirgendwo eine Gruppenbeschäftigung. Von einigen Pflegern und Schwestern werde ich komisch gemustert, oder bilde ich mir das ein? Irgendwann finde ich einen Kollegen, der was von einem Virus murmelt. Nun, da ich Bescheid weiß, gehe ich zurück in unseren Tagesraum. Wieder über die Treppe, denn jetzt ist es eh zu spät. Ein paar Minuten rede ich mit Frau N., bis meine Chefin kommt. Sie begrüßt mich per Handschlag. Dann schickt sie mich für die Bewohner einkaufen.

In einer nahegelegenen, gut besuchten Drogerie fasse ich hier ein Deo an, boah ist das teuer, und stelle es zurück, nehme dort ein Fläschchen Mundwasser in die Hand, huch, falsche Sorte, wieder ins Regal damit.

Erst Stunden nach Arbeitsbeginn, beim gemeinsamen Rauchen auf dem Balkon, erfahre ich Näheres.  Und zwar in Form eines Reiseberichtes. „Damals in Indonesien…“, stöhnt ein junger, kräftiger Kollege. „Mir war so schlecht, ich wollte nur noch sterben.“

Abends sitze ich am Computer. Ich suche und finde den Norovirus. Ich lerne, dass es kein Medikament dagegen gibt und keine Spritze. Dass es selbst bei penibelster Sauberkeit regelmäßig zum Befall von Altenheimen kommt. Dass die Gefahr nach der akuten Erkrankung lange nicht vorüber ist, weil man die Viren noch bis zu zwei Wochen weitergeben kann.

Es ist Wochenende. Ich habe Glück gehabt: Ab nächste Woche geht mein Pflegebasiskurs los, da bin ich zwei Monate nicht im Heim.

Weiter lese ich: Es gibt eine Meldepflicht. Aber die gilt für Heimleitungen, nicht für Ein-Euro-Jobber. Niemand hat mir verbindlich erklärt, wie ich mich verhalten muss, weder heute, noch am ersten Tag meiner Arbeit hier.

War das auch ganz sicher nicht Teil der Arbeitsschutzbelehrung?  Ganz sicher, denn ich hatte gar keine Arbeitsschutzbelehrung. Man hat mir lediglich das Haus gezeigt, ein paar Tage lief ich an der Seite von Kollegen mit und danach hieß es: Wenn du Fragen hast, frag uns ruhig.

Jetzt habe ich eine Frage. Sie überfällt mich, wenn ich an Treppenhäuser denke. An Drogerien, an Begrüßungen per Handschlag. Ausgerechnet diese Frage aber kann mir niemand beantworten.

——————————————–

Mehr Infos über den Norovirus:

http://www.noro-virus.seuchen-info.de/

http://www.bag.admin.ch/themen/medizin/00682/00684/01092/index.html

We have some freshly prepared oysters!!!!

I don’t know if this is going to make the 500 or so people who fell ill at the Fat Duck restaurant feel any better but they have found the cause of the food poisoning, human sewage. See I told you it wouldn’t make you feel any better but at least the fingers can stop being pointed at Gordon Ramsay and all the other jealous rivals. After a long and exhaustive investigation the culprit is a dodgy batch of oysters that were contaminated with human sewage (shit/feces/poo in other words). How it got on  the shellfish seems to be by human contamination. Someone handling the food had the notorious norovirus and transferred the virus onto the food. Bottom line don’t go to work sick and wash your friggin hands! Bon appetite!

It’s rather hard to top the story I posted last week, both literally and figuratively, so I guess the next best thing is some time traveling…. back to the Alaska trip of about a month ago. This final installment has been worth the wait – I guarantee it! I have three thrilling threads of subject matter for you: flora, fauna, and flu… and of course a few cache finds. I’ll start with those and work backwards.

FINDS
Here are the four caches I found on my last day in our 49th state:
Beaver View
Forget Meat? Not!
Inlet View
Anchorage TB Drop

That day, I took a rental car out for a spin up the gorgeous Turnagain Arm, just south of Anchorage, and finally got in to some serious scenery:

Fields and glaciers were all over the place:

I watched a gondola ascend from the nearby hotel, taking folks up for an even better view, I’m sure:

I didn’t have much time to look around, but I did see this bit of honesty:

FLU
Ah, yes, I got to experience the dreaded, all-to-common-on-tours-and-cruises Norovirus. Don’t ever get it. Since I did get it on a tour, though, they had me go to the hospital and everything. I wouldn’t do that again, either, even though I was well cared for. There are other adventures that are more worth having. I must say, I did get some nifty jewelry:

FAUNA
The only difference between caribou and reindeer is that the former are wild and the latter are captive. These would be the latter:

The only moose I saw was this stuffed specimen:

… and I thought the only real Alaskan wildlife I would see was this guy, one of our bus drivers:

… but I was so wrong! Heading back along Turnagain Arm, I glimpsed a bear crossing the road! He was foraging in the tall foliage by a bike path, and as I pulled over to see if I could get a better camera shot, here he came! I shot this with the windows up and engine running, but he was only interested in the weeds, and his mom was nowhere to be seen:

Now THIS made my whole trip, made up for wacko schedules, illness, smoky air, ALL of it. Wow.

FLORA
To close, here are some shots of some of the really beautiful things that grow around Alaska:

Until next week, happy caching, be they few or feverish!

You may remember the saga of the Marco Polo and norovirus. Well today, the Bremen, Germany based line, according to this Google translation, will go through a “restructuring.” This is also known in the U.S. as Chapter 11 bankruptcy.

Bijna driehonderd – samen met m’n vriendin op een tandem afgelegde - kilometers , 4 dagen, 3 nachten in een tent, een indrukwekkend bezoek aan voormalig kamp Westerbork en een doorgezeten zitvlak: zéér plezante en gezellige vakantie, die over enkele dagen nog voortgezet gaat worden met een bezoek aan het westen van het land. Het vermelde bezoek aan kamp Westerbork gaat denk ik nog wel een blogpost opleveren, maar vandaag voel ik me zoals de Britten zo mooi zeggen ‘a bit under the weather’; weinig zin in een dergelijk zwaar onderwerp. Daarom – en omdat een goede blogpost over het bezoek aan het kamp wat meer tijd zal vergen – hieronder wat zaken die mijn aandacht pakten. En me uiteindelijk hebben laten lachen. Maar mischien heb ik wel een beetje morbide gevoel voor humor…

Een beetje halfgaar zat ik door wat RSS feeds heen te lezen, toen mijn oog stuitte op een link op het weblog ‘Effect Measure’: feces for dinner?. Het is maar een kleine blogpost:

Infection with norovirus is something to which the adjective “unpleasant” hardly applies. While it’s a self-limiting affliction, if you’ve ever had it, it’s hard to imagine anyone subjecting themselves to norovirus willingly. But if anything illustrates the principle that people will do anything for a buck, this does:

“Getting sick for science (and money)”

Het is eigenlijk een soort van repost van een wat ouder artikel. Nu zijn alleen erg goede artikelen een repost waard en gelukkig wordt men daar ruimschoots in voorzien. Getting sick for science gaat over een studie naar vrijwillige infectie met het norovirus (Atmar et al., 2008), waarover we op de website van het RIVM lezen:

In 1972 werd in fecesmonsters, verzameld tijdens een epidemie van gastro-enteritis op een basisschool in Norwalk, voor het eerst het ‘Norwalkagens’ door middel van elektronenmicroscopie aangetoond. In de jaren daarna zijn ook andere virussen met vergelijkbare morfologie geïdentificeerd en genoemd naar de plaats waar ze gevonden waren (bijvoorbeeld Hawaii, Sapporo, Snow Mountain, Tounton).

Het norovirus staat ook wel bekend als het Norwalk virus, dat door bovenstaande mijns inziens redelijk is verklaard. Het virus is een bezig baasje volgens Revere, het pseudoniem dat een aantal zorgverleners en wetenschappers hebben aangenomen als digitaal alterego. Zo is het de meest voorkomende oorzaak van epidemische gatro enteritis in de VS (en in Nederland), en dat is geen pretje:

It’s the kind of food poisoning or stomach flu where first you’re afraid you’re going to die and then you’re afraid you’re not going to die.

Waarom dan toch deelnemen aan zo’n onderzoek? Of om te beginnen: mensen willen besmetten met een dergelijke ziekte? Is het een zieke uitspatting van een paar doorgedraaide artsen? Wees gerust;

Although in vitro replication systems for these viruses have recently been described grown in cell culture, human noroviruses cannot readily be grown in cell culture, and no small animal model of human norovirus infection is available. Much of what is known about these viruses has by necessity been learned from experimental human infection and from observational studies of naturally acquired infection.

Wetenschappers zijn dus, niet evil en kwaadaardig, maar hooguit wat beperkt in hun methoden. Dus filterden ze een hoeveelheid poep feces van een deelnemer aan een eerder onderzoek naar het norovirus en gaven het (oraal) aan 16 gewillige (kuch?) proefpersonen tussen de vijftien (is dat niet wat jong?) en vijftig jaar. Ligt het aan mij of komt ‘proef’persoon in een wat ander daglicht te staan? Wijsheid komt schijnbaar met de jaren. In ieder geval zijn de wetenschappers streng; je komt niet zomaar in aanmerking voor het onderzoek. Zo mocht men geen risicoberoep uitoefenen, zoals een baan in de gezondheidszorg (je collega’s zouden je denkbaar zijn). 16 personen kwamen in aanmerking voor besmetting. (lucky bastards!). Vijf waren overigens niet ziek genoeg om in de onderzoekgegeven terecht te komen. Uiteindelijk kwamen dus elf personen in aanmerking voor beschrijving in de publicatie. En daar moet je je toch redelijk beroerd voor voelen:

Viral gastroenteritis was defined as illness with moderate diarrhea (alone) for any continuous 24-hour period (moderate diarrhea is >200 g of watery feces that immediately take the shape of the collection container) or 1 vomiting episode plus 1 of the following: abdominal cramps or pain, nausea, bloating, loose feces (if not fulfilling the definition of diarrhea), fever (oral temperature >37.6°C), myalgia, or headache.

Hoeveel zou je betaald moeten worden om deel te nemen? Ik zou er toch even over na moeten denken. Nadat men ontslagen was uit het ziekenhuis (meer dan 18 uur niet overgeven of diarree) heeft men regelmatig feces van de deelnemers onderzocht op aanwezigheid van het virus. Resultaat: tot 56 dagen na besmetting is het virus te detecteren, maar 50% van de deelnemers was met het passeren van de 28e dag virusvrij. Overigens is de gebruikte methode om de aanwezigheid van het virus te bepalen geen methode om aan te tonen op welke dagen met ook daadwerkelijk besmettelijk is. Daar moet men dan weer nieuwe proefpersonen voor vinden. De webloggers van Effect Measure geven ook nog een ’interessante’ anekdote uit eigen koker. Want hoe krijg je het onderzoeksmateriaal in het laboratorium?

The logistics of feces collection weren’t described in the paper but in other experiments I’m familiar with, 24 hour fecal collection was done by evacuating into a wide mouth picnic thermos jug and delivered to the laboratory within one day (now you know a second reason why the volunteers have to be paid a lot). I was once at a meeting, about ten years ago, where one of these volunteer experiments with cryptosporidium was presented and on the slide it showed samples were collected from 82 out of 83 participants. Someone asked what happened to the lone volunteer whose fecal sample was missing. The answer was that this volunteer lived about two hours from the lab and took a bus to get there. He had his thermos next to him on the seat and he fell asleep. When he woke up he discovered someone had stolen it. 

Boontje komt om z’n loontje! De blogpost deed me ook denken aan een review door Carrat et al. (2008) die ik een tijd geleden las, over studies naar vrijwillige besmetting met een influenzavirus. In totaal vonden ze gegevens van meer dan 1200(!) personen die besmet zijn met een influenza A of B virus. Ook geen pretje:

The frequency of symptomatic infection was 66.9% (95% confidence interval: 58.3, 74.5). Fever was observed in 37.0% of A/H1N1, 40.6% of A/H3N2 (p = 0.86), and 7.5% of B infections (p = 0.001). The total symptoms scores increased on day 1 and peaked on day 3. Systemic symptoms peaked on day 2. No such data exist for children or elderly subjects, but epidemiologic studies suggest that the natural history might differ. 

Duidelijk is dus dat dergelijk besmettelijke ziekten zich erg lang kunnen ophouden in ons lichaam (of diens excreta) en zich niet altijd symptomatisch aandienen. En helaas (weer) geen informatie over ouderen in wetenschappelijk onderzoek…

Laat ik afsluitend mijn respect uitspreken voor hen die streden voor het grote goede op de fronten van de medische wetenschap en leden aan koorts, krampen en gekots. Maar een beetje ‘mad science’ is het wel. 

Atmar, R. L., Opekun, A. R., Gilger, M. A., Estes, M. K., Crawford, S. E., Neill, F. H., & Graham, D. Y. (2008). Norwalk virus shedding after experimental human infection. Emerging infectious diseases, 14(10):1553-1557. [DOI] [Pubmed] [PDF1] [PDF2]

As the vessel remains docked in Invergordon, Scotland, an autopsy of the one dead, revealed that he passed away from heart and lung problems that possibly lead to a heart attack. Three people are also at a hospital in Scotland suffering from the virus.  The BBC reports that the vessels crew did a very poor job in handling the situation. Local officials claim that the passengers were allowed off the ship, some infected with the norovirus. This lead to panic and passengers claiming to be vomiting in the streets. There apparently were no protocols in place on the ship to handle ill passengers that reached almost 50%. This situation will be interesting to follow to see if any changes are made to the town, public officials, and the line/ship.

The Marco Polo docked in Scotland Yesterday.

Norovirus on cruise ship

A boat on a mini cruise – that is berthed in Scotland has had a deadly outbreak of a vomiting bug; one unlucky passenger has died whilst another 150 were last night ill. The vessel that has been hit with the norovirus is a British registered ship called the Macro Polo. Police have said the passenger that passed away had underlying health problems.

The ship is docked in Ester Ross at Invergordon while passengers receive treatment for the better known name of the winter vomiting bug.  All steps are being taken to ensure the safety of all concerned.

Both the Telegraph and the BBC are reporting the death of a cruiser from the norovirus. The elderly man boarded Transocean Cruises Marco Polo for a cruise around the British Isles and Ireland. The man is thought to have had additional medical problems, as norovirus is not a serious medical condition.
The vessel is called at Invergordon today where the story broke. According to the BBC report, passengers were allowed off the ship, and able to freely roam the town, possibly still carrying the bug. Other reports say the ship was boarded by health officials and passengers were tested.
This is the first death of a passenger(If I’m wrong please comment or tweet me) from norovirus on a cruise ship. I’ll update with additional info if something comes up.
The Marco Polo made news in May when she had a near miss with a cliff in Norway.

Eccovi il link alla scheda sui Norovirus dell’Istituto Superiore di Sanità per approfondire tutti i particolari su sintomi, trasmissione e misure di prevenzione.

Leggendo a me pare proprio che i conti tornino con la nostra situazione sanitaria.
Vi consiglio di leggere tutta la scheda, ma gli estratti più significativi mi sembrano:

Sintomi e decorso
Il periodo di incubazione del virus è di 12-48 ore, mentre l’infezione dura dalle 12 alle 60 ore. I sintomi sono quelli comuni alle gastroenteriti, e cioè nausea, vomito, soprattutto nei bambini, diarrea acquosa, crampi addominali. In qualche caso si manifesta anche una leggera febbre. La malattia non ha solitamente conseguenze serie, e la maggior parte delle persone guarisce in 1-2 giorni senza complicazioni. Normalmente, l’unica misura è quella di assumere molti liquidi per compensare la disidratazione conseguente a vomito e diarrea. In particolare, la disidratazione può rappresentare una complicazione più seria per i bambini, gli anziani e i soggetti con precario equilibrio metabolico o cardiocircolatorio, e può quindi richiedere una certa attenzione medica.

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Trasmissione del virus
Il virus è altamente infettivo e bastano 10 particelle virali a dare vita a un’infezione. Data la loro persistenza nell’ambiente, che permette una loro replicazione e diffusione anche per due settimane dopo l’infezione iniziale, i norovirus sono difficili da controllare ed è quindi necessario applicare rigorose misure sanitarie per prevenirli e contenerli. La trasmissione avviene direttamente da persona a persona, per via orofecale o via aerosol, oppure tramite acqua o cibo infetti, ma anche per contatto con superfici contaminate.

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Misure di prevenzione
L’unica forma di controllo efficace del norovirus è l’attuazione di rigorose misure igieniche nella manipolazione e distribuzione di cibi e bevande. I norovirus sono piuttosto resistenti nell’ambiente, sopravvivono a temperature sopra i 60° C e anche in presenza di cloro, normalmente utilizzato per disinfettare le acque potabili. Inoltre, rimangono nelle feci delle persone infette per almeno 72 ore dopo la guarigione.
È quindi evidente che solo misure molto stringenti, a partire da un’accurata igiene personale degli addetti alla manipolazione e distribuzione dei cibi, possono prevenirne la diffusione. Vale in questo caso la serie di norme e consigli tipici della prevenzione di qualsiasi tossinfezione alimentare:

• lavarsi le mani molto bene prima di toccare i cibi (ovviamente aggiungo io con acqua non infetta)
• non lavorare e soprattutto non stare a contatto con il cibo quando si è indisposti, soprattutto se si è affetti da gastroenterite, e fino a tre giorni dopo la guarigione
• lavare e disinfettare accuratamente tutti i materiali e le superfici (dalle tovaglie e tovaglioli ai grembiuli e teli da lavoro, fino agli utensili) che possano essere venuti a contatto con una persona infetta e/o con il virus
• utilizzare solo cibi di provenienza certificata, soprattutto nel caso di alimenti che vengono cotti poco, come i frutti di mare o le verdure fresche
• eliminare tutte le scorte alimentari che potrebbero essere state contaminate da un addetto infetto e/o da altre fonti di norovirus
• tenere separati i soggetti che portano pannolini e pannoloni, soprattutto in asili e case di riposo, dalle aree dove viene preparato e distribuito il cibo.
  

E’ finita da poco la conferenza stampa di ASL e la stampa riporta questo resoconto:

Infezione da Norovirus. Questa la conclusione a cui è giunta l’ASL nell’indagine per definire l’origine dell’epidemia gastroenterica che si calcola abbia colpito oltre 2000 persone, residenti o turisti, a San Felice del Benaco, dal 9 giugno ad oggi.

Sotto accusa l’acquedotto, gestito da Garda Uno, i cui filtri sarebbero risultati inefficaci a trattenere alcuni batteri e virus.
Ad aggravare la situazione il pescaggio troppo vicino al fondo del lago rispetto allo standard stabilito.
Il tubo della rete comunale, risultava inclinato in maniera anomala, pescava a 3-4 metri dal fondo, rispetto ai 10 stabiliti, risucchiando oltre all’acqua anche materiale organico.

Di base, quindi, l’epidemia è stata alimentata dal Norovirus, a cui, in alcuni casi, si è associato il Rotavirus e il batterio del Clostridium Perfringens.
In 26 casi, di cui 18 erano bambini molto piccoli, si è reso necessario il ricovero in ospedale. Attualmente sono 5 le persone ricoverate.
La situazione dal punto di vista sanitario va quindi migliorando in queste ore.

Rimangono a disposizione dei cittadini presidi ambulatoriali e ospedalieri, soprattutto per i casi di recidività.

Rimane in vigore l’ordinanza del Sindaco di San Felice, Paolo Rosa, in attesa di conferme della potabilità.
L’ASL ha fronteggiato l’emergenza in stretto contatto con la Regione, il Ministero della Salute e l’ISS.
Con l’Istituto Zooprofilattico ha condotto le analisi su campioni di acqua e feci che hanno permesso di chiarire il quadro.

Per chi volesse ecco il link al testo del Comunicato Stampa di ASL pubblicato sul sito del Comune di San Felice.

Brava ASL, così va bene, questa sì che è informazione non reticente ai cittadini, ora però continuate a tenerci aggiornati con completezza.
Visto che a fare pressing gli aggiornamenti escono?

Ora però dateci indicazioni comportamentali per arginare l’epidemia e venite a fare formazione agli operatori soprattutto.

Another hit for the travel industry:  Swine flu

If you follow the news, you are probably paralyzed and won’t even leave your house.  Today I received more and more travel information about what airlines are offering, what cruise lines are doing, what resorts are offering and on and on.  Hysteria has hit the travel community.

Now, I am not down playing the fact that there is a sickness out there.  I went to the government web site to get the truth.  That is the most up to date CORRECT information out there.  Here is what they are saying about how to protect yourself:

What You Can Do to Stay Healthy

If you really want to know about the diseases in the world check out www.cdc.gov and you might opt to vacation in your backyard.  Now we have a new outbreak of Yellow fever in Brazil, Pertussis in Australia,  Cholera in Zimbabwe, Avian flu in US, and on and on.  You will always have sickness in the world as well as bed bugs in the bed.  But go anyway and fulfill your dreams.

Call a travel professional like myself who has traveled in the good and the bad.