Norovirus Lawyer & Attorney : Marler Clark : Norovirus Blog

NEWSLINK INDIANA
By: Megan Bastien
Staff Reporter
1/31/2005

MUNCIE, Ind. (NLI) - Local residents who thought they had the flu might have been wrong. Delaware County health officials have reported it actually could have been the Norwalk Virus.

The Norovirus is a common intestinal illness according to Delaware County Health Officer Dr. Donna Wilkins.

Wilkins said it's often confused with the flu. However, symptoms of the Norovirus include vomiting and diarrhea, while flu symptoms more often are fever, aches and coughing.

"People acquire the Norovirus through either contaminated food or water," said Wilkins. "It is a fecal-oral transmission, so it's the person who does not use good hygiene in the restroom and then goes and prepares food, or handles food that somebody else eats."

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Despite the crew's best efforts, the illness hit 200 passengers and 30 crew members on a Holland-America voyage through the Caribbean.
By SAUNDRA AMRHEIN, Times Staff Writer
Published January 29, 2005

TAMPA - Before their own tummies rumbled, before they were locked in their rooms, passengers aboard the cruise ship Veendam knew things were amiss.

"You would hear people in the room next to you at night," getting sick, said Kathy Miller, 53, of Iowa.

"It was a very vocal performance," added friend Luanna Raushenberger, 55.

Both women succumbed to a pesky virus that spread to about 200 passengers and 30 crew members aboard a Holland-America cruise through the Caribbean islands. Sick passengers experienced gastrointestinal problems and were quarantined to their rooms until they were better, passengers and officials said.

Because of the virus's effects on 230 of the 1,220 passengers and 572 crew members, the Veendam returned to Tampa 13 hours early, docking at Channelside around 5 p.m. Friday instead of its planned arrival around 6 a.m. today.

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Saturday, January 29, 2005

TAMPA, Florida (AP) -- About 230 people on a Holland America cruise ship came down with a gastrointestinal illness on a Caribbean voyage, forcing the trip to end early.

About 200 of the 1,220 passengers and 30 of the 572 crew members aboard the Veendam got sick on the trip, which ended in Tampa on Friday evening about 13 hours early. Sick passengers were quarantined to their rooms, passengers and officials said.

While they were disappointed at missed tours, several passengers said they were impressed with the staff's work to disinfect the ship. Crew members scrubbed banisters, elevator knobs and other exposed areas to eliminate the virus that spreads easily in close quarters.

Passengers said they were warned of a potential health hazard because travelers on the previous cruise fell ill. They were offered a refund if they wanted to cancel before the ship left Jan. 15. Passengers who took the trip will get partial refunds ranging from $125 to $250 (euro95 to euro190), Holland America spokeswoman Rose Abello said.

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BY ADAM SEXTON
asexton@kdrv.com
January 28, 2005

GRANTS PASS, Ore. -- Dozens more people are coming forward to tell the Josephine County Health Department they were infected with norovirus at a Grants Pass Mexican restaurant. Nurses have recorded more than 80 cases.

Media reports are helping more people identify the violent stomach illness they contracted after eating at Si Casa Flores in early January.

Tests came back positive Friday for norovirus. Initially, nurses recorded around 30 cases. The number balooned to over 80 Friday afternoon as more came forward.

The virus causes severe gastroenteritis. Patients usually recover in 24-48 hours, but the virus is very tough and can live on in its host for up to two weeks.

These are the first recorded health problems at Si Casa Flores. The most recent county health inspection gave the restaurant high marks for cleanliness, and there are no critical citations on record.

This outbreak of norovirus is the largest in the history of Josephine County. It is also the county's first since 1994.

Nurses say vigorous handwashing is the best way to reduce the chance of infection.

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By Laura Bly, USA TODAY
January 28, 2004

While recent blasts of snow and frigid temperatures may be prompting daydreams of umbrella drinks and midnight buffets, health and travel industry officials are cautioning vacationers about a seasonal rise in illnesses associated with the highly contagious and hard-to-kill stomach bug known as norovirus. And, in several cases, companies are waiving cancellation penalties and telling already-ill tourists to stay home rather than infect fellow travelers.

Since Jan. 1, six cruise ships calling at North American ports have reported gastrointestinal outbreaks to the federal Centers for Disease Control and Prevention. Last year, 28 ships had a total of 36 outbreaks, which the CDC defines as illness rates of 3% or higher among passengers or crew. This week alone, three ships ó Holland America Line's Veendam and Ryndam and Royal Caribbean's Empress of the Seas ó are reporting outbreaks affecting between 4.4% and 21% of passengers.

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In recent weeks people living at Juniper Hall dorms have been getting sick
Brent Henzi - The Broadside and Bend.com
Friday, January 28, 2005

For about a month now people residing at the Central Oregon Community College (COCC) Juniper Hall dorms have been getting very ill. People have been sick with similar symptoms, such as diarrhea, vomiting, stomach cramping, low fever, and fatigue, which are symptoms of a gastrointestinal virus called the Norwalk virus.

People can catch the virus by drinking liquids or eating food that are contaminated, touching contaminated surfaces, or having direct contact with someone with the illness.

The virus was spreading rapidly through the dorms for weeks and just recently has begun to die down, but that is no reason to think it has gone away for ever.

Eddie Johnson, a human biology professor here at COCC, explains by saying "we have discovered that the virus can survive up to 30 days on surfaces."

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KARE11.COM
By Scott Goldberg, KARE 11 News

The Centers for Disease Control is warning Americans to be careful about their winter vacations, and some Minnesota travel agencies are suspending trips to the Dominican Republic.

ìIt was bad,î said Ted Field, who returned from the Republic last Friday. ìIt was terrible.î

Last week, Field was doubled over in a hotel bathroom and his stomach was twisting in agony.

ìI woke up in the middle of the night,î he recalled, ìsort of choking back, uh, some nausea.î

Field is one of 20 Minnesota realtors who fled the cold for what they hoped would be a soothing week in the Republic. He says all but three in the group were stricken with symptoms of norovirus.

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News
January 28, 2005
By Janet Murray, R.E.H.S./Randolph County Health Department

During the week of December 20-25th, 2004 the Moberly area experienced its first suspect outbreak of Norovirus which is believed to have been spread through a local restaurant. Norovirus, previously known as Norwalk virus, are a group of related viruses that cause acute gastroenteritis in humans.

Norovirus in humans presents as acute-onset vomiting, watery non-bloody diarrhea with abdominal cramps, and nausea. Low-grade fever and headaches also occur frequently. The virus generally takes 24-48 hours to develop after exposure and symptoms usually last 24-48 hours. Recovery without treatment is complete, and there are no long term after-affects.

Norovirus are transmitted primarily from person-to-person spread or by the fecal-oral route. It can also be transmitted via the environment or on utensils, etc. Murray stated "Noroviruses are highly contagious, and it is thought that as few as 10 viral particles may be sufficient to infect an individual. In other outbreaks several modes of transmission have been documented; for example, initial foodborne transmission followed by secondary person-to person transmission. This is the virus that has hit the cruise ships with increased frequency over the last couple of years. There have also been several documented cases in tour busses of people visiting Branson."

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By HELEN BRANSWELL
Canadian Press
Friday, January 28, 2005

In a matter of a few years, the term Norwalk virus has become part of the public lexicon. At this time of year, it seems like it's everywhere: grounding planes and closing daycares, spreading misery in long-term-care facilities and schools.

Infectious-disease experts say they think outbreaks are more common and there's something changing in the behaviour of the nasty noroviruses.

"We certainly believe that what we've seen over the last five years is an increase in the activity of this virus," said Dr. Paul Sockett of the Public Health Agency of Canada.

"And this is early stages yet but we have some evidence which suggests that we may have a slightly more virulent strain that's been circulating in the past couple of years," he said, adding the bug has been sowing misery "fairly well across the country."

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Allegheny County Health Department
January 27, 2005

The Allegheny County Health Department is offering advice on how to prevent and control the spread of common viruses causing much of the intestinal illness or so-called "stomach flu" being reported this winter.

More than 90% of intestinal illnesses or stomach flu are caused by a group of viruses known as noroviruses, which are most frequently reported during the winter months.

The symptoms usually include nausea, vomiting, diarrhea and stomach cramps. While stomach flu isn't related to influenza, a respiratory illness, in some cases people with a norovirus infection also have influenza-like symptoms such as a fever, chills, headache and muscle aches.

The illness starts suddenly, but is usually brief, lasting only one or two days. It is generally not serious, however some people can feel very ill with frequent vomiting and diarrhea. They should drink plenty of fluids to prevent dehydration, especially the very young and elderly.

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www.about-norwalk.com

The norovirus (previously called Norwalk-like virusî or NLV) is a member of the family Caliciviridae. The name derives from the Latin for chiliceócalyxómeaning cup-like, and refers to the indentations of the virus surface.

Nature has created an ingenious bug in Norwalk. The round blue ball actually is a protein surrounding the virus's genetic material. The virus attaches to the outside of cells lining the intestine. Then it transfers its genetic material into that cell. There it reproduces, finally killing the human cell to release new copies of it that attach to more cells of the intestine's lining.

The family of Caliciviridae consists of several distinct groups of viruses that were first named after the places where outbreaks occurred. The first such outbreak occurred in 1968 among schoolchildren in Norwalk, Ohio. The prototype strain was identified four years later, in 1972, and was the first virus identified that specifically caused gastroenteritis in humans. Id. At S255. Other discoveries followed, with each strain named based on the location of its discovery-location, e.g., Montgomery County, Snow Mountain, Mexico, Hawaii, Parmatta, Taunton, and Toronto viruses. A study published in 1977 found that the Toronto virus was the second most common cause of gastroenteritis in children.

Eventually this confusing nomenclature was resolved, first in favor of calling each of the strains a Norwalk-like virus, and then simply, a norovirus ñ the term used today.

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News-Medical in Disease/Infection News
Wednesday, 26-Jan-2005

There is an increase in norovirus incidents across the country in hospitals, day care centers, nursing homes and schools, according to Dave Forney, chief of the Vessel Sanitation Program of the Centers for Disease Control and Prevention (CDC).

With the reported increased number of norovirus cases on land, reported from Virginia to Colorado, Canada and Japan, the International Council of Cruise Lines (ICCL) has observed a corresponding increase in norovirus incidents on board cruise ships.

The CDC estimates that 23 million people in the United States every year contract norovirus, or 8 percent of the U.S. population. Annually, less than 1 percent of all cruise ship passengers have been affected by norovirus, however, the cruise lines encourage all people -- cruise passengers or not -- to practice good hygiene by washing one's hands frequently and thoroughly with soap and warm water.

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International Council of Cruise Lines' Members Prepared for Increased Incidents of Norovirus and Encourage Everyone to Exercise Frequent Hand Washing to Stay Healthy

PR NEWSWIRE
ARLINGTON, Va., Jan. 25, 2005--- There is an increase in norovirus
incidents across the country in hospitals, day care centers, nursing homes and
schools, according to Dave Forney, chief of the Vessel Sanitation Program of
the Centers for Disease Control and Prevention (CDC). With the reported
increased number of norovirus cases on land, reported from Virginia to
Colorado, Canada and Japan, the International Council of Cruise Lines (ICCL)
has observed a corresponding increase in norovirus incidents on board cruise
ships.

The CDC estimates that 23 million people in the United States every year
contract norovirus, or 8 percent of the U.S. population. Annually, less than
1 percent of all cruise ship passengers have been affected by norovirus,
however, the cruise lines encourage all people -- cruise passengers or not --
to practice good hygiene by washing one's hands frequently and thoroughly with
soap and warm water.

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GRANTS PASS, OREGON
The Associated Press
January 21, 2005

At least 32 people were sickened, apparently with the Norwalk virus, after eating at a Grants Pass restaurant, health authorities said.

Dr. Paul Cieslak, communicable disease manager at the Oregon Department of Human Services, said that lab results will not be back for a few days.

People stricken ate at the Si Casa Flores restaurant Jan. 6-8. Health officials say that there no longer is a risk in eating there.

Cieslak said that Oregon typically has about 100 cases per year and that it is the most common form of food-borne illness.

"Usually, it's from a sick human who has diarrhea, doesn't wash their hands and prepares some food and gets the virus into the food," Cieslak said.

"There's always a possibility food came into the restaurant contaminated. We never did identify which food it was."

Norwalk's symptoms begin 24 to 48 hours after ingestion and typically last a day, Cieslak said. There is no long-term risk.

Symptoms include intense vomiting and diarrhea, Cieslak said.

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January 24, 2005

Cruise lines are required to report all cases of GI illness aboard cruise ships to CDCís Vessel Sanitation Program (VSP). Medical staff aboard cruise ships use clinical criteria to determine self-reported (by passengers and crew) cases of GI illness; disease reports from cruise ships do not require laboratory confirmation. VSP monitors the GI reports, and provides assistance to vessels with unusual cases or elevated levels of ill passengers and crew. VSP staff conduct investigations when an unusual GI illness pattern or characteristic is found.

In contrast to cruise ships' reporting to public health authorities, land-based facilities (clinics, hospitals, doctors' offices) do not report GI illnesses.

2005:
Royal Caribbean Cruise Line Enchantment of the Seas, 01/03-01/08, Pending
Princess Cruise Line Sun Princess, 01/08-01/18, Pending
Royal Caribbean Cruise Line Mariner of the Seas, 01/16-01/23, Pending
Holland America Cruise Line Veendam, 01/03-01/15, Norovirus
Holland America Cruise Line Ryndam, 01/13ñ01/29, Unknown

http://www.cdc.gov/nceh/vsp/surv/GIlist.htm

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www.Amednews.com
Health & Science

The latest edition of The Diagnosis and Management of Foodborne Illness is now available on the American Medical Association Web site (www.ama-assn.org/go/foodborne) for downloading to personal digital assistants. The primer was produced by the AMA in collaboration with several other health professional groups.

The first edition of the primer, released last year, was met with such demand that a PDA edition was created. The primer covers the diagnosis, treatment and reporting of foodborne illness. The latest edition includes sections on hepatitis A, noroviruses, antibiotic-resistant Salmonella, congenital toxoplasmosis and intentional contamination.

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January 24, 2005
www.nbc6.net

Workers at Port Canaveral are checking a Royal Caribbean cruise ship after hundreds of people got sick.

It happened on board the "Mariner Of The Seas," which took off last week and spent seven days touring the western Caribbean.

More than 250 passengers and crew members got a stomach virus, which officials with Royal Caribbean called a 24-hour bug. The ship was being checked for bacteria.

Passenger Crystal Wiles, an accountant from Frederick, Md., said she and her husband had been quarantined for three days. She said in a phone interview from the vessel that the cruise line handled the illness poorly and is undercounting the number of people affected by the virus.

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January 23, 2005
BY ELLEN CREAGER
DETROIT FREE PRESS TRAVEL WRITER

Travelers to popular Dominican Republic resorts in Punta Cana and Puerto Plata should take precautions against malaria and stomach viruses, the U.S. Centers for Disease Control and the Canadian Public Health Agency warned last week.

The CDC reported 18 cases of gastrointestinal illness among a group of 20 people who traveled to the eastern resort town of Punta Cana Jan. 3-10. Meanwhile, the CDC's Canadian counterpart reported several cases of a noro-type virus affecting Canadian tourists who traveled to the northern coastal town of Puerto Plata in early January.

Norovirus is a contagious stomach flu virus that can cause nausea, diarrhea, cramping, vomiting, high fever, chills and fatigue.

The Puerto Plata outbreak was centered at the RIU resort, especially at the RIU Bachata.

Darryl Burrows of Windsor says four of his seven family members who visited the RIU complex in Puerto Plata this month got violently sick. "First my brother-in-law, then my wife, then my daughter, all in a 12-hour period," Burrows said Friday. "I asked around the pool and almost everyone had been sick."

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January 21, 2005
The Associated Press

GRANTS PASS - At least 32 people were sickened, apparently with the Norwalk virus, after eating at a Grants Pass restaurant, health authorities said.
Dr. Paul Cieslak, communicable disease manager at the Oregon Department of Human Services, said lab results will not be back for a few days.

Those stricken ate at the Si Casa Flores restaurant Jan. 6-8.

Health officials say there is no longer a risk in eating at the restaurant.

Cieslak said Oregon typically sees about 100 cases a year and that it is the most common form of food-borne illness.

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January 23, 2005

A Royal Caribbean cruise ship is expected to dock at Port Canaveral, Florida, on Sunday, after more than 200 passengers became ill with a Norwalk-like stomach virus.

The Mariner of the Seas left Port Canaveral on Jan. 16 with 3,465 passengers and 1,190 crew members. The seven-day cruise was scheduled to take vacationers through the western Caribbean.

A spokesperson for the cruise line indicated the virus was traced to a guest who had symptoms of an illness two days before departure.

Ill passengers were treated with over-the-counter medications.

Royal Caribbean sent additional doctors and a nurse to help the ship's medical team deal with the outbreak.

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Cleaned vessel off on other trip
BY J.D. GALLOP
FLORIDA TODAY
January 23, 2005

PORT CANAVERAL -- All Maureen Wimmer wanted to do was cruise the topaz waters of the Caribbean Sea with her husband, enjoy the food and see the sights.

But what the 64-year-old and at least 260 other cruise ship guests got instead was confinement to quarters after what was believed to be the Norwalk virus swept through the 15-deck Royal Caribbean International Mariner of the Seas.

The South Carolina woman returned to Port Canaveral early Sunday with stories of how her seven-day cruise of the Western Caribbean was punctuated with bouts of vomiting, diarrhea and visits to the ship's medical staff.

"My second night started out with Norwalk," recalled Wimmer, accompanied by her husband, Jack, and at least 60 other couples from the Hilton Head, S.C., area.

"I went to the (infirmary), and there were a lot of people already there. Some people ended up on IVs because they were so dehydrated."

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Virus blamed on 2002-03 poor performance
BY DONNA BALANCIA
FLORIDA TODAY
Jan 22, 2005

The Norwalk virus is something the cruise industry knows well.

The virus was a contributing factor to relatively poor cruise-industry performance in 2002 and 2003. It prolonged the recovery for the cruise business after the terrorist attacks of 2001.

The new outbreak on Royal Caribbean International's Port Canaveral-based Mariner of the Seas has brought back into the spotlight the threat of the virus attacking the cruise industry's booming business. And though personnel scrub and clean the ships, and people continue to take voyages, the virus still hasn't been beaten.

"We take precautions every day with a rigorous cleaning process," Disney Cruise Line spokeswoman Rena Langley said Saturday. "We have signage on our ship to tell guests to wash their hands. The focus is on every day of the year, not just during virus season."

Disney Cruise Line, like many others in the business, has felt the financial sting of the Norwalk virus. More than two years ago, it reported more than 400 passengers became sick on cruises on its ship, the Magic, which is based at Port Canaveral. The company canceled the ship's scheduled cruise for the ensuing week.

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January 21, 2005

All 32 people ate at the Si Casa Flores restaurant in early January.

At least 32 people got sick after eating at a Grants Pass restaurant recently. Doctors think the Norwalk Virus is to blame.

All 32 people ate at the Si Casa Flores restaurant in early January. Health officials say there is no longer a risk in eating there.

The Norwalk virus is the most common cause of food-borne illness, with about 100 occurrences a year in Oregon. Doctors say the symptoms of Norwalk virus begin within 24 to 48 hours and typically last about a day.

Symptoms include intense vomiting and diarrhea.

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The Associated Press
January 20, 2005

GRANTS PASS, Ore. - At least 32 people were sickened, apparently with the Norwalk virus, after eating at a Grants Pass restaurant, health authorities said.

Dr. Paul Cieslak, communicable disease manager at the Oregon Department of Human Services, said lab results will not be back for a few days.

Those stricken ate at the Si Las Flores restaurant Jan. 6-8. Health officials say there is no longer a risk in eating there.

Cieslak said Oregon typically sees about 100 cases a year and that it is the most common form of food-borne illness.

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January 14, 2005

On January 11, 2005, the Centers for Disease Control and Prevention (CDC) was notified by the Ohio State Health Department about gastrointestinal illness in 18 of a group of 20 who had traveled from January 3-10, 2005 to the resort area of Punta Cana, Dominican Republic. The majority of ill travelers complained of diarrhea, nausea, cramps and fatigue. None required hospitalization. The Ohio State Health Department and CDC are investigating to determine the exact cause of illness. Based on the clinical presentation, norovirus disease is suspected.

Noroviruses are a group of viruses that cause the ìstomach flu,î or gastroenteritis and can be found worldwide. Recent outbreaks have been reported on cruise ships in the U.S. The symptoms usually include nausea, vomiting, diarrhea, and some stomach cramping. Although symptoms of vomiting and diarrhea can be severe, people usually get completely better after 1-3 days. It is important that people who are ill with diarrhea and vomiting drink plenty of fluids to prevent dehydration. Any traveler with persistent diarrhea and vomiting or fever should get immediate medical attention.

Frequent hand washing and attention to hygiene are important in decreasing the risk of contracting norovirus infection.

To learn more about noroviruses, including preventing and treating infection, see http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus-qa.htm.

For information about handwashing to prevent disease transmission, see http://www.cdc.gov/ncidod/op/handwashing.htm.

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Thursday, January 20, 2005
Local News

Port Everglades ñ Crew members have been preparing the "Sun Princess" to set sail from Port Everglades after a virus made dozens of crew passengers sick.

Eighty-nine passengers and five crewmembers onboard came down with a highly contagious stomach virus on the previous cruise.

The ship's medical staff quarantined one sick couple in their cabin for nearly the entire trip. Most passengers set to sail on the next cruise say they won't let the virus ruin their vacation.

"I have no worries at all. No, I'm just going to have a good time and, I'm not going to get sick. They'll make sure of that," said Alan Masters.

Still there were some passengers unhappy about the situation.

"Pissed off! That doesn't begin to tell you how I feel right now," said Ilene Rzecinski.

Crews disinfected the ship from stem to stern in preparation for the next voyage.

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January 19, 2005

MARIETTA, Pa. -- A Lancaster County couple is just back from a vacation they won't forget anytime soon.

They paid thousands of dollars only to get stuck aboard a cruise ship full of sick passengers.

Eileen and George Rzecinski only have three pictures from their 12-day Caribbean cruise. That's because they spent most of it, not sightseeing, but quarantined in their cabin.

"We were locked in our room, couldn't go anywhere," George Rzecinski said.

"It's the trip from hell. People say you're never going to forget it. You're not kidding," Eileen Rzecinski said.

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NBC6.net
January 19, 2005

MIAMI -- Princess Cruise Lines' Sun Princess is the latest ship to report an outbreak of the norovirus.

Officials said 89 passengers and five crew members on board the ship reported gastrointestinal problems during the sailing.

Lab results confirmed that norovirus is to blame.

The norovirus is highly contagious and easily transmitted.

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The good news about Norwalk virus is that it does not multiply in foods as many other bacteria do. In addition, thorough cooking destroys this virus. To avoid this illness, make sure the food you eat is cooked completely. Shellfish (oysters, clams, mussels) pose the greatest risk and any particular serving may be contaminated; there is no way to detect a contaminated oyster from a safe oyster. With shellfish, only complete cooking offers reliable protection.

Wash raw vegetables thoroughly before eating or preparing salads. If you are traveling in an area that appears to have polluted water, drink only boiled drinks or carbonated bottled beverages without ice.

Immunity to calciviruses is not permanent and reinfection can occur, and infection may also spread from person-to-person. So, if you or another household member suffer a bout of gastroenteritis, then

Wash hands with soap and warm water after toilet visits, before preparing or eating food; and after caring for the sick;

Exclude persons with gastroenteritis from the kitchen; and

Always dispose of sewage in a sanitary manner.

The Environmental Health Associates have published "Norovirus Outbreak Control Guidelines" for the lodging industry, but they state that: "These guidelines should be used in conjunction with the other laws and rules governing sanitation and communicable disease control in the lodging industry and advice from medical or public health advisers. The local circumstances should always be taken into account when deciding on a plan of action."

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By Janet Murray, R.E.H.S./Randolph County Health Department, Central Missouri
The Moberly Monitor-Index
January 17, 2005

During the week of December 20-25th, 2004 the Moberly area experienced its first suspect outbreak of Norovirus which is believed to have been spread through a local restaurant. Norovirus, previously known as Norwalk virus, are a group of related viruses that cause acute gastroenteritis in humans.

Norovirus in humans presents as acute-onset vomiting, watery non-bloody diarrhea with abdominal cramps, and nausea. Low-grade fever and headaches also occur frequently. The virus generally takes 24-48 hours to develop after exposure and symptoms usually last 24-48 hours. Recovery without treatment is complete, and there are no long term after-affects.

Norovirus are transmitted primarily from person-to-person spread or by the fecal-oral route. It can also be transmitted via the environment or on utensils, etc. Murray stated "Noroviruses are highly contagious, and it is thought that as few as 10 viral particles may be sufficient to infect an individual. In other outbreaks several modes of transmission have been documented; for example, initial foodborne transmission followed by secondary person-to person transmission. This is the virus that has hit the cruise ships with increased frequency over the last couple of years. There have also been several documented cases in tour busses of people visiting Branson."

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By KEITH ROYSDON
January 15, 2005
kroysdon@muncie.gannett.com

MUNCIE - Delaware County health officials confirmed Friday that several local residents recently sick from the "stomach flu" actually had contracted the Norwalk virus.

The norovirus - which causes nausea, diarrhea, vomiting and fever and is best known in recent years for affecting passengers on cruise ships - was found in seven of nine stool samples collected and tested by the Delaware County Health Department.

"We don't want to alarm folks, but we want to make people aware and focus on good handwashing practices," said Bob Jones, health department administrator.

"You can be very ill with this particular strain of viruses," he added. "Typically it's a couple-of-day episode, but you're very sick while you have it."

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Laboratory diagnosis is difficult. Diagnosis is often based on the combination of symptoms, particularly the prominence of vomiting, little fever, and the short duration of illness. Actual proof of infection requires research laboratory techniques in which Norwalk virus particles are identified by electron microscopy from samples of stool or vomitus.

www.about-norwalk.com

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Protracted Vomiting Torments Sufferers
By Susan Levine
Washington Post Staff Writer
Friday, January 14, 2005

If you're still eating breakfast while you read this, or catching a quick bite for lunch during work, that is good fortune and bad. Looking at life positively, it means you are not suffering from the miserable sickness that is the subject of this story. A couple of paragraphs of description, though, and there's no guarantee you won't start feeling queasy.

How else to explain the sledgehammer effect of an affliction with such a grossly apt moniker as "winter vomiting disease"? This highly contagious stomach bug, which mimics many aspects of food poisoning, is a norovirus that hits hardest this time of year.

For 24 to 48 hours, it lays waste to its victims.

"I was hugging the old commode," recounted Katherine Riddle of Oakton, the first in her family to fall ill in late December.

Riddle's only warning was a few minutes of dizziness while she was teaching an afternoon flute lesson at her house. "And then, boom!" she said. She ran for the bathroom and threw up. The lesson ended quickly, but her vomiting went on and on and on. "I was doing it for the rest of the night. It was incredible."

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January 12, 2005

PORT EVERGLADES, FL ó A single passenger may have unleased a norovirus that sickened 116 passengers aboard a Royal Caribbean cruise and caused the ship to return to port to undergo a deep cleansing and decontamination process, The Miami Herald reported Sunday.

The Herald said that cruise workers distributed letters to passengers who were preparing to board Saturday as the trip went back out on the sea, detailing the cleaning process and explaining the need for proper hand-washing.

The cleaning involves the use of disinfectants, especially in "high-touch" areas such as countertops, railings, exercise equipment, remote controls, light switches, elevator buttons and computer keyboards, according to the Herald.

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Research

Efforts to prevent foodborne illness target bacterial pathogens, yet noroviruses (NoV) are suspected to be the most common cause of gastroenteritis. New molecular assays allow for better estimation of the role of NoV in foodborne illness. We analyzed 8,271 foodborne outbreaks reported to the Centers for Disease Control and Prevention from 1991 to 2000 and additional data from 6 states. The proportion of NoV-confirmed outbreaks increased from 1% in 1991 to 12% in 2000. However, from 1998 to 2000, 76% of NoV outbreaks were reported by only 11 states. In 2000, an estimated 50% of foodborne outbreaks in 6 states were attributable to NoV. NoV outbreaks were larger than bacterial outbreaks (median persons affected: 25 versus 15), and 10% of affected persons sought medical care; 1% were hospitalized. More widespread use of molecular assays will permit better estimates of the role of NoV illness and help direct efforts to control foodborne illness.

Foodborne infections are estimated to cause 76 million illnesses, 300,000 hospitalizations, and 5,000 deaths annually in the United States (1). Several high-profile outbreaks in the last 15 years have focused attention on the role of bacteria in severe foodborne illness (2ñ4) and led to serious efforts to prevent bacterial contamination of food during all levels of processing and handlingóthe "farm-to-fork" model. However, in more than two thirds of outbreaks of foodborne illness, no pathogen is identified (5).

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SEATTLE POST-INTELLIGENCER STAFF
January 11, 2005

CLE ELUM -- Results from a state lab have confirmed that norovirus likely caused about 80 people to become ill after eating at a Cle Elum restaurant during the New Year's weekend, according to the Kittitas County Public Health Department.

Norovirus causes stomach flu-like symptoms, including nausea, vomiting and diarrhea. The virus is highly contagious and can be spread through contaminated food or liquids, according to the Centers for Disease Control and Prevention. Symptoms usually last one to three days.

No one was hospitalized with the virus, but at least two people were treated at a local emergency room for dehydration, said Bonnie Corns, community health services manager for Kittitas County.

The restaurant, Diamondback Restaurant and Lounge, has re-opened.

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Jason Misner
Jan 9, 2005

Two more patients from Joseph Brant Memorial Hospital are in isolation with probable Norwalk virus.

That brings to eight the total number of patients who have exhibited symptoms -- specifically vomiting and diarrhea -- consistent with the highly-contagious gastrointestinal virus. They have been placed in isolation as staff work to control the spread of the illness.

The patients are being isolated in 5 West, which is a unit usually comprised of patients awaiting medical care like cancer treatment. This unit has been closed to visitors since the last week of December.

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Usual symptoms of Norwalk virus infections include nausea, vomiting, diarrhea, and abdominal pain. Headache and low-grade fever may also accompany this disease. The disease is usually mild and brief. It will develop 24 to 48 hours after contaminated food or water is ingested and lasts for 24 to 60 hours. People infected with Norwalk Virus usually recover in 2 to 3 days without serious or long-term health effects.

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More than 100 passengers and crew members returned from a five-day cruise Saturday after suffering from symptoms of a virus.
BY EVAN S. BENN
ebenn@herald.com
January 9, 2005

A single passenger may have unleashed a Norwalk-like virus that sickened more than 100 of his fellow shipmates on a Royal Caribbean cruise.

It led to some not-so-smooth cruising for 108 passengers and eight crew members aboard the 1,950-passenger-capacity Enchantment of the Seas, which returned to Port Everglades early Saturday. The trip was not cut short as a result of the outbreak.

Like thousands of cruise passengers who fell ill to similar outbreaks in 2003, dozens on the Enchantment spent part of their five-night Caribbean excursion vomiting and doubled over with severe stomach cramps.

Cruise officials traced the virus to a man who told them he had symptoms before he boarded the Enchantment on Monday, Royal Caribbean spokesman Michael Sheehan said. The cruise line did not release the passenger's name.

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By ANDREA PARIS

CLE ELUM - Diamondback's Casino was closed by the Kittitas County Health Department Tuesday afternoon while it investigates a possible food-borne illness outbreak.

The Health Department reported more than 20 people have called with complaints of diarrhea, nausea and vomiting after eating at Diamondback's sometime over the New Year's weekend.

"We started getting calls Tuesday morning," Community Health Services Manager Bonnie Corns said. "We have sent samples to the state lab and expect results sometime tomorrow."

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The Virginian-Pilot
January 7, 2005

The Virginia Department of Health is tracking an increase in outbreaks of norovirus, also known as ìwinter vomiting disease,î in Virginia and Hampton Roads.

The gastrointestinal disorder occurs most often in the winter.

Symptoms include nausea, vomiting, diarrhea and occasionally a headache and low-grade fever. The condition generally lasts from two to three days.

Those with weak immune systems or those unable to care for themselves may be at risk of dehydration, said Dr. Nancy M. Welch , director of the Chesapeake Health Department.

It is very contagious and is passed in the feces and vomit, so outbreaks are generally reported in places where people are in close contact, such as dormitories and assisted-living facilities.

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News Release
For immediate release:
January 6, 2005

The Kittitas County Public Health Department is investigating a possible
foodborne illness outbreak in Cle Elum. Public Health is conducting an
investigation to identify the illness and the source.

More than 20 people have reported symptoms of diarrhea, nausea and vomiting
after eating at the Diamondbackís Restaurant and Lounge, located at 200 East
First Street in Cle Elum on New Yearís Eve. The health department has closed
the restaurant while conducting the investigation.

ìWe are concerned about the health of people in our community, said Dr. Rosalie Miller, Kittitas County Health Officer. We are working closely with the restaurant owner to track down the source of the illness and help the people who got sick.î

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The norovirus (previously called Norwalk-like virusî or NLV) is a member of the family Caliciviridae. The name derives from the Latin for chiliceócalyxómeaning cup-like, and refers to the indentations of the virus surface.

Nature has created an ingenious bug in Norwalk. The round blue ball actually is a protein surrounding the virus's genetic material. The virus attaches to the outside of cells lining the intestine. Then it transfers its genetic material into that cell. There it reproduces, finally killing the human cell to release new copies of it that attach to more cells of the intestine's lining.

The family of Caliciviridae consists of several distinct groups of viruses that were first named after the places where outbreaks occurred. The first such outbreak occurred in 1968 among schoolchildren in Norwalk, Ohio. 1 The prototype strain was identified four years later, in 1972, and was the first virus identified that specifically caused gastroenteritis in humans. Id. At S255. Other discoveries followed, with each strain named based on the location of its discovery-location, e.g., Montgomery County, Snow Mountain, Mexico, Hawaii, Parmatta, Taunton, and Toronto viruses. A study published in 1977 found that the Toronto virus was the second most common cause of gastroenteritis in children. 2

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William D. Marler (www.williammarler.com), an attorney at Marler Clark LLP PS (http://www.marlerclark.com) has extensive experience representing victims of bacterial and viral food poisonings. Since 1993, Marler Clark has represented victims of most of the largest foodborne illness outbreaks in the United States, including the 1993 Jack in the Box E. coli, 1998 Odwalla E. coli, 1999 Sun Orchard Salmonella, 2002 ConAgra E. coli and Chili's Salmonella outbreaks, the 2003 Chi Chi's Hepatitis A outbreak, and the 2004 Sheetz Salmonella outbreak.

Bill feels that a lawyer should do more than just sue corporations. That is why he speaks frequently on issues of safe food and formed Outbreak, Inc. (http://www.outbreakinc.com), a not-for-profit business dedicated to explaining to companies why it is in their interest to avoid food illness litigation. Bill also has created (http://marlerblog.com) as a way of updating the Web on issues of interest to him.

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Six patients test positive for highly-contagious virus
Jason Misner
Jan 5, 2005

Visitation restrictions are in place at Joseph Brant Memorial Hospital following an outbreak of the highly-contagious gastrointestinal virus known as Norwalk.
So far six patients have been confirmed as having contracted Norwalk in 5 West, which has been closed to visitors since last week. The hospital wing is comprised of patients awaiting medical care like cancer treatment.

Also, three patients have a Norwalk-like virus and are awaiting tests for confirmation.

"We ask people to defer visits, if possible," said Ebbe Marquardsen, Jo Brant's vice-president community relations. "Generally speaking, we are saying do not visit the hospital if you are sick."

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William Marler is the managing partner in the law firm Marler Clark L.L.P., P.S. Since 1993, Mr. Marler has represented thousands of victims of E. coli, Salmonella, Hepatitis A, Listeria, Shigella, Campylobacter and Norwalk Virus illnesses in over thirty States. As a trial lawyer, Mr. Marler has been involved with several cases of national importance. He represented the children murdered by Wesley Alan Dodd, an escaped Washington State convict; the family of William Louth, who died when a crane collapsed during Kingdome roof repairs; the Terlicker family in its suit against Martin Pang and the City of Seattle stemming from an arson fire; and Brianne Kiner in her $15.6 million E. coli settlement with Jack-in-the-Box. This settlement created a state record for an individual personal injury action. Mr. Marler resolved several other Jack-in-the-Box E. coli cases for more than $2.5 million each.

In May of 1998, he settled the Odwalla Juice E. coli outbreak for the families of children who were severely injured after consuming Odwalla apple juice for $12 million. He represented several children in an E. coli outbreak stemming from E. coli contaminated swimming pool water in Georgia. In 2001 he successfully tried to verdict an E. coli case involving a school lunch program in Washington State. The jury returned a verdict of $4.75 million. He also resolved dozens of E. coli cases in 2003 related to one of the largest meat recalls in United States. Mr. Marler recently settled an E. coli case for a young girl for $11 million. In addition, Mr. Marler has been lead counsel in:

Sheetz Salmonella Outbreak:
www.about-salmonella.com/articles/Sheetz/Sheetz.htm
Paramount Farms Salmonella Outbreak:
www.about-salmonella.com/articles/paramount/paramount.htm
Sequoias E. coli Outbreak:
www.about-ecoli.com/news/sequoias.htm
Chi Chi's Hepatitis A Outbreak:
http://www.about-hepatitis.com/articles/chichis/chichis.htm
Goldcoast Produce E. coli Outbreak:
http://www.about-ecoli.com/news/goldcoast.htm
Golden Corral Salmonella Outbreak:
www.about-salmonella.com/articles/goldencorral/goldencorral.htm
Habaneros E. coli Outbreak:
http://www.about-ecoli.com/news/habanero.htm
Chili's Salmonella Outbreak:
www.about-salmonella.com/articles/chilis/chilis.htm

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By Robert Miller
THE NEWS-TIMES
January 2, 2004

You can call it the Norwalk virus or the stomach flu. You can call it the flying death or the ups and outs. Or the heave ho and the pukes.
Whatever the name, it's making the rounds, leaving most people wretched and housebound for a day or two.

"We are seeing it," said Dr. William Gemmell, vice chairman of emergency medicine at Danbury Hospital. "Some years we see more of it than others. This is one of those years."

Barbara Burnsidespokeswoman for New Milford Hospital, said the emergency department there has also seen the illness on the rise ó especially in adults and seniors.

The illness is probably caused by a norovirus ó the group of viruses that circulate in the winter causing short-lived but intense bouts of vomiting and diarrhea. For most people, there's only one mode of treatment: drink lots of liquids to avoid dehydration and wait it out.

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