Kent, Ohio Norovirus Outbreak 2008

1. Kent, Ohio Norovirus Outbreak 2008 Shawn Kise BSN, RN, MS Student

2. Objectives • Have a general knowledge base for the Norovirus. • Understand the process and steps taken in the outbreak investigation. • Be able to apply information received to patient education. • Correctly answer the quiz questions at the end of the presentation.

3. The Outbreak • In April 2008, a large number of individuals starting getting sick with severe nausea, vomiting, and diarrhea in Kent, Ohio. • A large majority were Kent State University students. • With a large increase in cases, the local hospital notified the Kent City Health Department.

4. The Investigation • Stool samples were collected from individuals and sent for testing at the Ohio Department of Health laboratory. • Interviews were conducted by Kent health officials of affected individuals. • A common theme from the interviews was haven ate at the Chipotle restaurant just off of Kent State University campus.

5. What was the cause? • Stool samples revealed that the Norovirus Genotype G2 was the cause. • After further investigation it was determined that food contaminated with the Norovirus served from April 14th though April 18th at the Kent Chipotle was the source of the outbreak.

6. Investigation Continued • The Chipotle restaurant was closed and food samples were collected from the restaurant for testing. • Leftover Chipotle food samples from affected individuals was also collected and tested. • All employees of the restaurant were also interviewed.

7. Results • Total ill - 509 primary and secondary cases. • Organism – Norovirus • Source – contaminated food from a Chipotle restaurant. No specific source was found. • No patients were hospitalized as a result of the outbreak.

8. Results Cont. • The Chipotle restaurant was closed. All food was thrown away and the restaurant was sanitized, including all cooking equipment. • The Restaurant was reopened with new employees from other Chipotle locations. • The cost of the outbreak to the Kent community was estimated to be between $130,000 and $305,000.

9. Epidemiological Triangle

10. Agent • The Norovirus • The most common cause of acute gastroenteritis in the United States. • Accounts for approximately 70,000 hospitalizations and 800 deaths per year.

11. Host • Contaminated food and infected individuals • The norovirus is spread by infected humans, contaminated food or fluids, and inanimate objects contaminated the virus on them. • The most contagious time for the norovirus is when a person has the illness and up to three days after recovery.

12. Environment • Unsanitary food preparation and/or uncleanly environment • Washing your hands before food preparation must be done, especially after using the restroom. • Proper washing of fruits and vegetables • Sanitizing cooking areas • Instructing employees not to work when they are sick.

13. Time • A person can be contagious the same day they contract the norovirus and are highly contagious from onset of symptoms to three days after recovery. • The virus can remain in your stool for two weeks or more after recovery.

14. How can we stop the spread of the Norovirus • Education, Education, Education!!! • Hand washing • Washing fruits and vegetables thoroughly • Cooking seafood thoroughly • Do not prepare food or take care of others when you are sick. • Do not eat or drink after another person • Keep sick children and adults away from food preparation areas.

15. Norovirus • No know treatment for the viral infection. • Treat dehydration with IV and oral fluids. The symptoms are treated with medications (ex. nausea and fever). • The Norovirus can be serious especially in young children, the elderly, and the immunocompromised.

16. It’s quiz time • How long is a person contagious with the norovirus? a. one year b. two weeks c. twenty four to forty eight hours d. for life

17. Answer • two weeks

18. Question • People with the norovirus are treated with antibiotics? a. True b. False

19. Answer • False

20. Question • The norovirus is a. only contagious by human to human contact b. contracted from animals that live in close quarters with other animals c. the most common cause of acute gastroenteritis d. all of the above

21. Answer • The most common cause of acute gastroenteritis

22. Question • The norovirus is responsible for approximately how many hospitalizations each year? a. 800 b. 8,000 c. 700,000 d. 70,000

23. Answer • 70,000

24. Question • What was the host in the Kent Norovirus outbreak of 2008? • A bird • Contaminated food • The door handles of the entrance to the restaurant • None of the above

25. Answer • Contaminated food

26. Questions

27. References • Action News 19, (2008). Test results are back for Norovirus at Kent Chipotle. Retrieved from http://www.woio.com/global/story.asp?s8236821 • Centers for Disease Control and Prevention, (2012). Norovirus. Retrieved from http://www.cdc.gov/norovirus/about/overview.html • Foodborne Illness Database, (2012). Chipotle grill restaurant burritos 2008. Retrieved from http://www.outbreakdatabase.com/details/chipotle-grill-restaurant-burritos- 2008/?organism=Norovirus&year=2008&state=18&month=4 • Payne, J. W., 2008. Ohio disease outbreak linked to Chipotle restaurant. Retrieved from http://health.usnews.com/health-news/family-health/articles/2008/04/21/ohio- disease-outbreak-linked-to-chipotle-restaurant