University Norovirus Outbreak 31st October 2008

1. University Norovirus Outbreak 31st October 2008 Tui Shadbolt B.Hlth.Sc, MVS Coordinator Health Protection MidCentral Public Health Service

2. Roadmap • Notification of the outbreak • CIMS • Resources • Food Hall joint visit • Epidemiology • Practical interventions • Conclusions

3. 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

4. Intelligence gathering • 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

5. Health and Safety Incident Controller Tui Shadbolt HPO Media & Communications DHB Dennis Geddis UniLiaison H&S Operations Brett Munro HPO H&S Manager Planning & Intel Tui Shadbolt HPO Logistics Chris Bland HPO Coordinated Incident Management Structure (CIMS) Structure for UniOB 2008 response Medical officer of Health advisor Patrick O’Connor

6. 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

7. Resources available • 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

8. 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?

9. The 10:30am pre planned meeting “change of focus” • 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!!

10. Resource Shopping List • Bulk Signage • Bulk Handsanitiser • Bulk Electrolytes • Bulk Vomit bowls • Bulk Biohazard bins • Bulk Bottled water • Bulk Case Logs for Hostels • Bulk Questionnaires

11. 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

12. The Uni Food Hall

13. What was our gut feeling based on evidence gathered Reports of Food handlers with Ds & Vs Tuesday 28th FH 1 worked rostered shift at campus 1 preparing salads and sandwiches including food sent to campus 2 Weekend of the 25th and 26th FH 1 cared for family with D and V’s (FH1 no symptoms) Campus 1 Wednesday 29th FH3 onset 6:30am at home Campus 1 FH4 onset 6pm at home Campus 2 Wednesday 29th FH2 onset D & V’s 6am at work This is what happened on the Thursday 30th and Friday the 31st

14. Sick food handlers

16. 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

17. 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

18. UniPersonal 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

19. 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

20. Was it a busy year

21. Thank you • Questions?