Gastroenteritis
Gastroenteritis (norovirus, "Stomach bug") outbreaks have been noted in the community. Here are some quick facts.
Incubation period: 12 to 48 hours (median approx. 33 hours)
Period of communicability: Varies but in general from onset of symptoms until 72 hours after symptom resolution (communicability can be prolonged in immunocompromised individuals)
Symptoms: Acute onset of nausea, vomiting, diarrhea, abdominal cramping, fatigue and low grade fever. (Acute diarrhea is defined as the abrupt onset of 3 or more loose stools per day and lasts no longer than 14 days)
Treatment: Supportive, watch for signs and symptoms of dehydration and treat dehydration appropriately
Lab testing: RT-PCR from stool. In the absence of clinical laboratory diagnostics or in the case of delay in obtaining laboratory results, use Kaplan’s clinical and epidemiologic criteria to identify a norovirus gastroenteritis outbreak.
Kaplan’s Criteria
1. Vomiting in more than half of symptomatic cases and,
2. Mean (or median) incubation period of 24 to 48 hours and,
3. Mean (or median) duration of illness of 12 to 60 hours and,
4. No bacterial pathogen isolated in stool culture
Not all of norovirus outbreaks meet these criteria, if the criteria are not met, it does not mean that outbreak was not caused by norovirus. Testing should be done to determine the cause of illness.
Immunity: Short term after infection, no vaccination available
Report to Public Health: Within one day of two or more similar illnesses resulting from a common exposure that is either suspected or laboratory-confirmed to be caused by norovirus.
Key points to remember during an outbreak:
Rapid identification and isolation of suspected cases. Ill residents should be placed on enteric isolation precautions.
Increased adherence to hand hygiene particularly the use of soap and water after contact with symptomatic patients
Designate staff to care for ill residents and minimize staff movement between areas in the facility with illness and areas not affected by the outbreak. Consider setting up a separate break room for staff caring for ill residents.
Enhanced environmental cleaning and disinfection using EPA approved disinfectants for norovirus.
Cancel group activities and consider serving all meals to residents in their rooms if the outbreak is widespread.
Only essential kitchen staff should be allowed in the kitchen area. If reasonable, kitchen staff should have a designated bathroom during norovirus outbreaks.
Exclude ill staff until their symptoms have been resolved for at least 48 hours.
- Place signs around facility indicating that an outbreak is occurring. Limit visitation and exclude anyone with Noro-like illness from visiting the facility.
Check out the Norovirus Outbreak Control Checklist for Health and Long-Term Care Facilities from the Washington State Department of Health.
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