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PANDEMIC ALERT LEVEL
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Now tracking the new emerging South Africa Omicron Variant

OT-Are there any viruses going around-USA?

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Is this going around?
 
 
 
N Engl J Med. 1981 Apr 9;304(15):911. Related Articles, Links 

Conjunctivitis in human beings caused by influenza A virus of seals.
 
Webster RG, Geraci J, Petursson G, Skirnisson K.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote roxy Quote  Post ReplyReply Direct Link To This Post Posted: October 18 2006 at 11:00pm
 hi to all,   illness going around  connecticut,1} i had it, aches and pains in your bones and body lasting a few weeks. there are others at work and their family members who had it .2} also upper respiratory, a lot of sputum,3} also a head ache, sore throat thing. three differant illness going around , roxy
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Hi , do hope your feeling better Roxy , it sounds a horrible bug . More news about West Nile , seems more have tested postive .
 

More Birds Test Positive For West Nile
KIRO 7 Seattle-Tacoma - 0 KB- Found: 3 hours ago
Two more birds in King County and one in Snohomish County have tested positive for West Nile Virus.

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more West Nile
 

More birds found with West Nile
North County Times - 0 KB- Found: 1 hour ago
Four more birds in San Diego County have tested positive for West Nile virus, it was reported today.

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From RSOE HAVARIA 2/11/06
 

Epidemic Hazard - North-America Common Alerting Protocol

Event summary
GLIDE Number EH-20061102-8215-CAN    
Event type Epidemic Hazard Date / time [UTC] 02/11/2006 - 04:40:10 (Military Time, UTC)
Country Canada Area Boniface General Hospital
County / State Manitoba Province City Winnipeg
Cause of event Unknow Log date 02/11/2006 - 04:40:10 (Military Time, UTC)
Damage level Moderate Time left
Latitude: N 49° 52.980 Longitude: W 97° 10.020
Number of deaths: Not or Not data Number of injured persons: Not or Not data
Evacuated: - Infected 100
DESCRIPTION
The highly contagious norovirus is spreading in Winnipeg's hospitals and personal care homes, the city's medical health officer warned Wednesday. Dr. Margaret Fast, medical officer of health for the Winnipeg Regional Health Authority, said that norovirus has appeared in city hospitals, emergency rooms and personal care homes. For the past number of years, norovirus infection seemed to be on the increase, and it's not an officially reportable disease, so we don't have accurate numbers on cases," Fast said. But there have been "cases and outbreaks in higher numbers than usual across the whole country," she said. "People need to be concerned to the extent that they take reasonable precautions." The number of norovirus infections is difficult to track because not everyone seeks hospital treatment once they contract it. But officials said at St. Boniface General Hospital they have seen about 100 cases in the past week. The term norovirus refers to a group of viruses that affect the gastrointestinal system. It was formerly known as the Norwalk virus. Symptoms of the norovirus are similar to those for a stomach flu, including vomiting, diarrhea and cramps. Unlike the flu, there is no vaccine for norovirus. However, Fast said norovirus does not usually require a trip to the emergency room. Those who are concerned about a possible norovirus infection can call the province's HealthLinks service.

Norovirus spreads very easily, "either through direct contact or through what we call indirect contact," Fast said. "For example, I've got some on my fingers, and I touch a surface — maybe my keyboard — and then you come along and use my keyboard, and you're eating your lunch there at the same time. You don't need many viral particles to cause infection and illness." Symptoms can last up to three days, but the illness can still be spread for days after those symptoms disappear. As for avoiding norovirus, Fast said people should keep their hands clean as much as possible. "Wash your hands frequently with soap and water, after you've been to the washroom particularly, but also at other times when they've become contaminated," she said. "But if you don't have access to soap and water, there are a number of hand hygiene products on the market now and those are very good as well." Fast said those who believe they have norovirus should drink lots of fluids and not prepare food that others will eat.
<
http://visz.rsoe.hu/alertmap/woalert.php?lang=eng

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    Influenza here in NC they have shut schools down in yancy county.
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Nov 4, 2006 8:03 am US/Eastern

More Whopping Cough Cases Confirmed At Children's

(CBS4) BOSTON Several more staff members at Children's Hospital have been confirmed cases of whopping cough, according to health officials.

Boston health authorities are also investigating whether a 3-year-old caught the disease outside the hospital or after coming for treatment.

Twenty-five employees at Children's have been diagnosed with whopping cough since a 19-month-old boy was admitted to the hospital with the disease in September.

As a precaution, 200 staff members are being tested after showing flu-like symptoms. Those who are showing the symptoms are off duty until they finish five days of antibiotics.
http://cbs4boston.com/health/local_story_308071718.html

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Archive Number 20061116.3282
Published Date 16-NOV-2006
Subject PRO/AH/EDR> West Nile virus update 2006 - Western Hemisphere (19)
WEST NILE VIRUS UPDATE 2006 - WESTERN HEMISPHERE (19)
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] Canada - human surveillance
[2] Canada - bird surveillance
[3] USA - CDC/Arbonet
[4] USA - USGS/CDC maps
[5] Mexico - suspected, RFI

*****
[1] Canada - human surveillance
Date: 28 Oct 2006
From: ProMED-mail <promed@promedmail.org>
Source: West Nile Virus Monitor, Public Health Agency of Canada [edited]
<http://www.phac-aspc.gc.ca/wnv-vwn/mon-hmnsurv_e.html>


Human cases were reported for week 43 (as of 28 Oct 2006) from the 
following provinces:

Province / Neurological / Non-Neurological / Unclassified;
Unspecified / Total* / Asymptomatic**
Alberta / 1 / 23 / 0 / 24 / 0
Ontario / 16 / 24 / 1 / 41 / 0
Manitoba / 15 / 28 / 7 / 50 / 1
Saskatchewan / 2 / 9 / 0 / 11 / 0
TOTALS / 34 / 85 / 8 / 127 / 1

* Neurological syndrome + Non-Neurological syndrome + Unclassified + 
Unspecified = Total
** Most identified through blood donor testing; not included in total cases

--
ProMED-mail
<promed@promedmail.org>

[This is the same report as in the previous update (West Nile virus update 
2006 - Western Hemisphere (17) Archive No. 20061109.3221). - Mod.TY]

******
[2] Canada - bird surveillance
Date: 18 Oct 2006
From: ProMED-mail<promed@promedmail.org>
Source: Canadian Cooperative Wildlife Health Centre [edited]
<http://wildlife1.usask.ca/en/west_nile_virus/current_maps/canada06en.jpg>


Of the 7 provinces testing dead wild birds for West Nile virus as of 18 Oct 
2006, those having positives / numbers tested include:
Ontario 257 / 972
Alberta and Saskatchewan 17 / 939

The positive birds / total tested include:
American crow 233 / 1981
Black-billed magpie 2 / 55
Blue jay 36 / 253
Common raven 1 / 146
Other 1 / 14

--
ProMED-mail
<promed@promedmail.org>

[No change from the previous update (Archive No. 20061109.3221). - Mod.TY]

******
[3] USA - CDC/Arbonet
Date: 14 Nov 2006
From: ProMED-mail <promed@promedmail.org>
Source: USA CDC, Division of Vector-Borne Infectious Diseases, West Nile 
Virus [edited]
<http://www.cdc.gov/ncidod/dvbid/westnile/surv&controlCaseCount06_detailed.htm>


Human Cases have been reported from:
State / Neuroinvasion* / *West Nile* fever** / Other*** / Total **** / 
Fatalities
Alabama / 7 / 0 / 0 / 7 / 0
Arizona / 47 / 56 / 38 / 141 / 6
Arkansas / 21 / 5 / 0 / 26 / 0
California / 78 / 178 / 11 / 267 / 6
Colorado / 60 / 250 / 0 / 310 / 4
Connecticut / 7 / 2 / 0 / 9 / 1
District of Columbia / 0 / 1 / 0 / 1 / 0
Florida / 3 / 0 / 0 / 3 / 0
Georgia / 2 / 5 / 1 / 8 / 1
Idaho / 111 / 730 / 6 / 847 / 11
Illinois / 117 / 70 / 24 / 211 / 9
Indiana / 26 / 7 / 42 / 75 / 3
Iowa / 21 / 13 / 2 / 36 / 0
Kansas / 17 / 13 / 0 / 30 / 4
Kentucky / 5 / 1 / 0 / 6 / 1
Louisiana / 87 / 77 / 0 / 164 / 0
Maryland / 7 / 1 / 2 / 10 / 0
Massachusetts / 2 / 1 / 0 / 3 / 0
Michigan / 41 / 2 / 5 / 48 / 4
Minnesota / 30 / 35 / 0 / 65 / 3
Mississippi / 84 / 89 / 0 / 173 / 10
Missouri / 47 / 12 / 1 / 60 / 3
Montana / 12 / 21 / 1 / 34 / 0
Nebraska / 41 / 176 / 0 / 217 / 1
Nevada / 34 / 75 / 14 / 123 / 1
New Jersey / 2 / 2 / 1 / 5 / 0
New Mexico / 3 / 5 / 0 / 8 / 0
New York / 8 / 4 / 0 / 12 / 2
North Dakota / 20 / 117 / 0 / 137 / 1
Ohio / 35 / 11 / 0 / 46 / 4
Oklahoma / 26 / 18 / 3 / 47 / 5
Oregon / 6 / 48 / 8 / 65 / 0
Pennsylvania / 8 / 1 / 0 / 9 / 2
South Dakota / 38 / 75 / 0 / 113 / 3
Tennessee / 15 / 2 / 0 / 17 / 1
Texas / 205 / 101 / 0 / 305 / 26
Utah / 55 / 101 / 0 / 156 / 5
Virginia / 0 / 0 / 4 / 4 / 0
Washington / 0 / 3 / 0 / 3 / 0
West Virginia / 1 / 0 / 0 / 1 / 0
Wisconsin / 11 / 9 / 0 / 20 / 1
Wyoming / 15 / 40 / 10 / 65 / 2
TOTALS / 1355 / 2356 / 176 / 3887 / 120

* Cases with neurologic manifestations (such as WN encephalitis, 
meningitis, and myelitis).
** Cases with no evidence of neuroinvasion.
*** Cases for which insufficient clinical information was provided.
**** Total number of human cases of WNV illness reported to ArboNET by 
state and local health departments.

Neuroinvasive Disease refers to severe disease cases, particularly West 
Nile meningitis and West Nile encephalitis.

West Nile fever refers to typically less severe cases that show no evidence 
of neuroinvasion.

West Nile fever is not currently on the list of nationally notifiable 
diseases, and therefore, it is optional whether or not state health 
departments report these cases to CDC. Click the above CDC site [URL above] 
for further explanations of neuroinvasive West Nile virus disease and West 
Nile fever.

Other Clinical includes persons with clinical manifestations other than WN 
fever, WN encephalitis or WN meningitis, such as acute flaccid 
paralysis.  Unspecified cases are those for which sufficient clinical 
information was not provided.

Total Human Cases Reported to CDC: These numbers reflect both mild and 
severe human disease cases occurring since 1 Jan 2006 reported to ArboNet 
by state and local health departments.

ArboNet is the national, electronic surveillance system established by CDC 
to assist states in tracking West Nile virus and other mosquito-borne 
viruses. Information regarding 2006 virus/disease activity is posted when 
such cases are reported to CDC.

--
ProMED-mail
http://www.promedmail.org/pls/promed/f?p=2400:1000
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Newfoundland hospital restricts visitors after cases of Norwalk virus

Provided by: Canadian Press
Nov. 18, 2006

GRAND FALLS-WINDSOR, N.L. (CP) - A hospital in central Newfoundland has closed its doors to visitors after reporting cases of the Norwalk virus.

The Central Newfoundland Regional Health Centre in Grand Falls-Windsor started banning visitors on Friday after cases were reported in the hospital and in the community.

Hospital officials expected to decide Monday whether the restrictions would be lifted.

Similar restrictions have been put in place at the Carmelite Seniors Home, though no cases of Norwalk have been detected at the facility.

Symptoms range from nausea and diarrhea to dehydration.

The virus spreads easily and can survive up to 12 hours on surfaces such as toilets and sinks.

A hospital in Digby, N.S., reported several cases of the virus earlier this month.

In October, there were outbreaks of the virus at two Maritime universities.

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Also in the England , two hospitals on the news with Norovirus and have closed wards .

Norwalk prompts tighter rules at Grand Falls hospital

Last Updated: Monday, November 20, 2006 | 9:22 AM NT

CBC News

A rash of cases of Norwalk virus at a hospital has prompted health officials in central Newfoundland to tighten visiting restrictions both there and at the adjoining nursing home.

Some 17 cases were confirmed at the Central Newfoundland Regional Health Centre in Grand Falls-Windsor.  

The Central Health regional authority says the virus — which attacks the gastrointestinal system, causes severe diarrhea and easily spreads — has not been found at the Carmelite seniors' home. However, it has come under the same restrictions because it is attached to the hospital.

The health authority is expected to decide whether to lift the restrictions on Monday.

Family members have been asked to contact appropriate nursing units to check on family members' conditions.

Health officials say all the cases involve patients who had already been admitted to the hospital, although they believe norovirus is also in the community.http://www.cbc.ca/canada/newfoundland-labrador/story/2006/11/20/norwalk-virus.html

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Ouch
Bug bites abroad sicken 2
Coloradans fall victim to exotically named chikungunya
 
 
By Fernando Quintero, Rocky Mountain News
November 22, 2006
A warning to overseas travelers: Don't forget the bug spray.

At least two Coloradans returned home recently from Asia and East Africa with chikungunya, an infectious disease transmitted by mosquitoes.

According to the national Centers for Disease Control and Prevention's Web site, the disease can cause fever, headache, nausea, joint pain and other symptoms. No deaths related to the infection have been documented.

The unusual name, pronounced chi-kun-GUN-ya, is Swahili for "that which bends up."

Chikungunya is among several types of mosquito-borne diseases that people can contract when they travel abroad, said John Pape, an epidemiologist with the Colorado Department of Public Health and Environment.

"Each year, we get reports of -dengue, malaria and other diseases from travelers," Pape said. "There is no outbreak of these diseases locally, and it's not mosquito season. So there's really no danger to the general public." Confused

But Eileen Farnon, a medical epidemiologist with the CDC, said the disease is nonetheless a concern because mosquitoes may still be prevalent in other parts of the country.

She said at least 28 cases have been confirmed nationwide this year.

In India and islands of the Indian Ocean, an outbreak of chikungunya has afflicted more than 1.4 million people since March 2005.

The virus also has circulated throughout much of Africa. There is no vaccine or preventive drug for the disease.

For those traveling abroad, the best way to avoid infection is to prevent mosquito bites, expert say. Use insect repellant, wear long sleeves and pants and have secure screens on windows and doors to keep insects out, they say.

Web site, www.cdc.gov/travel, for more information.

Chikungunya virus

At least two cases confirmed in Colorado and 28 nationwide.

Disease is spread by mosquitoes.

Infection can cause fever, headache, fatigue, nausea, vomiting and muscle-joint pain.

Acute fever typically lasts a few days to several weeks.

No cure or vaccine.

Rest, fluids and pain relievers recommended to alleviate symptoms.Source: Centers For Disease Control And Prevention

target="">http://www.rockymountainnews.com/drmn/local/article/0,1299,DRMN_15_5161636,00.html
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 24/11/06 Canada A new outbreak of C. difficile , three men dead early Nov . There has been a bit of shhhhhhh about this .see post .
 

Epidemic Hazard - North-America Common Alerting Protocol

Event summary
GLIDE Number EH-20061124-8541-CAN    
Event type Epidemic Hazard Date / time [UTC] 24/11/2006 - 04:10:00 (Military Time, UTC)
Country Canada Area -
County / State Quebec Province City Drummondville
Cause of event Unknow Log date 24/11/2006 - 04:10:00 (Military Time, UTC)
Damage level Moderate Time left
Latitude: N 45° 53.000 Longitude: W 72° 28.933
Number of deaths: 1 persons Number of injured persons: Not or Not data
Evacuated: - Infected -
-
DESCRIPTION
A new outbreak of C. difficile has been linked to the deaths of three men in Drummondville, about 100 kilometres east of Montreal. The men ranged in age from 72 to 92 and they died at l'hôpital Ste-Croix before Nov. 12, hospital officials said. All three already suffered from serious health problems. Clostridium difficile infections cause severe diarrhea and are sometimes fatal. They are often acquired in hospitals, where they are associated with the use of antibiotics. Hospital officials said they are trying to get rid of the strong strain of bacteria. On Wednesday, specialists at the hospital held a news conference saying many planned surgeries have been cancelled because of a lack of beds.

Elsewhere in the province, the Trois-Rivieres regional health centre has also instituted special measures to control the spread of the bacteria following several infections there. Over the last six months, four patients have died after contracting C. difficile, and 22 new people have become infected in the last month at Trois-Rivieres, which is about 125 kilometres east of Montreal. Meanwhile, Dr. Jacques Pépin, a specialist in infectious diseases at the University of Sherbrooke who described the first outbreak of C. difficile in the province, said people were afraid to speak about the increase in infections when they occurred. No one should be afraid to lose their job for saying something politicians don't want to hear, Pépin said in calling for the director of public health to be free of political interference. The director of public health is in charge of informing the public about such problems. "I think it would give this person freedom to speak his mind," said Pépin. But it might not make much difference since the person would still be appointed by the party in power, said the scientific director of public health, Marc Dionne. Pépin is also asking the province for a wide-ranging inquiry into the hundreds of C. difficile deaths in the last three years.

http://visz.rsoe.hu/alertmap/woalert_read.php?id=8541&cat=dis&lang=eng
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 Heres a little info on epidemic post below ........................
 

Clostridium Difficile Colitis
(Antibiotic-Associated Colitis, C. difficile colitis)

Medical Author: Dennis Lee, M.D.
Medical Editor: Jay Marks, M.D.

What is Clostridium difficile colitis (C. difficile)?

Clostridium difficile (C. difficile) is a bacterium that is related to the bacterium that cause tetanus and botulism. The C. difficile bacterium has two forms, an active, infectious form that cannot survive in the environment for prolonged periods, and a nonactive, “noninfectious” form, called a spore, that can survive in the environment for prolonged periods. Although spores cannot cause infection directly, when they are ingested they transform into the active, infectious form.

C. difficile spores are found frequently in hospitals, nursing homes, extended care facilities, and nurseries for newborn infants. They can be found on bedpans, furniture, toilet seats, linens, telephones, stethoscopes, fingernails, rings, floors, infants’ rooms, and diaper pails. They even can be carried by pets. Thus, these environments are a ready source for infection with C. difficile.

What is Clostridium difficile (C. difficile) colitis?

Antibiotic-associated (C. difficile) colitis is an infection of the colon caused by C. difficile that occurs primarily among individuals who have been using antibiotics. It is the most common infection acquired by patients while they are in the hospital. More than three million C. difficile infections occur in hospitals in the US each year. After a stay of only two days in a hospital, 10% of patients will develop infection with C. difficile. C. difficile also may be acquired outside of hospitals in the community. It is estimated that 20,000 infections with C. difficile occur in the community each year in the U.S.


 1   2   3   4   5   6   7   Glossary   Clostridium Difficile Colitis Center   | Next

Next: How does Clostridium difficile cause colitis? >>

http://www.medicinenet.com/clostridium_difficile_colitis/article.htm
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: December 02 2006 at 4:06am
  is probably viral and could have spread through air particles, said Cynthia Morrow, health commissioner of Onondaga County. The Centers for Disease Control and Prevention were notified because the people who may have been affected were from across the country, Morrow said.
 
 .At least 600 people came down with a gastrointestinal illness after eating.
viral and could have spread through air particles, said Cynthia Morrow, health commissioner of Onondaga County.

Epidemic Hazard - North-America Common Alerting Protocol

Event summary
GLIDE Number EH-20061202-8665-USA    
Event type Epidemic Hazard Date / time [UTC] 02/12/2006 - 05:21:31 (Military Time, UTC)
Country USA Area -
County / State New York City Syracuse
Cause of event Unknow Log date 02/12/2006 - 05:21:31 (Military Time, UTC)
Damage level Heavy Time left
Latitude: N 43° 2.528 Longitude: W 76° 6.277
Number of deaths: Not or Not data Number of injured persons: Not or Not data
Evacuated: - Infected 600
-

DESCRIPTION
At least 600 people came down with a gastrointestinal illness after eating at a popular biker bar and restaurant, health officials said Friday. Bacteria have been ruled out as the cause, meaning last weekend's outbreak linked to the Dinosaur Bar-B-Que is probably viral and could have spread through air particles, said Cynthia Morrow, health commissioner of Onondaga County. The Centers for Disease Control and Prevention were notified because the people who may have been affected were from across the country, Morrow said. Patrons from as far away as Massachusetts, New Jersey, Vermont and California have reported symptoms. Some were sickened after eating at the restaurant, while others became ill after being exposed to those who had, health officials said. The most common symptoms include nausea, vomiting, diarrhea, abdominal cramps and chills lasting 12 to 48 hours. The county health department on Thursday ordered the restaurant closed for at least 72 hours. Workers threw away hundreds of pounds of prepared foods. No specific foods have been implicated. Restaurant owner John Stage said he plans to reopen Monday.

http://visz.rsoe.hu/alertmap/woalert_read.php?id=8671&cat=dis&lang=eng
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2nd posting for the night . USA
Beth Israel Deaconess Hospital Needham is busy disinfecting the hospital after a gastrointestinal virus sickened 22 employees and two patients. Caused by a family of germs known as noroviruses, the disease - often incorrectly referred to as a "stomach flu" - causes nausea, vomiting, diarrhea and abdominal cramps.

Epidemic - North-America Common Alerting Protocol

Event summary
GLIDE Number EP-20061202-8659-USA    
Event type Epidemic Date / time [UTC] 02/12/2006 - 04:48:46 (Military Time, UTC)
Country USA Area -
County / State Massachusetts City Needham
Cause of event Unknow Log date 02/12/2006 - 04:48:46 (Military Time, UTC)
Damage level Moderate Time left
Latitude: N 42° 17.862 Longitude: W 71° 14.062
Number of deaths: Not or Not data Number of injured persons: Not or Not data
Evacuated: - Infected 24
-
DESCRIPTION
Beth Israel Deaconess Hospital Needham is busy disinfecting the hospital after a gastrointestinal virus sickened 22 employees and two patients. Caused by a family of germs known as noroviruses, the disease - often incorrectly referred to as a "stomach flu" - causes nausea, vomiting, diarrhea and abdominal cramps. It is not life-threatening. Spokeswoman Margaret Pantridge said the hospital first became aware of the outbreak Thursday, when a number of workers called in sick. They notified the Needham Board of Health and the Massachusetts Department of Public Health, as required by law, the same day. The two patients were already in the hospital for unrelated medical reasons, she said. They have been isolated in private rooms, with health care personnel taking special precautions to prevent spreading the infection. Their condition was not available Friday afternoon. Hospital officials are unsure of how the virus arrived at the hospital, but Pantridge said they believe it was spread through person-to-person contact rather by eating contaminated food, another common means of infection.

"There's no indication that the outbreak resulted from our own clinical practices," Pantridge said. Pantridge said that sick employees have been told not to come to work until 72 hours after their symptoms have cleared. Symptoms usually last 1-2 days. So far, none of the hospital's services have been affected by the absences. The hospital, which employees 330 people, has contingency plans in place in case the outbreak spreads, Pantridge said. A spokeswoman for the Massachusetts Department of Public Health, Donna Rheaume, said that outbreaks can be especially common this time of year. "People spend time indoors more, there's more person to person contact. So typically in any year we have several dozen outbreaks" involving two or more people, Rheaume said. In January 2003, for example, Boston public health officials tracked more than 700 cases of the Norwalk virus. Noroviruses get their name from an outbreak of diarrhea-causing illness that happened in Norwalk, Ohio in 1972. They are common in environments where people spend lots of time in close quarters, such as cruise ships, schools, nursing home sand long term-care facilities. Rheaume said that in Massachusetts, they are usually found in the latter two.

Handwashing and disinfection are the best ways to prevent the disease, but are not foolproof. The disease can live on surfaces and is so easily spread that it only takes one infected person to cause an outbreak. Many, but not all, cases of "stomach flu" are caused by noroviruses. The health department recommends washing hands after using the bathroom or changing diapers and before preparing food; washing fruits and vegetables before eating; and cooking food completely. There's not much to do in the way of treatment -- antibiotics don't work for viruses, and in most cases the disease just has to run its course while the afflicted drinks plenty of fluids and gets lost of rest. There are so many different strains of noroviruses that people are often sickened by it more than once over a lifetime. Rheaume cautions that dehydration is a risk, especially in young children whose small bodies lose fluid more quickly. If a child has persistent, severe diarrhea, call a health care provider.

http://visz.rsoe.hu/alertmap/woalert_read.php?id=8671&cat=dis&lang=eng
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Meningitis death has gay community worried

Meghan Hurley, National Post
Published: Saturday, December 02, 2006

Dozens of people lined up at the Church Street Community Centre for meningitis vaccinations yesterday, the line snaking over two floors, after a man died soon after visiting a neighbourhood bar.

Health officials won't identify the man who died, but say he went to the Crews and Tango bar at 508 Church St., near Wellesley, where he may have passed on the disease, Toronto Public Health warns.

"The clinic was quite busy all night long, which is nice because it means that people are taking it seriously," said Drew Rowsome, who worked for the Miss Canada Continental Pageant that showcased many drag queens from Crews and Tango.

On Thursday, health officials issued a public warning urging people who went to this bar on Nov. 17 or Nov. 18 to get vaccinated.

But some think that warnings should be issued for all bars in the area.

"How do they know he wasn't at every other bar in the area?" said Kevin Levesque who performs at Crews and Tango.

Meningitis can be contracted by kissing someone, sharing a cigarette or drink and close face-to-face contact, Toronto Public Health medical officer, Dr. Venita Dubey, said.

For information on meningitis visit www.toronto.ca/health.

© National Post 2006
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Archive Number 20061203.3415
Published Date 03-DEC-2006
Subject PRO/AH/EDR> E. coli O157 - USA (NJ)
E. COLI O157 - USA (NEW JERSEY)
*******************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sun 3 Dec 2006
From: Pablo Nart <pablo.nart@terra.es>
Source: The Newark Star Ledger [edited]
<http://www.nj.com/news/ledger/jersey/index.ssf?/base/news-5/1165129713175630.xml&coll=1>


A serious _E. coli_ [O157:H7] outbreak in central New Jersey has led 
to 11 confirmed cases and at least 6 suspected cases over the past 2 
weeks. The victims, from towns in Middlesex, Somerset and Monmouth 
counties, are primarily children, though 2 adults also have been 
infected, said Middlesex County Director of Health David Papi.

In the 2 most serious cases, the victims have developed hemolytic 
uremic syndrome, or HUS, a serious condition that can cause permanent 
kidney damage. Those victims, along with 4 others, remained 
hospitalized last night [2 Dec 2006], Papi said. "This is a 
significant outbreak of a serious disease, and a significant amount 
of people are ill," he said, calling the magnitude of the outbreak 
uncommon.

Investigators have yet to determine the source of the outbreak, 
though a Taco Bell restaurant on Stelton Road in South Plainfield is 
suspected. Nine of the 11 confirmed victims ate at the Taco Bell, and 
on Thu 30 Nov 2006, the fast food restaurant agreed to voluntarily 
shut down until the source is identified, Papi said.

An inspection of the restaurant last week did not reveal any 
significant health code violations, Papi said, but investigators are 
still waiting on the results of stool tests run on 21 Taco Bell 
employees.

Health officials were also awaiting test results on the 6 suspected 
cases, 2 of which were reported just yesterday [2 Dec 2006]. The 1st 
confirmed case was reported on 17 Nov 2006, Papi said. Since then, 
cases have been confirmed in Edison, Woodbridge, Atlantic Highlands, 
Franklin Township, Piscataway, New Brunswick and Monroe Township.

The oldest victim so far is 23, while the youngest is just a year 
old. The victims have been treated at John F. Kennedy Medical Center 
in Edison, Saint Peter's University Hospital in New Brunswick and 
Newark Beth Israel Medical Center in Newark, Papi said.

Papi said initial food samples sent from the South Plainfield Taco 
Bell to the state Department of Health have tested negative for the 
organism, though investigators are still assembling a list of common 
foods eaten by several victims. Two other eateries, a local diner and 
another Taco Bell, also have been inspected but remain open with no 
evidence of contamination, Papi said.

[Byline: Jonathan Casiano and Nyier Abdou]

--
Pablo Nart
<pablo.nart@terra.es>

[It is not yet proven that the fast food restaurant was indeed the 
source of the organism. Likewise, if the restaurant source is 
confirmed, it is yet to be determined which food was the vehicle, 
although ground beef would be high on the list. The reader should 
recall that the organism was 1st clearly recognized as a cause of 
significant human illness related to fast food restaurant-related 
clusters in 2 states in the USA in 1982 (Riley L, Remis R, Helgerson 
S, et al. Hemorrhagic colitis associated with a rare _Escherichia 
coli_ serotype. N Engl J Med 1983;308: 681-85). - Mod.LL]

[see also:
E. coli O157, spinach - USA (multistate)(20) 20061027.3067
E. coli O157, spinach - USA (multistate): alert 20060915.2608
E. coli O157, day care - USA (TN) 20060701.1823
E. coli O157 - USA (multistate): unknown source 20060410.1068
E. coli O157, unpasteurized milk - USA (OR,WA)(04) 20060121.0199
2005
----
E. coli O157, unpasteurized milk - USA (OR,WA) 20051216.3622
E. coli O157 - USA (HI): alert 20050830.2564
E. coli O157, lake swimming - USA (MN) 20050712.1983
E. coli O157, ground beef - USA (multistate): recall 20050610.1612
E. coli O157, religious camp - USA (OR)(02) 20050602.1540
E. coli O157, religious camp - USA (OR) 20050531.1504]
.
http://www.promedmail.org/pls/promed/f?p=2400:1000
..........................ll/msp/lm

 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote MississippiMama Quote  Post ReplyReply Direct Link To This Post Posted: December 04 2006 at 7:26pm
  Today while shopping at Walmart's I bumped into a friend of mind that's a nurse at the hospital.  She said there is a lot of flu going around in the area, the flu is very early and severe.  She said it is mostly strain A.  She said in a lot of the case the people are very very sick with flu symptoms and when they do the test nothing shows up.  She doesn't understand this.  Everyone in her family was sick with the flu for over 2 weeks including her.  She said the flu seem to be striking small children more than any one else.  She said that she has washed her hands so much that they are very sore.  She stated that she is afraid to be out Christmas shopping with all the sick people around.  I asked her if she heard of anything at the hospital that's unsual related to the flu to please let me know. 
Mississippi Mama
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Some kinda of stomach bug is going around here.And my daughter is sick again she sounds like maybe its sinusitis and shes complaining of a sore throat and shes coughing so it looks like another trip to the Dr's office tomorrow morning
after she had pneumonia I tend to panic.
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Archive Number 20061206.3442
Published Date 06-DEC-2006
Subject PRO/EDR> Varicella, school children - USA (NC)
VARICELLA, SCHOOL CHILDREN - USA (NORTH CAROLINA)
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 4 Dec 2006
From: Brent Barrett <salbrent@sbcglobal.net>
Source: My Fox WGHP [edited]
<http://www.myfoxwghp.com/myfox/pages/News/Detail?contentId=1681516&version=1&locale=EN-US&layoutCode=TSTY&pageId=3.2.1>


USA: Chickenpox outbreak in schools in Yadkin County, North Carolina
-----------------------------------------------
Parents and school officials are on alert as dozens of children in 3 
Yadkin County elementary schools are being treated for chickenpox 
(varicella), and one 8-year-old has died while recovering from a mild 
case of the disease. At Jonesville Elementary school, almost 60 of 
the school's 480 students have been diagnosed with or displayed 
symptoms of chickenpox over the past month. The exact cause of the 
child's death has not been determined, but local health officials say 
they doubt chickenpox is to blame. The classic symptoms of this 
highly contagious disease are blisters that break out and scab over 
after a few days. Oftentimes, the blisters are preceded by a headache 
and fever.

According to the school's principal, the outbreak isn't limited just 
to students who haven't been vaccinated. "We have had both kids who 
have had vaccination and those that haven't to have the chickenpox," 
said principal Rick Swaim.

Across the state, the current class of kindergartners was the 1st 
required by law to be vaccinated for chickenpox. In September [2006], 
the state issued a recommendation urging parents to get a 2nd booster 
shot. Because the disease appears to be so widespread -- affecting 
not just Jonesville, but also West Yadkin and Booneville elementary 
schools -- the Yadkin County Health Department has sent out a letter 
to notify parents and doctors.

All over North Carolina, parents are being urged to make sure their 
children have both the vaccine and the booster. Health officials say 
that since state law doesn't require chickenpox cases to be recorded, 
they don't know whether 60 cases in one county in one month is odd.

--
Brent Barrett
Indianapolis, IN, USA
<salbrent@sbcglobal.net>

[According to the Centers for Disease Control and Prevention (CDC) 
website, chickenpox-related deaths happened in about 100 people a 
year before 1995, prior to introduction of an improved vaccine. The 
CDC states that about 40 percent of deaths due to chickenpox happen 
in children younger than age 10.

Research results indicate the current vaccine is about 85 percent 
effective in preventing an outbreak. Unfortunately, the absence of a 
requirement in North Carolina to record chickenpox cases makes 
interpretation of this extensive outbreak affecting 3 elementary 
schools in Yadkin County difficult to interpret. Possible reasons are 
inadequate vaccine coverage, delay in implementation of universal 
vaccination, requirement for more than a single immunization to 
achieve sufficient protection.

Comprehensive accounts of chickenpox
<http://www.cdc.gov/nip/diseases/varicella/>
and chickenpox vaccination
<http://www.cdc.gov/nip/menus/vaccines.htm#varicella>
are available at the CDC website.

A map of the counties comprising the state of North Carolina is 
available at 
<http://geology.com/state-map/north-carolina.shtml>.  Yadkin County 
lies inland towards the northwest of the state. - Mod.CP]

[see also:
Varicella, Asian Games - Qatar ex Maldives 20061129.3385
2004
----
Varicella - Mexico (Yucatan) 20040318.0757
1997
----
Varicella, congenital & neonatal - Australia 19971126.2369
1996
----
Varicella, neonatal? (6) 19960113.0086
Varicella, neonatal? (5) 19960112.0083
Varicella, neonatal?: RFI 19960110.0050
1995
----
Varicella, hemorrhagic? (5) 19951220.1301
Varicella, hemorrhagic?: Case report 19951212.1239]
..........................cp/msp/mpp
http://www.promedmail.org/pls/promed/f?p=2400:1000
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Thanks. Good posts.
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Archive Number 20061206.3440
Published Date 06-DEC-2006
Subject PRO/EDR> Viral gastroenteritis, bikers' bar - USA (Multistate ex NY)
VIRAL GASTROENTERITIS, BIKERS' BAR - USA (MULTISTATE EX NY)Ouch A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 4 Dec 2006
From: ProMED-mail <promed@promedmail.org>
Source: The Atlanta Journal-Constitution, Associated Press report [edited]
<http://www.ajc.com/news/content/shared-gen/ap/Health_Medical/Restaurant_Sickness.html>


600 Sickened After Eating at N.Y. Bar
---------------------------------------------
At least 600 people came down with a gastrointestinal illness after 
eating at a popular biker bar and restaurant, health officials said 
on Friday [1 Dec 2006].    no motors runing ......

Bacteria have been ruled out as the cause, meaning last weekend's 
outbreak linked to the Dinosaur Bar-B-Que is probably viral and could 
have spread through air particles, said Cynthia Morrow, health 
commissioner of Onondaga County.

The Centers for Disease Control and Prevention were notified because 
the people who may have been affected were from across the country, 
Morrow said. Patrons from as far away as Massachusetts, New Jersey, 
Vermont and California have reported symptoms.

Some were sickened after eating at the restaurant, while others 
became ill after being exposed to those who had, health officials said.

The most common symptoms include nausea, vomiting, diarrhea, 
abdominal cramps and chills lasting 12 to 48 hours.

The county health department on Thursday [30 Nov 2006] ordered the 
restaurant closed for at least 72 hours. Workers threw away hundreds 
of pounds of prepared foods. No specific foods have been implicated.

Restaurant owner John Stage said he planned to reopen on Monday [4 Dec 2006].

--
ProMED-mail
<promed@promedmail.org>

[The association of such a large outbreak of presumptive viral 
gastroenteritis with a single restaurant and subsequent spread of 
gastroenteritis among contacts of those present at the restaurant 
suggests that the agent responsible may be a norovirus. Noroviruses 
are highly infectious ubiquitous viruses that can be transmitted both 
from contaminated produce and also directly from person-to-person. 
Outbreaks associated with restaurants have been frequent in the past, 
but are less common now as a result of greater awareness of the 
problem and general improvements in food processing and handling. 
Outbreaks are more common now in situations where unrelated 
individuals congregate together at high density; e.g. in schools, in 
hospitals, on board cruise ships, etc. - Mod.CP]

[see also:
Viral gastroenteritis - cruise ships 20061205.3432
Norovirus, restaurant-associated - USA (MI) 2005 20060413.1097
Norovirus, retirement center - USA (WA) (02) 20060412.1086
Norovirus, retirement center - USA (WA) 20060410.1073
Norovirus, cruise ship - Caribbean 20060305.0718
Norovirus outbreak - New Zealand (Dunedin): susp. 20060131.0316
Viral gastroenteritis, cruise ships - USA: backgro... 20060309.0753
Viral gastroenteritis, cruise ships - USA: background 20060306.0727]
.........................mpp/cp/msp/mpp

http://www.promedmail.org/pls/promed/f?p=2400:1000
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Ouch
 
TB case in Reynoldsburg leads to testing of teachers, students
Friday, December 08, 2006
Encarnacion Pyle
THE COLUMBUS DISPATCH

Columbus health officials will test several Reynoldsburg High School students and teachers for tuberculosis next week, after the recent diagnosis of the infection in a student.

The Columbus Public Health Department wouldn’t say how many people will be tested. But school officials said the parents of any students who might have been exposed have been notified.

Officials also sent letters to the parents of the school’s more than 2,200 students, informing them that a teen had contracted the illness and that they were taking precautions in case others were exposed.

"We sent two letters because we want parents to know exactly what we know," Assistant Superintendent Steve Dackin said.

Students and teachers who have been exposed will be tested Tuesday and again in eight weeks, Dackin said.

If anyone else is found to have contracted tuberculosis, more students will be checked.

Tuberculosis is a highly contagious infection that causes severe coughing, pain in the chest and coughing up of blood or phlegm from deep in the lungs.

When a person with TB coughs or sneezes, people nearby breathe the bacteria, which can settle in the lungs and begin to grow. It is most often contracted through prolonged, frequent close contact with an infected person.

"We’re most concerned about people who breathe the same air a lot," said Debbie Coleman, an assistant health commissioner and chief nursing officer at the Health Department. "People who have only passing contact with an individual who is infected in hallways or the cafeteria would be at a low risk."

But anyone who wants to be tested will be. "We’re all about preventing the spread of the disease," Coleman said.

Tuberculosis testing requires a small **** under the skin. Those who test positive undergo a chest X-ray to see whether they have the active disease.

People with the disease have to take four drugs daily for six months.

Anyone with questions can call Columbus Public Health at 614-645-3209 or visit the high school from 3 to 4 p.m. Monday.

epyle@dispatch.com 

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3 Flu Strains Appear in Iowa Earlier than Expected
DES MOINES, IA (AP) -- Three strains of influenza have made an early appearance in Iowa this season.

Kevin Teale is a state health department spokesman. He says it's not unusual for the state to see three strains of flu in one season, but it is unusual for the emergence of three strains this early in the flu season.

He says it's not known if the early appearance of multiple strains is a harbinger of things to come.

Teale says the flu's emergence should serve as a reminder to people to get a flu shot, which covers all three strains.

He estimates about one thousand Iowans die each year from the flu or pneumonia. Most of those deaths occur in people 70 or older.


Updated: December 8, 2006, 10:09 am
http://www.kttc.com/News/index.php?ID=10118
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Norovirus nails Deer Lodge
'Stomach flu' flattens staff, patients

Fri Dec 8 2006

By Mary Agnes Welch

DEER Lodge is the latest health facility to get walloped by the norovirus -- a.k.a. the "stomach flu."

The personal care home and rehabilitation centre on Portage Avenue has seen about 80 patients and 41 staff members get sick since November, most in the last two weeks.

Right now, there are about 25 patients and staffers laid up with the virus, which has taken root in the city and is expected to last most of the winter.

The city's emergency rooms and urgent care centres have also weathered wave after wave of norovirus sufferers since the outbreak began more than a month ago.

Health officials reported four cases at Concordia Hospital and nine in the Grace Hospital emergency room yesterday. Doctors at Seven Oaks suspected another couple of cases.

Noroviruses like the Norwalk virus can survive on practically any surface, including door handles, sinks, railings and glassware, and they're not particularly susceptible to chlorine.

Don't get it...

  • Wash hands frequently.
  • Eat food that is well cooked, and fruits and vegetables that have been thoroughly washed.
  • Thoroughly disinfect contaminated surfaces, including clothing or linens, immediately after an episode of illness.

But if you do...

  • Drink plenty of fluids to stay hydrated.
  • Don't prepare or handle food that will be eaten by others.
  • Wash your hands, especially after using the washroom or preparing food.
Outbreaks are common where people are in close quarters, such as cruise ships, schools and hospitals.

The vomiting, diarrhea and aches caused by the norovirus usually subside within a couple of days.

Kevin Scott, director of community relations at Deer Lodge, said facility staff are trying to limit the number of group activities and are cleaning rooms more frequently in an effort to stem the spread of the virus.

They've also launched a campaign to get staff and patients to wash their hands religiously.

"Handwash, handwash, handwash," said Scott. "We're really reinforcing the importance of handwashing."

Other hospitals are keeping norovirus sufferers in the same isolation room and practising infection-control procedures.

Heidi Graham, spokeswoman for the Winnipeg Regional Health Authority, says most people with stomach illness who end up in hospital are suffering from another condition that's exacerbated by the virus or the dehydration that often accompanies vomiting and diarrhea.

She says people who think they have the virus can call the Health Links line at 788-8200 to check their symptoms with a nurse.

maryagnes.welch@freepress.mb.ca

http://www.winnipegfreepress.com/subscriber/local/story/3806651p-4402919c.html

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  Posted: Today at 8:36am

Rockland's first flu cases diagnosed

By JANE LERNER
THE JOURNAL NEWS

Flu facts
- Influenza is a virus that attacks the respiratory tract, including the nose, throat and lungs.
- The flu is different from a cold and often includes fever, headache, extreme fatigue, dry cough, sore throat, nasal congestion and body aches.
- Most people who get influenza will recover in one to two weeks, but some people will develop life-threatening complications, such as pneumonia.
- About 10 percent to 20 percent of the population nationwide will get influenza each year.
- An average of 36,000 people per year in the United States die from influenza, and 114,000 have to be admitted to the hospital as a result of influenza every year.
- People 65 and older, people of any age with chronic medical conditions and very young children are more likely to get complications from influenza.
- Pneumonia, bronchitis and sinus and ear infections are three examples of complications from flu.

Source: national Centers for Disease Control and Prevention

Where to go for shots
Rockland residents 9 and older can get a flu shot at clinics run by the county Health Department.
The clinics will be from 1 to 4 p.m. today at the Dr. Robert L. Yeager Health Center in Ramapo.
The vaccine is free for anyone 60 and older. People who are younger will be charged $20.
For more information, call the county Health Department at 845-364-2534.

< =text/>
(Original publication: December 8, 2006)

Two children have become the first people in Rockland County to be diagnosed with confirmed cases of influenza this season, health officials said yesterday.

Laboratory tests this week showed that both youngsters had Type A influenza, the Rockland County Department of Health said.

"It's not unusual to start to see cases around this time of year," said Pat McAlpin, the department's director of patient health services.

The state Department of Health is reporting flu cases in several parts of the state, including Orange and Ulster counties and in New York City

http://www.thejournalnews.com/apps/pbcs.dll/article?AID=/20061208/NEWS03/612080402/1019
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Michigan     
Livingston County health officials are sending out a reminder to get your flu shot. Four children in that county are infected with the highly-contagious illness.

Flu season arrived in Michigan in mid-November, and now the flu has reached Livingston County. Over the past couple of weeks, the Livingston County Public Health Department has confirmed four cases of influenza in children.

Ted Westmeier: "We do have influenza activity in our community."

Livingston County Health Department Director Ted Westmeier says there are three different kinds of influenza. The four children have influenza type A, which is a little different from another kind, type B.

Ted Westmeier: "The literature does indicate influenza A is involved in more-severe epidemics, and B has milder symptoms." If you do have the flu, you will have some or all of these symptoms: fever, headache, tiredness, dry cough, sore throat, runny or stuffy nose and body aches, and to avoid getting sick, there's a simple solution.

Ted Westmeier: "We do have a vaccine available, the best way to protect yourself from influenza." While flu season has arrived, Westmeier says cases won't peak until January or February. That gives residents plenty of time to make sure they're protected. Ted Westmeier: "December is still an excellent time to receive the vaccine, so you have adequate time to develop an adequate immunity to it." If you'd like more information about flu shots, call your doctor or your local health department.

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Ouch
Posted on Thu, Jan. 04, 2007
Gates open wide for cold and flu season: Patients test positive for virus that affects respiratory tract
By Sandy Kleffman
CONTRA COSTA TIMES

Experts say there is no way to know for sure what is behind the nasty colds sweeping through the Bay Area and leaving some people with a hacking cough that drags on for weeks.

Kaiser Permanente reports numerous positive tests for respiratory syncytial virus, or RSV. It typically arrives around this time of year and strikes young children particularly hard.

Other people may be sickened by a parainfluenza virus, mycoplasma pneumonia or some other hardy bug.

"It's really hard for us to know what it is," said Dr. Carol Glaser, chief of the state's viral disease laboratory in Richmond. "I'd love to know what's causing these illnesses."Confused

The uncertainty exists because California does not have a statewide system for reporting and tracking colds. Even if it did, most people do not seek medical help. They simply suffer through it.

Anecdotally, there are plenty of reports of office ranks thinning and sniffles and coughs interrupting family gatherings.

"It's pretty widespread," said Francie Wise, communicable disease chief for Contra Costa County. "It does seem to be a cold that's hitting more people this year. This one seems to just last a lot longer."

Anyone who has been stricken will swear this year is worse than normal, though experts are not so sure.

"It clearly is the respiratory season now," said Dr. Peggy Weintrub, chief of pediatric infectious diseases at UC San Francisco. "But none of it seems astronomical."

One thing that does appear clear: Most people have been hit by something other than the flu. California has had only sporadic flu activity thus far.

Kaiser Permanente now is seeing strong evidence of RSV at nearly all of its major medical centers in the region. Nearly 30 percent of the swabs it recently tested have proved positive for the infection.

"That's real high," said Dr. Roger Baxter, an infectious disease specialist. "Over 10 percent is considered pretty high. The vast majority of them are little infants, and they're testing them because they're coming in to the hospital and they want to isolate them if they have RSV."

RSV infects the lungs and respiratory tract, bringing a runny nose, cough, low-grade fever, sore throat and mild headache.

"The cough is particularly bad, because it goes into your airways more than other infections do," Baxter said. "It causes a nasty cough that can go on for weeks and weeks."

Most adults recover without any problem. But RSV can be dangerous for young children, especially babies younger than 6 months and those born prematurely or with congenital heart or lung disease. It can also cause problems for the elderly.

Each year in the United States, as many as 125,000 infants are hospitalized with severe RSV, and a small percentage die.

Because it is a virus and not a bacterial infection, antibiotics are useless against it. Doctors may occasionally prescribe antibiotics, however, to deal with a bacterial complication, including a middle ear infection or pneumonia.

Experts recommend over-the-counter medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). They will help reduce fever but will not cure the infection or make it go away sooner.

In severe cases, other medications may be used to open air passages in the lungs and relieve wheezing. Some hospitalized children are hooked up to mechanical ventilation to ease breathing.

RSV is so common that by age 2, most children have been infected.

As people get the virus periodically, they develop some immunity.

"The immunity is short-lived, so by the time the next season runs around, you don't get so sick you go to the hospital, but you get what seems to be a really bad cold," Baxter said.

RSV is a hardy virus that can exist for as long as 24 hours on door knobs and other surfaces, Glaser notes. She recommends frequent hand washing to help stave off the illness.

The virus enters the body through the eyes, nose or mouth and can spread easily when people cough, sneeze or shake hands. People are usually most infectious during the first week of their illness.

Although California now is seeing many cases of RSV, the numbers are similar to last year, based on reports from 20 sentinel laboratories in the state, Glaser said.

She suspects some people may be hit by other things, including mycoplasma pneumonia.

"There's probably a mixture of things going on," Glaser said.

UC San Francisco recently has had more positive reports for parainfluenza than RSV, Weintrub said. Parainfluenza is an upper respiratory infection that can lead to croup in young children and produces coldlike symptoms in adults.

Those who already have suffered through the ailment this year may think they are home free. Not so fast, experts warn.

Kaiser noticed an increase in flu cases last week, which may be a sign the flu season is beginning.

"It looks like it's about to take off," Baxter said.

"As the kids go back to school, I think we'll start to have outbreaks in schools."

The bad news: Having RSV provides no immunity against the flu, so it is possible to get both in one season.

Reach Sandy Kleffman at 925-943-8249 or skleffman@cctimes.com.

TO EASE SYMPTOMS

• Keep your room warm, but not overheated. If the air is dry, a cool-mist humidifier or vaporizer can moisten it.

• Sit in an upright position to make breathing easier. Place sick infants in a car seat.

• Drink warm fluids, including soup.

• Saline nasal drops can help ease congestion.

• Try over-the-counter pain relievers such as acetaminophen (Tylenol) to help reduce fever.

• Stay away from cigarette smoke, which can aggravate symptoms.

TO AVOID ILLNESS

• Wash hands frequently.

• Limit contact with people who have fevers or colds.

• Keep countertops clean in the kitchen and bathrooms, and discard used tissues immediately.

Source: MayoClinic.com

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Check out today's Drudge Report. 20,000 kids kept home from school in Rhode Island.
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http://news.yahoo.com/s/ap/20070104/ap_on_re_us/schools_closed_meningitis_3
 
Health scare closes several R.I. schools

By JUSTIN M. NORTON, Associated Press Writer 2 hours, 44 minutes ago

COVENTRY, R.I. - Rhode Island officials canceled school Thursday for more than 20,000 students while health experts search for any connection between a suspected case of meningitis and a second-grader's encephalitis death two weeks ago.

"Given the parents' concerns and our concerns, we felt that out of abundance of caution we would keep schools closed for the next two days," Dr. David Gifford, director of the state's Public Health Department, said early Thursday.

"Calling it an outbreak at the time is premature," he said.

The meningitis case was reported late Wednesday in a student at Hopkins Hill School in Coventry. Meningitis is an inflammation of membranes protecting the brain and spinal cord that requires hospitalization in severe cases.

Encephalitis also involves brain inflammation caused by a virus. It was blamed for the death of one Warwick student last month and two other children's illnesses.

There has been an unusually high incidence of pneumonia in those communities, Gifford said. Several Warwick students in recent months developed infections of mycoplasma pneumonia, or "walking pneumonia," which is common and can, in rare cases like that of the Warwick second-grader, progress to encephalitis or meningitis.

Health investigators will spend the next few days talking to school nurses and looking for possible additional cases in hospitals.

More epidemiologists from the U.S. Centers for Disease Control and Prevention are also headed to the state to assist the half-dozen scientists already in Rhode Island, officials said Thursday. Gov. Don Carcieri was briefed on the illnesses and supports the actions the health department has taken, said spokesman Jeff Neal.

"This is a significant development, and the governor is monitoring it closely to ensure that we are doing everything possible to determine the cause and stop the spread," Neal said Thursday morning.

Health and school officials plan to meet over the weekend to determine when the public schools will reopen.

Classes were called off Thursday and Friday for 11,500 public school students in Warwick, 6,000 in Coventry, and 4,000 in West Warwick.

The Catholic Diocese of Providence said eight private schools in Warwick, West Warwick and Coventry, with a combined 2,600 students, would also be closed for at least the next two days as a precaution — though there were no reported cases of meningitis or encephalitis among the students, said diocese spokesman Michael Guilfoyle.

Schools in other parts of the state will remain open, Gifford said.

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They are saying that 2007 will be the warmest year yet. If so, how will this effect west nile virus ? Those little bugger's will be everywhere.
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  This season, St. Louis County health officials have recorded most flu cases among school-age children, Williams said.
The county has recorded 386 laboratory-confirmed cases of influenza this season. Statewide, Missouri has 2,654 cases since the flu season started in October, with 626 reported the last week of the year. Illinois does not track the number of influenza cases but is reporting "localized" levels of flu. Only 46 flu cases have appeared in St. Louis, said city health director, Dr. William Kincaid.
Flu season is on the upswing; RSV is worse
By Tina Hesman Saey
ST. LOUIS POST-DISPATCH01/06/2007

Influenza is rising in the Metro area, right on schedule for a typical flu season.

"Last year was low and late," said Dr. Michael Williams, director of the communicable disease division at the St. Louis County Health Department. "This year looks much more typical.
The number of flu cases began to increase in the middle of last month. The peak is generally in late January or early February.
"We're just now really entering into the heart of influenza season," said Dr. Ericka Hayes, a pediatric infectious disease specialist at St. Louis Children's Hospital. It is most severe for the elderly and very young children. This season, St. Louis County health officials have recorded most flu cases among school-age children, Williams said.

The county has recorded 386 laboratory-confirmed cases of influenza this season. Statewide, Missouri has 2,654 cases since the flu season started in October, with 626 reported the last week of the year. Illinois does not track the number of influenza cases but is reporting "localized" levels of flu. Only 46 flu cases have appeared in St. Louis, said city health director, Dr. William Kincaid.
It's too early to say how the flu season will ultimately shape up, but health officials agree that it's not too late to get a flu shot.
Kincaid credits vaccination efforts with keeping the number of flu cases in the city low. Vaccines are available through family doctors, the Visiting Nurse Association and other health care organizations, and at some drugstores.http://www.stltoday.com/stltoday/news/stories.nsf/sciencemedicine/story/720DB003D79FCBED8625725B0013E3CB?OpenDocument
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Hi anyone remember the Chris Rea song Texas ???
Posted from TB thread ....
http://www.dfw.com/mld/dfw/news/state/16396061.htm
 
Texas  ...... USA      Hi found this today searching for other info , wasn't sure which thread to post on ,forum has a few TB thread's going , scarey in Africa ....... hope its just all a may have been for all these folks . Cheers ....
 
Posted on Sat, Jan. 06, 2007
Health officials: 2,800 may have been exposed to TB
Associated Press

LUBBOCK, Texas - Concerned that about 2,800 people may have been exposed to tuberculosis at a West Texas hospital, state health officials are mailing warnings encouraging testing for the disease.

The possible exposure at Lubbock's University Medical Center occurred between September and November of last year, but the hospital was not alerted until last month. Privacy laws don't allow the hospital to name who caused the possible exposure to TB.

Hospital employees are tested for TB each year, hospital spokesman Greg Bruce.

The Texas Department of State Health Services said only people who receive the letter should be tested. The agency stressed this was not an outbreak.

"There's no immediate danger," Bruce told the Lubbock Avalanche-Journal for Thursday editions.

TB is caused by bacteria that can attack the kidney, spine and brain, according to the Centers for Disease Control and Prevention. The disease can be fatal if left untreated.

Letters are standard procedure whenever TB is reported, state health services spokesman Barry Wilson said. He noted that officials were very liberal in compiling the list of people who may have been exposed.

"Unless they've been coughing for three weeks or more, it's not something they should be overly concerned about," Wilson said. "This is really a routine procedure for us."Confused  Thats like a Monty Python movie { only a flesh wound }

Dr. Richard Lampe, the hospital's chairman of infection control, said it was doubtful that anyone exposed at UMC would show symptoms yet.

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    Check genomed.com for the West Nile Virus Horse Studies...
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U.S. National Flu Report

Influenza activity estimates, as reported by state health departments. Weekly reports are published about 10-12 days after the "week ending" date, due to the time required to compile national data.
Legend
No report No activity Sporadic Local Activity Regional Widespread
                        
Source: U.S. Centers for Disease Control and Prevention
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...
Are the people in PENNSYLVANIA and South Carolina too ill to give a report?
 
 
 
And now that the children are all back to school trading germs,
the folks in Massachusetts are all much better...
 
 
 
 

U.S. National Flu Report

Influenza activity estimates, as reported by state health departments. Weekly reports are published about 10-12 days after the "week ending" date, due to the time required to compile national data.
Legend
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 It's Back
DESCRIPTION
Health officials were investigating an outbreak of the Norwalk virus at a Bedford nursing home Monday. Officials said that 36 people, including 10 staff members, were infected by the virus at the Ridgewood Center, the second nursing home to be affected by Norwalk virus recently. The illness can cause vomiting and diarrhea, and officials said it spreads easily. Director of Public Health Mary Ann Cooney said that it's common this time of year because people spend more time inside, and it usually isn't dangerous. Cooney said the best way to prevent the spread of the virus it proper hand-washing.

Epidemic Hazard - North-America Common Alerting Protocol

Event summary
GLIDE Number EH-20070109-9245-USA    
Event type Epidemic Hazard Date / time [UTC] 09/01/2007 - 07:01:09 (Military Time, UTC)
Country USA Area -
County / State New Hampshire City Bedford
Cause of event Unknow Log date 09/01/2007 - 07:01:09 (Military Time, UTC)
Damage level Moderate Time left
Latitude: N 42° 56.418 Longitude: W 71° 31.276
Number of deaths: Not or Not data Number of injured persons: Not or Not data
Number of missing persons: Not or Not data Number of infected persons 36
Number of evacuated persons: Not or Not data Summary: 36 persons *
http://visz.rsoe.hu/alertmap/woalert_read.php?id=9245&cat=dis&lang=eng

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Originally posted by AnnHarra AnnHarra wrote:

...
Are the people in PENNSYLVANIA and South Carolina too ill to give a report


I live in PA and I've heard nothing about the flu - seems it really isn't very active here.    
b4giving
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Post Options Post Options   Thanks (0) Thanks(0)   Quote IMLKSK Quote  Post ReplyReply Direct Link To This Post Posted: January 12 2007 at 5:42am
THERE ARE 3 CONFIRMED CASES OF SCARLET FEVER IN MOUNT HOLLY,NC.  ALL THREE CHILDREN ARE AGED 18 - 24 MONTHS.  THEY ARE IN MY 20 MONTH OLD SON'S DAYCARE CLASS.  THE DAYCARE STAFF HANDED OUT PAMPHLETS TO ALL THE PARENTS OF THE KIDS IN HIS CLASS ON WHAT SYMPTOMS TO BE WATCHING OUT FOR.  2 OF THE CHILDREN WERE CONFIRMED TO HAVE IT ON THE 10TH OF JANUARY AND THE THIRD JUST WENT OUT YESTERDAY WITH IT.
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Pneumonia, strep  in NYS...
 
 
my dad also had it...and he had the pneumonia shot.
 
never had it in my life.... not sure what I had (in chest) got this...
 
Zithromax.com - The Zithromax Z-PAK (500 mg qd day 1, followed by 250 mg qd for 4 days)
 
is indicated for community-acquired pneumonia (CAP)
 
due to Chlamydia pneumoniae,
 
Haemophilus influenzae,
 
Mycoplasma pneumoniae,
 
or Streptococcus pneumoniae, ......................?
 
for patients appropriate for oral therapy.
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    Heard something on the news this a.m. about "norwalk" virus...nasty strain of stomach flu, I guess. I'm trying to find the news link. The reporter mentioned area closings due to this highly contageous outbreak this year. Yuck. JD
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Originally posted by mamasjob mamasjob wrote:

     Heard something on the news this a.m. about "norwalk" virus...nasty strain of stomach flu, I guess. I'm trying to find the news link. The reporter mentioned area closings due to this highly contageous outbreak this year. Yuck. JD


Found it... here it is...
    http://www.wndu.com/news/headlines/5253366.html


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Hi Mammasjob ,this is Boston More than 3700 patients stricken with nausea, vomiting, and diarrhea have
visited Boston's emergency rooms during the past 6 weeks in a wave of
gastrointestinal illness that has swept cities across North America

Archive Number 20070118.0239
Published Date 18-JAN-2007
Subject PRO/EDR> Norovirus - USA (Boston)

NOROVIRUS - USA (BOSTON)
************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 17 Jan 2007
From: ProMED-mail <promed@promedmail.org>
Source: The Boston Globe, boston.com, Wed 17 Jan 2007 [edited]
<http://www.boston.com/yourlife/health/diseases/articles/2007/01/17/intestinal_germ_leaves_trail_of_misery/>


More than 3700 patients stricken with nausea, vomiting, and diarrhea have 
visited Boston's emergency rooms during the past 6 weeks in a wave of 
gastrointestinal illness that has swept cities across North America. 
Federal health authorities are so concerned that they will conduct a 
telephone conference call this week with disease trackers from across the 
nation to gauge the impact of an outbreak attributed to norovirus 
infection. [Noroviruses are] intestinal [viruses] that travel easily from 
person to person.

Dr Marc-Alain Widdowson, a norovirus specialist at the US Centers for 
Disease Control and Prevention, said the current outbreak of illness 
appears to be the worst since 2002-2003. "But the bottom line is we don't 
really know why," said Widdowson, who speculated that the virus currently 
circulating may be a different strain, one that is more easily transmitted 
or one that spawns more severe symptoms.

For Dr Anita Barry, Boston's director of communicable disease control, any 
lingering doubts about the breadth and severity of the outbreak were erased 
when she saw figures delineating ER visits on Christmas [day] -- a day when 
patients do almost anything to avoid a trip to the hospital. On that day, 
73 patients with gastrointestinal woes turned up in Boston's 10 emergency 
rooms. "If people are coming to the emergency room on Christmas Day," Barry 
said, "that suggests to me this illness is more severe than your routine 
gastrointestinal illness."

Day by day, the Boston Public Health Commission has been tracking the march 
of the intestinal infection, using a surveillance network that monitors 
patients' ailments in emergency rooms. It creates something akin to a daily 
Dow Jones of disease, showing trends in infectious illnesses and other 
medical conditions. The network, activated shortly before the Democratic 
National Convention in 2004, acts as an early-warning system that gives 
health authorities a potentially decisive edge in their battle with 
microscopic foes. The system does not provide an actual diagnosis, but it 
can identify clusters of patients with similar symptoms.

"This gives us a clue earlier on that something may be up," Barry said. By 
the middle of December [2006], Barry knew that the increase in ER patients 
with their hands clutching their stomachs was no fluke. And while the 
volume fluctuated, it was generally increasing. Health Commission 
specialists know more than just how many people are coming to the ER: They 
also know patients' ages and their ZIP codes. While certain neighborhoods 
were hit harder than others -- Roxbury had the highest concentration of 
gastrointestinal illness -- no community escaped the virus.

That was another major clue for disease specialists, and it showed them 
that they needed to direct their efforts to the whole city, not just 
individual communities. City health authorities said they do not know for 
sure why certain neighborhoods generated more ER visits, but speculated it 
could reflect everything from patients lacking primary care physicians to 
some neighborhoods having greater population density, allowing the virus to 
spread more swiftly.

Sophisticated, real-time disease-tracking systems had been in the works for 
years, but the terrorist attacks of 11 Sep 2001, as well as the arrival of 
anthrax-laden letters a month later, caused researchers to expedite 
development of the networks. Initially, the tracking systems, known as 
syndromic surveillance networks, were trumpeted for their potential to 
detect bioterror attacks. But since dozens of public and private health 
agencies activated the networks, specialists have increasingly recognized 
that the first-generation systems now in operation may be better suited for 
identifying large outbreaks of gastrointestinal and respiratory illnesses.

"Diseases that tend to have explosive onset with a large number of cases 
early on do show up quite nicely," said Dr James Nordin, a clinical 
investigator at HealthPartners Research Foundation in Minnesota, which runs 
a tracking system in the Twin Cities. Norovirus [infection] is one of those 
diseases. And the consequences are seen in hospitals like Boston Medical 
Center, where ER doctors have treated a steady stream of patients. "We have 
seen a large number of cases of what appears to be a sudden onset and 
intense, short-lived diarrhea, nausea, and some abdominal pain," said Dr 
Jonathan Olshaker , Boston Medical's emergency department chief. "Although 
if you're going through it, it doesn't seem short-lived."

[byline: Stephen Smith]

-- 
ProMED-mail
<promed@promedmail.org>

[The tracking of the norovirus outbreak in Boston illustrates the potential 
of the syndromic approach to detection and surveillance of certain 
outbreaks of infectious disease. Readers are referred to comments posted 
previously on ProMED-mail (Norovirus - USA (multistate)(02) 20070113.0183) 
by a correspondent indicating that the increased norovirus activity 
observed in several parts of the northern hemisphere may be associated with 
emergence of a new variant of norovirus genotype GGII4 -- the genotype 
responsible for most institutional outbreaks, that is evolving quite 
rapidly. - Mod.CP]

[see also:
Norovirus - USA (multistate)(02) 20070113.0183
Norovirus - USA (multistate) 20070112.0145
2006
---
Norovirus outbreak, students - USA (DC) (02) 20061217.3549
Norovirus outbreak, students - USA (DC) 20061217.3544
Norovirus, hospitals - USA (CA) 20061215.3531
Norovirus, oysters - USA (OR) ex Korea 20061213.3503
Norovirus, prison outbreaks: USA (CA) 20060519.1411
Norovirus, retirement center - USA (WA) (02) 20060412.1086
Norovirus, retirement center - USA (WA) 20060410.1073
2005
---
Norovirus, post-hurricane - USA 20050911.2693
2003
---
Norovirus, foodborne - USA (MI): suspected 20030307.0566
Norovirus activity 2002 - USA 20030123.0206]

......................cp/pg/sh
http://www.promedmail.org/pls/promed/f?p=2400:1000
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ny new ones?
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 Ouch  Norovirus 
Archive Number 20070121.0290
Published Date 21-JAN-2007
Subject PRO/EDR> Norovirus outbreak, airport hotel - USA (VA)
NOROVIRUS OUTBREAK, AIRPORT HOTEL - USA (VIRGINIA)
**************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Fri 19 Jan 2007
From: Thomas Roesel <roesel@lycos.com>
Source: Washington Post online [edited]


Norovirus outbreak affects 100 guests
-------------------------------------
About 100 guests and employees at a Hilton hotel near Dulles International 
Airport have been sickened by the highly contagious norovirus, forcing the 
hotel to stop taking reservations as it sanitizes the building, authorities 
said last night [18 Jan 2007]. By yesterday, dozens of guests had accepted 
offers to move to hotels in the area, although others remained at the 
Hilton Washington Dulles Hotel. Late last night, the Fairfax County Health 
Department confirmed that the sickness was caused by norovirus infection, 
sometimes called "the cruise ship illness" because of outbreaks in recent 
years. The Herndon area hotel said that on Tuesday [16 Jan 2007] night, 
some guests began complaining of gastrointestinal distress, including 
nausea, vomiting, and diarrhea.

[byline: Allan Lengel]

-- 
Thomas Roesel
<roesel@lycos.com>

******
[2]
Date: Sat 20 Jan 2007
From: Stephen Guptill <sguptill@usgs.gov>
Source: Washington Post online [edited]
<http://www.washingtonpost.com/wp-dyn/content/article/2007/01/19/AR2007011901617.html?referrer=emailarticle>


USA: norovirus cleaning begins at Dulles Hotel
----------------------------------------------
The Hilton Washington Dulles Airport hotel closed yesterday [19 Jan 2007] 
for the weekend so crews could scrub and sanitize every surface after about 
120 employees and guests were sickened by the highly contagious norovirus, 
which officials say is particularly severe this year [2007]. As the last 
guests filtered out early in the afternoon, workers from a professional 
cleaning company prepared to scrub every nightstand and counter twice with 
a chlorine bleach solution. The crew will also clean carpets and drapes and 
mist each room with a disinfectant. "It's a floor-by-floor, room-by-room, 
surface-by-surface process," said Jim Cree, the hotel's director of sales 
and marketing, who was washing his hands more than hourly yesterday [19 Jan 
2007] to avoid the bug. "This will be the most sanitized building in the 
country."

This season is shaping up to be a particularly severe one for the illness 
sometimes known as "winter vomiting disease," said an expert at the federal 
Centers for Disease Control and Prevention, which helps track some of the 
23 million cases of norovirus infection that occur each year. 1st 
identified in 1972 but only routinely tested for in the past decade, 
norovirus is perfectly suited for causing dramatic outbreaks in crowded 
settings, including cruise ships, hospitals, nursing homes and hotels. Even 
a very small amount of the virus can cause infection. It survives prolonged 
periods on such surfaces as counters and door handles, and it can become 
airborne under some circumstances. Some common disinfectants -- such as 
alcohol-based waterless hand scrubs -- won't kill it.

The chief mystery about the microbe, to both scientists and the public, is 
whether norovirus infections are becoming more common or just better 
publicized. "That is the key question, and I don't think we really have an 
answer to it," said Robert L Atmar, a norovirus researcher at Baylor 
College of Medicine in Houston. "We certainly have better tools to diagnose 
the infection now, and they are being applied more frequently. That said, 
it seems that in the last year, there has been an increase in the number of 
norovirus outbreaks that have been reported," he said.

Marc-Alain Widdowson, a medical epidemiologist at CDC, said that "this 
winter season [2006-2007] seems to be worse than previous winter seasons. 
The last time we had things this bad was 2002-03." The severity of 
outbreaks may vary year to year, as is the case with influenza, even if the 
long-term incidence is not rising, he said. Current estimates are that at 
least half of the more than 75 million annual cases of foodborne illness in 
the United States are caused by norovirus. About 20 per cent of people who 
go to a doctor because of acute diarrhea are infected with it. The virus is 
believed to cause 10 times as many cases of diarrhea-and-vomiting illness 
as the next most commonly implicated microbe.

The Virginia Department of Health has reported 52 norovirus outbreaks -- 
which account for many more individual cases -- this winter [2006-2007], 
according to the most recent data available. Last month [December 2006], 
dozens of Catholic University students fell ill with norovirus. Far from 
Washington, there was an outbreak on the Queen Elizabeth 2 during a voyage 
from England to New York. In Maryland, 34 gastroenteritis outbreaks have 
been reported this year [2007], state health officials said. Ten appear to 
be caused by norovirus, and test results are pending in the other 
instances. A District health spokesman said last month's outbreak at 
Catholic University was the only large norovirus incident reported in 
recent years.

At the Hilton, guests 1st began reporting symptoms Tuesday [16 Jan 2007] 
night, and some suspected food poisoning, Cree said. The hotel contacted 
the Fairfax County Health Department, and scientists examined the 
restaurant and kitchen and collected stool samples from people who were 
ill. Tests on those samples confirmed norovirus as the culprit. Hilton 
officials found reservations at other hotels for guests checking in 
mid-week and through the weekend and moved a gala and other events. 
Employees will return to work Mon 22 Jan 2007, and the hotel is scheduled 
to reopen at noon Tuesday. The Hilton isn't the only area hotel that has 
been forced to close because of the virus. In 2003, dozens of guests and 
visitors at the nearby Hyatt Dulles fell ill. The hotel reopened after 3 
days of top-to-bottom cleaning.

Lucy Caldwell, a Virginia Department of Health spokeswoman, said the best 
way to avoid the misery of norovirus is frequent hand washing. If you do 
become ill, disinfect everything you've touched. "Spend time cleaning the 
toilet, including the handle," Caldwell said. "Clean anything you touch. 
The soap dish, your phone, the remote control." Norovirus is almost always 
passed through vomitus or feces. Perhaps as few as 10 virions -- individual 
virus particles -- are enough to cause infection. The incubation period is 
usually a day or more. Three-quarters of people report vomiting and 
diarrhea, although only 1/3rd have fever, and symptoms usually last about 5 
days. About 20 per cent of whites appear to be genetically resistant to one 
strain of norovirus, called Norwalk virus. Death from the infection is 
uncommon, but it can occur in the debilitated elderly.

Norovirus has been responsible for several large, dramatic outbreaks that 
illustrate its extreme contagiousness and persistence. Early this decade, 
660 patrons of a restaurant in Nagasaki, Japan became infected with 
norovirus. Boiled broccoli that had been handled with bare hands after 
cooking was the most likely source of infection. Contaminated drinking 
water, and even insufficiently chlorinated swimming pools, have caused 
outbreaks of norovirus infection.

[byline: David Brown, Maria Glod and Susan Levine]

-- 
Stephen Guptill, PhD
Research Physical Scientist
US Geological Survey
Reston VA 20192
<http://www.promedmail.org/pls/promed/f?p=2400:1000">sguptill@usgs.gov>
http://www.promedmail.org/pls/promed/f?p=2400:1000
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