Norovirussen Hoe kom je eraan en er vanaf?

Transcription

1 Norovirussen Hoe kom je eraan en er vanaf? Erwin Duizer SNIV September

2 Norovirus Virologie, epidemiologie Hoe kom je er aan? Hoe kom je er vanaf? 2

3 NoV Noroviruses Populatie Gastroenteritis: microbiology nm, ssrna no envelope % of total outbreaks Total: 282 outbreaks unknown unknown unknown 3 Norovirus Norovirus Norovirus Adenovirus Adenovirus Rotavirus Rotavirus Rotavirus 2002: explosieproject Salmonella Salmonella Salmonella Campylobacter Campylobacter Campylobacter Shigella Shigella Shigella Van Duynhoven et al., 2005

4 Norovirus, burden The Netherlands Symptomatic infections, annually 500, ,000 In Outbreaks (reported) <5,000 38/1000 inhabitants Costs estimates GE ~650 million NoV > 100 million Hospitalizations Children and Adults (~10-20%) Mortality Elderly (>85 yr), OBs: ~20 Hospitalization and mortality rates were 0.54% and 0.06%(OBs) Extra intestinal ischemic colitis, urticaria, Guillain- Barre, convulsions (case reports) 4 Verhoef et al., 2012; Friesema et al., 2012; Van Asten et al., 2011; Desai et al., 2012

5 Missed norovirus infections in relation to bacterial infections in stool samples of patients (n = 1,203) sent for bacteriological culture from December 2008 to July Beersma M F C et al. J. Clin. Microbiol. 2012;50:

6 Gastroenteritis (outbreak) testing Algorithm Notification* Food-borne infection suspected? yes no 2 and 3 contact FSA Specific clinical picture? Additional methods** yes no Basic methods 1 st choice** 3,5 blood Nursery school 2, if symptoms > 1 week: 4 2, 3, 5 Consultation lab mortality Residential institution 2 6 Consultation lab antibiotics hospital 2 Consultation lab Other. community None, unless? *Anamnesis Who is ill residents/ (kitchen) personnel Does spread occur within institute? Potentially food-related? Do outbreaks occur in related institute? Symptomatic pattern (vomiting, diarhea (bloody), fever) Duration of illness (if already known) 6 **Diagnostics 1 = virus quick testing (noro, rota) 2 = 1, if negative 3 and virus PCR 3 = bacterial package: Salmonella, campylobacter, (shigella) 4 = parasitological investigation: Giardia, cryptosporidium 5 = 10 E. april coli = C. difficile

7 Norovirussen Hoe kom je eraan? Hoe kom je er vanaf? 7

8 Non-Food Food Transmission of norovirussen Route relevance key factor Person-to-person Most common Hygiene Food-borne Common (15-30%?) Food-handler-hygiene Contaminated food Waterborne variable Environmental in many outbreaks Persistence of virus in environment Resistance of virus to disinfection Airborne? Variable vomiting (toilet flushing) Zoonotic? Not detected 8

9 Overdracht: vieze vingers mens 9

10 Transmission psychiatric institution Hospital Transmission Virus donor is patient: 75% Virus donor in HCW: 25% Transmission Worst Minor symptomatic staff asymptom. staff Heijne et al., Suhkrie et al., 2012

11 Norovirussen Hoe kom je eraan? Hoe kom je er vanaf? 11

12 Hand hygiene: NoV reduction Fingerpad test N=12; 30 sec Virus Mean PCR unit reduction (log 10 ± SD) [No. of positive samples] Sterillium Soap and water MNV1 1.5 ± 1.3 [12] 5.7 ± 0.2* [ 0 ] Human NoV GI ± 2.8 [ 8 ] 6.2 ± 0.2* [ 0 ] Human NoV GII ± 1.3 [ 2 ] 3.9 ± 0.0* [ 0 ]?? Reliability of intervention?? MNV a suitable model 12 Tuladhar et al., 2012

13 Return to work? 48 h?? 13

14 Oppervlakte desinfectie manually 14

15 Oppervlakte desinfectie Afname PCRU (log10) Norovirus afname door vegen: NoV GI en GII GI.4 GII Vloeibaar zeep chlorine 1000 ppm Vloeibaar zeep en chlorine 250 ppm 1000 ppm 15 Tuladhar et al., 2012

16 Rotavirus SA11 a,b b a a a,c c a,c a,c c c d d Influenza A (H1N1) virus -Wiping once or twice -Target level = transfer rate * ID Residual contamination -Target level -consistency a a b c c c? Differences in resistance to disinfection? a St. aereus a a b 3 c 2 1 c 0 control 16 water liquid soap Soap/ ppm chlorine 250 ppm Soap/ 1000 ppm Tuladhar et al., 2012

17 120 ppm Temp ( O C) RH (%) H 2 O 2 (ppm) Time Scale 1 h 17

18 Oppervlakte desinfectie Alpha D3-Fogging Virucidaal effect van waterstof peroxide damp Reduction (log10) table closet Corner window Closed closet Open closet Stainless steel Trespa Gauze Poliovirus: complete inactivatie, niet in dichte kast 18 Tuladhar et al., 2012

19 Oppervlakte desinfectie Alpha D3-Fogging Infectivity reduction in an isolator (Complete inactivation) Amount of virus loaded Stainless steel Trespa Gauze Log10 reduction Murine norovirus 1 Murine norovirus 1 (1% stool) Poliovirus Sabin 1 Adenovirus type 5 Rota virus SA 11 Influenza A (H1N1) virus 19 Viruses

20 Environmental decay of poliovirus and influenza virus at room temperature. Tuladhar E et al. Appl. Environ. Microbiol. 2012;78:

21 Reduction of infective poliovirus and influenza virus by different IQACs after 1 h of exposure at room temperature. Tuladhar E et al. Appl. Environ. Microbiol. 2012;78:

22 Conclusions NoV: Transmission and intervention Hand Hygiene Environment Cleaning and Disinfection Infected person Virus Donor via feces or vomit?? Hand Hygiene Hand Hand Hygiene Aerosol Food Uninfected person Heating Irradiation HP Water Irradiation Membrane filtration Chlorination. 22

23 Conclusies Norovirus gaat direct of indirect van mens op mens Goed handen wassen verwijdert veel virussen van de handen Waterstof peroxide damp lijkt een goede methode voor ruimte (oppervlakken, textiel) ontsmetting Schoonmaken gevolgd door desinfectie met 1000 ppm chloor is consistent een decontaminerende behandeling (en meestal zal 250 ppm voldoen) 23

24 Ackowledgements Foodborne Viruses LIS VIROLOGY Marion Koopmans Harry Vennema Annelies Kroneman Bas van der Veer Joukje Siebenga Sanela Svraka Faizel Sukhrie Linda Verhoef Era Tuladhar Gökhan Uslu Sabine van der Sanden Food and water microbiology Ana Maria de Roda Husman Saskia Rutjes Martijn Bouwknecht WUR, levensmiddelen microbiologie Marcel Zwietering Rijkelt Beumer Wilma Hazeleger SOHIT Research Paul M. J. Terpstra FBVE Network 24

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26 Viral food safety is simple.. No feces in foods 26