New Norovirus Surveillance Test Kit LT Michael Kramer Environmental Health Officer Navy Environmental and Preventive Medicine Unit TWO

New Norovirus Surveillance Test Kit

LT Michael Kramer Environmental Health OfficerNavy Environmental and Preventive Medicine Unit TWO

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Navy Environmental and Preventive Medicine Unit TWO

Disclaimer: The views expressed in this presentation are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U. S. Government.

NAVY ENVIRONMENTAL AND PREVENTIVE MEDICINE UNIT TWO

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Navy Environmental and Preventive Medicine Unit TWO

Provides public health services to Fleet and Shore units within the Navy and Marine Corps.

Composed of 5 main Departments:o Admino Fleeto Threato Deployable Platform Department (DPD)o Lab

Active Duty/Civilian personnel consisting of Audiologists, Biochemists, Entomologists, Environmental Health, Health Promotions, Industrial Hygiene, Microbiologists, Occupational and Prev Med Doctors and Preventive Medicine Technicians.


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Microbiology Lab

Provides support and assistance for the Navy and Marine Corps in areas of:o Outbreak or contact investigationso Diagnostic testing and researcho Detection of bioterrorism agentso Training and consultative services

COLA accredited


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Norovirus Overview

A group of non-enveloped single-stranded RNA viruses that causes acute gastroenteritis (AGI).

Belong to the family of Caliciviridae Currently 6 recognized Norovirus genogroupso Three of which cause acute gastroenteritiso GI, GII and GIV


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Foodborne Illness Overview

Norovirus is the leading cause of acute gastroenteritis in the U.S. Directly attributed to:o 19 – 21 million illnesseso 56,000 – 71,000 hospitalizationso 570 – 800 deaths

Account more than 50% of AGI Outbreaks


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Impact

Global impact ~ 21 million annually in U.S. Most common cause of non-

bacterial gastroenteritis 50% GI outbreaks


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State of Reporting in the Fleet

Norovirus is hardo Most individuals don’t get testedo Testing is not commonly available at most military treatment

facilities (MTF’s) January 1 2012 – December 31 2014 o 31 Outbreak reportso 18 of these or 58% are either confirmed or suspected noroviruso Vast majority of remaining 13 appear norovirus given

symptomology and duration


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Highly Virulent

Low infectious dose = 10 particles Pre-symptomatic viral shedding Peaks 2-5 days post-onset Peak viral load ~100 billion virus

particles per gram of feces 1 patient can infect 50% or more of

the people around them Large populations in enclosed

environments are most vulnerable


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Symptoms

Watery non-bloody diarrhea Abdominal cramps Nausea Acute-onset explosive (projectile)

vomiting Occasional low grade fever Incubation Period:o 24-48 Hours

Self Limiting:o Usually 24-72 hours


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Transmission

Person to persono Fecal – oralo Airborne inhalation of dropletso Environmental contamination

Foodborneo Infected food handlerso Food distribution

Waterborneo Large community outbreaks

(recreational and drinking water as vehicle)


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Prevention


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State of Outbreak Reporting

Known outbreaks are not often reported and burden of disease uncertain

USS Abraham Lincoln: 21 May – 3 June 2012o Total case documented in CVN 72 Medical = 214o Total lost work days = 90o Conservatively 250+ khaki personnel did not report to Medicalo No mission degradation


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Recent Outbreak Data USS LINCOLN (CVN-72)


Number of Patients 3 3 20 12 24 26 7 29 23 25 18 7 13 4

Lost Work Days 0 0 6 5 8 9 0 4 16 11 7 8 11 5

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How Big is the Problem?


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Burden of Norovirus in the United States.


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State of Reporting Aboard U.S. Navy Ships


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Total Outbreaks of AGI in U.S. Navy Ships


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Outbreaks of AGI in the Fleet by Ship Class


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Outbreak?

Persons cleaning areas heavily contaminated with vomitus or feces

should wear N95 mask.

Surgical mask provides no protection vs Norovirus

Use chlorine bleach or EPA approved disinfectants

Place patients in private rooms or cohort such patients

Simple routine daily cleaning of ship’s heads, targeting frequently touched areaso Ongoing intrusive leadership to ensure rigorous attention to hygiene and

sanitation countermeasureso Closed self-service food line


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Eureka Moment

Developed a fast, economical way to test the burden of norovirus in the Fleet

Takes out the guess work in norovirus surveillance

Help with more accurate reporting and risk assessment

Takes up fewer resources

No cost to ship.


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Test Kit


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Test Kit


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Specimen Collection Procedural Guidelines


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Procedure


Filter Card Fecal Collection Procedural GuidelinesFilter Card Fecal Collection Procedural Guidelines

26NAVY ENVIRONMENTAL AND PREVENTIVE MEDICINE UNIT TWO

Summary of Presentation

Old Method New Method

Large footprint Takes up very little space

Requires freezing Room temperature storage

Needs dry ice for shipping Shipped at room temperature

Collected by health care provider Collected by patient

Expensive extraction kit Very inexpensive extraction

Difficult to use as screening tool Easy to screen many samples

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Questions?

Contact NEPMU-2 Microbiology Laboratory

[email protected]

NAVY ENVIRONMENTAL & PREVENTIVE MEDICINE UNIT TWONORFOLK, VA

757-953-6600


Documents

New Norovirus Surveillance Test Kit LT Michael Kramer Environmental Health Officer Navy Environmental and Preventive Medicine Unit TWO