Outbreak of Norovirus Associated with Gulf Coast Oysters, TN, 2009 Sarah Hill and Margaret Zylstra...
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Transcript of Outbreak of Norovirus Associated with Gulf Coast Oysters, TN, 2009 Sarah Hill and Margaret Zylstra...
Outbreak of Norovirus Associated with Gulf Coast Oysters, TN, 2009
Sarah Hill and Margaret Zylstra
Tennessee Department of Health, Chattanooga-Hamilton County Health Department
Norovirus
• Common
• Low infectious dose
• Human fecal pathogen
• Contaminates fresh and marine waters
• Environmentally stable
• Not the reservoir for norovirus
• Filter water over gills and mantle, 5 L/h
• Viruses and bacteria
• Frequently consumed raw
Public Health Investigation
• Outbreak?– 3/9, 3 ill persons call CHR report eating raw
oysters at Restaurant A
• Environmental investigation– Facility inspected– Score of 83, one critical violation
• Chicken salad holding at 45° F rather than <41° F• All oyster storage and serving was adequate
– Raw oysters (n=24) and tags collected from restaurant
Investigation Results
• Case definition: Person who developed vomiting and/or diarrhea within 3 days of eating at Restaurant A 3/5-3/7
• 13 ill identified and 30 controls enrolled• 4 confirmed norovirus genogroup 1• Cases from TN, AL, GA, MO• No ill restaurant staff
• Oysters: negative for norovirus
Onset of Illness following consumption of MS A2C oysters
0
1
2
3
4
5
6
7
8
9
10
3/4 3/5 3/6 3/7 3/8 3/9
Onset date
Nu
mb
er il
l
A2C oysters consumed at Restaurant A
Food OR 95% CI P value
Raw Oysters 108 10-1147 <0.0001
Fried Oysters 0.5 0.1-5.4 0.6
Fire-roasted Oysters
0.1 0-1.8 0.04
Salad 1.2 0.3-5.1 0.8
Other entrée 0.1 0-0.4 0.0007
Actions
• 3/14 CHR and Tennessee DOH inform FDA of epi association
• Mississippi Dept of Marine Resources – 3/17 closed harvest area– Recalled 2/24 harvest– Recommended cooking oysters harvested 2/25-
3/17
• Tennessee (3/20) and FDA (3/21) advised consumers to avoid oysters harvested 2/25-3/17
Discussion
• Surveillance and rapid investigation, cooperation of Restaurant A key
• Epi data v. lab data
• Mississippi investigating illness reports
• Mississippi Dept of Marine Resources has requested FDA assistance to evaluate potential sources of contamination
Questions?
Tennessee Department of HealthCommunicable and Environmental Diseases1st Floor, Cordell Hull Building425 5th Avenue NorthNashville, TN 3724615.741.7247