Applying Epidemiology
Charles B. Moore
HCA 415
Instructor: Quida Davis
April 27, 2014

Applying Epidemiology
A mother of a young child called the Vermont Department on February 5 to report the possibility of a foodborne disease outbreak after her child aged 5 years and two other children of her neighbor aged 7 and 10 years became ill with a lot of vomiting and diarrhea that took place within an interval of 12 hours. The child’s sickness became severe that the mother took her to a local hospital where she was kept at the emergency department.
The mother stated that the child complained of nausea at 10 o’clock the February 2nd, later, the child began vomiting and having multiple episodes of diarrhea, she was not able to eat or drink anything without vomiting. In the evening, the woman took the child to the local hospital where she was admitted at the emergency department, here they noted the child was dehydrated and had a high fever. The stool and blood specimen of the child was collected and the child was given intravenous fluids as a treatment and later she was released; the following day the mother made follow ups on the test results for the child and it turned out the stool culture displayed negative results for usual bacteria (Brehm-Stecher et al, 2009, p. 1774).
Two children who were nearby neighbors reported to have nausea, diarrhea, vomiting and fever, these were similar symptoms that the other child had even though these two children were not as ill as the woman’s child. These symptoms began a few hours earlier than that of the woman’s child and the two children were able to go to school the following day after becoming ill. The three children did not play together from time to time and they only attended a birthday party on February 1st, one of the main concerns from the mother was the homemade ice cream that was served at the birthday party and she heard the ice cream was prepared using raw eggs.
The first step in the epidemiological steps is to provide test characteristics for norovirus and its outbreak using clinical criteria, methods that will be used in the collection and the characteristics used in diagnosis of norovirus. Kaplan criteria can be used in detecting norovirus outbreak, this criterion has a high sensitivity of detecting an outbreak of norovirus and in situations where there is vomiting and a brief duration of the illness and a mean incubation of 24 to 48 hours, the criteria has high sensitivity. During specimen collection, a reverse transcriptase polymerase chain reaction method can be used and if one of the tests turns out to be positive, the test sensitivity will be great. During the diagnosis of norovirus the characteristics of EIA that include reverse transcriptase, EM, ELISA and nucleic acid will undergo amplification that is sequence based in order to detect norovirus that is present in the human fecal specimen (Wymyslo, 2011, p. 40).
Interventions for norovirus intervention and prevention will deal with viral shedding, recovery of norovirus and an analysis of components for outbreak and prevention and a containment program this will include the use of medication. During viral shedding, children aged six months and below have a high risk of having prolonged viral shedding even after symptom resolution, in addition to this; infants have a possibility of shedding high titers of virus levels (Cabot et al, 2012, p. 1040).
Fomite contamination is not associated with norovirus infection but norovirus present on surfaces can be transferred to other fomites through touching things such as door handles, taps, among others via finger tips. This takes place even if the virus is left to dry for 15 minutes, hence environment contamination is associated with norovirus hence the virus is available in fomites that include the toilet, carpets, cushions and furnishings and equipment including kitchen surfaces. Foods and the preparation of food are not significant source for transmission of norovirus, but norovirus transfer is more efficient when it is inoculated onto surfaces that are moist as compared to dry surfaces. Norovirus can also be recovered from water and water acts as a source of transmission of the disease, therefore, recreational water venues can be associated with the outbreak of norovirus disease.
There is no single intervention for prevention of norovirus; therefore an early intervention and rapid implementation of infection control measures are key to controlling norovirus disease transmission. Hand hygiene is a primary prevention behavior and practical intervention that is effective in controlling the outbreak of the disease, the protocol include the switching to an exclusive use of soap when washing the hands and blend the washing with alcohol-based hand sanitizers (Neha, 2013, p. 63). Other measures include ensuring there is personal protective equipment, isolation of patients that have norovirus disease symptoms, educating the public and disinfection of the environment. Medication cannot reduce the risk of illness and those under antipsychotic drugs are not likely to become symptomatic and the medication can act as a surrogate maker for biologically plausible protective factor.
Norovirus are viruses that cause an individual have stomach flu; some key symptoms include vomiting, nausea, diarrhea, and stomach cramping and at other levels there is low grade fever. The illness begins unexpectedly making the person infected feel very sick; the norovirus disease makes the patient very sick and become unable to replace liquid lost during the diarrhea (Edge et al, 2007, p. 306). A person will become infected with the disease after taking foods or drinks tainted with norovirus, touching surfaces that are contaminated, or being in contact with a person infected with the disease. The main indicators of the disease appear the first twenty four to forty eight hours after the person has ingested the virus and they will appear as early as twelve hours after being exposed to the virus. The virus is very contagious spreading easily from one person to another hence particular care should be taken for children using diapers. Norovirus are contagious from the moment a patient feels ill and will last 3 days to over a period of two weeks after recovering from the illness; any person can therefore get norovirus infection which are of different strains. Vaccine for prevention of the virus has not been found and there is no drug that will treat a person infected with norovirus disease since the antibiotics can tread bacteria and not viruses. To prevent infections, several preventive measures should be taken, this includes frequent washing of the hands, washing fruits and vegetables, disinfecting contaminated surfaces using a bleach-based household cleaner, discarding any vomits and ensuring the surrounding area is clean and the person infected by the virus should not prepare food for a period of three days after recovering from the illness.

Reference
Brehm-Stecher, B., Young, C., Jaykus, L., & Tortorello, M. L. (2009). Sample preparation: The forgotten beginning. Journal of Food Protection, 72(8), 1774-89.
Cabot, R. C., Harris, N. L., M.D., Shepard, J. O., M.D., Rosenberg, E. S., M.D., Cort, A. M., M.D., Ebeling, S. H., . . . Kim, JiYeon,M.D., M.P.H. (2012). Case 8-2012. The New England Journal of Medicine, 366(11), 1039-1045.
Edge, Victoria L,M.Sc, PhD., Odoi, A., PhD., Fyfe, M., M.D., MacDougall, L., M.Sc, Majowicz, S. E., PhD., Doré, K., MSc, . . . Sockett, P. N., PhD. (2007). Physician diagnostic and reporting practices for gastrointestinal illnesses in three health regions of british columbia. Canadian Journal of Public Health, 98(4), 306-10.
NEHA AEC 77th ANNUAL EDUCATIONAL CONFERENCE & EXHIBITION. (2013). Journal of Environmental Health, 75(9), 61-75.
Wymyslo, T. E., M.D. (2011). 75th AEC JUNE 18-20, 2011 COLUMBUS, OH. Journal of Environmental Health, 73(9), 39-42.