The Butte County Public Health Department has been using public health measures to stop a gastrointestinal illness (GI) outbreak in all monitored shelters.  Since the shelters opened to house Camp Fire evacuees, 145 people have been sick with vomiting and/or diarrhea. As of Wednesday evening, there were 41 people experiencing symptoms at the following shelters:
•Neighborhood Church: 179 total evacuees at the shelter, 21 currently experiencing illness
•Oroville Nazarene Church: 352 total evacuees at the shelter, 10 currently experiencing illness
•Butte County Fairgrounds: 142 total evacuees at the shelter, 9 currently experiencing illness
•East Avenue Church: 200 total evacuees at the shelter, 1 currently experiencing illness
The number of sick people is increasing every day.  Twenty-five people have been to the hospital for medical support. Staff serving the shelters have also been sick. The outbreak has been identified and confirmed by the Butte County public health laboratory to be the Norovirus which is highly contagious.  Norovirus spreads through touching surfaces contaminated with the virus, close contact with someone who is infected, or eating contaminated food or drink.
Norovirus is the leading cause of outbreaks of diarrhea and vomiting in the U.S., and it spreads quickly in schools, shelters, and places where many people are in close quarters. There is no medication to get rid of the virus and there is no vaccine.  Most people are sick for 1-3 days and get better without medical support.  Seniors, young children, and people with chronic diseases can suffer from more severe illness, may get dehydrated, and require medical support. Norovirus particles are extremely small and billions of them are in the stool and vomit of infected people.  Any vomit or diarrhea may contain Norovirus and should be treated as though it does.  People can transfer Norovirus to others for at least 48 hours after symptoms go away.
Butte County Public Health is working with the Red Cross, as well as state and federal partners to prevent and reduce the spread of Norovirus at Camp Fire evacuation shelters with the following actions:
•Coordinated additional medical staff to support affected shelters
•Provided education about the illness and preplanning actions to shelter staff (both medical and Red Cross)
•Established separate shelter areas for sick evacuees, which include separate hand washing and bathroom areas, and limited in-and-out access
•Ensured that shelters are being cleaned with supplies effective against Norovirus and scheduled additional cleaning
•Supplied medical staff with personal protective equipment to minimize exposure
•Provided additional bathrooms and handwashing stations, including bathrooms and handwashing stations dedicated for use by ill persons
•Active monitoring of shelter residents for signs and symptoms of norovirus illness and coordinating laboratory testing to confirm the cause of the outbreak as norovirus
Include fever, nausea, vomiting, diarrhea and stomach pain.  Symptoms last for 1-3 days.  However, after symptoms go away, people are still highly infectious, especially for 48 hours after symptoms go away.  There is no treatment for Norovirus.  The most important steps to prevent the spread of Norovirus is to stay home if you are sick for another 48 hours after symptoms go away and for everyone to regularly wash their hands.
Butte County Public Health Officer Andy Miller, MD stated, “This virus can spread quickly through the community.  Norovirus had begun to spread in our community even prior to the fires.”  Please follow these recommended steps to prevent further spread:
•Stay home if there is any sign of illness such as stomach pain, fever, nausea, vomiting and/or diarrhea.
•Stay home for an additional 48 hours after symptoms are gone.Even though you feel better, you still carry the virus and can infect other people.
•Wash your hands frequently throughout the day with soap and water.
•Clean contaminated surfaces regularly with appropriate disinfectant, such as bleach.
•Do not prepare food and drink for others if you are sick.
•Questions related to symptoms and treatment should be directed to your primary care provider or clinic.
•If your child is sick, notify the school and tell them know your child’s symptoms.
The spread of Norovirus can be prevented by practicing proper hand hygiene.  Important strategies include washing hands with soap and water, especially after using the toilet and changing diapers, and always before eating, preparing or handling food.

Transylvania Public Health has received confirmatory laboratory tests from the N.C. State Laboratory of Public Health. Of those people who were tested by their medical providers, a majority were positive for norovirus. We believe this outbreak was caused by being exposed to a highly-contagious virus in a public place.

Although more information is continuing to come in, Transylvania Public Health has received more than 70 cases of nausea, vomiting and diarrhea reported by medical providers, as well as phone calls reporting similar symptoms in more than 200 people since Tuesday, July 31.

Norovirus typically causes diarrhea, vomiting, nausea and stomach pain that lasts for 1 to 3 days. Other symptoms can include fever, headache and body aches. These symptoms and length of illness match closely with the symptoms being reported by those who are ill.

People get norovirus from direct contact with an infected person, consuming food or water that has been contaminated with norovirus or touching contaminated surfaces and then putting your unwashed hands in your mouth. It only takes a few virus particles to make someone sick, and those who are ill shed billions of these particles. People are most contagious when they are having symptoms like vomiting and for the first few days after recovering, although they can spread norovirus for two weeks or more after they feel better.
Norovirus symptoms usually appear 24-48 hours after being exposed to the virus. Many (but not all) of the people who reported symptoms to us recalled visiting a local restaurant 1-2 days before becoming ill. Other people reported having close contact with someone who had norovirus symptoms prior to becoming ill.

Public health officials do not believe that this outbreak is connected to the multi-state recall of salads due to cyclosporasis contamination.

According to press reports: “The McDonald’s in Brevard reopened Friday after closing voluntarily to deep clean the restaurant in the middle of the food illness outbreak.”

The California Department of Public Health (CDPH) today warned consumers to avoid eating raw oysters harvested from south and central Baynes Sound, in British Columbia, Canada. The raw oysters are linked to an outbreak of norovirus illnesses.

In California, as of April 27, approximately 100 individuals have reported illness after they consumed raw British Columbian oysters sold by restaurants and retailers throughout the state. Laboratory testing has confirmed norovirus infection in several patients from both California and Canada. Although the number of reported new illnesses has decreased during the last week, the investigation is ongoing.

Canada has reported 172 cases of gastrointestinal illness linked to consumption of raw oysters.

Four oyster farms in the south and central Baynes Sound area of British Columbia that were linked to illnesses were closed between March 23 and April 13, 2018, and remain closed at this time. Restaurants and retailers should not distribute or serve oysters from these farms, which can be recognized by the following landfile numbers located on the shellfish tags: CLF #1402060, CLF #1411206, CLF #1400483, and CLF #278757. Restaurants and retailers are encouraged to check Canada’s above website for closure statuses and notices of re-opening.

Anyone who eats raw oysters should visit their doctors if they become ill, and should report the incident to the local health department.

“Avoid eating raw and undercooked shellfish, including oysters, to reduce your risk of illness,” said CDPH Director and State Public Health Officer Dr. Karen Smith. “If you do eat shellfish, cook it until it reaches an internal temperature of at least 145°F. Quick steaming isn’t sufficient to kill norovirus.”

Norovirus is highly contagious and can spread easily from person-to-person through contaminated surfaces, and by eating contaminated food, including raw or undercooked oysters. Symptoms of norovirus usually begin 12 to 48 hours after a person has come in contact with the virus, and can last for 1 to 3 days. Common symptoms include vomiting, diarrhea, nausea, and stomach cramps. People who develop symptoms of norovirus infection should consult their health care providers.

Norovirus:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Norovirus outbreaks. The Norovirus lawyersof Marler Clark have represented thousands of victims of Norovirus and other foodborne illness outbreaks and have recovered over $650 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Norovirus lawyers have litigated Norovirus cases stemming from outbreaks traced to a number of food products and restaurants.

If you or a family member became ill with Norovirus after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Norovirus attorneys for a free case evaluation.

The U.S. Food and Drug Administration is working with federal, state, and local officials regarding a norovirus outbreak linked to raw oysters from British Columbia, Canada. The FDA has confirmed that potentially contaminated raw oysters harvested in the south and central parts of Baynes Sound, British Columbia, Canada, were distributed to California, Illinois, Massachusetts, New York, and Washington. It is possible that additional states received these oysters either directly from Canada or through further distribution within the U.S.

FDA and the states are conducting a traceforward investigation to determine where the raw oysters were distributed and ensure they’re removed from the food supply. Retailers should not serve raw oysters harvested from the following harvest locations (or landfiles) within Baynes Sound: #1402060, #1411206, #1400483, and #278757.

Oysters can cause food-related illness if eaten raw, particularly in people with compromised immune systems. Food contaminated with noroviruses may look, smell, and taste normal.

Currently in Canada, a total of 172 cases of gastrointestinal illness linked to oyster consumption have been reported in three provinces: British Columbia (132), Alberta (15), and Ontario (25). No deaths have been reported. Individuals became sick between mid-March and mid-April 2018.

The Vermont Department of Health is investigating an outbreak of norovirus at The Windjammer Restaurant and its affiliated Upper Deck Pub in South Burlington, following more than 50 reports of illness and nine lab-confirmed cases of norovirus infection.

Health officials said the restaurant’s management has been cooperating in the investigation and has voluntarily closed for 48 hours to conduct a thorough cleaning of the establishment, including discarding prepared food items. According to The Windjammer’s management, several employees were out sick with similar symptoms. The restaurant is working closely with the Health Department to ensure the employees have the opportunity to be tested for norovirus and receive information about hand washing and glove use policies.

Noroviruses are a group of viruses that cause acute gastroenteritis illness, sometime called the “stomach flu,” but they are not related to influenza. Norovirus is very contagious and can spread easily from person to person via fecal-oral route, contact with contaminated surfaces, and through ingestion of contaminated food or water.

Illness from norovirus often begins suddenly. Symptoms usually include nausea, vomiting, diarrhea and some stomach cramping. While everyone can be affected, older people, children and those with chronic health conditions are at greater risk of complications. Symptoms usually resolve within 24-48 hours. Because of the risk of severe dehydration, drinking plenty of fluids such as juice or water or an oral rehydration solution is recommended. Sports drinks are not the best source for replacing lost nutrients and minerals. Anyone who is experiencing symptoms should contact their health care provider.

The Health Department has been reaching out by text messaging and calls to people who may have dined at the restaurant or pub since March 11, 2018. Patrons are asked to each complete a questionnaire designed to aid in the investigation. A link to the questionnaire and more information can be found at the department’s norovirus web page: www.healthvermont.gov/norovirus

Tacoma-Pierce County Health Department has identified new cases of norovirus, bringing the total number from the outbreak at two El Toro Restaurants to 434. The Tacoma location, 5716 N. 26th St., has 423 cases. The restaurant in University Place, 3820 Bridgeport Way W., has 11.

Both restaurants closed for a thorough cleaning and sanitizing, a Health Department requirement for outbreaks like this. They have since reopened. Reports from people who say they got sick after dining at the restaurants have slowed down.

“Norovirus is highly contagious and is more common in cold weather months,” said Katie Lott, food and community safety program manager. “The best thing people can do to protect themselves and keep the virus from spreading is wash their hands frequently and stay home when they’re sick,” she said.

The outbreak started at the restaurant in Tacoma’s Westgate neighborhood. The Health Department closed the restaurant Jan. 8 after receiving the first reports of illness. The Department worked with the restaurant to ensure it was thoroughly cleaned and sanitized before it reopened Jan. 9. On Jan. 11, the Department received confirmation from the state’s Public Health Laboratories that a customer who ate at the Tacoma restaurant during the onset period tested positive for norovirus.

On Jan. 10, the Health Department received illness reports from diners who ate at the El Toro Restaurant in University Place. The restaurant followed the same protocol and closed for cleaning and sanitizing. It reopened on Jan. 11.

Two staff members at the Tacoma location worked while ill during the time customers dined and later got sick. It’s still unclear if the outbreaks at the two locations are connected.

“Because of the nature of norovirus outbreaks, we may never know the exact affected items that caused illness,” Lott said. “All the cases have dining at the El Toro Restaurants in common,” she said.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Norovirus outbreaks. The Norovirus lawyers of Marler Clark have represented thousands of victims of Norovirus and other foodborne illness outbreaks and have recovered over $600 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Norovirus lawyers have litigated Norovirus cases stemming from outbreaks traced to a number of food products and restaurants.

If you or a family member became ill with Norovirus after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Norovirus attorneys for a free case evaluation.

The Tacoma/Pierce County Department of Health updated the El Toro Norovirus outbreak this afternoon.

As of today, the Health Department has a total of 542 cases—520 from the Tacoma location and 22 suspect cases from the University Place location. We have a lab confirmation of norovirus from the Tacoma location.

According to the departments, outbreaks can last a few days, a few weeks, or a few months. This a large number of cases for us, but we know cases of norovirus typically go unreported. And likely, the high number reflects secondary cases—people who became ill from eating at the restaurant, then went home and infected family members. It’s highly contagious. People will get norovirus an average of five times in their lives and not necessarily realize what it is—and they will probably not report it to the health department.

Norovirus outbreaks typically have greater numbers of cases than other types of outbreaks because of the low number of virus particles needed to cause infection and the rapid person-to-person transmission. This outbreak had much higher numbers than usual because:

  • The exposure period lasted eight days before we received notification people were sick.
  • We shared more about this outbreak than others in the past. Media coverage and our own public outreach through our blog and social media expanded awareness of the outbreak and how to report foodborne illness. More people became aware their symptoms might be norovirus, and they contacted us. 

In the case of the El Toro Restaurants, both received 65 critical points—not a passing score—during their last routine inspections, but they passed their follow up inspections. (See the two-year inspection history for the Tacoma El Toro and University Place El Toro.)

We rely on people who have become sick to report their illness to us. For an outbreak at a food establishment, we look for two or more reports:

  • From different households.
  • With meals at the same food establishment during the same time period.
  • Common incubation times and symptoms.

We match these criteria to what we know about different foodborne pathogens. In this case, they matched norovirus and the restaurants were the only thing all the sick people had in common. Then we investigate if any employees were sick, what tasks they performed, and what foods the sick people ate.

On Jan. 1, the state’s new Paid Sick Leave Law took effect. The law requires employers provide their employees with paid time off to take care of their health. Learn more about paid sick leave on the Labor and Industries website.

Because norovirus and the flu are in circulation, we want everyone to take preventative steps to stay healthy and keep those around you from getting sick. Wash your hands often, cover your coughs and sneezes, and stay home if you’re sick. Learn more about norovirusthe flu, and handwashing.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Norovirus outbreaks. The Norovirus lawyers of Marler Clark have represented thousands of victims of Norovirus and other foodborne illness outbreaks and have recovered over $600 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Norovirus lawyers have litigated Norovirus cases stemming from outbreaks traced to a number of food products and restaurants.

If you or a family member became ill with Norovirus after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Norovirus attorneys for a free case evaluation.

Tacoma-Pierce County Health Department has identified new cases of norovirus, bringing the total number from the outbreak at two El Toro Restaurants to 434. The Tacoma location, 5716 N. 26th St., has 423 cases. The restaurant in University Place, 3820 Bridgeport Way W., has 11. Both restaurants closed for a thorough cleaning and sanitizing, a Health Department requirement for outbreaks like this. Reports from people who say they got sick after dining at the restaurants have slowed down.

“Norovirus is highly contagious and is more common in cold weather months,” said Katie Lott, food and community safety program manager. “The best thing people can do to protect themselves and keep the virus from spreading is wash their hands frequently and stay home when they’re sick,” she said.

The outbreak started at the restaurant in Tacoma’s Westgate neighborhood. The Health Department closed the restaurant Jan. 8 after receiving the first reports of illness. The Department worked with the restaurant to ensure it was thoroughly cleaned and sanitized before it reopened Jan. 9. On Jan. 11, the Department received confirmation from the state’s Public Health Laboratories that a customer who ate at the Tacoma restaurant during the onset period tested positive for norovirus.

On Jan. 10, the Health Department received illness reports from diners who ate at the El Toro Restaurant in University Place. The restaurant followed the same protocol and closed for cleaning and sanitizing. It reopened on Jan. 11.

Two staff members at the Tacoma location worked while ill during the time customers dined and later got sick. It’s still unclear if the outbreaks at the two locations are connected.

“Because of the nature of norovirus outbreaks, we may never know the exact affected items that caused illness,” Lott said. “All the cases have dining at the El Toro Restaurants in common,” she said.

Learn more about norovirus at www.tpchd.org/norovirus. We have been providing updates on our blog. If we have new information on this investigation, we will post it to our blog Tuesday, Jan. 16. Find our blog at www.tpchd.org/blog.

About Tacoma-Pierce County Health Department: Tacoma-Pierce County Health Department’s mission is to protect and improve the health of all people and places in Pierce County. As part of our mission, the Health Department tackles known and emerging health risks through policy, programs and treatment in order to protect public health. We are one of only 163 accredited health departments in the country and among six in the state to have met or exceeded the Public Health Accreditation Board’s quality standards. Learn more at www.tpchd.org.

Norovirus

Norovirus is the leading cause of gastroenteritis, or what we commonly think of as stomach flu symptoms. It causes 23 million cases of gastroenteritis per year, or over half of all gastroenteritis cases in the U.S., and is the second most common virus after the common cold.

Norovirus is usually transmitted from the feces to the mouth, either by drinking contaminated food or water or by passing from person to person. Because noroviruses are easily transmitted, are resistant to common disinfectants, and are hard to contain using normal sanitary measures, they can cause extended outbreaks.

SYMPTOMS OF NOROVIRUS

The norovirus incubation period tends to be 24 to 48 hours, after which symptoms begin to appear. An infection normally lasts only 24 to 60 hours. However, in some cases, dehydration, malnutrition, and even death can occur. These complications are more likely among children, older people, and patients in hospitals and nursing homes with weakened immune systems. Common symptoms include:

  • Nausea
  • Diarrhea
  • Vomiting
  • Abdominal pain
  • Headache
  • Low-grade fever
NOROVIRUS DIAGNOSIS

Norovirus usually takes its course and goes away on its own after one to three days. It is hard to diagnose using samples in a lab, and so is usually diagnosed based on the combination of common symptoms, including mild fever, vomiting, and short duration of illness.

NOROVIRUS TREATMENT

There is no specific treatment for norovirus. However, it is essential to replenish fluids and minerals, as these are depleted with diarrhea.

HOW TO PREVENT NOROVIRUS INFECTION

The good news is that norovirus does not multiply on food, since it is a virus and not a bacterium. There is no way to tell whether foods – like shellfish, which are often eaten raw – are contaminated with norovirus. The only way to assure you don’t get norovirus from foods like shellfish is to cook them thoroughly. Here are other norovirus prevention methods:

  • Wash hands properly, especially after being at events with catered meals, nursing homes, schools, or on cruise ships
  • Wash raw vegetables thoroughly before serving them
  • While traveling, only drink boiled drinks or carbonated bottled beverages
  • Avoid letting anyone known to have norovirus in kitchen spaces
ADDITIONAL RESOURCES FOR NOROVIRUS

About-Norovirus.com is a comprehensive site with in-depth information about norovirus infection.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Norovirus outbreaks. The Norovirus lawyers of Marler Clark have represented thousands of victims of Norovirus and other foodborne illness outbreaks and have recovered over $600 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Norovirus lawyers have litigated Norovirus cases stemming from outbreaks traced to a number of food products and restaurants.

If you or a family member became ill with Norovirus after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Norovirus attorneys for a free case evaluation.

Jan. 10, 2018, 2:58 p.m.

The Health Department has more reports of ill customers from the suspected norovirus outbreaks at two El Toro restaurants. We have received reports of 232 ill customers at the Tacoma location and four at the one in University Place. We continue to receive more reports and interview more customers.

If you ate at El Toro Restaurant and became ill, contact the Health Department at food@tpchd.org, report online at www.tpchd.org/reportfoodborneillness, or call (253) 798-4712.

Jan. 10, 2018, 12:21 p.m.

Tacoma-Pierce County Health Department is working with El Toro Restaurant on a second suspected norovirus outbreak. Today, the Health Department closed the restaurant’s University Place location, 3820 Bridgeport Way W., for at least 24 hours or until thoroughly cleaned and sanitized.

We received two reports on Jan. 8 from customers in separate households who say they got ill after dining at the University Place location. Each report has multiple cases. We are still confirming the total and gathering information about new cases.

The customers got sick after they ate at El Toro’s University Place restaurant on Jan. 6. They experienced symptoms, which include vomiting and diarrhea, 24-36 hours after eating. Their symptoms lasted one to two days. We suspect norovirus to be the pathogen based on the symptoms.

It’s unclear if this outbreak is connected to our ongoing norovirus investigation at El Toro’s Tacoma restaurant in the Westgate neighborhood, 5716 N. 26th St.

“Someone exposed to norovirus can spread it 24 hours before showing symptoms,” said Katie Lott, food safety program manager. “That’s why preventing bare hand contact with food is so important,” Lott said.

Ill employees can return to work at a food establishment 48 hours after they become well.

“Food establishments benefit when sick food workers stay home: They don’t lose business and don’t jeopardize the health of their customers,” said Lott. “With Washington’s new paid sick leave law, food workers don’t have to be penalized financially for taking care of their health.” Learn more about paid sick leave on the Labor and Industries website.

In a recent editorial, the News Tribune supported the new sick leave law. The newspaper quoted research that said the law may benefit public health, in part, because of a “connection between paid sick leave and overall better population health, including fewer infectious outbreaks.”

Norovirus:

  • Is highly contagious.
  • Causes explosive diarrhea and violent vomiting, often at the same time.
  • Is the same virus often related to cruise ship outbreaks.

Cleaning for norovirus

Clean vomit or diarrhea accidents immediately.

Step 1. Remove vomit or poop.

  • Pick up the chunks with paper towels or other disposable material.
  • Soak up liquids with absorbent materials. Use kitty litter or dry oatmeal for carpeted areas.
  • Double bag and discard.
  • Do not use a vacuum cleaner.

Step 2. Sanitize.

  • Disinfect hard surfaces using 1 2/3 cups of household bleach per gallon of water. Allow for 1 minute of contact time.
  • Sanitize all handles and knobs in your house with the bleach solution.
  • Linens (including clothing, towels, napkins): Wash separately in hot water and dry on high.
  • Steam clean carpets using the highest setting for heat.
  • Avoid cross-contamination (use separate sanitation cloths for bathroom and other surfaces).
  • Clean and disinfect all containers used (e.g., buckets).

Handwashing

Wash hands often with soap and warm water for at least 20 seconds. Especially after cleaning, restroom use and before eating.

If you ate at El Toro Restaurant and became ill, contact the Health Department at food@tpchd.org, report online at www.tpchd.org/reportfoodborneillness, or call (253) 798-4712.

Learn more about norovirus at www.tpchd.org/norovirus. Sign up for restaurant closures at www.tpchd.org/notify.