Reported outbreaks of norovirus — the nasty gastrointestinal illness associated with sick and miserable cruise ship passengers — have increased tenfold in the past six years in Colorado.
The highly contagious illness strikes mainly nursing homes, where communal living, social dining and hygiene all play a role in the virus’ spread.
In 2008, the state health department received 145 reports of norovirus outbreaks. That’s about 10 times more than the 14 outbreaks reported in 2003 — the year the state began keeping track — and double the 72 outbreaks reported in 2007.
Each outbreak typically infects at least a handful of people. In all, 6,517 have contracted the virus and 13 died from it during the six-year period.
The 13 deaths and the majority of outbreaks occurred in long-term-care centers for senior citizens. The elderly are more susceptible to dehydration after two- or three-day bouts with vomiting and diarrhea.
Other outbreaks occurred in child-care centers, camps and hospitals.
State health officials say much of the spike is due to better reporting, not necessarily a major increase in infectious disease.
Improved lab tests that pinpoint the infection, increased knowledge of norovirus’ symptoms and heightened awareness of a state law that requires nursing homes, child-care centers and others to notify public health workers about outbreaks have led to increased reporting.
But, health officials say, it’s also likely the virus’ prevalence is on the rise because more people are living together in close quarters.
“The trend is a clear increase,” said Richard Vogt, executive director of Tri-County Health Department. “We have certainly seen long-term-care facility outbreaks frequently.”
The number of outbreaks reported to Tri-County, which includes Adams, Arapahoe and Douglas counties, doubled from 2007 to 2008. There were 36 norovirus outbreaks reported to the department in 2008, compared with 17 in 2007.
Nursing homes sometimes have “real challenges with sanitation,” Vogt said. The virus is typically spread when someone gets fecal matter on their hands and then touches or feeds another person.
National data also show a jump in reported outbreaks.
No national tracking system
There is no national tracking system for norovirus because requiring public health departments to file reports on the sickness would overburden them. But the Centers for Disease Control and Prevention investigated the prevalence of the illness in 2006 after receiving numerous requests from state health departments.
The CDC found a 250 percent spike in reported outbreaks from 2005 to 2006.
Two new strains of the virus hit Americans particularly hard in 2006 and 2007, and the magnitude and consistency of reports from multiple states suggested an actual increase in the illness — not just an increase in reporting, according to a CDC analysis.
Norovirus was first discovered in the 1960s in Norwalk, Ohio, but emerged in public consciousness in 2002, when outbreaks on cruise ships were widely reported in the media, said Dr. Aron Hall, a CDC medical epidemiologist.
“Although not life-threatening, it’s a pretty miserable experience,” he said.
At first sign of an outbreak, nursing homes are supposed to break out the spray bottles of bleach and quarantine the infected patients.
At Chateau des Mons Care and Assisted Living in Englewood, where there was an outbreak just after Christmas, staff put on masks, gowns and gloves. They didn’t feed sick residents in the main dining room, didn’t invite them to social activities or exercise class, and they put a sign on the door telling visitors they couldn’t enter.
No one was admitted or discharged until public health officials determined the outbreak was over. Meanwhile, workers switched to disposable dishes, filled bottles with a bleach-water solution and started scrubbing.
“All you do is clean, clean, clean, clean,” said executive director Heidi Pedersen. “If you keep cleaning fast enough, you can just limit it to the first three or four people who got it.”
Outbreaks kept confidential
Good sanitation pays off; the center for people with dementia has had only two norovirus outbreaks in eight years, Pedersen said.
Some nursing homes have outbreaks much more frequently, but it’s impossible to tell which ones. The state law that requires facilities to report outbreaks also gives them confidentiality.
The purpose of the confidentiality clause is to encourage reporting of outbreaks, said Alicia Cronquist, an epidemiologist with the state Department of Public Health and Environment. When health authorities know about an outbreak, they can help contain it, she said.
It’s unfair to blame nursing homes for outbreaks because the virus — called “winter vomiting disease” in Europe — is as common as the flu, said department spokesman Mark Salley. And it usually makes its way into a nursing home with a visitor.
“Just because they have a norovirus outbreak doesn’t mean they are (not) reputable,” Salley said. “It’s a very common stomach illness. There is no way to prevent norovirus from being introduced into a facility by a sick person who comes in for a visit.”
Nursing homes are inspected by the state randomly every nine to 15 months, and those reports are available to the public online.
Jennifer Brown: 303-954-1593 or jenbrown@denverpost.com
