SUBJECT Outbreaks of Viral Gastroenteritis in Schools

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					                                          STATE OF NEW HAMPSHIRE
                                  DIVISION OF PUBLIC HEALTH SERVICES
                                         29 HAZEN DRIVE, CONCORD, NH 03301-6504
John A Stephen                603-271-4469 1-800-852-3345, Ext. 4469 TDD Access: 1-800-735-2964
 Commissioner                          Fax: 603-271-0545, Website:

Mary Ann Cooney

     Message Type: Health Advisory
     Status: Actual
     Severity: Minor
     Sensitive: No
     Jurisdiction: State

     DATE: 12/19/2006

     TO: School Nurses and DHHS Outbreak Team

     FROM: Jose Montero, MD, MPH, State Epidemiologist

     SUBJECT: Outbreaks of Viral Gastroenteritis in Schools

     NH Department of Health and Human Services (NH DHHS) recommends:
        • Vigilance for suspect gastrointestinal outbreaks in school settings
        • Timely reporting of suspect outbreaks to the NH DHHS Communicable Disease Control
           and Surveillance Section at 603-271-4496 (after hours 1-800-852-3345 ext.5300)
        • Strict adherence to infection control practices during a suspect outbreak (see
           recommendations below)

     NH DHHS has received multiple reports of gastrointestinal illness in communities, schools, and
     childcare facilities. Many of these illnesses are caused by Norovirus and are transmitted person-
     to-person or through contact with contaminated surfaces. Noroviruses are one of the most
     common causes of acute viral gastroenteritis in the United States. These viruses are highly
     communicable and can be transmitted in a number of ways including person-to-person contact,
     consumption of contaminated food and water, airborne droplets of vomit, and contact with
     contaminated surfaces. Infection is primarily characterized by vomiting and diarrhea, which may
     also be accompanied by abdominal cramps, nausea, fever, and headache. Symptoms of infection
     may last between 12 and 60 hours. Aside from supportive therapy for dehydration in severe cases,
     there is no treatment given for Norovirus infection since it is a viral agent and symptoms usually
     resolve within 48 hours.

     Infection Control Recommendations During an Outbreak:

     1. Promptly clean areas contaminated with vomit and feces and follow up disinfections with
     freshly prepared 0.1% (1000 ppm) hypochlorite solutions.
     2. Review kitchen hygiene practices and health status of all food workers, exclude any
     symptomatic food handlers from work until full recovery.
3. Assess health status of students and staff and exclude all symptomatic individuals from
school/work until full recovery.
4. Practice frequent hand washing and gloving by all food workers in the facility.
5. Practice frequent hand washing by all students and staff.
6. Use gloves and aprons whenever contact with an affected individual or contaminated
environment is anticipated.
7. Wash hands after contact with affected individuals, on leaving affected areas or before
handling food or drinks.
8. Clean soiled carpets and soft furnishings with hot water and detergent or steam clean; avoid
vacuum cleaning.
9. Clean frequently handled objects such as door handles.
10. Conduct terminal cleaning 72 hours after resolution of the last case.

Attachment: Norwalk Virus Fact Sheet

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