norovirus and norovirus- like illness (nli) in michigan · viral particles per gram of feces...

Norovirus and Norovirus-Like Illness (NLI) in Michigan

Jennifer C. Beggs, MPHMichigan Department of Health and Human Services

Communicable Disease Division

Norovirus

Incubation: 12–48 hours (median 33–36 hours) Duration: 12–60 hours Symptoms: diarrhea, vomiting, nausea,

abdominal cramping, low grade fever Survival on surfaces: 40°F, >60 days 68°F (room temp), 21-28 days 98.6°F, less than 1 day

Norovirus

Viral shedding: up to 2–3 weeks (peaks at 4 days)

1010 viral particles per gram of feces Infectious dose: 18–1,000 virus particles

Less than 20 virons (virus particles) can be infectious

Virons can stick together like Velcro and form a clump (usually containing 20–30 virons)

Short-term immunity:

Disease Burden Estimates per Year, United States

21 million cases 1.7 million outpatient visits 414,000 ED visits 71,000 hospitalizations 800 deaths

Required Outbreak Reporting: Public Health

R 325.173 Details the reporting requirements for health care providers, health care facilities, and clinical laboratories

R 325.174 Gives local and state public health officials the authority to investigate possible cases of illness

www.michigan.gov/orr

Disease Reporting “…report any unusual

occurrence, outbreak, or epidemic of any disease or condition including healthcare-associated infections.”

Report within 24 hours of outbreak detection

Report to LHD or MDCH Any information pertinent to

the outbreak should be reported E.g., Number ill, onset,

incubation, duration, organism, control measures

Disinfection Virus is viable up to 7 days on inanimate

objects Must remove visible contaminants of

vomitus and diarrhea prior to disinfection Use dilute bleach (inexpensive and effective) Alternatives:

EPA-registered disinfectants Accelerated Hydrogen Peroxide Glutaraldehyde (0.5%) Iodine (0.8%) Lysol® or Pinesol® (2–4x manufacturer's

recommended concentration)

Disinfection Concentrations

Stainless steel, food/mouth items, toys 200ppm 1 tablespoon of bleach to 1 gallon of water

Non-porous surfaces, tile floors, counter-tops, sinks, toilets 1000ppm 1/3 cup bleach to 1 gallon of water

Porous surfaces, wooden floors 5000ppm 1 and 1/2 cup bleach to 1 gallon water

Norovirus-Like Illness (NLI) Outbreak Definition

Gastrointestinal illness (GI) clusters are defined as NLI outbreaks when:

Cases present with signs and symptoms consistent with norovirus infection

Are not laboratory confirmed as norovirus For facilities (e.g., hospitals, schools,

daycares, prisons), GI activity is above normal baseline

NLI Outbreaks per Year, Michigan 2004–2019*

4834

147120

138 128141

157

198

165

129

163180

145 154

73

0

50

100

150

200

250

Year * As of April 9, 2019

Num

ber o

f Out

brea

ks

NLI Outbreaks and Case Counts1, Michigan 2014–2019*

1 Case counts based on initial report

YearTotal

Outbreaks Cases2014 129 3,2922015 163 3,8202016 180 3,9242017 145 4,5432018 154 2,5132019* 73 1,128

* As of April 9, 2019

2005

Norovirus Outbreaks 2005

RegionCountyType# illWhenConfirmed?Multi-jurisdictional?Multi-State?

1LenaweeHealthcare-related13Apr-05No

1ShiawasseeOther29Jun-05Yes

3GeneseeRestaurant - related8Jan-05Yes

3GeneseeSchool related25Oct-05No

3MidlandHealthcare-related40Feb-05Yes

3SaginawHealthcare-related35Jan-05Yes

5BarrySchool-related/other50Apr-05No

5BerrienRestaurant - related9Apr-05No

5BerrienRestaurant - related5Apr-05No

5BerrienHealthcare-related16Dec-05Yes

5KalamazooSchool-related160Nov-05Yes

5St. JosephOther8Feb-05Yes

5Van-BurenOther100Mar-05Yes

6IoniaSchool-related/other150Oct-05Yes

6KentHealthcare-related14Feb-05Yes

6KentHealthcare-related104Feb-05Yes

6KentRestaurant - related86May-05Yes

6KentSchool-related100Nov-05No

6MecostaOther55May-05Yes

7Grand TraverseOther30May-05Yes

8DickinsonSchool-related/other25Jun-05Yes

8MackinacHealthcare-related14Jan-05Yes

8Western UPRestaurant - related9Jun-05Yes

2NMacombRestaurant - related5Mar-05Yes

2NOaklandRestaurant - related5Jan-05No

2NOaklandOther40Aug-05Yes

2NOaklandSchool-related100Dec-05Yes



2SCity of DetroitHealthcare-related7Jan-05Yes

2SWashtenawSchool-related43Jan-05No

2SWayneRestaurant - related13Apr-05No

OHIOWoodOther16Mar-05YesYes

2006



1ClintonHealthcare facility related229/6/06negative

1EatonRestaurant related4951/28/06YesYes



1EatonHealthcare facility related5512/19/06not tested

1EatonHealthcare facility related1412/26/06not tested

1GratiotHealthcare facility related3212/26/06

1InghamRestaurant related2885/4/06YesYes

1InghamHealthcare facility related225/22/06Yes

1InghamHealthcare facility related116/21/06Yes

1InghamHealthcare facility related4312/19/06yes

1InghamHealthcare facility related1712/24/06not tested

1InghamHealthcare facility related1212/27/06not tested

1JacksonHealthcare facility related302/10/06Yes

1JacksonRestaurant related804/7/06YesYes

1JacksonHealthcare facility related4311/20/06Yes

1Jacksonother - prison20012/20/06yes

1JacksonHealthcare facility related3112/27/06yes

1JacksonRestaurant related1412/27/06yes

1LenaweeRestaurant related188/17/06Yes

1LivingstonHealthcare facility related422/22/06Yes

1LivingstonRestaurant related136/9/06No

1ShiawasseeHealthcare facility related2012/1/06yes

1ShiawasseeHealthcare facility related512/11/06yes

1ShiawasseeHealthcare facility related2812/28/06not tested

3ArenacHealthcare facility related11/28/06Yes

3ArenacHealthcare facility related12/18/06yes

3BayHealthcare facility related5812/27/06yes

3GeneseeHealthcare facility related503/31/06No

3Geneseeother305/23/06Yes

3Geneseeother126/26/06No

3GeneseeHealthcare facility related377/21/06Yes

3GeneseeHealthcare facility related1711/14/06Yes

3GeneseeHealthcare facility related4311/29/06not tested

3GladwinHealthcare facility related4811/16/06Yes

3GladwinHealthcare facility related2911/20/06Yes

3HuronHealthcare facility related6812/27/06yes

3Indiana wedding - Tuscola Co residentsother610/28/06YesYesYes

3SaginawHealthcare facility related325/23/06Yes

3SaginawHealthcare facility related306/22/06Yes

3Saginawother239/20/06Yes

3Saginawother239/23/06Yes

3SaginawRestaurant related911/29/06yes

3Sanilacother - potluck612/7/06yesyesyes

3TuscolaHealthcare facility related55/23/06No

3TuscolaRestaurant related105/30/06Yes

5Alleganother158/15/06Yes

5AlleganHealthcare facility related4311/6/06Yes

5AlleganHealthcare facility related4312/27/06not tested

5BerrienSchool/Camp/Daycare related402/1/06negative

5BerrienHealthcare facility related373/7/06Yes

5Berrienother4011/3/06not tested

5KalamazooRestaurant related212/24/06Yes

5KalamazooRestaurant related73/14/06negative

5KalamazooSchool/Camp/Daycare related53/16/06No

5Kalamazooother65/6/06No

5KalamazooHealthcare facility related256/14/06Yes

5KalamazooSchool/Camp/Daycare related209/20/06not tested

5KalamazooSchool/Camp/Daycare related209/20/06not tested

5KalamazooHealthcare facility related1510/25/06Yes

5KalamazooHealthcare facility related1112/12/06not tested

5KalamazooHealthcare facility related3712/12/06yes

5KalamazooHealthcare facility related3412/24/06nt

5KalamazooHealthcare facility related1512/26/06not tested

5St. Josephother305/5/06YesYesYes

5St. JosephHealthcare facility related2512/31/06nt

6ClareRestaurant related2812/12/06yes

6ClareRestaurant related6512/12/06yes

6IoniaHealthcare facility related305/30/06No

6IsabellaHealthcare facility related235/1/06Yes

6IsabellaHealthcare facility related4211/28/06yes

6IsabellaSchool/Camp/Daycare related412/5/06not tested

6KentHealthcare facility related491/26/06No

6KentHealthcare facility related802/14/06Yes

6KentRestaurant related264/25/06Yes






6Kentother407/31/06YesYes



6KentHealthcare facility related2112/4/06yes

6KentHealthcare facility related12/5/06yes

6MasonSchool/Camp/Daycare related201/25/06No

6MuskegonSchool/Camp/Daycare related502/6/06YesYes

6MuskegonRestaurant related208/15/06Yes

6Oceanaother655/24/06YesYesYes

6OceanaSchool/Camp/Daycare related176/15/06Yes

6OttawaHealthcare facility related285/5/06Yes

6Ottawaother155/15/06YesYesYes



6OttawaSchool/Camp/Daycare related406/9/06YesYes

7CharlevoixHealthcare facility related804/14/06Yes

7Charlevoixother506/15/06NoYes

7CharlevoixHealthcare facility related327/25/06Yes

7CheyboyganHealthcare facility related?6/26/06No

7CrawfordSchool/Camp/Daycare related365/18/06Yes

7EmmetHealthcare facility related5012/5/06not tested

7ManisteeHealthcare facility related308/3/06Yes

7OsceolaHealthcare facility related407/28/06Yes

7OscodaHealthcare facility related3012/27/06not tested

7Presque IsleRestaurant related186/26/06YesYes

7RoscommonRestaurant related1711/30/06yesYes

8BaragaSchool/Camp/Daycare related655/9/06Yes

8ChippewaHealthcare facility related1312/12/06yes

8ChippewaHealthcare facility related1412/15/06yes

8ChippewaHealthcare facility related2812/29/06not tested

8DickinsonHealthcare facility related1510/30/06Yes

8Marquetteother103/30/06No

2NMacombRestaurant related156/5/06No

2NMacombother1110/26/06Not tested

2NMacombHealthcare facility related2311/2/06Yes

2NMacombHealthcare facility related512/7/06not tested

2NOaklandHealthcare facility related183/9/06Yes

2NOaklandRestaurant related44/5/06No

2NOaklandRestaurant related295/3/06Yes

2NOaklandHealthcare facility related115/10/06No

2NOaklandHealthcare facility related1712/4/06yes

2NOaklandRestaurant related1012/6/06yesyes

2NOaklandRestaurant related612/12/06not tested

2NOaklandRestaurant related1212/12/06not tested

2NOaklandHealthcare facility related1012/20/06Yes

2NOaklandHealthcare facility related1012/26/06not tested





2NSt ClairHealthcare facility related2011/6/06Yes

2NSt. ClairHealthcare facility related811/20/06yes

2NSt. ClairHealthcare facility related6311/28/06yes - epilink

2SCity of DetroitRestaurant related11/1/06not testedYes

2SCity of DetroitRestaurant related411/27/06not tested

2SDetroit CityHealthcare facility related52/17/06No

2SDetroit Cityother207/28/06NoYes

2SWashtenawRestaurant related452/3/06No

2SWashtenawHealthcare facility related1004/13/06negative

2SWashtenawother1807/25/06YesYes

2SWashtenawRestaurant related5012/5/06yes

2SWashtenawHealthcare facility related912/13/06not tested



2SWayneRestaurant related501/21/06No

2SWayneother3510/25/06YesYesYes

2SWayneother - Crystal Gardens1011/22/06negative

2007



1ClintonHCF2512/21/07nt

1EatonHCF269/18/07negative

1EatonSchool23010/27/07Yes

1GratiotHCF63/23/07Yes

1HillsdaleOther/school123/20/07nt

1InghamHCF1/22/07nt

1InghamHCF161/22/07nt

1InghamRestaurant145/4/07nt

1Inghamother65/9/07nt

1Jacksonother372/27/07Yes

1JacksonHCF124/20/07nt




1JacksonHCF1911/5/07negative

1JacksonSchool7012/10/07nt

1JacksonHCF1112/13/07Yes

1LenaweeHCF131/5/07nt

1LenaweeHCF234/19/07nt

1LivingstonOther304/19/07YesYes

3BayHCF1271/11/07nt

3BayHCF351/26/07nt

3GeneseeSchool20012/21/07

3HuronHCF273/27/07nt

3MidlandHCF373/7/07nt

3SaginawHCF371/23/07nt

3SaginawRestaurant47/2/07nt

3SanilacOther1510/23/07nt

3SanilacOther5011/28/07negative

3TuscolaHCF221/11/07nt



5BerrienRestaurant-related1911/13/07Yes

5BerrienHealthcare facility related4612/28/07nt

5BranchRestaurant105/17/07nt

5CalhounHCF472/16/07nt

5CalhounHCF4312/3/07Yes

5CalhounRestaurant-related1812/18/07Yes

5CassOther125/18/07nt

5KalamazooHCF481/2/07nt



5KalamazooSchool82/6/07nt




5KalamazooOther116/21/07nt


5KalamazooRestaurant-related510/5/07nt

5KalamazooSchool912/20/07Yes

5KalamazooHealthcare facility related4212/23/2007 (reported in 1/18)nt

5St. JosephOther407/10/07Yes

5St. JosephOther307/25/07Yes

5Van BurenHCF72/5/07nt

5Van BurenSchool309/14/07nt

6ClareHCF121/2/07nt

6Ioniaother3001/10/07Yes

6IsabellaOther1212/17/07negative

6IsabellaOther812/21/07

6KentHCF301/5/07nt

6KentHCF231/8/07nt

6KentHCF1231/15/07Yes

6KentRestaurant72/14/07nt

6Kentother202/16/07nt

6KentSchool805/9/07YesYes

6MontcalmHCF811/2/07Yes

6MontcalmHCF81/4/07nt

6MuskegonOther103/29/07nt

6MuskegonRestaurant55/22/07negative

6NewaygoHCF312/8/07Yes

6OttawaHCF371/23/07Yes

6OttawaHCF92/6/07nt

6OttawaHCF362/6/07nt




6OttawaOther107/2/07nt

7AlpenaHCF401/29/07nt

7CheyboygenOther538/24/07Yes

7CrawfordHCF201/11/07Yes

7CrawfordOther136/29/07nt

7Grand TraverseOther307/23/07nt

7ManisteeHCF61/24/07nt

7MissawkeeHCF51/11/07nt

7RoscommonHCF411/2/07Yes

8DickinsonHCF1/10/07nt

8LuceHCF291/22/07nt

8MackinacHCF264/19/07Yes

8MarquetteHCF703/15/07nt



8SchoolcraftOther/resturant253/26/07nt

2NMacombRestaurant-related118/11/07Yes

2NOaklandHCF241/8/07Yes

2NOaklandHCF145/2/07nt

2NOaklandother1005/4/07nt

2NOaklandSchool225/17/07nt

2NOaklandOther126/11/07nt

2NOaklandOther167/11/07nt

2NOaklandHCF10/19/07negative

2NOaklandHCF410/30/07nt

2NOaklandRestaurant-related1312/21/07nt

2NSt. Clairother/rest121/25/07nt

2NSt. ClairHCF112/5/07nt



2SMonroeSchool11012/21/07nt

2SWashtenawSchool202/1/07nt

2SWashtenawHCF103/5/07nt


2SWashtenawSchool406/18/07nt

2SWashtenawOther118/15/07nt

2SWashtenawOther118/15/07ntfamily reunion in TN


2SWayneHCF171/24/07nt

2SWayneRestaurant123/15/07nt

2SWayneOther223/21/07Yes

2SWayneSchool4/3/07nt



2SWayneOther2010/30/07nt

2008

Norovirus Outbreaks January 2008-present

RegionCountyType# ill (est.)WhenConfirmed?Multi-jurisdictional?Multi-State?

5KalamazooH131/1/08ntnono


2NOaklandH101/7/08ntnono

1ShiawasseeH81/10/08ntnono

6KentR111/11/08Yes

1BEDHDR41/4/08nt

2NOaklandH51/22/08ntnono

2NOaklandR81/19/08nt

5CalhounH471/30/08ntnono


2SWayneH212/12/08ntnono

1ShiawasseeH82/11/08ntnono

2NMacombH2/15/08ntnono

2NMacombH152/15/08ntnono

3GeneseeS202/15/08

6MasonH682/19/08

271

Sheet1

YearTotal OutbreaksCases

20141293,292

20151633,820

20161803,924

20171454,543

20181542,513

2019*731,128

0

10

20

30

40

50

6015

-Jan Mar

May Ju

lSe

ptN

ov16

-Jan Mar

May Ju

lSe

ptN

ov17

-Jan Mar

May Ju

lSe

ptN

ov18

-Jan Mar

May Ju

lSe

ptN

ov19

-Jan Mar

NLI Outbreaks by Onset Date per Month, Michigan Jan 2015–April 2019*

Year and Month

Num

ber o

f Out

brea

ks


43

30

16

7 8

13 3

5 4 6

22

39

31

20 21

4

13

1 1 1

5

2728

20

25

0

05

10152025303540455017

-Jan Fe

bM

arA

prM

ayJu

ne Jul

Aug

Sept

Oct

Nov Dec

18-J

an Feb

Mar

Apr

May

June Ju

lA

ugSe

ptO

ctN

ov Dec

19-J

an Feb

Mar

Apr

*

NLI Outbreaks by Onset Date per Month, Michigan Jan 2017–April 2019*

Year and Month

Num

ber o

f Out

brea

ks


NLI Outbreaks by Onset Date per Month, Michigan 2015–2019*

Num

ber o

f Out

brea

ks

0

10

20

30

40

50

60

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

20152016201720182019*


Percentage of NLI Associated Settings, Michigan 2015–2019*

0

10

20

30

40

50

60

70

80

2015 2016 2017 2018 2019*Healthcare School Foodborne OtherP

erce

nt (%

) of N

LI O

utbr

eaks


NLI Outbreaks by Region, Michigan 2016–2019*

0

5

10

15

20

25

30

35

40

45

1 2N 2S 3 5 6 7 82016 20172018 2019** As of April 9, 2019

Num

ber o

f NLI

Out

brea

ks

Region

Percentage of PCR Confirmed Norovirus Outbreaks, Michigan 2019*

1%22%

4%3%

70%

Norovirus GI

Norovirus GII

Negative

Sapovirus

Not Tested

N = 73


Percentage of PCR Confirmed Norovirus Outbreaks, Michigan 2018

3%

22%

5%1%69%

Norovirus GI

Norovirus GII

Negative

Sapovirus

Not Tested

N = 154


3% 13%

1%

81%

1%1%

Norovirus GINorovirus GIINorovirus GI and GIINot TestedNorovirus NegativeAstrovirus

N = 145


4%

22%

1%

71%

2%

Norovirus GI

Norovirus GII

Norovirus GI and GII

Not Tested

Norovirus Negative

N = 180


2%

30%

60%

8%

Norovirus GI

Norovirus GII

Not Tested

Norovirus Negative

N = 163

NLI Outbreak Laboratory Results, Michigan 2016–2019*

Result: 2016 Count

2017 Count

2018 Count

2019* Count

Norovirus GI and GII 1 1 0 0

Norovirus GI 7 5 4 1

Norovirus GII 41 19 35 16

Sapo/Astro Virus1 0 1 1 2

Noro, Astro, SapovirusNegative

5 2 8 3

Pending 0 0 0 0

Not Tested 126 117 106 51

Total 180 145 154 731Outbreaks that test negative for norovirus are then tested for astrovirus and sapovirus. * As of April 9, 2019

Sequences Identified, Michigan 2016-20182017

GI.3 GI.5 GII.1 GII.2 GII.3 GII.4 New Orleans GII.4 Sydney GII.4 untypeable GII.6 GII.7

2016 GI.3b GI.5 GI.6 GII.3 GII.4 Sydney GII.4 untypeable GII.7

GI.1 GI.6 GI.7 GII.1 GII.2 GII.4 New Orleans GII.4 Sydney GII.4 untypeable

2018

Norovirus Resources

www.michigan.gov/cdinfo

General Norovirus Fact Sheet Guidelines for Environmental Cleaning and

Disinfection of Norovirus Guidelines for the Control of a Suspected or

Confirmed Outbreak of Viral Gastroenteritis in a Nursing Home

Norovirus Investigations in Long Term Care Facilities: Things to Consider

QuestionsJennifer C. Beggs, MPH

Surveillance and Infectious Disease EpidemiologyMichigan Department of Community Health

[email protected](517) 284-4942

www.michigan.gov/cdinfo

Norovirus and Norovirus-Like Illness (NLI) in MichiganNorovirusNorovirusDisease Burden Estimates per Year, United StatesRequired Outbreak Reporting: Public HealthDisease ReportingDisinfectionDisinfection ConcentrationsNorovirus-Like Illness �(NLI) Outbreak DefinitionNLI Outbreaks per Year, �Michigan 2004–2019*NLI Outbreaks and Case Counts1, Michigan 2014–2019* �Slide Number 12NLI Outbreaks by Onset Date per Month, �Michigan Jan 2017–April 2019*NLI Outbreaks by Onset Date per Month, Michigan 2015–2019*Percentage of NLI Associated Settings, Michigan 2015–2019*NLI Outbreaks by Region, Michigan 2016–2019*Percentage of PCR Confirmed Norovirus Outbreaks, Michigan 2019*Percentage of PCR Confirmed Norovirus Outbreaks, Michigan 2018Percentage of PCR Confirmed Norovirus Outbreaks, Michigan 2017Percentage of PCR Confirmed Norovirus Outbreaks, Michigan 2016Percentage of PCR Confirmed Norovirus Outbreaks, Michigan 2015NLI Outbreak Laboratory Results, Michigan 2016–2019*Sequences Identified, Michigan 2016-2018Norovirus ResourcesQuestions

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