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Volume 2 No 42; 17 October 2008

Increasing norovirus activity in the community, September/October 2008

Surveillance evidence suggests that norovirus cases in the community are rising and that the annual 'norovirus season' is likely to have begun. In the past, rises of reports of norovirus from children in the community have preceded outbreaks in healthcare settings. Therefore, those working in infection control in hospitals and nursing homes should be aware of the increase in the community cases and should respond quickly to cases of vomiting and diarrhoea. Precautions to prevent the spread of enteric viruses should be emphasised. Published guidelines are available [1] and should be used to prevent and control outbreaks of diarrhoea and vomiting.

Norovirus is the most common cause of gastrointestinal disease in the UK. During the winter months, from October to March, increasing numbers of norovirus-related cases and outbreaks are reported. Norovirus is highly infectious and easily spread in settings where people are in close contact with one another.

In the past, early detection of the seasonal rise in cases has been difficult due to the inherent delays in laboratory reporting. However, collaborative work between the Health Protection Agency's Centre for Infections (CfI), HPA West Midlands and NHS Direct has led to the development of new tools to determine when the norovirus season has begun in the community. This has been achieved by analysing historic data on laboratory reports to CfI and calls to NHS Direct about vomiting in children under five. Once other causes of increased calls (mainly rotavirus) have been excluded, calls about vomiting in this age group are a reliable early indicator of norovirus outbreaks in healthcare settings. Data from the past three weeks indicates that the number of calls for vomiting in children under five (excluding those estimated to be due to rotavirus) has followed a rising trend. Vomiting calls to NHS direct exceeded 4% of all call volume in week 40.

Q Surveillance® data on diarrhoea and vomiting GP consultations have also shown a recent increase. The over level of calls and consultations is not higher than expected for this time of year and is not indicative of higher than normal seasonal activity.

References
1. Chadwick PR, Beards G, Brown D, Caul EO, Cheesbrough J, Clarke I, et al.Management of hospital outbreaks of gastro-enteritis due to small round structured viruses. Journal of Hospital Infection 2000; 45: 1-10. Available at http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1194947408355

Pathogenic arenavirus causes three deaths in South Africa, ex Zambia

Four human cases of arenavirus infection, three of whom have died, have been identified in South Africa since 12 September 2008. The virus is related to the Lassa fever virus, and although arenaviruses have previously been isolated in southern Africa, they have not been associated with human disease.

The index case, a 36 year old female, working in the tourism sector and based in Lusaka, Zambia, was medically evacuated to South Africa with an undiagnosed illness on 12 September 2008 and died in a Johannesburg hospital on 14 September [1, 2]. She was reported to have had close contact with horses and a possible history of tick exposure [3, 4]. Two further deaths were reported – on 2 October and 5 October – among medical staff who had had direct contact with infected body fluids from the index case [5]. All three patients experienced a fever, headache, diarrhoea and myalgia, developing into rash and hepatic dysfunction with rapid deterioration before death. There was no significant bleeding [1]. A fourth case, confirmed by PCR, who worked with one of the secondary cases, is undergoing treatment. The incubation period for cases ranges from 7-13 days [5]. Laboratory results for a cleaner who died and had performed terminal cleaning of the room of the index case are awaited.

Tests at the National Institute for Communicable Diseases (NICD) in South Africa and the Centre for Disease Control (CDC) in the Unite States have proved negative for a range of viral haemorrhagic fevers including Crimean-Congo haemorrhagic fever, Lassa fever, Ebola, Marburg, Rift Valley fever and Hantavirus. In addition, patients tested negative for malaria, leptospirosis and rickettsia [3]. Preliminary investigations have detected an arenavirus in tissue and blood samples from the fatal cases. Further analysis and characterisation of the virus is on-going and contacts of the cases are being traced in South Africa and Zambia.

Specific advice for travellers to Zambia and South Africa is available at: http://www.nathnac.org/pro/clinical_updates/arenavirus_151008.htm

References
1. WHO Epidemic and Pandemic Alert and Response, 10 October 2008: http://www.who.int/csr/don/2008_10_10/en/index.html
2. WHO Epidemic and Pandemic Alert and Response, 13 October 2008: http://www.who.int/csr/don/2008_10_13/en/index.html
3. NICD, Communicable Disease Communique: outbreak of an acute disease,
ex-Zambia, October 2008, vol 7, alert (1): http://www.nicd.ac.za/pubs/communique/2008/NICDSpecialCommOct_alert01.pdf
4. ECDC Threat Assessment, 10 October 2008: http://ecdc.europa.eu/en/files/pdf/Health_topics/20081010_unknown_disease_Zambia-Final.pdf
5. Promed, 13 October 2008: http://www.promedmail.org/pls/otn/f?p=2400:1001:3263212593792122::NO::F2400_P1001_BA
CK_PAGE ,F2400_P1001_PUB_MAIL_ID:1000,74355

Expert Advisory Group on AIDS – vacancies for members

The Expert Advisory Group on AIDS (EAGA) is an advisory non-departmental public body whose role is to provide independent expert scientific advice to the Chief Medical Officers of the United Kingdom on HIV/AIDS.

EAGA has vacancies for three expert members: a consultant virologist, a genitourinary medicine/HIV nurse consultant, and a representative of black and minority ethnic groups affected by HIV.

Members of EAGA must be knowledgeable about, and experienced in, the area of HIV/AIDS and have an outstanding record of achievement in their own field. Excellent interpersonal and communication skills are essential. All members have a collective responsibility for the operation of EAGA and members actively participate in reviewing scientific data and in producing or contributing to papers presented to the Group.

Information about the application procedure for these vacancies, for which the closing date is Monday 3 November 2008, is available on the Appointments Committee website at: http://www.appointments.org.uk/view_vac.asp?ID=2295.

Further information about the EAGA is available at http://www.advisorybodies.doh.gov.uk/eaga/index.htm