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    Cas Study of NoV: Key facts

    During summer 0f 2009, a cruiseship having 1,5000 passengers and60 crews travelled for for 14 days

    The cruised stopped 7 days shortand subitted 675 passengers and

    50 crews with NoV infection

    Most victims ate:

    steak (rare, medium, well-done)

    Baked potato

    fresh salad

    2 cooks were positive for NoVupon boarding

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    Page 3

    Questions:

    1

    Thelikeliness of Nov to be present in the 3 types of food

    mentioned (steaks, salad, baked potato)

    2

    Handling and processing steps of the above food that maycontribute to the survival of the virus in the products

    3 Incubation time and sypmptoms of NoV infection

    4 The scenario on how the outbreak may have occurred

    5

    How do you prove that the worker were indeed the sourceof the viruses?

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    ClassificationGroup : IV ((+)ssRNA (single stranded RNA)Family : CaliciviridaeGenus : Norovirus

    Other names:-Norwalk virus, Norwalk-like virus, Norovirus(2002)1st outbreak: 1968 di Norwalk, Ohio, USA

    Morphologiy:Shape : small, round structural viruses (SRSVs)Primary compound: proteinWeight = 58-60 k DA

    Length = 27-38 nmIt doesnt have envelope

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    Norovirus classification by Genogroup

    GI, GII, GIV : HumanGI: Norwalk V, Southampton V, desert shield V

    GII: Hawaii V, snow mountain V, Toronto V,Bristol V, hunter V, Grimsby virus

    GIV: Alphatron)

    GIII : bovine, pig (Jena virus)

    GV : miceOutbreak on human : GI & GII

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    Transmission person-to-person:

    fecal-oral route ingestion of aerosolized vomitus

    indirect exposure via fomites contaminated environmental surfaces

    foodborne infected food handlers during preparation further upstream in the food distribution system

    Waterborne

    Shedding: fecal (104 106/gram) and vomit Infection dose: 10-100 viruses

    NoV still could be detected on fecal 4 weeks after infection

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    They cant replicate on food/water

    Viruses need living cell to be able to replicate (parasyte)

    MAP is not effective

    Survive for 30 minutes at 60

    o

    C FCV cant be detected again when treated with boiling water for 1

    min (inner T >70oC)

    FCV Inactivated with high hydrostatic pressure and irradiation

    NoV Only survive for 3 hours at pH 2.3 at ambient T

    FCV survive at 4oC for 20 days on juice/milk/veggies/fruit

    Freezing for 2 days: can reduce FCV for upto 2 log on strawberry

    7 days at ambient T : FCV still can be found on environmentalsurfaces

    Chlorine 200 ppm: 0-2.9 log reduction on FCV (E. coli: 5.5 log)

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    Page 8Baert, L., Debevere, J., & Uyttendaele, M. 2009. The efficacy of preservation methods toinactivate foodborne viruses. International Journal of Food Microbiology, 131: 83-94.

    http://localhost/var/www/apps/conversion/current/tmp/scratch_6/NoV/efektivitas%20preservasi%20noV.pdfhttp://localhost/var/www/apps/conversion/current/tmp/scratch_6/NoV/efektivitas%20preservasi%20noV.pdfhttp://localhost/var/www/apps/conversion/current/tmp/scratch_6/NoV/efektivitas%20preservasi%20noV.pdfhttp://localhost/var/www/apps/conversion/current/tmp/scratch_6/NoV/efektivitas%20preservasi%20noV.pdfhttp://localhost/var/www/apps/conversion/current/tmp/scratch_6/NoV/efektivitas%20preservasi%20noV.pdfhttp://localhost/var/www/apps/conversion/current/tmp/scratch_6/NoV/efektivitas%20preservasi%20noV.pdfhttp://localhost/var/www/apps/conversion/current/tmp/scratch_6/NoV/efektivitas%20preservasi%20noV.pdfhttp://localhost/var/www/apps/conversion/current/tmp/scratch_6/NoV/efektivitas%20preservasi%20noV.pdfhttp://localhost/var/www/apps/conversion/current/tmp/scratch_6/NoV/efektivitas%20preservasi%20noV.pdfhttp://localhost/var/www/apps/conversion/current/tmp/scratch_6/NoV/efektivitas%20preservasi%20noV.pdfhttp://localhost/var/www/apps/conversion/current/tmp/scratch_6/NoV/efektivitas%20preservasi%20noV.pdf
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    Based on NoVcharacteristic and stability,NoV may survive in:

    Inadequate temperature

    - rare steak(

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    Cooks still cooked eventhough theyre sick

    (Infected Food Handler)

    Cooks didnt wash their hand or inadequate

    handwashing and then they touched and preparethe food

    Food was washed with water that might already hadbeen infected from the chefs

    Cooking utensil, environmental surface that mightbe infected with viruses trasnmitted by the chefscontaminated the foods

    Food was served fresh, raw, and without heating (minimal

    processing) /FRESH SALADInadequate heating temperature of food (

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    Page 12

    Symptoms and Incubation Time of NoV

    Incubation time: 24 48 jam

    Duration : 12 60 jam

    Symptoms:

    acute gastroenteritis

    Nausea, diarrhea, vomit, stomach cramp

    Dehydration and malnutrition It could be fatal

    if not treated, especially for childern, elders, and

    immunosuppressed people

    30% NoV infection are asymptomatic

    But, in general: Norovirus infections are not

    usually dangerous

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    Page 13

    Kaplans Criteria

    70 % of NoVs outbreaks fit these categories

    1 Duration of sickness 12-60 hours

    2 Incubation time 24-48 hours

    3 More than 50% people are vomiting

    4

    Patoghen bacteria cannot be found in feses

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    Page 14

    Outbreak Scenario of Norovirus

    Chefs

    (feses,vomit)

    Fresh salad,Rare steak

    Environmetalsurface

    Water, air

    Passengers/crews

    Crowded room,small space

    -Present when people vomit

    -Sharing food and utensils

    -Caring for sick people

    -Handshake

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    Page 15

    Epidemiology

    study review medical

    log, interview,questionnaire

    Sanitationinspection

    cara penanganganmakanan, cara praktekpersonal hygiene,fasilitas, suhu udara dll

    Spesimen collection Fecal, vomit, serum, environmet and

    food swab

    spesimen identification

    Electron Microscope EIA or ELISA Serology

    RT-PCR (Reverse TranscriptasePCR)

    Detection of NoV at outbreak

    - - ELISAs sensitifity < 50 %, but can be a rapid method for detection during outbreak

    The most sensitive : RT-PCR- If NoV(+) : sequencing and genotyping

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    REFERENCES

    http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2011/ucm278659.htm http://www.kalbe.co.id/?mn=news&tipe=detail&detail=1933

    Baert, L., Debevere, J., & Uyttendaele, M. 2009. The efficacy of preservation methods toinactivate foodborne viruses. International Journal of Food Microbiology, 131: 83-94.

    Doyle, M.P., Beuchat, L.R., & Montville, T.J. 2001. Food Microbiology, Fundamentals andFrontiers, 2ndEdition. Washington, DC: AMS Press.

    Jay, J.M. 2000. Modern Food Microbiology, Sixth Edition. Gaithersburg: AspenPublishers, Inc.

    Khan, A.S., Moe, C.L., Glass, R.I., Monroe, S.S., Estes, M.K., Chapman, L.E., Jiang, X.,Humphrey, C., Pon, E., Iskander, J.K., Schonberger, L.B. 1994. Norwalk Virus-Associated Gastroenteritis Traced to Ice Consumption aboard a Cruise Ship in Hawaii:Comparison and Application of Molecular Method-Based Assays. Journal of Clinical

    Microbiology, 32: 318-322. Vivancos, R, Amir S., Margaret S., Heather A., Chris I. G, Linda M., Hamid M., Pat N.

    2009. Food-related norovirus outbreak among people attending two barbeques :epidemiological, virological and environmental investigation. International Journal ofInfectious Diseases 13: 629635

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