{"id":2485,"date":"2018-05-07T02:58:47","date_gmt":"2018-05-07T02:58:47","guid":{"rendered":"http:\/\/www.outbreakmuseum.com\/mobile\/?p=2485"},"modified":"2018-05-07T03:30:43","modified_gmt":"2018-05-07T03:30:43","slug":"diaper-changing-station-norovirus","status":"publish","type":"post","link":"https:\/\/www.outbreakmuseum.com\/mobile\/norovirus\/diaper-changing-station-norovirus\/","title":{"rendered":"Diaper Changing Station Norovirus"},"content":{"rendered":"\n<table id=\"tablepress-106\" class=\"tablepress tablepress-id-106\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\"><b>Outbreak:<\/b> Diaper Changing Station Norovirus<\/th>\n<\/tr>\n<\/thead>\n<tbody class=\"row-striping\">\n<tr class=\"row-2\">\n\t<td class=\"column-1\"><b>Product:<\/b> Diaper Changing Station<\/td>\n<\/tr>\n<tr class=\"row-3\">\n\t<td class=\"column-1\"><b>Investigation Start Date:<\/b> 5\/16\/2012<\/td>\n<\/tr>\n<tr class=\"row-4\">\n\t<td class=\"column-1\"><b>Location:<\/b> Washington County, OR<\/td>\n<\/tr>\n<tr class=\"row-5\">\n\t<td class=\"column-1\"><b>Etiology:<\/b> Norovirus<\/td>\n<\/tr>\n<tr class=\"row-6\">\n\t<td class=\"column-1\"><b>Earliest known case onset date:<\/b> 5\/15\/2012<\/td>\n<\/tr>\n<tr class=\"row-7\">\n\t<td class=\"column-1\"><b>Latest case onset date:<\/b> 5\/15\/2012<\/td>\n<\/tr>\n<tr class=\"row-8\">\n\t<td class=\"column-1\"><b>Confirmed \/ Presumptive Case Counts:<\/b>  12 \/ 4<\/td>\n<\/tr>\n<tr class=\"row-9\">\n\t<td class=\"column-1\"><b>Positive Samples:<\/b> 1<\/td>\n<\/tr>\n<tr class=\"row-10\">\n\t<td class=\"column-1\"><b>Hospitalizations:<\/b> 0<\/td>\n<\/tr>\n<tr class=\"row-11\">\n\t<td class=\"column-1\"><b>Deaths:<\/b> 0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-106 from cache -->\n<div id=\"metaslider-id-2490\" style=\"width: 100%; margin: 0 auto;\" class=\"ml-slider-3-99-0 metaslider metaslider-flex metaslider-2490 ml-slider ms-theme-default\" role=\"region\" aria-label=\"Diaper Station Noro\" data-width=\"400\">\n    <div id=\"metaslider_container_2490\">\n        <div id=\"metaslider_2490\">\n            <ul class='slides'>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2496 ms-image \" aria-roledescription=\"slide\" data-date=\"2018-05-07 02:42:59\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2018\/05\/2012-05-22-14.29.26-400x300.jpg\" height=\"300\" width=\"400\" alt=\"\" class=\"slider-2490 slide-2496 msDefaultImage\" title=\"2012-05-22-14.29.26\" \/><div class=\"caption-wrap\"><div class=\"caption\">Underside of implicated diaper changing station in this outbreak; fecal material is visible.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2497 ms-image \" aria-roledescription=\"slide\" data-date=\"2018-05-07 02:42:59\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2018\/05\/2012-05-24-12.00.48-400x300.jpg\" height=\"300\" width=\"400\" alt=\"\" class=\"slider-2490 slide-2497 msDefaultImage\" title=\"2012-05-24-12.00.48\" \/><div class=\"caption-wrap\"><div class=\"caption\">Collection kit for environmental samples that were taken to the Oregon State Public Health Laboratory for norovirus testing.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2498 ms-image \" aria-roledescription=\"slide\" data-date=\"2018-05-07 02:42:59\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2018\/05\/2012-05-24-12.44.43-400x300.jpg\" height=\"300\" width=\"400\" alt=\"\" class=\"slider-2490 slide-2498 msDefaultImage\" title=\"2012-05-24-12.44.43\" \/><div class=\"caption-wrap\"><div class=\"caption\">Underside of another diaper-changing station in Washington County that was tested for norovirus. Debris was visible on the underside of most diaper-changing stations viewed in this investigation.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2499 ms-image \" aria-roledescription=\"slide\" data-date=\"2018-05-07 02:42:59\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2018\/05\/epicurve-400x300.jpg\" height=\"300\" width=\"400\" alt=\"\" class=\"slider-2490 slide-2499 msDefaultImage\" title=\"epicurve\" \/><div class=\"caption-wrap\"><div class=\"caption\">Epi curve.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2502 ms-image \" aria-roledescription=\"slide\" data-date=\"2018-05-07 02:45:02\"><a href=\"http:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2018\/05\/OB-2391-v9-fixed-b.pdf\" target=\"_self\" aria-label=\"View Slide Details\" class=\"metaslider_image_link\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2018\/05\/Report-pic-400x300.jpg\" height=\"300\" width=\"400\" alt=\"\" class=\"slider-2490 slide-2502 msDefaultImage\" title=\"Report-pic-400x300\" \/><\/a><div class=\"caption-wrap\"><div class=\"caption\">Outbreak report created by Oregon epidemiologists during the investigation of a norovirus outbreak at an auto dealership.<\/div><\/div><\/li>\n            <\/ul>\n        <\/div>\n        \n    <\/div>\n<\/div>\n\n<table id=\"tablepress-107\" class=\"tablepress tablepress-id-107\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\">Outbreak Summary:<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr class=\"row-2\">\n\t<td class=\"column-1\">This outbreak initially appeared to be a standard foodborne point-source outbreak from a restaurant with known previous critical violations. However, upon extensive interviewing, it transpired that a toddler with explosive diarrhea and the associated contaminated surfaces were the source of the outbreak.<br \/>\n<br \/>\n<strong>Documents<\/strong><br \/>\n<ul><li>\u2022 <a href=\"http:\/\/www.outbreakmuseum.com\/wp-content\/uploads\/2016\/08\/2012-2391-Q.pdf\" target=\"_blank\"><strong>Outbreak Questionnaire (PDF)<\/strong><\/a><a href=\"http:\/\/www.outbreakmuseum.com\/wp-content\/uploads\/2016\/08\/2012-2391-Q.doc\" target=\"_blank\"><strong>(MS Word)<\/strong><\/a><\/li><br \/>\n<li>\u2022 <a href=\"https:\/\/academic.oup.com\/jid\/article\/208\/2\/295\/801586\" target=\"_blank\"><strong><em>Journal of Infectious Diseases<\/em> Brief Report: A Norovirus Outbreak Related to Contaminated Surfaces<\/strong><\/a><\/li><br \/>\n<br \/>\n<strong>Media Coverage<\/strong><br \/>\n<li>\u2022 <a href=\"http:\/\/www.oregonlive.com\/washingtoncounty\/index.ssf\/2013\/05\/diaper_table_linked_to_hillsbo.html\" target=\"_blank\"><strong>Oregonlive: Baby changing station linked to Hillsboro norovirus outbreak<\/strong><\/a><\/li><br \/>\n<\/ul><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-107 from cache -->\n\n<table id=\"tablepress-108\" class=\"tablepress tablepress-id-108\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\">Details:<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr class=\"row-2\">\n\t<td class=\"column-1\"><b>Introduction<\/b><br \/>\nOn May 16, 2012, a local auto dealership called the Washington County (Oregon) Health Department to report a potential foodborne illness outbreak among employees who had attended a staff meeting on May 13. The meeting was held in an open space off the showroom floor. Submarine sandwiches, chips, and condiments from a nearby fast-food restaurant had been provided to attendees.<br \/>\n<br \/>\nEnvironmental health staff conducted an onsite environmental inspection of the restaurant and its operations. Food handlers and restaurant managers reported no recent gastrointestinal illness (within previous 2 weeks) was reported by food handlers or restaurant managers. No other patrons had complained. The restaurant was cited for 2 violations defined by environmental health staff as critical: presence of potentially hazardous food not maintained at proper hot or cold holding temperatures and presence of open beverages on the food preparation table. During interviews with dealership employees, one recalled that a customer with a sick child had used the diaper-changing station in the women\u2019s restroom before the lunch. When the woman and toddler left, the restroom was a mess. The employee cleaned it up as best she could with dry paper towels. She didn\u2019t wear gloves or use bleach but did wash her hands. She left the restroom, opened the dealership\u2019s front door for another employee carrying the food and was the first to take a sandwich from the platter.<br \/>\n<br \/>\n<b>Methods<\/b><br \/>\nOregon epidemiologists conducted a retrospective cohort study among meeting attendees, using a standard questionnaire to ask about food, environmental exposures, and any history of illness. Cases were defined as meeting attendees who developed vomiting or diarrhea (defined as \u22653 loose stools within a 24-hour period) within 72 hours after the meeting. Environmental health staff evaluated the operations of the restaurant that provided the food, with particular attention to hand washing, food preparation practices, and recent employee illness. Stool specimens were solicited from ill persons and tested for norovirus. Epidemiologists collected environmental samples for norovirus testing from the diaper-changing station at the auto dealership and from a convenience sample of similar diaper-changing stations in public restrooms throughout Washington County.<br \/>\n<br \/>\n<b>Results<\/b><br \/>\nStool specimens from 2 employees and the toddler\u2014who was located through auto sales records\u2014were positive for norovirus (genotype GII.6.C) with indistinguishable sequences. According to the mother, the child had been ill for 1 day before the visit to the auto dealership. Although the dealership diaper changing station had reportedly been routinely cleaned twice by a professional janitorial service, using quaternary ammonium disinfectants, we observed brown matter inside and underneath the changing station. Swabs of the brown matter on the changing station were positive for norovirus genotype GII, although the samples did not amplify in viral capsid coding regions C or D, rendering sequencing impossible.<br \/>\n<br \/>\nTo assess the prevalence of norovirus on diaper-changing stations in Washington County, epidemiologists tested a convenience sample of 14 stations in various restroom locations: 1 restaurant, 3 parks, 3 grocery stores, 1 gas station, 2 shopping malls, 1 aquatic center, 2 libraries, and 1 public health clinic. Eight (57%) of 14 stations had visible brown discoloration on the underside of the fold-down hinge or bed area. All 14 dispensers for disposable bed liners were empty. Norovirus was not detected in swabs of any of the diaper-changing stations other than that the auto dealership.<br \/>\n<br \/>\n<b>Lessons learned &amp; historical significance<\/b><br \/>\nThis outbreak initially appeared as a standard foodborne point-source outbreak from a restaurant with known previous critical violations. However, extensive interviewing revealed that a toddler with explosive diarrhea, and the associated contaminated surfaces, were the source of the outbreak. This outbreak confirms the ability of fomites to transmit norovirus, and the importance of reserving judgment regarding potential foodborne transmission and of considering environmental investigation as a key part of investigating outbreaks of enteric disease.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-108 from cache -->\n<p><a href=\"https:\/\/www.outbreakmuseum.com\/mobile\/exhibits\/\"><strong>Back to Outbreak Exhibits<\/strong><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Back to Outbreak Exhibits<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[68],"tags":[],"class_list":["post-2485","post","type-post","status-publish","format-standard","hentry","category-norovirus"],"_links":{"self":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/2485","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/comments?post=2485"}],"version-history":[{"count":5,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/2485\/revisions"}],"predecessor-version":[{"id":2509,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/2485\/revisions\/2509"}],"wp:attachment":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/media?parent=2485"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/categories?post=2485"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/tags?post=2485"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}