Centers for Disease Control and Prevention. 1 . Stop Norovirus: - PowerPoint PPT Presentation

The Virtual Immunization Communication (VIC) Network is a project of the National Public Health Information Coalition (NPHIC) and the California Immunization Coalition, funded through a cooperative agreement with the Centers for Disease Control and Prevention. 1

. Stop Norovirus: Protect Yourself and Others Webinar Objectives • Provide overview of norovirus and the disease burden. • Learn how to prevent and control Norovirus. • Understand issues and challenges related to norovirus vaccine development. • Highlight surveillance systems that track norovirus outbreaks. • Highlight CDC norovirus communication materials available for various audiences 2

A nationwide ‘virtual’ immunization community of health educators, public health communicators and others who promote immunizations. 3

Access the Q&A Panel From Split Screen Welcome to the Webcast! We Will Be Starting Momentarily.

Questions for Presenters? 5

Frequently Asked Questions 1. Will I be able to get a copy of the slides after the webinar?  Yes – a copy will be posted on the VICNetwork.org site 2. Will I receive a copy of the webinar recording?  Yes - a copy will be posted on the VICNetwork.org site

TITLE of PRESENATION Jessica Allen, MSW, MPH Health Communications Specialist, Northrup Grumman 7

Daniel C. Payne , PhD, MSPH Principal Investigator and Project Officer, Centers For Disease Control and Prevention 8

Stop Norovirus: Protect Yourself and Others Daniel Payne PhD, MSPH Jessica Allen MPH, MSW Virtual Immunization Communication Network Wednesday March 23, 2016 Department of Health and Human Services Centers for Disease Control and Prevention

Poll Question  What acute gastroenteritis pathogen causes the most cases of diarrheal disease each year? a. Rotavirus b. Norovirus c. E.coli d. Salmonella e. Shigella f. Clostridium difficile

NOROVIRUSES: PERFECT HUMAN PATHOGEN? Highly contagious Rapidly and prolifically shed Diverse and constantly evolving Evoke limited immunity Moderately virulent

Highly Contagious  How Norovirus Spreads • Water & Foodborne o eating food or drinking liquids that are contaminated with norovirus • Environmental o touching surfaces or objects contaminated with norovirus then putting your fingers in your mouth • Person-to-Person o having contact with someone who is infected with norovirus http://www.cdc.gov/norovirus/multimedia.html

Moderately virulent  Common norovirus symptoms include: • diarrhea • vomiting • nausea • stomach pain http://www.cdc.gov/norovirus/index.html Symptoms usually develop 12 to 48 hours after exposure  Most people get better within 1 to 3 days  Young children and the elderly are more likely to have  severe illness There’s no specific treatment for norovirus other than  making sure people stay hydrated

Rapidly and prolifically shed • Shed mainly in stool, but also in vomit • Shedding occurs for at least 2-3 weeks • Peaks 4 days after exposure – Can persist after resolution of symptoms • Infectious dose: 18-2,800 viral particles • Infectivity of prolonged viral http://www.cdc.gov/vitalsigns/norovirus/infographic.html#graphic shedding and role in transmission is unknown

Diverse and constantly evolving Classification of Noroviruses GII.4 • cause >75% of disease • Causes more severe disease

Produces Time-Limited Immunity  Human studies have found immunity to norovirus may last 6 – 24 months  Mathematical modeling based on observed disease suggests immunity may last for as long as 4 – 8 years

Annual Burden of Norovirus Disease in the U.S. 570 – 800 Deaths, mostly in young children and the elderly 56,000 – 71,000 Hospitalizations 400,000 Emergency Department Visits 1.7 – 1.9 million Outpatient Visits 19 – 21 million Total Illnesses

Poll Question  What types of norovirus communication materials would be most helpful for the work you do? a. Prevention and control fact sheet for patients/public b. Prevention and control posters for placement in offices and public heath buildings c. Multimedia prevention materials such as infographics and videos d. Other

REPORTING AND SURVEILLANCE

U.S. Norovirus Outbreak Surveillance • NORS – Epidemiologic surveillance for all enteric disease outbreaks – Data on setting, transmission mode, exposures, demographics, outcomes

U.S. Norovirus Outbreak Surveillance • CaliciNet – Laboratory surveillance using molecular genotyping of outbreak- associated specimens – Data on genotypes to identify new strains and potentially link outbreaks http://www.cdc.gov/norovirus/reporting/calicinet/index.html

NoroSTAT: Norovirus Sentinel Testing and Tracking • Near-real time reporting of norovirus outbreaks by network of sentinel states – Implemented August 2012 in 5 states – Expanded to 7 in 2015 and 9 planned for 2016 – Improved timeliness, completeness, and linking of outbreak reports in NORS and CaliciNet http://www.cdc.gov/norovirus/reporting/norostat/flowchart.html

Active, Prospective Pediatric Surveillance • NVSN: New Vaccine Surveillance Network – Enrolls children visiting a participating hospital or emergency department with diarrhea and /or vomiting. – Obtains epidemiologic data, clinical data, specimens and vaccination histories – Assesses disease burden http://www.cdc.gov/surveillance/nvsn/index.html among US children

NOROVIRUS TRENDS AND OUTBREAKS

http://www.cdc.gov/norovirus/trends-outbreaks.html

Transmission Mode of Norovirus Outbreaks, NORS, 2009-2012 (N=4,318) Foodborne Environmental 23% 0.3% Waterborne Unknown 0.3% 7% Person-to- person 69%

Setting of Norovirus Outbreaks, NORS, 2009-2012 (N=3,243) Restaurants 17% Schools 5% Caterer/Banquet Facility 5% Hospitals 3% Private Long-Term Care Residence Facilities 2% 59% Daycares 2% Other/Multiple 7%

Norovirus Outbreak Settings • Norovirus is the leading cause of illness and outbreaks from contaminated food in the United States http://www.cdc.gov/vitalsigns/norovirus/infographic.html#infographic

Pediatric burden of norovirus • NVSN surveillance found that norovirus is now the most common and costly cause of severe gastroenteritis in U.S. kids seeking medical care • Norovirus is responsible for ~1 million pediatric medical care visits in the U.S. each year

PREVENTION AND CONTROL

How to Prevent Norovirus Infection Wash your hands carefully with 1. soap and water Wash fruits and vegetables and 2. cook seafood thoroughly When you are sick, do not prepare 3. food or care for others who are sick Clean and disinfect contaminated 4. surfaces Wash laundry thoroughly 5. http://www.cdc.gov/norovirus/multimedia.html

Preventing Norovirus in Long Term Care Facilities http://www.cdc.gov/norovirus/images/stop-norovirus-lg.jpg

Preventing Norovirus in Food Settings http://www.cdc.gov/vitalsigns/norovirus/infographic.html#infographic

Preventing and Controlling Norovirus http://www.disinfect-for-health.org/resources

NOROVIRUS VACCINE

GI.1 intranasal GI.1/GII.4 intramuscular

Norovirus Vaccine Development • Two randomized trials involving healthy adults ages 18-50. 1. Intranasally delivered Norwalk virus (genotype GI.1) VLP vaccine followed by homologous challenge – Vaccine protected against illness (~50%) and decreased infection frequency (~25%) – First demonstration that a norovirus vaccine can prevent disease 2. Intramuscular bivalent (GI.1 and consensus GII.4) VLP vaccine followed by GII.4 challenge – Did not significantly reduce illness or infection, but did reduce disease severity and decreased viral shedding – Hampered by low disease rate from challenge and high baseline infection rate in control group

Challenges for a norovirus vaccine – Role of prior infection history? – Duration of protection? – Protection against multiple genotypes? – Need to be updated to keep up with viral evolution? – Need for different vaccine formulation for certain groups? – Variation in human genetic susceptibility? http://www.cdc.gov/norovirus/downloads/global-burden-report.pdf

Poll Question  If a norovirus vaccine was licensed and shown to be effective in preventing norovirus infection, would you get it yourself or have your child get it? a. Get it myself b. Have my child get it c. Get it myself and have my child get it d. No

ADDITIONAL NOROVIRUS COMMUNICATION MATERIALS

A good place to start for materials: http://www.cdc.gov/norovirus/about/index.html

Communications: For Health Care Providers http://www.cdc.gov/hai/pdfs/norovirus/229110-ANoroCaseFactSheet508.pdf http://www.medscape.com /viewarticle/778880

Communications: For Food Workers http://www.cdc.gov/norovirus/downloads/foodhandlers.pdf http://www.cdc.gov/norovirus/multimedia.html

Communication: For Everyone http://www.cdc.gov/norovirus/multimedia.html http://www.cdc.gov/norovirus/downloads/keyfacts.pdf

Special Thanks Aron Hall Ben Lopman Mary Wikswo Jeanette St. Pierre