Reno takes action after viral outbreak

By Dorsey Griffith -- Bee Medical Writer
Published 2:15 a.m. PDT Tuesday, May 6, 2003

While severe acute respiratory syndrome, or SARS, has struck fear in the hearts of people around the world in recent weeks, another highly contagious virus plagues millions in the United States every year.

The norovirus, which sickened hundreds of people and sidelined six teams competing in a girls' volleyball tournament in Reno two weeks ago, is responsible for an estimated 23 million cases of acute gastroenteritis (stomach flu) in this country annually.

And just as the Norwalk virus, a type of norovirus, nearly unhinged the cruise ship industry late last year, tourism officials hope norovirus outbreaks don't have a similar impact on the hotel and convention business.

"Our tourism industry doesn't need one more challenge at the moment," said Deanna Ashby, executive director of marketing for the Reno-Sparks Convention and Visitors Authority, which owns the center where the volleyball tournament was held. "It's an additional threat to getting people to travel to our destination, and that is something we are taking very seriously."

Jim Abrams, president and CEO of the California Hotel & Lodging Association, acknowledged the damage a large outbreak could have on the industry.

"We spend a great deal of time educating our members and reminding them about the need to pay attention to things, which if they go unminded are the biggest sources of food-borne illness outbreaks," including employee hand-washing guidelines and proper temperature controls for food preparation.

More than 400 people contacted the Washoe County District Health Department in the wake of the outbreak in Reno. They reported telltale norovirus symptoms -- stomach cramps, violent vomiting and diarrhea that last one or two days.

Late last week, a Las Vegas hotel told Clark County health officials a Las Vegas resident lodged a similar complaint. The woman said as many as 30 people who attended a family celebration and stayed at the hotel became sick within two days of their visit.

A norovirus is difficult to control because the hardy bug moves rapidly and is hard to detect. Local or state health officials track reports only if they suspect a link to food handling.

As a result, said Randall Todd, a Nevada state epidemiologist, noroviruses likely are more widespread than most people think.

"There may be lots of people who get a case of gastroenteritis that would turn out to be a norovirus but was never brought to the public health department's attention," he said.

Marc Widdowson, a veterinarian and norovirus expert at the national Centers for Disease Control and Prevention, noted that it is difficult to monitor norovirus outbreaks without the kind of public health reporting required for diseases such as AIDS, meningitis and tuberculosis.

The CDC will begin monitoring norovirus in 10 sites, including Alameda and San Francisco counties -- already part of a broader federal food-borne disease surveillance program, he said.

Noroviruses are found in the stool or vomit of infected people. People can contract the illness by having close contact with someone who is infected, by consuming contaminated food or beverages, or by touching a contaminated surface, then placing their hand in their mouth.

The good news, said Todd, is that for most people the illness doesn't last long or lead to chronic health problems.

The CDC in January reported that norovirus outbreaks have increased in the United States, and that since July, 41 percent were associated with a single, newly identified strain.

The surge last year may be due to a variety of factors.

"Better reporting and testing and diagnosis of infection has helped us in the last few years. We hear more about it because of that," said the CDC's Widdowson. "However, there is a natural variation in the incidence of the bug itself. Last year, there was a genuine increase."

This year, he said, norovirus outbreaks seem to have waned.

Until the past year or so, most health departments did not have the tools to detect the virus in stool samples, and sometimes it would take weeks to identify the illness, said Todd of the Nevada State Health Division.

In contrast, he said, more sophisticated testing technology allowed the Washoe County District Health Department to identify norovirus as the cause of the recent outbreak within a day or two of the first reported cases.

Still, tracking the source of an outbreak can be a challenge, as has been the case in Reno.

"It's extremely difficult to recover the norovirus from food; it only multiplies to any degree in the human intestine," said Debra Brus, a veterinarian and public health epidemiologist for the Washoe County health agency.

In Reno's most recent case, she said, "we are not going to find a smoking gun because of the way this virus operates. We don't think it was any meal, food or beverage."

Brus noted that the volleyball tournament offered many opportunities to spread the disease.

"Just imagine the type of hand-to-hand contact you have among girls," she said. "The high-fiving, batting the same ball around, crowding into the restroom at the convention center together."

Dr. Stuart Cohen, an infectious disease specialist at UC Davis Medical Center, said that like cruise ships, hotels and convention centers have common areas visited by large numbers of people -- potentially good environments for a norovirus to spread, whatever its original source.

While an infection cannot be treated, health officials say people can prevent its spread by diligent hand-washing and thoroughly cleaning of any surface that may be contaminated.

Reno's convention center and area hotels are beefing up sanitation practices and disinfectant applications, said Ashby of the Reno-Sparks Convention and Visitor's Authority.

So far, it seems to be working. She said no additional illnesses were reported last week at the convention center, where more than 18,000 women gathered for a national bowling event.

And if the center is taking extraordinary precautions, so is Donna Pochron, commissioner of the Northern California Volleyball Association, which hosted the recent tournament in Reno.

The organization has reserved 40 courts for another event at the same convention center in June.

"All of our equipment will be cleaned, scrubbed and sprayed," Pochron said.

The group will also order new balls and distribute fliers to participants urging good hand-washing practices and warning them against sharing drinks or food.

"We are having to do all of that to make sure this thing doesn't happen again," she said.

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