Norovirus Returning: Time is of the Essence for Handwashing

Key Points:

COVID

1. In today’s Recommendation for Industry, we discuss the return of norovirus and its spread through insufficient handwashing. Read more below.
2. COVID booster adds substantial protection against Omicron hospitalization. Three doses of an mRNA COVID-19 vaccine during a time of Omicron variant predominance were tied to a 59% lower odds of hospitalization than two doses, although protection waned over time, finds a US case-control study published late last week in JAMA. Compared to people who only had their initial vaccinations, people with boosters were a lot less likely to have severe COVID for 4-5 months after the booster shot. The authors said that even if the added protection of a third dose wanes over time, the overall risk of hospitalization among vaccinated patients is still low.
3. European countries see early signs of autumn COVID-19 rise. In Britain, Susan Hopkins, MBBCh, chief medical officer at the Health Security Agency, in a statement yesterday said COVID-19 rates are still low, but data from the past 7 days shows a rise in hospitalizations and a rise in positive tests reported from the community. In the United States, the Omicron subvariant proportions continue to shift, with BA.5 decreasing slightly again, from 84.6% to 83.1% over the past week, the Centers for Disease Control and Prevention (CDC) said today in its weekly update. Proportions of two subvariants are growing, though their numbers are still small. Levels of BA.2.75 increased from 1.0% to 1.4%, and BF.7 increased from 1.6% to 2.3%. Nationally, COVID markers are still trending downward, the CDC said today in an overview. The 7-day average for new daily cases is 54,186, down 10.6% compared to the previous week. The weekly average for new hospitalizations for COVID declined 9.9% last week, and weekly deaths dropped 12.2%. Since the first week of September when doses of the new updated booster rolled out, 4.4 million people have received it, the CDC said.
4. Collected from HealthMap.org, China reports that COVID is still considered worse than flu because it infects a larger % of the population, it seems to mutate more easily evading immunity, and the death toll is likely going to continue to be higher.

Monkeypox

1. Global monkeypox cases drop 22%. Steady drops in new monkeypox cases continue in North America and Europe, resulting in a 22% overall decline in cases reported in the last week. There are 5 more global deaths since the WHO’s previous report on Sep 7, raising the total to 23 (of the deaths, 14 are from African countries). In the past week, 23 nations have reported increases in cases, with Chile reporting the most significant jump. Three countries have reported their first cases, Guam, Bahrain, and Ukraine. The WHO director-general said 105 countries have reported 62,000 confirmed cases of the virus but underscored the direction of falling cases.

Food Safety & Public Health

1. New York state health officials said that four deaths at a Manhattan nursing home were confirmed to be linked to an outbreak of Legionnaires’ disease, a serious type of pneumonia caused by bacteria that grows in warm water, while a fifth death remains under investigation.  Investigation of the source is underway, with recommendations for water restrictions in place.
2. Hundreds of thousands of people displaced by the floods in Pakistan are living in the open and as flood waters spread over hundreds of kilometers start to recede, which officials say may take two to six months, stagnant waters have led to diseases like malaria, dengue fever, skin and eye infections and acute diarrhea. Over 2.7 million people have been treated for water-borne diseases at makeshift or mobile hospitals set up in flood-hit regions since July 1.
3. The largest documented outbreak of norovirus illness in the Grand Canyon backcountry resulted in more than 200 confirmed cases, and likely a lot more that went uncounted. Norovirus outbreaks have popped up in the Grand Canyon previously since the virus can live in the river’s water, and then easily spread among groups who all use the same toilets and eat communally. The virus can survive in beach sand, where rafters set up camps, allowing it to spread between trips. Hand sanitizer, a favorite among backpackers or rafters looking to bring less gear, doesn’t kill norovirus, according to the CDC. As the number of tourists visiting the national park has grown, outbreaks have become more frequent over the years.
4. Norovirus returns to pre-pandemic levels, CDC data show. Data from NoroSTAT — a network of 12 states that report norovirus outbreaks to the CDC — showed there were nearly triple the outbreaks from August 2021 through July 2022 compared with the same time period in 2020-2021. Norovirus transmission can be prevented by thorough handwashing, avoiding food preparation for at least 2 days after symptoms end, and properly cleaning contaminated areas, according to the CDC.

1. Uganda Ebola outbreak area expands, cases jump to 36, deaths to 23. Uganda’s health ministry today reported a steady increase in Ebola Sudan cases in the past few days, bringing the total to 36 of which 23 (64%) have proved fatal. Last week, the World Health Organization (WHO) said the outbreak location poses a risk of further spread, because it is on a busy road that leads to the Democratic Republic of the Congo and because the area contains gold mines that attract people from within and outside of Uganda. The WHO said the risk to Uganda is high, since there is no vaccine and that the outbreak may have started 3 weeks before the first case was detected, raising the possibility of several undetected transmission chains. Doctors Without Borders (MSF) also said it is putting together a team of health workers, epidemiologists, and logisticians who have experience with hemorrhagic fevers to start work this week.
2. Cheese, fish, dried fruit among foods subject to new import enforcement: An update from the FDA can be found here, with detailed information on the import alerts that have been modified.
3. Nearly 44 tons of meat products recalled after Listeria found in processing facility. Behrmann Meat and Processing Inc., of Albers, IL, is recalling 87,382 pounds of various ready-to-eat (RTE) meat products that may be adulterated with Listeria monocytogenes, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced. The problem was discovered through product and environmental testing performed by FSIS and the establishment. These items were shipped to retail locations and wholesale distributors in Illinois, Kentucky, and Missouri. The various RTE meat items were produced from July 7, 2022, to Sept. 9, 2022. The list of affected products can be found here.
4. U.S. slips down rankings in food security index. The study from Economist Impact put Finland at the top, followed by Ireland, Norway, and France. Canada was seventh and the United Kingdom was ninth. The United States dropped to 13th from ninth in the previous edition. Based solely on the quality and safety metric, Canada was first and the United States was third. The UK was 29th. GFSI data for the United States suggests that it needs to improve policy commitments around food security and access by establishing a food security agency and implementing a related strategy.

Recommendations for Industry

Norovirus Returning: Time is of the Essence for Handwashing

With CDC data showing norovirus having returned to those of pre-pandemic levels, both CDC recommendations and the Grand Canyon outbreak (in Key Points, above) show the value of proper handwashing. Not only do many (if not most) people wash for too little time, replacing handwashing with hand sanitizer is proven ineffective against norovirus.

How do you instill proper handwashing procedures and time in your workers?

While wetting the hands, adding soap, rubbing, and rinsing is fairly well imbedded in most people’s minds for handwashing, doing so for a full 20 seconds is less common. One way to encourage workers to stay scrubbing longer is the use of a timer:

1. There are various timers that can be located at handwashing stations. Some are touchless, initiated by waving a hand in front of it, some have alerts for each handwashing step, some have 20-second countdowns with music or ending beeps, and some are integrated with the soap dispenser or faucet, automatically starting when soap is dispensed/water turned on.
2. Some of today’s watches include a handwashing timer. When the watch detects handwashing movement and running water, a timer pops up with a countdown timer. After 20 seconds, a chime sounds and a thumbs up symbol appears. Encourage workers who have these watches to enable the mode and use it regularly.

While your workers have good intentions for full and proper handwashing, 20 seconds can feel interminable or be difficult to determine when they’re standing at the sink. Placing handwashing signage in the area as well as a timer can help them understand both the why and the complete how of proper hand hygiene.

In case you missed it:

COVID

1. In last Thursday’s Recommendation for Industry, we discussed TAG’s weekly updates on infectious disease and some further advice in reducing norovirus transmission. Read more here.
2. Canada to make ArriveCan optional, drop vaccine requirement at the border by Sept. 30. The federal government plans to drop the COVID-19 vaccination requirement for people who enter Canada by the end of September, the same day it ends random testing of arrivals and makes optional the ArriveCan app. The changes, for arrivals at land, air and seaports of entry, are planned for Sept. 30, but have yet to be finalized by cabinet. The mask requirement for people on trains and planes will remain. Most European countries dropped entry requirements related to COVID-19 before summer began, returning to prepandemic standards in a bid to welcome tourists after more than two years of widespread illness, lockdowns and stay-home orders. The United States requires all entrants to be vaccinated, and it is not known if the requirement will be lifted at the same time as Canada’s.
3. Global COVID-19 cases stabilize as deaths drop. After a 5-week drop, global COVID-19 cases stabilized last week, though deaths continued to decline, the World Health Organization (WHO) said in its weekly update on the pandemic. Of more than 3.2 million new cases reported last week, the five countries reporting the most were Japan, the United States, South Korea, Russia, and China. Meanwhile, deaths declined 17% from the previous week, with countries reporting more than 9,800 fatalities to the WHO. Amid reports of shortages of Moderna’s updated booster shots, the agency will soon release 10 million doses that were held back due to safety reviews at an Indiana plant that is bottling the packaging the product, according to the Washington Post.

Monkeypox

1. Monkeypox vaccines:
   • Portugal approves preventive monkeypox vaccination for risk groups. Portugal has received 2,700 doses of the Bavarian Nordic’s (BAVA.CO) Imvanex vaccine in July and has started vaccinating close contacts. Portugal’s health authority widened its monkeypox vaccination strategy to include preventive shots for groups most at risk and approved the use of smaller doses, an approach known as “dose-sparing”, due to limited supplies
   • Hong Kong to start monkeypox vaccination on October 5. Hong Kong will launch a monkeypox vaccination programme for “high-risk groups” from Oct. 5 following the discovery of an imported case of monkeypox this month. Those groups include healthcare workers, laboratory personnel and people with “high-risk sexual practices” such as sex workers.

Food Safety & Public Health

1. Uganda reports Ebola Sudan virus outbreak. Uganda’s health ministry today announced an Ebola Sudan virus outbreak in the central part of the country, with one confirmed case involving a man who died and eight suspected infections in people who are now receiving medical care. The man who passed away was confirmed to be a 24-year-old from Mubende district. In a statement, the World Health Organization (WHO) said the health ministry had been investigating six suspicious deaths in the district this month and that eight suspected patients are receiving medical care in a healthcare facility. Globally, there have been seven earlier Ebola Sudan outbreaks, four in Uganda and three in Sudan, with the most recent in Uganda in 2012.
2. FDA leader updates infant formula status. For the past several months, the U.S. Food and Drug Administration has been working around the clock with our U.S. government partners, including the U.S. Department of Health and Human Services and the U.S. Department of Agriculture, to expand consumer access to infant formula products, while also ensuring that these products meet the agency’s safety, nutrition and quality standards. Yesterday, Dr. Solomon released the results of the review in a 10-page report, which includes information gleaned from interviews with FDA staff directly involved in the agency’s response to infant formula shortages as a result of the Sturgis facility closure. The report released yesterday highlights detailed findings and recommendations that will support the agency’s ongoing efforts to ensure that our most vulnerable population has consistent access to infant and specialty formula products in the future. Importantly, it also identifies the need for additional resources and authorities that will ensure the agency can fulfill our consumer protection role and gain important visibility into the supply chain with the aim of preventing these issues in the future.
3. CDC issues Salmonella alert for people traveling to Mexico. Public health officials in the United States are warning travelers who have spent time in Mexico to be aware of multidrug-resistant strains of Salmonella Newport. The Centers for Disease Control and Prevention reports that some travelers have been infected with the strains, which have developed the ability to defeat drugs designed to kill them. “Many travelers with MDR (multidrug-resistant) Salmonella Newport infections reported eating beef, cheese — including queso fresco and Oaxaca— beef jerky, or dried beef — carne seca — before they got sick,” according to the alert from the CDC. The CDC has provided a list of recommendations for individuals who plan to travel to Mexico here.
4. Risk Assessment of Norovirus Transmission in Food Establishments. This risk newly published assessment continues the analysis of  the dynamics of norovirus transmission from ill or infected food employees in food establishments (restaurant setting). The previously published FDA quantitative risk assessment model in Duret et al. 2017, was used to evaluate more than 60 scenarios examining the impact of implementation and compliance with recommendations in the FDA Food Code for: restaurant surface cleaning and sanitizing, hand hygiene and employee health. For more information on FDA Food Code recommended intervention strategies for preventing norovirus, see Retail Food Protection.