a viral trip…

A Viral Trip…

Daisy Ooms Medical Doctor in Communicable Disease Control

Public Health Authority Kennemerland, the Netherlands

André Jacobi Policy Advisor

Dutch National Institute for Public Health and the Environment

A Viral Trip

• Interactive discussion

• Aim and objectives

– To stimulate cooperation

– Underline the need for preparedness at Points of Entry.

A Viral Trip

• Split up in four groups

• The moderator will guide you

Message 1

A Boeing 777-300ER, in which 350 passengers are seated, is on its way to an international airport in your country (estimated time of arrival in 3 hours).

On board of the aircraft

• The cabin crew has noticed several passengers suffering from stomach cramping, vomiting and frequently using the toilet.

• Now ill passengers occupy all lavatories; some passengers could not make it to the lavatory in time, which has resulted in vomit and defecation on the ground.

• The cabin crew has notified the pilot about the situation.

Message 2

After arrival the aircraft has come to a standstill. The passengers want to disembark as soon as possible.

Norovirus

“winter vomiting disease”

“stomach flu”

Characteristics • Common cause of gastroenteritis

• Highly contagious

• Multiple ways of transmission

• Stable in the environment (survives up to 2 weeks)

• Resistant to routine disinfection methods

Transmission • Faeco-oral route mouth gut (replication) faeces

• Foodborne – Unhygienic preparation of food – Shellfish from contaminated water.

• Waterborne

• Human-to-human – Hands – Air (aerosolization with vomitus) – Environmental (contaminated) surfaces

Clinical symptoms • Incubation period: 12-48 hours

• Acute onset of symptoms

• Self-limiting disease – Duration of illness: 12-60 hours

– No specific treatment

– Prevention of dehydration (especially in risk-groups: the young and elderly)

• vomiting

• nausea

• headache

• diarrhea

• abdominal cramps

• mild fever

Disinfection

• Stable in the environment: Norovirus survives up to 2 weeks outside the host.

• Resistant to routine disinfection methods

• Disinfection – Cleanse: to reduce viral load

– Disinfectant:

• Alcohol: not effective

• Chloride: not allowed to use in aircrafts

• ???

Conclusions

• Norovirus is a common cause of gastroenteritis

• “Mild” and self-limiting disease no real threat for public health

• But: highly contagious (food, vomit and faeces)

• Resistant to routine disinfection methods challenge for aviation!

• Risk of contamination of passengers on subsequent flights for two weeks