MMWR News Synopsis for May 14, 2015

Norovirus Outbreak Associated with a Natural Lake Used for Recreation — Oregon, 2014

Julie Sullivan-Springhetti
Multnomah County
503-502-2741
julie.sullivan-springhetti@multco.us

Decrease in Rate of Opioid Analgesic Overdose Deaths — Staten Island, New York City, 2011–2013

Christopher Miller
NYC Department of Health & Mental Hygiene
347-396-4177
pressoffice@health.nyc.gov

Infection with Pathogens Transmitted Commonly Through Food — 10 U.S. Sites, 2006–2014

Controlling the Last Known Cluster of Ebola Virus Disease — Liberia, January–February 2015

Initiation of a Ring Approach to Infection Prevention and Control at non-Ebola Health care Facilities, Liberia, January — February 2015

CDC Media Relations
404-639-3286

Norovirus Outbreak Associated with a Natural Lake Used for Recreation — Oregon, 2014

Here are a few easy and effective steps all swimmers can take each time we swim to protect ourselves, our family, and our friends:

• Keep the pee, poop, sweat, and dirt out of the water!
• Don’t swim if you have diarrhea or have been vomiting.
• Shower before you get in the water.
• Don’t pee or poop in the water.
• Don’t swallow lake water.
• Every hour — everyone out!
• Take kids on bathroom breaks.
• Check diapers, and change them in a bathroom or diaper-changing area to keep germs away from the water.

To get your FREE CDC Healthy Swimming brochure visit: www.cdc.gov/healthyswimming.

To learn more about norovirus, visit: www.cdc.gov/norovirus. In July 2014, a norovirus outbreak linked to swimming in a lake in Oregon sickened 70 people. More than half of those who got ill were children under 10 years old. The likely cause of the outbreak was a sick, infected swimmer who had diarrhea or vomited in the swimming area; other swimmers apparently swallowed the contaminated water. To prevent other people from getting sick, the lake was closed to swimmers for 10 days. Norovirus outbreaks linked to swimming tend to disproportionately affect young children. All swimmers and parents of young swimmers can take steps to maximize the health benefits of swimming while minimizing the risk of getting sick.

Decrease in Rate of Opioid Analgesic Overdose Deaths — Staten Island, New York City, 2011–2013

After implementation of an aggressive, targeted public health strategy that involved health care providers, community organizations and the general public, Staten Island saw a 29% decrease in opioid-analgesic-involved overdose mortality and a 9% decrease in opioid analgesic high-dose prescribing. This underscores the need to take a multi-prong approach to prevent overdose deaths. From 2000-2011, the rate of unintentional drug poisoning (overdose) deaths involving opioid analgesics increased 435% in Staten Island, from 2.0 to 10.7 per 100,000 residents, with widening disparities between Staten Island and the other four New York City (NYC) boroughs between 2005 and 2011. In response, the NYC Department of Health and Mental Hygiene implemented a comprehensive public health strategy, with both citywide and Staten Island-targeted efforts. After implementation of the multi-prong public health initiatives, Staten Island saw two years of declines in opioid analgesic high-dose prescribing and opioid-analgesic-involved overdose mortality following 11 years of increases. In addition, the decreases in opioid analgesic overdoses on Staten Island were not offset by increases in heroin-involved overdose mortality.

Infection with Pathogens Transmitted Commonly Through Food — 10 U.S. Sites, 2006–2014

Foodborne infections continue to be an important public health problem in the United States. Targeted prevention efforts and continued close monitoring of foodborne illness trends are key. Reducing all types of foodborne infections will require a variety of approaches and collaboration between public health, regulatory agencies, industry, and the public. Progress in reducing foodborne illness has been limited or mixed in recent years. This report shows some progress in reducing infections from E. coli O157 and one type of Salmonella while illness from six other infections showed little or no recent improvements. The Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program conducts surveillance in 10 U.S. sites for all laboratory-confirmed infections caused by selected pathogens transmitted commonly through food to help assess whether efforts to decrease illnesses are succeeding. This report describes 2014 surveillance data and trends since 2006. The information contributes to our understanding of the human health impact of foodborne diseases.

Controlling the Last Known Cluster of Ebola Virus Disease — Liberia, January–February 2015

Investigating the last chain of Ebola virus disease transmission in Liberia reinforced how important it is to quickly detect and isolate new cases; identify, monitor, and support contacts in acceptable settings; and effectively triage symptomatic patients within the healthcare system. On May 9, Liberia became the first West African country to be declared free of Ebola virus transmission, halting the country-wide Ebola epidemic that had lasted more than a year. The lessons learned in controlling this outbreak were applied to this last transmission chain of 22 cases. The risk for re-introduction of Ebola into Liberia will remain high as long as transmission continues in the region. National efforts to strengthen surveillance, alert and response, border screening, and triage and infection prevention and control in healthcare facilities are high-priority activities in the government of Liberia’s recovery plan. The Ebola epidemic in Liberia lasted over a year and caused a reported 10,604 illnesses and 4,769 deaths. The epidemic was marked by widespread urban transmission, multiple community outbreaks with source cases coming from the urban areas, and outbreaks in healthcare facilities. This report describes the comprehensive efforts to stop the last known chain of Ebola virus transmission in Liberia. Transmission was stopped due to the successful implementation of effective Ebola response strategies including a clear incident-management structure; early detection of new cases; identification, monitoring, and support of contacts in acceptable settings; effective triage within the healthcare system; and rapid isolation and appropriate care of symptomatic contacts.

Initiation of a Ring Approach to Infection Prevention and Control at non-Ebola Health care Facilities, Liberia, January — February 2015

The implementation of ring infection prevention and control (IPC) in Liberia might offer a useful model for rapid response to Ebola virus transmission and healthcare worker exposure in response to clusters of disease. The adoption of essential IPC practices among healthcare workers, such as hand washing and proper use of personal protective equipment, is crucial to interrupting the transmission of Ebola. As new confirmed cases of Ebola in Liberia began decreasing, a focused IPC response effort, termed ring IPC, was developed collaboratively to target healthcare facilities at increased risk for exposure to someone with Ebola. Rapid, intensive, and short-term IPC support was provided at these healthcare facilities following rapid needs assessments focused on triage procedures and personal protective equipment use. While a comprehensive strategy remains critical to improving IPC capacity nationwide, an appropriately-targeted ring IPC approach might be an effective supplemental strategy to focus IPC support in response to clusters of disease.

Notes from the Field: 

Hepatitis E Outbreak Among Refugees from South Sudan — Gambella, Ethiopia, April 2014–January 2015

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES