Norovirus Gastroenteritis - Ministry of Health Advises Institutions to be Vigilant with Hygiene Measures

07 Oct 2006

There has been an increase in the number of persons attending the polyclinics for acute diarrhoea over the past three weeks. The average weekly attendances during this three-week period was about 20 per cent higher than the attendances for the week just before this three-week period. Such fluctuations do take place throughout the year. This increase over the past three-week period is only 5 per cent higher compared to the corresponding period last year. However, in view of the recent outbreaks of norovirus gastroenteritis in two schools affecting a large number of school children, the Ministry of Health (MOH) would like to advise the public to be vigilant about diarrhoeal illnesses.

Noroviruses are a group of viruses that can cause "gastric flu" or viral gastroenteritis. The symptoms of norovirus illness usually include nausea, vomiting, watery diarrhoea and abdominal pain. Sometimes people also have fever, chills, headache, muscle aches, and a general sense of tiredness. In general, children experience more vomiting than adults.

The illness often begins suddenly, and the infected person may feel very sick. However, the illness is usually not serious. Most people get better within 1-2 days, and they have no long-term health effects related to their illness.

Noroviruses are found in the stool or vomit of infected people. People can become infected with the virus in several ways, including:

• Eating food or drinking liquids that are contaminated with norovirus.

• Touching surfaces or objects contaminated with norovirus, and then placing their hand in their mouth.

• Having direct contact with another person who is infected and showing symptoms (for example, when caring for someone with illness, or sharing foods or eating utensils with someone who is ill).

Noroviruses are very contagious. As the infection can spread easily from person to person, institutions e.g. schools, day-care centers, residential homes, nursing homes and hospitals are vulnerable to norovirus outbreaks. MOH advises such institutions to be vigilant with hygiene measures in their institutions. Residents with symptoms suggestive of viral gastroenteritis should be managed with proper infection control measures. In addition, institutions should monitor their staff who are ill and not allow them to return to work until all their symptoms have resolved.

MOH also advises persons who are having symptoms suggestive of viral gastroenteritis to refrain from attending school or work until they are well. When people are ill with vomiting and diarrhea, they should drink plenty of fluids to prevent dehydration. Persons who become dehydrated because they are unable to drink enough fluids to replace the liquids they lost because of vomiting and diarrhoea should seek medical attention.

You can decrease your chance of coming in contact with norovirus by following these preventive steps:

• Frequently wash your hands, especially after toilet visits and changing diapers and before eating or preparing food.

• Carefully wash fruits and vegetables, and steam oysters before eating them.

• Thoroughly clean and disinfect contaminated surfaces immediately after an episode of illness by using household bleach in a ratio of one unit to 50 units of water.

• Immediately remove and wash clothing or linens that may be contaminated with virus after an episode of illness (use hot water and soap).

• Flush or discard any vomitus and/or stool in the toilet and make sure that the surrounding area is kept clean.

Persons who are ill with vomiting and diarrhea should not prepare food while they have symptoms and for three days after they recover from their illness. Food that may have been contaminated by an ill person should be disposed of properly.

Recent Outbreaks in Schools

In the last two weeks, Ang Mo Kio Secondary School and Stamford Primary School had each reported cases of more than 100 students and staff falling ill with symptoms such as vomiting and diarrhoea. MOH has investigated into the Ang Mo Kio Secondary School outbreak which occurred on 25-28 Sep and established the cause as norovirus gastroenteritis. Investigations into the cause of outbreak at Stamford Primary School are still in progress although norovirus has also been identified.

As at Friday, 6 Oct, two other schools [ACS(I) and Maris Stella (Primary)] have reported 20-30 cases of students and staff falling ill with similar symptoms. These cases are also being investigated to determine their cause.

As a precautionary measure to pre-empt further outbreaks, the Ministry of Education (MOE) has instructed schools to take the following actions starting from this weekend:

• Cleaning of all schools over the weekend and intensifying the cleaning regime of school premises in the following weeks until the situation stabilizes. Particular attention will be paid to the cleaning of canteens and toilets.

• Strengthening canteen hygiene - school staff such as the Administration Manager and the Operations Manager will conduct daily and regular checks on food handling by canteen vendors.

• Visually screening students, staff, vendors and visitors for their well-being, in particular to look out for symptoms such as vomiting and diarrhoea. If any student, staff, vendor or visitor are unwell, they will be isolated and advised to seek medical attention. Parents of students who are unwell will be asked to take their children to the doctor.

• Reminding students to heed MOH's advice on good hygiene to minimize coming into contact with the norovirus.

Examinations

MOE has guidelines in place for schools to make special arrangements to help our students who are unwell, while sitting for national or school-based examinations.

In grading the affected pupils' examination papers, the Singapore Examinations and ssessment Board (SEAB) or schools will take into account the circumstances under which these pupils took the examinations. Thus, the MOE and SEAB would like to assure parents that no student will be disadvantaged because of such incidents.

MOE and schools will continue to look into the welfare of the students and to monitor the situation closely

MINISTRY OF HEALTH

MINISTRY OF EDUCATION

7 OCTOBER 2006