Norovirus in Vermont
It is a type of virus that causes gastroenteritis. Gastroenteritis is a gut infection that is usually characterized by vomiting and diarrhea. Dehydration is the main risk when one is infected. The virus is highly contagious, and it is mainly spread through contaminated water or food. Close contact with an infected person can also spread the virus (Ahmed 3). The symptoms usually begin 12-48 hours after exposure to the virus. However, norovirus symptoms last between one to three days and most people recover fully but so some people they do not, it occurs mostly to those with underlying diseases, infants and older patients. Norovirus infection often occurs in crowded places such as nursing homes, hospitals, schools, and child care centers.
Question 1
When did the vomiting start? What triggered the vomiting? Did they have something to eat before the vomiting started? Are the children in school? The priority in this situation is to establish what the children have in common if its school or a favorite food place would be a probable source of the infection (Marsh 5).
Question 2
Etiological agents are infectious agents, in this case, are the three children in the neighborhood. Although they do not play together, they came into contact with each other during a birthday party, and it is most likely where the patient acquired the infection (Marsh 3). The party is the commonplace was the children could have easily acquired the infection and spread it. The children also share the same school and this virus is highly prevalent in crowded places and this case, it is in the school.
Question 3
Take samples of what was taken by the children while at the party if possible. Take a sample from the pool and test for the virus. All those who attended the party are to be contacted. (Marsh 8)The club management is also to be contacted and ask if there are any complaints about the pool. Additional information that would be necessary is to know where the cake, ice cream and anything consumed in the party was purchased.
Question 4
The swim club manager should be informed about the cases and the condition that the children are in after the party that was held there. It can be done through the arrangement of a meeting with the manager and convince him/her to allow investigations to go on to establish the source of infection (Arnold 13). It could help prevent the spreading of the infection.
Question 5
Children started vomiting and diarrhea after they attended a birthday party held at a swimming club on February 1st. in addition, the manager of the swimming club also said he had received reports of illness among other people who had used that swimming pool during that period. Those who accessed the pool between January 27th and the 1st of February were contacted (Streiner 6). It was established that 21 people visited the pool and they had reported to the health center with the symptoms. The 90% of them were vomiting, 81% vomiting, 67% had abdominal cramps, 48% had diarrhea and fever (Streiner 7). The symptoms began between 8-62 hours after exposure to the swim club. The earlier suspicions that the party could have been among the source of the infection was right. The swimming pool is most likely to be the source since those who shared the pool apart from the children also had similar symptoms. The cases were clustered across the demographic characteristics especially for those who had accessed the pool. Infant mothers who had swimming classes and children who attended the party were the ones affected. The time course of the outbreak was between 29th of January to the 3rd of February.
Question 6
A retrospective cohort study is the appropriate method of approach in this case because it involves a private swimming pool that in most cases usually has a small population. Investigators will have to contact each person who visited the swimming club on those particular dates and determine if they had accessed the swimming pool and it should be noted if they later became ill or not (Musa et al. 10). After collection of this data from each person that was at the swim club during those particular dates, the rate of infection is calculated. The infection rate of those who accessed the swimming pool and those that did not. If the rate of infection is high among those who accessed the pool compared to those who did not, then the pool is the definite source of the infection.
Question 7
To prevent or reduce contamination in swimming pools, controlling the clarity of water measures are taken. It involves treating the water adequately through filtration and coagulation. However, controlling of pathogens in the pool is done through recycling of water in the pool through treatment (Anderson18). The water is typically filtered and disinfected during this process. In addition, application of chemical disinfectants is made regularly to inactivate microorganisms that might be introduced to the pool by, for instance, bathers. Some pools cannot be treated, and in such cases, they need special management. However, not all infectious are killed by the disinfectants, and pool treatment by removal is slow therefore it is important to minimize cases of accidental fecal release and vomits. When these accidents occur the swimming pool attendants are required to respond effectively to minimize the introduction of microorganisms in the swimming pool.
Furthermore, disinfecting agents are also controlled by dilution to ensure that they are in safe quantities for swimmers. It is routine in some swimming pools for one to shower before swimming (Anderson 20). Pre-swim showering removes traces of urine, sweat, cosmetics, fecal matter and other substances that can potentially contaminate the water. Pre-swim hygiene makes the pool clean and easier to disinfect thus requiring a little amount of sanitizing chemicals making it even more pleasant for one to swim. Post-swim showers are also necessary especially those that are private and allow nude showering. They should be located on the route from changing rooms to the pool. Post-swim showering also helps in the removal of any microbes that one might have acquired from the pool while swimming.
Question 8
Turnover rate is the amount of time taken in hours by a swimming pools circulation system to circulate a specific number of gallons equal to the total volume of the pool. The minimum recommendation of a pools turnover rate is 12hours, which means that all water in the pool should have been cleaned and filtered within 12 hours after the circulatory pump is turned on (Anderson 24). The purpose of circulating water in a pool is to filter and ensure that the water is clean and conducive for swimming.
Different swimming pools have different turnover rates. Examples of these pools are wave pools that require having a minimum turnover rate of 2 hours. The difference in turnover rates of different pools is due to the difference in size especially depth and the type of the pool. However, different states have different turnover rates for their pools (Anderson, pg, 30). For instance, in Montana, a spa pool is required to have a turnover rate of 30 minutes wading pools are required to have a minimum turnover rate of 1 hour.
Question 9
When chlorine is added to water, it breaks down and forms hypochlorous acid (HOCL) and hypochlorite ion (OCl-) (van Veldhoven 6). These chemicals kill the bacteria and microorganisms by attacking their lipid cell wall. They also destroy the structures and enzymes found in the cell rendering them harmless and oxidized. The effectiveness of chlorine as a disinfectant is influenced mainly by its concentration as it is being applied in the pool. There are thresholds and maximum levels set for the concentration of chlorine so that it can be useful when applied in a pool. However, if the concentration is too high chorine might also affect the skin of those swimming. Swimming pools are set to have a maximum level of 1.5mg/l of chlorine and a minimum of 0.5 mg/l (Rachmadi 9).
Question 10
The main tests performed in a swimming pool using the test kits are; pH, which should be between 7.2-7.8 to ensure that someone’s skin is not corroded as they swim. Secondly, chlorine levels which should be at1.0-2.0, a total alkalinity of the pool which should be range from 80-120 ppm. Calcium hardness is also tested, and it should be between 200 and 400 ppm (Rachmadi 12). Cyanuric acid levels are also tested and should be ranging from 20-50 ppm and finally the total amount of dissolved solids especially for outdoor swimming pools, and they should be below 5000 ppm. Samples from the pool can be collected using test tubes or small water containers for further analysis and testing
Question 11
Pool cloudiness can be due to failure in the swimming pools filtration system. However, the sample that showed that chlorine levels were 1.5 ppm and an excess of 0.5 ppm indicates chlorine levels were higher than the recommended levels (Lempart 10). High level of chlorine in the water was the reason why the pH to be at 6.8. Recommended pH levels in a pool should range from 7.2-7.8 meaning that the water is neutral. A pH of 6.8 indicates that the water in the pool is slightly acidic therefore not suitable for swimming. Excess chlorination in swimming pool water causes the swimmers to feel slight irritation on the eyes and skin as they swim. In addition, low pH in the water in a pool is corrosive (Lempart 12). It is felt by swimmers as the water usually strings their nasal passages and eyes. This is because of the acidic strips the body of its natural oils.
Question 12
The duration one took while swimming is the major risk factor. Those who took longer the duration of time while swimming is at the greatest risk exposure to the pathogens. The accidental taking of the pool water while swimming is also a risk factor (Adam 7). Taking a shower before and after swimming is also import. It will help establish those who tried to reduce their risk of being infected.
Question 13
The results indicate that not all of those who were exposed to the swimming pool got sick. However, there are those who did not access the swimming pool and still had the symptoms. The highest risk of exposure to the facility was 59%, and most of them were well but also recorded the highest number of those who got sick. These results, therefore, indicate that those who ate at the facility acquired the infection more compared to those who swam or accidentally took water while swimming.
Question 14
From the results, it is definite that eating or drinking from the club was a risk factor. To explore these findings, staff who serve at the facility should be interviewed and establish the source of the food and drinks served at the facility. Also, the facility should also be assessed if it is fit for consumption of food.
Question 15
The pool staff should be upgraded and employ more experienced and educated pool attendants. The facility’s management should ensure that the staffs have standard operating producers that can deal with pool emergency situations such as over chlorination of pool water. In addition, the facility should also ensure that swimmers shower before getting in the pool for the reduction of chances of pool infection (Adam 34). Regular pool tests should be done, and the results kept well for future reference. Finally, the facility should ensure that the foods and drinks that are served are of good quality without any form of contamination.
Question 16
The incidents differ because in diarrheal cases the fecal matter is at risk of easily infiltrating through the filtration system and causing more damage to other systems connected to the same pool. However, stool incidents are easier to deal with since stool won’t be allowed to pass through the filters.
Question 17
Information to be shared with the swim club members is that they should embrace pre-swim hygiene. Shower before and after getting into the pool and they should also be careful with what they drink or eat while at the facility.
Reference
Ahmed, Sharia M., et al. “Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis.” The Lancet infectious diseases 14.8 (2014): 725-730.
Marsh, Zachary, et al. “Epidemiology of Foodborne Norovirus Outbreaks– the United States, 2009–2015.” Food Safety (2018): 2017028.
Arnold, Elizabeth C., and Kathleen Underman Boggs. Interpersonal Relationships-E-Book: Professional Communication Skills for Nurses. Elsevier Health Sciences, 2015.
Streiner, David L., and Jan Kottner. “Recommendations for reporting the results of studies of instrument and scale development and testing.” Journal of Advanced Nursing 70.9 (2014): 1970-1979.
Anderson, David Bradford, et al. “Above-water monitoring of swimming pools.” U.S. Patent No. 8,669,876. 11 Mar. 2014.
van Veldhoven, Karin, et al. “Effects of exposure to water disinfection by-products in a swimming pool: a metabolome-wide association study.” Environment international 111 (2018): 60-70.
Rachmadi, Andri Taruna, et al. “Free chlorine disinfection as a selection pressure on norovirus.” Applied and Environmental Microbiology (2018): AEM-00244.
Lempart, Anna Maria, et al. “The impact of the circulation system on the concentration level of micropollutants in the swimming pool water treatment system.” Inżynieria Ekologiczna 19.2 (2018): 23-31.
Adam, E. A., et al. “Giardiasis outbreaks in the United States, 1971–2011.” Epidemiology & Infection 144.13 (2016): 2790-2801.
Musa et al. “Hypotheses, rationale, design, and methods for evaluation of a randomized controlled trial using Tocotrienol, an isomer of Vitamin E derived from palm oil, on the prevention of atrial fibrillation after coronary artery bypass grafting surgery.” F1000Research 7 (2018).