Dear Emory community,

As noted in Thursday night’s all-student email, we were awaiting laboratory results regarding a gastrointestinal illness that had affected many students in our Emory community.  Friday night we received confirmation from the Georgia Public Health Laboratory and Emory Medical Lab that all patient samples from the first morning of our outbreak, Wednesday, November 12, tested positive for Norovirus (6 of 6 samples at the State Lab and 2 of 2 samples at Emory Medical Lab).

Information on norovirus:  Norovirus is a highly contagious intestinal virus that causes vomiting, diarrhea and abdominal pain and can lead to dehydration.  Norovirus is now the most common cause of gastroenteritis in the United States, with an estimated 21 million cases a year.  The most serious Norovirus cases occur in small children and the elderly.  The good news is that the most significant symptoms usually do not last longer than 48 hours.  However, individuals can still transmit the virus for several days after symptoms resolve.  An excellent 2-page CDC fact sheet on Norovirus can be found at: http://www.cdc.gov/norovirus/downloads/keyfacts.pdf. 

Update on illnesses:  On our campus, 89 students have now sought care for gastroenteritis at Student Health Services or the University Hospital Emergency Department since the early morning hours of Wednesday, November 12.  The severity of the illness has varied, and the number of new cases seen slowed Friday (we had a total of 74 cases seen by late Thursday night).  However, we do know that other students have been ill, have done self-care and have not come to Student Health Services or the University Hospital Emergency Department. 

We are still working with DeKalb County Board of Health and experts at Emory Infectious Diseases and the Rollins School of Public Health to try to identify the original source of the infection.  As noted in Thursday night’s email, all left over food served in the Dobbs Market on Tuesday, November 11 has been isolated and will now be tested for Norovirus.  We will share those results with the community when they become available.  The tests will be performed at a Norovirus research lab at the Rollins School of Public Health.  Admittedly, this testing is more challenging than testing on human specimens and may be inconclusive.

Our goal:  For individuals and for our Emory community, our goal is to stop the spread of this virus.  There is no vaccine for Norovirus, and while medications can help control symptoms, there are no drugs to treat the virus itself.  But the virus can be controlled and contained.  Our best weapons are fluids, rest and prevention.  To that end:

• Wash your hands with soap and water.  The best way to prevent the spread of Norovirus is to wash your hands frequently with soap and water, 20 seconds or more each time.  Unfortunately, hand gels and foams do not work as well against Norovirus.  We must always wash our hands after using the restroom and before preparing or serving food.  This is important for all of us, since studies have shown it is possible to get a Norovirus infection and not become clinically ill.  Therefore, everyone must be vigilant.
• If you are ill with Norovirus or other gastrointestinal illnesses and need medical attention, you should seek care either at Student Health Services or the Emory University Hospital Emergency Department.
• If you have been ill:
  • Do not prepare or serve food to others for a full week after symptoms subside. 
  • Do not provide care for others, especially small children or the elderly, who are most vulnerable to Norovirus.
  • Do not use swimming pools for a full week after symptoms subside.
• If surfaces are contaminated by vomit or diarrhea spillage:
  • If you live on campus and there are facilities that have become visibly contaminated, please contact your RA or the RA on-call and they will arrange for clean-up.  Please do not be alarmed to see custodians wearing regular surgical masks and gloves; we want to provide them with additional protection when they are cleaning up contaminated spills.  Please remember to say thanks when they are done.     
  • If you live off campus, clean and disinfect all surfaces contaminated by vomit or diarrhea spillage.  Use a disinfectant with chlorine bleach at a concentration of 1000-5000 ppm or 5-25 tablespoons of household bleach (5.25%) per gallon of water.  One option would be Clorox Healthcare^® Bleach Germicidal Wipes (5500 ppm chlorine), and there are likely others.  If unsure, check the label. 
• If clothes or laundry are contaminated by vomit of diarrhea spillage:
  • Immediately remove and wash thoroughly any clothing or linens contaminated by an ill person. 
  • Wash your hands thoroughly after handling contaminated laundry. 
  • Wash laundry items with detergent on the longest cycle and machine dry them.  
• If you are not ill and are preparing or sharing food:
  • Wash all fruits and vegetables and cook all seafood thoroughly.
  • Until we have stopped this campus outbreak, avoid hand-sharing communal food.  Sorry, no popcorn bowl or nachos for football this weekend.  
• Additional measures are being taken at Emory Dining Services.   In addition to added safety measures instituted Wednesday morning, Emory Dining Services did a round of full-sanitizing cleaning with CDC and EPA-recommended chlorine-based cleaners Saturday morning.  While most of us are not fond of the smell of chlorine, when you smell it on the Emory campus over the next few days, it is a good thing.

Please consider sharing this message with your parents, family members or significant others as appropriate or helpful.  It may also be helpful to share Thursday night’s email (November 13, 2014), which you can find below, since we will not completely repeat the information contained in that email.   

As before, we will follow with additional information as it becomes available.  Although I am an Emory team physician and I love our Eagles, right now my favorite school spirit is the spirit of prevention.  I hope yours is, too.  For additional information about Norovirus, go to: www.cdc.gov/norovirus. 

Yours in health,   

Michael J. Huey, MD
Assistant Vice President and Executive Director
Emory University Student Health and Counseling Services
Associate Professor (MEST), Family and Preventive Medicine
Emory University School of Medicine

Thursday, November 13, 2014

Dear Emory student: 

As you may or may not be aware, since late Tuesday night/early Wednesday morning, Emory has had a number of students with gastrointestinal illness on campus.  The seriousness of illness has varied.  As of this morning, over 50 students have been seen and treated at Student Health Services and The Emory University Hospital Emergency Department.  Stool cultures from several ill students have been sent to the State of Georgia Laboratory and results are pending.

Emory medical staff and Campus Life administrators are evaluating the affected students, and working closely with Emory Infectious Diseases experts and the DeKalb County Board of Health to investigate the cause(s) of the illnesses.  Efforts are being made to identify clear commonalities among the students who are/were ill, including but not limited to: dining locations, food choices, activities, residence and classes.  

Gastrointestinal illnesses are caused primarily by viruses, bacteria and food-borne toxins.  At this time, the cause of our current cluster of illnesses is unclear.  However, during the investigation, additional safety measures have been put in place to preserve the health of the Emory community, and Campus Life staff are supporting affected students.

Reports of illness on a college campus always require a rapid response from Campus Dining for those who visit our facilities, which serve more than 14,000 people every day. Campus Dining has followed established public health protocols which included: 

1. All leftover food served on Tuesday, November 11 has been isolated and retained for analysis as required by policy;
2. DeKalb Health Department inspected the premises on Wednesday, November 12, and found no issues of concerns or infractions;
3. Hand sanitizer stations are being positioned more prominently;
4. The campus-wide food service safety/sanitation specialist has been placed at Dobbs Market full time; 
5. Staff are being refreshed on the importance of sanitation practices; and 
6. Common use customer utensils are being replaced more often than is required.

With gastrointestinal illness, the most important way to stop the spread is good hand washing and hand hygiene.  If students are ill, they should carefully wash their hands after any bathroom visit.  Students who are ill should not prepare food for or serve food to others.  It is also important to get adequate rest and good fluid hydration, both when ill and when trying not to become ill.  Students who become ill and need medical care should be seen either at Student Health Services or the Emory University Hospital Emergency Department. 

We will follow with additional information as it becomes available. 

Yours very truly,

Michael J. Huey, MD