Norovirus report completed for the European Centre for Disease prevention and Control

March 2nd 2012

The European Centre for Disease prevention and Control (ECDC) is the agency of the European Union that identifies and assesses current and emerging threats to human health from communicable disease. In July 2010 ECDC asked us to undertake a large-scale project to identify key scientific evidence around preventing outbreaks in childcare and school settings.

Norovirus infections are a common problem in the EU and worldwide. Estimates suggest that norovirus accounts for 12% of severe gastroenteritis cases among children <5 years of age, and that each year norovirus causes 64,000 episodes of diarrhoea requiring hospitalisation and 900,000 clinic visits among children in industrialised countries. Norovirus outbreaks commonly occur in nurseries and schools.

Although hand washing and hygienic measures (e.g. hand sanitisers and surface disinfection) have been shown to reduce absenteeism in school, there are few guidelines available for this setting. The primary research available in this area was also known to be sparse. But worse than this, what is known is not being used in practice. This is a typical area for our “evidology” services - the science of identifying and applying evidence to real problems.

We worked with Dr Katie Geary, a Consultant in Communicable Disease Control working with the Health Protection Agency in East Midlands (and by the way thanks, Katie, it was really great working with you) and a reference group.

Our innovative approach developed new methods to review and grade primary and secondary research, and adapt existing guidelines on the prevention and control of norovirus outbreaks. The method extends the GRADE approach for grading recommendations into areas where there is a lower quality body of evidence and a modified ADAPTE guideline process to provide a synthesis of guideline messages.

A focus on the key messages has allowed the health communication experts at ECDC to focus on the steps required for dissemination and implementation, the translation of what is already known into effective public health action.

The full report will be published later this year and will contain summary advice on:

Primary prevention of gastroenteritis in child care facilities (hand hygiene, catering standards, environmental cleaning)
Identification of an outbreak of gastroenteritis (actions for school staff during a suspected outbreak and confirmed outbreak)
Infection control interventions during an outbreak (exclusion policies, hygiene and environmental disinfection)
Post-event review and remediation planning (education and training, review of procedures)