Chipotle and Norovirus!?

What?!

Are you as surprised as I was? According to the website Fortune, a Chipotle in California has experienced a Norovirus outbreak. Yes...Chipotle, our favorite Mexican fast-food "restaurant". The video on the website (which, unfortunately I cannot upload on here?) is a one-minute interview with people who just left a chipotle in California. The interviewer is asking each chipotle costumer whether they will still enjoy their food knowing about this outbreak. Surprisingly, a lot of people said yes! ...Or is that not surprising? Well, if you ever had the stomach flu, you would probably not enjoy your food, for you know the dreaded feeling of getting up to vomit every few hours. But, it seemed as though a lot of the people being interviewed were in denial of them ever contracting the Norovirus! Tsk tsk... Well, hopefully you guys agree with me on this one that it could in fact happen to anyone. Actually, chances are you're probably going to get it at one point, have already gotten it, or know someone close to you who has. Be careful!

The link is below for those of you who wish to watch the video!

Link: Chipotle and Norovirus Article + Interview

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References

http://fortune.com/2016/01/21/chipotle-accused-norovirus-cover-up/

Prevention Documentary

So, here is a documentary that MicrobeWorld put up on Norovirus. In this video, Stanley Maley, Ph.D. and Lee-Ann Jaykus, P.h.D. discuss the the possible prevention methods of Norovirus as well as possible detection methods. 

Jaykus mentions that the number one cause of Norovirus spread is infected fecal matter in food. Therefore, thorough hand washing is necessary in the prevention of contracting Norovirus (New Methods 5:32). I agree with this as previously posted in my blog. She also mentions that alcohol will not do much in killing the virus. I found this surprising, since a lot of hand-sanitizers are mainly alcohol. She also mentions the CDC's requirement for prevention, which is using a thousand parts per million of chlorine on surfaces to disinfect (New Methods 6:50). I'm pretty sure that is a whole lot of chlorine! I feel as though this is impractical and unrealistic since for one, not everyone would have the time to create this solution and complete this tedious act and second, this is inapplicable on carpet and upholstery, so roughly half of the house could not be sanitized. However, if one even managed to accomplish this, one's entire house would probably smell like chlorine... not too inviting.  

Jaykus mentions how this virus is easily spread due to the low percentage of people who actually wash their hands before handling food in fast-food restaurants (25%) (New Methods 9:00). I find this number to be very disturbing but, unfortunately not surprising. 

Maley mentions the need for detection methods to prevent contaminated food. Jaykus responds by stating that there are not too many detection methods, other than some reverse transcriptase PCR based methods, and even these are not enough to formulate a proper detection method, and thus prevention is our number one goal (New Methods 10:02). There are just too many strains which impact clinical diagnosis. I completely agree with this, in that it is very difficult to detect a virus, even if there were detection methods. Since these 'detection methods' would only be utilized in laboratory settings and would not be readily available to the general population on any given day. Therefore, these detection methods would do very little in protecting individuals outside of the clinical setting. Therefore, as mentioned multiple times we should take precautions and maintain good hygiene in order to prevent contracting the virus. 

There was a question regarding long-term immunity, which I found to be interesting. Jaykus mentions how there is no long-term immunity for this virus and the cause of this inability to acquire long-term immunity is unknown (New Methods 11:57). So, unfortunately, those who have endured this awful virus, would have to go through it again if contracted again. Not fun.   

One of the main themes of the documentary revolved around transmission of the Norovirus during recreational activities and crowded areas (i.e., cruise ships, swimming pools, airplanes). The argument was that these places are the most common places to contract this virus due to the crowded nature of the place. In these instances, I would agree that prevention would be the best solution, yet again. In an environment where there is a heavy crowd, to ensure appropriate cleaning methods to prevent contracting a virus from others. 

Towards the end of the documentary Jaykus laughs about how if she saw a women throwing up in a restroom, she would immediately turn around and leave (New Methods 26:00). Humor aside, she makes a good point. It is important to remember that anyone could have any ailment (severe or benign), but it is always good to practice general precaution. Too many times than not, I have witnessed individuals be in denial that they would ever contract disease X or virus Y, or bacteria Z. But, in reality it can happen! You may even get it from someone you love! Ok, so that doesn't mean be completely afraid of everyone and your surrounding for the fear of acquiring a life-threatening disease, just be aware and definitely not in denial!

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References

https://www.youtube.com/watch?v=BIxeR6stTzI

Images

http://www.cdc.gov/features/norovirus/tips.html

A Possible Treatment?

As I previously have mentioned, there is no known cure for Norovirus. However, a group of researchers in Germany published an article, "Treatment of Norovirus Particles with Citrate", for which they conducted a study and concluded that citrate (lemon juice) may be an effective treatment for Norovirus after all.
Koromyslova et al., 2015, sought out study whether citrate would have any impact on the Norovirus GII. 10 P-domain which protrudes out from these particles' capsid shown in image below.

 

Researchers treated Norovirus-like particles (VLPs) with similar structures to that of Norovirus with varying levels of citrate buffer for 30 minutes at room temperature. The objective of this was to detect any possible structural changes in the virus to then establish any potential vulnerabilities in the virus. The varying amounts of buffer were 0mM (control), 0.49mM, 1.95mM, 3.91mM, 7.85mM, 15.63mM, 31.25mM, 62.50mM and 125.00mM. The buffer concentrations between and including 0.49mM and 7.85mM were found to be indistinguishable from the control group (0mM of citrate buffer). Thus, concluding that those concentrations did not have any effect on the structure of the virus. The citrate buffer concentration 15.63mM had a slight structural change in the virus (the outer protruding 'spikes' on the virus were surrounded by a couple of rings). The citrate concentration of 62.50mM resulted in the most structural changes causing the virus to exhibit multiple rings around the protruding spikes as well as a substantial increase in width and diameter of the virus. The concentration of 125.00 showed decreased structural changes as compared to 62.50mM. The control VLP's diameter was ~42 to 44nm, and the experimental VLP's treated with 62.50mM exhibited a diameter of ~46 to 49nm (the greatest diameter exhibited).

  Once the VLP's were exposed to a citric buffer, the VLP's were analyzed using ELISA (a assay which uses monoclonal and polyclonal antibodies to identify a particle). The VLP's exposed to 0.25mM to 7.81mM citrate buffer, resulted in low polyclonal antigen binding indicative from the low optical density (OD490= 0.15). These results were similar to those seen in the control group (0mM citrate buffer). The optical density continuously rose with increasing amounts of citrate buffer. The max optical density was reached at 62.50mM citrate buffer (OD490= 2.20). The same results presented when analyzes with monoclonal antigens; the control group's OD450=0.11 and the peak optical density was reached at 62.50mM citrate buffer (OD450= 3.60). As citrate buffer increased (leveled off at 62.50mM, increasing amounts of antigens were able to bind to the virus, thus promoting viral death.

An x-ray crystallography was conducted to see whether lemon juice and disinfectant citrate would bind to the P domain on the Norovirus. There are different subtypes of P domains on the Norovirus (i.e., P1 subdomain and P2 subdomain) which differ from another structurally (i.e., different amounts of ∂-helixes and ß-sheets). The results of the x-ray crystallography displayed that the Norovirus and disinfectant complex diffracted to 1.78 Å resolution which was also observed in the lemon juice and Norovirus complex. It was conclusive that citrate disinfectant and lemon juice were capable of binding to the P domain on Norovirus.
The implications for this study are that citrate buffer at a max concentration of 62.50mM is capable of structurally changing the Norovirus (increasing its diameter and width). This structural change allows for antibodies to easily access the P domain, thus rendering the virus useless. In addition to this, it was also found that citrate bound to the histo-blood group antigen binding pocket, attachment factors for Norovirus.
Though this study shows promise for potential future Norovirus treatment, further studies should be conducted particularly  on the effects of lemon juice on Norovirus to further conclude lemon juice as a treatment.









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References
Koromyslova, A., White, O., & Hansman, G. (2015). Treatment of Norovirus Particles with Citrate. Elsevier, 199-204.


Images in order of appearance

http://jvi.asm.org/content/85/13/6687.figures-only
Koromyslova, A., White, O., & Hansman, G. (2015). Treatment of Norovirus Particles with Citrate. Elsevier, 199-204.

How Easily Can You Contract Norovirus?

Norovirus is globally prevalent. GII, the most common Norovirus strain, is a major contributor to worldwide Norovirus outbreak. The specific prevalence rates are dependent on the time of the year and the location on the globe. Above the equator, the virus is generally more common during winter (December through January) and below the equator, the virus is generally more common during summer (June through August). Near the equator, prevalence rates tend to remain consistent throughout the year. The following image is of a map indicating the areas around the world where the GII strain has been detected (**note it is not an image of the prevalence previously mentioned).

As mentioned previously, Norovirus is highly contagious, as in it is very easy to contract the illness from the environment and or others. The virus is characterized with high attack rates (speed of spread). The disease can be spread through human to human direct contact, human to food indirect contact, or general contact with infected fecal matter and or vomitus. It does not take many viral particles to infect an individual.

The individuals at risk are the general human population (any age, race, and gender), meaning you.
There are many forms of transmission for this illness, so, let's break it down. First and foremost, transmission can occur indirectly from vehicle (i.e., food or liquid) to host (humans). Any food (raw or cooked) and or liquid may become contaminated with the virus through previous contact and handling with infected host. The consumption of such contaminated food and or liquid will transmit the virus to the host. Thus, this virus can be classified as a food borne illness (being transmitted from food).
Secondly, transmission can occur directly from infected host to host. If an infected individual shares an item with a healthy individual (i.e., food, utensils, cups etc.), the healthy individual ay contract the virus. Additionally, a healthy individual can contract the virus if he or she comes in contact with infected fecal matter and or vomitus, since both of these contain viral particles. Thirdly, transmission can occur through contact with contaminated surfaces. If an individual comes in contact with contaminated surfaces and then proceeds to handle food and or touches their mouth, they can acquire the virus. Not too many people think of this, but one should keep in mind that when I say liquid as a vehicle, I just don't mean just drinkable liquid, swimming pools may also transmit this virus through the contact with pool water and one's mouth so, be careful! Additionally, airplanes, cruise ships, and raw seafood are all known to be highly associated with transmission of the virus.

I'm sure now that you have read all about the Norovirus and what violent and horrible symptoms it causes, you are slightly panicking on the inside for the fear of contracting such a contagious virus. Well, you're in luck, because now I will inform you on preventative measures you can take!

There are numerous preventative measures one can take to decrease chances of contracting the awful Norovirus. The most important, as well as the easiest, is hand washing! This technique should always be utilized, especially before eating or feeding others, before and after handling food, after using the bathroom, and after coming in contact with possible infected hosts and their fecal matter or vomitus.

         

Furthermore, individuals should practice general hygiene (i.e., maintaining clean house through disinfectant, disposal of any contaminated material etc.). Another precaution that should be taken is the thorough inspection and cleaning of food products. Wash all raw fruits, vegetables, and seafood thoroughly. If there is any suspicion of a food being contaminated with Norovirus, it should be thrown out. In addition to hygiene practices and kitchen safety, try not to share utensils, food, or drinks with others and do not consume food prepared by an infected individual.
If an individual you are living with is sick, disinfect all surfaces and items he or she comes into contact with. Wash their clothes thoroughly. Do not share items, food, or drinks with them. These precautions must be taken even 48 hours after symptoms have alleviated.
If you are sick, you may quarantine yourself for a few days. Try not to prepare any food for anyone else and or share anything orally.
As far as treatments go, there are not any*. The virus goes away on its own after a couple of days and does not necessarily have any treatments. However, depending on the severity of symptoms, an infected individual may receive anti-nausea medication such as Zofran and Dramamine to help alleviate nausea and other symptoms associated with nausea. Additionally, due to the serious secondary symptoms of the virus (i.e., dehydration**), it is crucial that an infected individual maintain fluid balance in the body. In other words, if you are infected, be sure to drink plenty of clear fluids to prevent dehydration and any further complications of the virus that will land you in a hospital.
I would recommended the anti-nausea medication for alleviated pain. I would also highly recommend over the counter Pepto-Bismol (Bismuth Subsalicylate) for such symptoms. I would also recommend drinking plenty of clear fluids (i.e., water, gatorade etc.) as well as light food (since consuming anything heavy will further induce your stomach to throw it up). Foods such as chicken soup, or any broth based soap, and jello are great. Keep in mind that this is a violent virus and your body is doing anything it can to rid it from your body. Therefore, anything you put into it, will more than likely come back up, so, eat light foods and drink plenty!


*A journal article I will review later on discusses the possible treatment of this virus with lemon juice!
**dehydration symptoms include dry sticky mouth, headache, dizziness, and thirst.






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References

http://www.cdc.gov/hicpac/norovirus/008_norovirus-background.html
http://www.cdc.gov/norovirus/about/transmission.html
http://www.nhsggc.org.uk/media/233225/norovirus.pdf
http://www.cdc.gov/nceh/vsp/cruiselines/norovirus_summary_doc.htm
https://www.colorado.gov/pacific/sites/default/files/OEPR_Preventing-and-Treating-Dehydration.pdf
http://www.mayoclinic.org/diseases-conditions/dehydration/basics/symptoms/con-20030056

Images in order of appearance

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21178
(2) http://www.cdc.gov/norovirus/
https://eunj.wordpress.com/2012/04/15/wash-your-hands/
http://www.washinghands.net/images/posters/hand-washing-poster-5.jpg

What is Norovirus?

Norovirus (NoV) or acute gastroenteritis, commonly known as the stomach bug, is a highly contagious virus that causes severe gastrointestinal symptoms (discussed below). The virus was previously called Norwalk virus due to its initial outbreak in Norwalk, Ohio in 1968 amongst a group of school children. The virus is a calicivirus because it belongs to the family Caliciviridae. As evident in the picture above, the virus is small (26-35nm) spherical in shape. The virus does not have a viral envelope and contains single-stranded RNA molecules. Possible human genoogroups include GI, GII, GIV. GI and GII are responsible for the majority of illnesses in humans.
The virus is the leading cause for gastroenteritis all around the world in all age groups. The virus accounts for over half of all reported cases of gastroenteritis each year. According to the CDC, in the United States, it is the most common cause of food borne disease outbreaks. It causes 19 to 21 million illnesses each year. Of those 56,000 to 71,000 individuals are hospitalized, and roughly 800 individuals die from the virus.
The symptoms of this virus include but are not limited too, diarrhea, vomiting, nausea, stomach cramps/pain, fever, headaches and or general body ache. Secondary symptoms include dehydration due to excessive vomiting and diarrhea. Onset of symptoms generally begins 12 to 48 hours after exposure and usually begin seeing relief in symptoms about 1 to 3 days after onset.  
Once contracted, infected individuals will be diagnosed predominantly through their obvious signs and symptoms mentioned above. However, in addition to this, a fecal/stool sample may be taken to then be processed in a laboratory for further confirmation. Additionally, reverse transcriptase PCR based methods could be utilized for detection, though this is not common and not extensively done.


Here is a cute video!

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References

http://www.cdc.gov/hicpac/norovirus/008_norovirus-background.html

http://wwwnc.cdc.gov/eid/article/19/8/13-0465_article

http://www.lapublichealth.org/acd/docs/NorovirusFactSheet_06.pdf

http://www.nhsggc.org.uk/media/233225/norovirus.pdf

Images

http://boingboing.net/2014/06/03/we-call-norovirus-the-cruise.html