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News From the Centers for Disease Control and Prevention
July 14, 2020

Norovirus Spread Among Hundreds of 2018 California Fire Evacuees

JAMA. 2020;324(2):129. doi:10.1001/jama.2020.11551

During Northern California’s 2018 Camp Fire—the state’s deadliest wildfire—the CDC reported that more than a quarter of people who evacuated to shelters developed likely norovirus infections. As this year’s wildfire season collides with coronavirus disease 2019, the CDC stressed the importance of infection prevention and control practices in shelters during natural disasters.

Theodore J. Muller, MD

Acute gastroenteritis affected 292 evacuees among 1100 who stayed in 9 shelters during the Camp Fire. Cases were detected at 8 of the 9 shelters. Norovirus, which spreads easily and is resistant to some disinfectants, was detected in 16 of 17 stool samples from affected individuals. Outbreaks of the virus have been reported in emergency shelters during other disasters, the authors noted.

Investigators found that infection prevention and control practices (IPC) varied among the 9 shelters. At one, all staff and evacuees were observed following handwashing recommendations, but at 5 others, adherence ranged from zero to 50%. Many staff and evacuees were unaware that soap and water, not just hand sanitizer, are needed to prevent norovirus transmission, according to the authors.

Three shelters allowed food and beverage self-service, which can contribute to transmission. Many lacked illness screening protocols or facilities to isolate sick evacuees. Public health officials worked to educate staff and evacuees, implement screening, and institute better infection control practices.

The authors acknowledged the difficulties that disaster relief agencies face in establishing emergency shelters. Yet they argued that better advanced planning for infectious disease surveillance and infection control in shelters is needed, particularly as the growing threat of wildfires meets the ongoing pandemic.

“[E]xpanding and implementing the lessons learned from the Camp Fire response on surveillance and IPC will be critical to prevent additional morbidity and mortality,” the authors wrote.

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