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Tour bus surveillance identifies potential norovirus cases at Yellowstone
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A surveillance system that tracked gastrointestinal illness in tour bus passengers to Yellowstone National Park may be valuable in identifying potential norovirus outbreaks without significantly imposing on tour guides’ time, researchers reported at the Annual Epidemic Intelligence Service conference.
“Our bus tracking system shows promise in preventing large norovirus outbreaks in national parks and other tourism settings. Creative partnerships between the National Park Service, hospitality concessioners, and the tour bus industry are feasible and important for safeguarding visitor health,” Cara Cherry, DVM, MPH, an Epidemic Intelligence Service Officer at the CDC, told Infectious Disease News.
In 2013, a norovirus outbreak affected more than 475 visitors and employees at Yellowstone National Park, including infected tour bus passengers. Yellowstone attracts more than 222,000 bus-tour visitors annually, according to Cherry. Norovirus is highly contagious and crowded environments are conducive to person-to-person transmission.
Cara Cherry
Researchers administered questionnaires to 299 tour bus guides who registered their groups’ first Yellowstone National Park hotel stay. Of the guides, 290 voluntarily provided information evaluating the number of passengers with self-reported vomiting or diarrhea, tour company name, date and location of first overnight stay, and city of origin. The hotel front desk staff faxed completed questionnaires on a daily basis to the National Park Service Office of Public Health. A post-pilot assessment pertaining to system feasibility was completed by 18 front-desk managers.
Although tour guide participation was high, only 66% of completed forms included the date and location of the first overnight stay. Five of the guides reported passengers with vomiting or diarrhea. The researchers said they found no associations between illness and previously described variables.
In the post-pilot assessment, front-desk managers reported a median time of 1 minute for completion of the questionnaires. Ninety-four percent of front-desk said the guides were amenable to the questionnaire. Eight managers said the questionnaire was helpful in promptly identifying ill passengers, and half expressed an interest in continuing this surveillance program.
“Bus-specific syndromic surveillance posed a minimal time burden for bus guides, but aided prompt identification of five potential norovirus clusters,” the researchers wrote. “Locating park-associated clusters early is essential for limiting transmission. This system appears useful in detecting outbreaks; further testing in other high-volume tourism settings is warranted.” – by Jen Byrne
Reference:
Cherry C, et al. Norovirus Syndromic Surveillance among Commercial Tour Bus Passengers: A Pilot Project — Yellowstone National Park, August 2014. Presented at: Annual Epidemic Intelligence Service conference; April 20-23, 2015; Atlanta.
Disclosure: Cherry reports no relevant financial disclosures.