The State Center for Health Surveillance (Cevs) this week issued a warning about the occurrence of outbreaks of acute diarrheal disease (ADD) in 25 municipalities in Rio Grande do Sul, identified since the end of August. In nine of these cities a virus called norovirus as the cause of these cases of gastrointestinal diseases. It is possibly associated with drinking water, but it can also be transmitted through food or from person to person.
In other cities, cases are still under investigation. Until now, more than 2,000 cases have already been notified, and some municipalities only reported that they had one or more outbreaks identified, to confirm the number of people. The investigation and control measures are being carried out by the respective municipalities, Regional Health Coordinations (CRS) and Cevs.
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The main orientation to the population is the consumption of water only from safe and treated sources, which have a chlorine disinfection process or other technology. It is also important to periodically clean water tanks. “These types of occurrences reinforce these preventive measures in relation to water, which must occur permanently throughout the population, regardless of the occurrence or not of these outbreaks”, comments the health specialist at the Center for Water and Food Transmission Diseases at the Cevs, Lilian Borges Teixeira.
Clinical samples from people with symptoms are sent to the State Central Laboratory (Lacen) in Porto Alegre. Water samples have also been collected in some of these municipalities, which are awaiting results from Fiocruz, in Rio de Janeiro.
Cities with outbreaks under investigation and number of cases reported to date
- Barra Funda* – 26 cases
- Bento Gonçalves* – 394 cases
- Carlos Barbosa – outbreaks identified (without information on the number of cases)
- Caxias do Sul – outbreaks identified (without information on the number of cases)
- Colorado* – 19 cases
- Dois Irmãos* – more than 200 cases
- Esteio – 144 cases
- Garibaldi – identified outbreaks (without information on the number of cases)
- Horizontina – 69 cases
- Lavras do Sul – 174 cases
- Mato Leitão – 50 cases
- Monte Belo do Sul – outbreaks identified (without information on the number of cases)
- Morro Reuter – about 20 cases
- Pinto Bandeira – identified outbreaks (without information on the number of cases)
- Porto Alegre* – 03 cases
- Marine Saldanha – 228 cases
- Santa Cruz do Sul* – 374 cases
- Santa Maria – identified outbreaks (without information on the number of cases)
- Santana do Livramento* – 214 cases
- Santa Rosa – 28 cases
- Holy Christ – 14 cases
- São Marcos – identified outbreaks (without information on the number of cases)
- Sarandi* – 49 cases
- Tucunduva* – 33 cases
- *cities that have already had at least two clinical samples from people confirmed for norovirus
Norovirus may be resistant to chlorine concentrations applied to treated water provided for in potability legislation. Lilian comments that the increase of organic residues in the water can make this virus resist the foreseen chemical treatment. “If we have more organic matter present than normal, the amount of chlorine used may not be enough to eliminate it”, he comments.
The main symptom presented in these cases is diarrhea. The increased number of bowel movements may or may not be accompanied by abdominal pain, nausea, vomiting, and fever. The outbreak occurs from two cases, with the same clinical picture and epidemiological link between them. In case of symptoms of this type, rest and increased fluid intake are recommended to avoid dehydration, especially in children and the elderly. If there are severe symptoms, the nearest health unit should be sought.
Recommendations for the general population
- – Consume water from safe (drinking) treated sources, which have a chlorine disinfection process or other technology. If the source is unknown, in emergency situations, it is recommended to boil it before consumption and before preparing food for at least 5 minutes.
- – The cleaning of surfaces, equipment and utensils used in the preparation and consumption of food must be carried out with treated and/or boiled water.
- – Ice for consumption or food preservation must come from drinking and/or boiled water.
- – Properly sanitize your hands, washing them with soap and water, especially after using the bathroom, changing diapers, before preparing and handling food and before meals.
- – Keep sick people away from food handling activities and reinforce personal hygiene even after symptoms disappear.
- – Clean the water tank once a year or whenever necessary.
Nursery and school environments demand greater attention, as they are the most common places for these types of outbreaks.
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