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CONTAGIOUS: a close-up view of norovirus, which is affecting people across the country

As the country has battled with the worst outbreak of norovirus for five years, there have been fears that the situation could get worse after children went back to school and workers went back to their offices and factories after the Christmas break.

Hospitals and other confined institutions such as schools and nursing homes are always more at risk of succumbing to the virus.

In common with hospitals all over the country, the Leeds Teaching Hospitals Trust has had to close various wards to new admissions as they have become affected by the outbreak.

But so far this year, the Wharfedale Hospital has been operating normally after being affected twice in the run up to Christmas.

The Health Protection Agency has confirmed that cases of norovirus have hit a high not seen since 2002.

Doctors estimate that 100,000 people a week are being affected across the country - but it is believed the true number of cases could be as high as 200,000.

Anyone affected by the virus is being urged not to visit patients in hospital until they have been completely free of symptoms for three days.

The Leeds Trust's Chief Nurse and Director of Infection Prevention and Control, Ruth Holt, said: "Viral gastroenteritis has been affecting hospitals in the Leeds Teaching Hospitals since the end of November. During this time staff have been working exceptionally hard to control the spread of the illness and ensure our hospitals keep running.

"Winter is traditionally a time when we see these types of bugs spreading in the community, but there does seem to be evidence that the current outbreak is more severe and long-lasting.

"Where infection is identified in a patient on a ward, the most important thing is to close it to new admissions to prevent other people becoming infected. Those affected are then nursed in a way to prevent the infection spreading to other patients or to staff, who are equally at risk.

"Using these methods we have successfully contained cases in a way which has allowed most of our wards to function as normally as possible.

"Over the last six weeks or so we have consistently had between three and six wards on different sites closed to new admissions. This does need to be seen in context though, as we are one of the largest Trusts in Britain with around 2,500 beds.

"Given their size, understandably St James's and Leeds General Infirmary have been worst hit, but Wharfedale Hospital has also been affected on two occasions.

"Currently Wharfedale is clear, but across the Trust there are three wards closed to new admissions and two partially closed."

Ruth said patients arriving at Accident and Emergency departments were being screened for symptoms of gastroenteritis so they could be placed appropriately to prevent the spread of the virus.

She added: "We have also been urging people with any of the symptoms of viral gastroenteritis not to visit patients in hospital until they feel better and have been completely clear of symptoms for three days.

"People at home with symptoms are advised to ring NHS Direct on 0845 46 47 if they need advice."

Described by the Health Protection Agency as "relatively mild", norovirus is the most common cause of infectious gastroenteritis in England and Wales.

Immunity to it is not long-lasting, and people can fall victim at any age.

It is estimated that Norovirus affects between 600,000 and a million people in the UK each year.

The HPA says the numbers of cases fluctuate each year, with those reported to laboratories representing only a small fraction of the total as most are not reported.

In its report for January 2008, it says the current season has seen almost double the number of cases reported compared with the same period last year.

But it says several factors are thought to have contributed to the increase in cases already reported this year.

As well as an uncharacteristically early start in the norovirus season, it is believed more cases are being identified because of an increased level of awareness among members of the public and doctors.

But, because the illness is self limiting and only last a few days, the majority of cases are never reported, making it difficult to give accurate figures for the number of people affected.

The HPA says increased sensitivity in testing may also have resulted in more cases being diagnosed.

As the virus spreads quickly in confined spaces it is not unusual to see outbreaks in hospitals - or in other confined areas such as cruise ships and schools.

Norovirus is highly contagious, and the HPA stresses the importance of good hygiene in helping to prevent the spread of the illness, with the emphasis on thorough hand washing, especially after using the toilet, as well as disinfecting any contaminated surface.

Sufferers are also advised to avoid food preparation until three days after symptoms have disappeared. With confined settings such as hospitals and schools being particularly at risk, prompt action has to be taken to control outbreaks.

In April 2006, a visitor ban was imposed at Burley Oaks School, Burley-in-Wharfedale, after an outbreak of the virus.

Although only a small number of pupils were affected, the school was given the advice by environmental health officers against a backdrop of an epidemic in Bradford.

In November, Green Meadows special school in Guiseley was closed for nearly a week after staff and pupils were struck down by an outbreak of winter vomiting.

Prof Mark Wilcox, former Director of Infection Prevention and Control for the Leeds Teaching Hospitals Trust, said: "Viral gastroenteritis is highly infectious, affects all ages and has become much more common in recent years in the UK and Europe. The term winter vomiting disease' is sometimes used, but this name is misleading because cases are increasingly seen throughout the year.

"Viral gastroenteritis typically causes diarrhoea and vomiting, and although it rarely causes long-term health problems it is very unpleasant both for the affected individual and those close at hand.

"Most importantly, viral gastroenteritis spreads rapidly, typically among people in close contact such as children in nurseries, patients and healthcare workers in hospitals and holidaymakers on cruise ships. An outbreak in such settings can severely affect normal activity - in a hospital it can result in ward closures and operation cancellations and undo so much of the hard work that goes into making our services as efficient as we can.

"Not only is the diarrhoea infectious, but crucially vomiting creates a cloud' of virus which can contaminate surfaces around the affected individual. Touching these surfaces may then contaminate the hands of patients or healthcare workers, followed possibly by ingestion of the virus. There is some evidence that the virus clouds may directly infect some people in the immediate vicinity of the vomiting person."

Mr Wilcox added: "For these reasons it is of paramount importance that symptomatic patients are isolated wherever possible, that contacts (who may be incubating the virus) must not be transferred to other healthcare settings (eg. wards or nursing homes where they may act as a source of a new cluster of cases), and that staff and patients use scrupulous hand hygiene."

1:53pm Thursday 17th January 2008

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