Norovirus GII.P16-GII.4 Sydney in Camp Fire Evacuation Shelter Populations – Butte County, California, 2018

  • The Camp Fire was the largest and most destructive wildfire in California to date, leading to the loss of 85 lives and evacuation of over 50,000 people from their homes. Massive damage to local infrastructure and loss of property resulted in the need for immediate and sustained emergency sheltering of evacuees with integrated public health surveillance and critical infection prevention and control measures. Even with a coordinated multi-agency response, the immediacy and magnitude of the task presented many challenges.
  • Norovirus, in particular, is a very contagious virus that spreads easily in congregate living settings, including emergency shelters. After the Camp Fire, over 290 people among a fluctuating population of ~1100 evacuees staying in supported emergency shelters experienced acute gastrointestinal illness.  An outbreak investigation estimated an attack rate of 27% among shelter residents with sixteen of seventeen (94%) stool specimens PCR positive for norovirus.
  • Infectious diseases outbreaks, particularly norovirus, are common occurrences in emergency shelters following natural disasters such as fires.  Infection prevention/control and disease surveillance should be included in disaster response algorithms of sheltering organizations and public health jurisdictions to mitigate the potential for infectious disease outbreaks among sheltered populations and shelter workers during emergency sheltering efforts.
Quote from the Disease Detective

“The norovirus outbreak after the Camp Fire wildfire was an additional hardship for a community that had already suffered the loss of their homes and loved ones. This outbreak is an important reminder of how easily norovirus and other infectious diseases can spread in shelter settings. The more we can invest in establishing basic public health measures, including early illness screening, isolation, and infection prevention and control measures as part of shelter planning and operations, through a collaboration between public health, non-governmental partners, and the community, the greater protection and support we can provide for our populations during their times of greatest need.”

– Ellora Karmarkar, MD, MSc, EIS Class of 2018

visit to a shelter isolation area to document infection prevention and control practices[PNG - 756 KB]

EIS officer Ellora Karmarkar (right) and the California Department of Public Health’s Alice Brodkin visit a shelter isolation area to document infection prevention and control practices.

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Ellora Karmarkar


Ellora Karmarkar, MD, MSc,
EIS Class of 2018
California Health and Human Services

Education: MD: University of California, Los Angeles, 2014
MSc: University of California, San Francisco, 2013
BS: Stanford University, 2008
Resident(Internal Medicine/Pediatrics): University of Chicago, Chicago, Illinois, 2014-Present

Work Experience: Resident Assistant, Stanford University, Stanford, California, 2007-2008

Volunteer Experience: Community Service Co-Coordinator, University of Chicago, Chicago, Illinois, 2015- Present
Volunteer, Teach AIDS, Palo Alto, California, 2012-2013
Co-Coordinator of Alternative Spring Break in Mental Health, Alternative Spring Break, Stanford University, Stanford, California, 2007-2007