Norwalk virus airplane

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Aliment Pharmacol Ther 24 — Norovirus gastroenteritis successfully treated with nitazoxanide. J Infect 63 — Chronic norovirus infection in a transplant patient successfully treated with enterally administered immune globulin. Development of Norwalk virus-specific monoclonal antibodies with therapeutic potential for the treatment of Norwalk virus gastroenteritis. J Virol 87 — Chronic norovirus gastroenteritis in a double hematopoietic stem cell and lung transplant recipient.

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J Clin Microbiol 40 — Noroviruses: a comprehensive review. J Clin Virol 44 :1—8. Emergency department visit data for rapid detection and monitoring of norovirus activity, United States. Emerg Infect Dis 19 — Likely transmission of norovirus on an airplane, October Clin Infect Dis 50 — Disease transmission and passenger behaviors during a high morbidity Norovirus outbreak on a cruise ship, January Clin Infect Dis 52 — The epidemiology of published norovirus outbreaks: a review of risk factors associated with attack rate and genogroup.

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A multistate outbreak of Norwalk virus gastroenteritis associated with consumption of commercial ice. Waterborne gastroenteritis due to the Norwalk agent: clinical and epidemiologic investigation. Am J Public Health 72 — Waterborne gastroenteritis outbreak at a scouting camp caused by two norovirus genogroups: GI and GII. J Clin Virol 47 — An analysis of water quality in the Colorado River, —04; an investigation into recurring outbreaks of norovirus among rafters.

Wilderness Environ Med 20 :6— Norwalk virus enteric illness acquired by swimming exposure. Am J Epidemiol — An outbreak of gastroenteritis caused by norovirus-contaminated groundwater at a waterpark in Korea. Norovirus distribution within an estuarine environment.

Appl Environ Microbiol 75 — One year monitoring of norovirus in a sewage treatment plant in Rio de Janeiro, Brazil. J Water Health 8 — Norovirus removal and particle association in a waste stabilization pond. Environ Sci Technol 42 — Evaluation of removal of noroviruses during wastewater treatment, using real-time reverse transcription-PCR: different behaviors of genogroups I and II. Appl Environ Microbiol 73 — Calicivirus removal in a membrane bioreactor wastewater treatment plant.

Appl Environ Microbiol 77 — Outbreak of viral gastroenteritis due to drinking water contaminated by Norwalk-like viruses. Norovirus outbreak associated with undercooked oysters and secondary household transmission. Two-year systematic study to assess norovirus contamination in oysters from commercial harvesting areas in the United Kingdom. Appl Environ Microbiol 78 — Determination of norovirus contamination in oysters from two commercial harvesting areas over an extended period, using semiquantitative real-time reverse transcription PCR.

J Food Prot 71 — Localization of norovirus and poliovirus in Pacific oysters. J Appl Microbiol — Optimization of methods for detecting norovirus on various fruit. J Virol Methods — Differences in the binding of human norovirus to and from romaine lettuce and raspberries by water and electrolyzed waters. J Food Prot 74 — A simple method to recover norovirus from fresh produce with large sample size by using histo-blood group antigen-conjugated to magnetic beads in a recirculating affinity magnetic separation system RCAMS.

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Chlorine treatment to inactivate norovirus on food contact surfaces. J Food Prot 75 — A foodborne outbreak due to norovirus in Austria, J Food Prot 72 — Multistate outbreak of Norwalk-like virus gastroenteritis associated with a common caterer. Fallahi S, Mattison K. Evaluation of murine norovirus persistence in environments relevant to food production and processing.

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The OzFoodNet experience. Clin Infect Dis 47 — The frequency of a Norwalk-like pattern of illness in outbreaks of acute gastroenteritis. Reevaluation of epidemiological criteria for identifying outbreaks of acute gastroenteritis due to norovirus: United States, Clin Infect Dis 42 — Norovirus specimen collection.

J Clin Microbiol 48 — European multicenter evaluation of commercial enzyme immunoassays for detecting norovirus antigen in fecal samples. Clin Vaccine Immunol 14 — Laboratory efforts to cultivate noroviruses. J Gen Virol 85 — Updated norovirus outbreak management and disease prevention guidelines. Detection of Norwalk virus in stool specimens by reverse transcriptase-polymerase chain reaction and nonradioactive oligoprobes.

J Clin Microbiol 30 — Norwalk-like viruses: demonstration of genomic diversity by polymerase chain reaction. J Clin Microbiol 31 — Detection of Norwalk virus in stool by polymerase chain reaction.

Application of PCR to detect Norwalk virus in fecal specimens from outbreaks of gastroenteritis. J Clin Microbiol 32 — Detection and differentiation of antigenically distinct small round-structured viruses Norwalk-like viruses by reverse transcription-PCR and Southern hybridization.

J Clin Microbiol 33 — Broadly reactive reverse transcriptase polymerase chain reaction for the diagnosis of SRSV-associated gastroenteritis. J Med Virol 47 — Evaluation of a degenerate primer for the PCR detection of human caliciviruses. Vinje J, Koopmans MP. Put on rubber or disposable gloves and wipe the entire area with paper towels, then disinfect the area using a bleach-based household cleaner as directed on the product label.

Leave the bleach disinfectant on the affected area for at least five minutes, then clean the entire area again with soap and hot water. Finish by cleaning soiled laundry, taking out the trash, and washing your hands.

To help make sure that food is safe from norovirus, routinely clean and sanitize kitchen utensils, counters, and surfaces before preparing food. Facts About Noroviruses on Cruise Ships. Follow these tips to prevent norovirus at youth camps. Learn about food safety practices that can help prevent these outbreaks. Ways to Prevent Foodborne Norovirus Outbreaks.

Skip directly to site content Skip directly to page options Skip directly to A-Z link. This progress is well-illustrated in reports of recent outbreaks linked to contaminated water, oysters, and other food items In certain outbreaks, the detection of a genetically identical strain of NLV among patients from different geographic locations provided substantial evidence to support the link among the cases that was indicated by epidemiologic observations.

In other outbreaks, the detection in the implicated vehicle of NLVs with a sequence identical to that of the strain detected from the patients confirmed the causal link. Although diagnostic advances have improved the investigation of gastroenteritis outbreaks, they have also required that investigators collect clinical and environmental specimens accurately and in a timely manner and collaborate with the laboratory during the investigation.

This report reviews recent advances in NLV diagnosis, and provides CDC's guidelines and recommendations for investigating gastroenteritis outbreaks, including methods for collecting specimens and preventing and controlling outbreaks.

Norwalk virus is the prototype strain of genetically and antigenically diverse single-stranded RNA ribonucleic acid viruses, previously called small round-structured viruses SRSVs , that are classified in the genus Norwalk-like viruses in the family Caliciviridae Other genera in the Caliciviridae family include "Sapporo-like viruses," which also cause gastroenteritis among both children and adults, and Lagovirus and Vesivirus , neither of which are pathogenic for humans.

The burden of NLV-caused endemic disease is unknown because simple and sensitive diagnostic assays are not readily available. However, the potential burden of NLV disease can be understood by examining the disease burden of gastroenteritis of all causes with the insights obtained during the limited number of studies in which newer diagnostics for NLVs have been applied.

Annually, approximately ,, episodes of diarrhea leading to , hospitalizations and 3, deaths occur among adults in the United States In other countries e. Although rotavirus is the leading cause of severe diarrhea among children 56 , data from recent studies demonstrate that NLVs also might be a factor in childhood gastroenteritis NLV-caused gastroenteritis has an average incubation period of hours and lasts hours.

Illness is characterized by acute onset of nausea, vomiting, abdominal cramps, and diarrhea. Vomiting is relatively more prevalent among children, whereas a greater proportion of adults experience diarrhea. Patients can experience vomiting alone, a condition first identified as winter vomiting disease Constitutional symptoms e.

Although rare, severe dehydration caused by NLV gastroenteritis can be fatal, with this outcome occurring among susceptible persons e. No long-term sequelae of NLV infection have been reported. Fecal-oral spread is probably the primary NLV transmission mode, although airborne and fomite transmission might facilitate spread during outbreaks Frequently during an outbreak, primary cases result from exposure to a fecally contaminated vehicle e.

Previously, researchers believed that a person remained contagious hours after recovery from NLV gastroenteritis However, data from recent studies using more sensitive diagnostic assays demonstrate that this belief might require further evaluation. Viral shedding in stool began 15 hours after virus administration and peaked hours after virus administration. Unexpectedly, viral antigen could be detected by ELISA in stool specimens collected 7 days after inoculation in both symptomatic and asymptomatic persons.

Anecdotal evidence from outbreak investigations also demonstrates that viral shedding can occur for a prolonged period and in the absence of clinical illness 46,48, However, the epidemiologic significance of these findings is unclear. Additional research is need to determine whether the viral antigen that is detectable for prolonged periods after recovery from illness is evidence of infectious virus or just a soluble antigen and to assess the time of maximal viral shedding so that control measures can focus on the period during which the person is most likely to be contagious.

Characteristics of NLVs facilitate their spread during epidemics Table 1. The low infectious dose of NLVs i. Prolonged duration of viral shedding that can occur among asymptomatic persons increases the risk for secondary spread and is of concern in foodhandler-related transmission. The ability of the virus to survive relatively high levels of chlorine 82 and varying temperatures i. Because of the diversity of NLV strains, lack of complete cross-protection, and lack of long-term immunity, repeated infections can occur throughout life.

Studies of NLV immunity have been hampered by the inability of these viruses to be cultivated in cell lines, and thus, in vitro neutralization assays are not available. Certain studies also demonstrated, paradoxically, that persons with higher levels of preexisting NLV antibodies would probably experience illness if exposed to the virus 84, Researchers hypothesized that certain persons might be genetically more susceptible to NLV infection and disease.

If true, this hypothesis could explain why those with greater levels of preexisting antibody are more likely to experience NLV infection and disease after reexposure to virus. Outbreaks of NLV gastroenteritis occur in multiple settings. Protracted outbreaks of NLV disease have been reported among elderly persons living in institutional settings, e.

In certain cases, the outbreak was initially caused by a common-source exposure to a fecally contaminated vehicle e. Later, the outbreak spreads through person-to-person transmission among the residents; this spread is facilitated by the enclosed living quarters and reduced levels of personal hygiene that result from incontinence, immobility, or reduced mental alertness.

Because of underlying medical conditions, the disease among these persons can be severe or fatal. A report from Minnesota demonstrates the relevance of NLVs as a cause of foodborne outbreaks Investigations of foodborne NLV outbreaks have implicated multiple food items, including oysters, salads, sandwiches, cakes, frosting, raspberries, drinking water, and ice , In certain outbreaks, the implicated food is fecally contaminated with NLVs at its source e. However, foodhandlers might contaminate food items during preparation.

The risk for contamination through foodhandlers is increased when the food item is consumed without further cooking e. Passengers and crew members on cruise ships and naval vessels are frequently affected by outbreaks of NLV gastroenteritis 35,92, These ships dock in countries where levels of sanitation might be inadequate, thus increasing the risk for contamination of water and food taken aboard or for having a passenger board with an active infection.

After a passenger or crew member brings the virus on board, the close living quarters on ships amplify opportunities for person-to-person transmission. Furthermore, the arrival of new and susceptible passengers every 1 or 2 weeks on affected cruise ships provides an opportunity for sustained transmission during successive cruises.

NLV outbreaks extending beyond 12 successive cruises have been reported Consequently, efforts to prevent both the initial contamination of the implicated vehicle and subsequent person-to-person NLV transmission will prevent the occurrence and spread of NLV gastroenteritis outbreaks. Theoretically, any food item can potentially be infected with NLVs through fecal contamination. However, certain foods are implicated more often than others in outbreaks of NLV gastroenteritis.

Shellfish e. In addition, cooking e. Until reliable indicators for routine monitoring of viral contamination of harvest waters and shellfish are available, measures to prevent the contamination of harvest waters with human waste e. Food contamination by infectious foodhandlers is another frequent cause of NLV gastroenteritis outbreaks. Because of the low infectious dose of NLVs and the high concentration of virus in stool, even a limited contamination can result in substantial outbreaks.

Ready-to-eat foods that require handling but no subsequent cooking e. Previously, the exclusion of ill foodhandlers for hours after resolution of illness was recommended to prevent outbreaks caused by foodhandlers Data from recent human volunteer and epidemiologic studies demonstrate that viral antigen can be shed for a longer duration after recovery from illness and in the absence of clinical disease.

Although data are limited regarding whether this detectable viral antigen represents infectious virus, foodhandlers should be required to maintain strict personal hygiene at all times. Although waterborne outbreaks are far less common than foodborne outbreaks, NLV gastroenteritis outbreaks have been associated with sources of contaminated water, including municipal water, well water, stream water, commercial ice, lake water, and swimming pool water.

Because current analytic methods do not permit direct monitoring of NLVs in water, indicator organisms e. However, because the size, physiology, and susceptibility to physical treatment and disinfection of bacterial indicators differ from those of NLVs, inherent limitations of this approach exist. Until reliable methods for assessing the occurrence and susceptibility to treatment of NLVs are available, prevention methods should focus on reducing human waste contamination of water supplies.

If drinking or recreational water is suspected as being an outbreak source, high-level chlorination i. Person-to-person spread of NLVs occurs by direct fecal-oral and airborne transmission.

Such transmission plays a role in propagating NLV disease outbreaks, notably in institutional settings e. Although interruption of person-to-person transmission can be difficult, certain measures might help. Frequent handwashing with soap and water is an effective means of prevention. Because spattering or aerosols of infectious material might be involved in disease transmission, wearing masks should be considered for persons who clean areas substantially contaminated by feces or vomitus e.

Soiled linens and clothes should be handled as little as possible and with minimum agitation. They should be laundered with detergent at the maximum available cycle length and then machine dried.

Because environmental surfaces have been implicated in the transmission of enteric viruses, surfaces that have been soiled should be cleaned with an appropriate germicidal product e. In situations in which the epidemic is extended by periodic renewal of the susceptible population e. Naval aircraft carrier following the clinical recognition of cases of gastroenteritis over a 2-week period September , during coastal exercises. A random sampling of 44 cases from personnel who sought medical attention was compared with 19 controls.

There was no evidence of shipboard geographic clustering of cases. Furthermore, no single food type was associated with illness on the basis of comparative analysis cases versus controls.