How to Prevent Norovirus

Three Parts:Preventing the Transmission of the NorovirusKeeping the Virus from SpreadingUnderstanding Norovirus

There are 21 million cases of Norovirus annually in the US.[1] Norovirus is the most common viral pathogen to infect the gastrointestinal tract, or digestive system.[2] Norovirus is a highly contagious virus that can spread from person to person quickly. The virus may only last for one to three days, but the symptoms may last for weeks.[3] If you are concerned about getting norovirus, there are ways that you can decrease your risk.

Part 1
Preventing the Transmission of the Norovirus

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    Practice proper hand hygiene. Hand hygiene is the cornerstone of prevention against the transmission of the norovirus. Norovirus is transmitted via fecal-oral transmission, so washing your hands after using the restroom or changing a diaper is one of the best ways to prevent the disease. You should also wash your hands before preparing or touching food.
    • To practice proper hand washing, put soap on your hands and rub the soap in. Rinse off the soap with warm or hot water (at least 140 degrees Fahrenheit) for 20 seconds or more.
    • If you do not have access to running water and soap, you may use a hand sanitizer or prepackaged alcohol pads, but these alcohol based cleansers are not particularly effective at killing norovirus.[4]
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    Keep your hands away from your face. The most common way to contract norovirus is to ingest it. If you avoid touching your face or putting your hands near your mouth, you will be less likely to get the virus.
    • Keep in mind that you can also get the virus by touching your nose and eyes, so keep your hands away from these areas as well.[5]
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    Handle and cook food properly. When you are preparing food, make sure to wash all fruits and vegetables well. Since the virus can be transmitted via infected water, make sure you properly cook oysters and other shellfish before you eat them. They should be cooked at temperatures higher than 140 degrees Fahrenheit.
    • You should also not prepare food while you are suffering from the norovirus or for at least two days after your symptoms have subsided.[6]
    • Do not change a baby’s diapers near the same area where food is prepared, such as in the kitchen. Take the baby to a separate room and wash your hands well before returning to the kitchen.
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    Clean commonly used surfaces. There are many places in your home that are touched by every member of your family. Doorknobs, counter tops, computer keyboards, handheld electronic devices, and any surface in the bathroom and kitchen are common places where norovirus might live. Clean these areas with household cleaners that contain bleach or with other products such as Lysol.
    • You can keep Lysol or bleach wipes handy to wipe down these surfaces every day. This will help you cut down on any transmission from your family members or guests to your home.[7]
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    Visit only safe food suppliers. There are certain kinds of food suppliers that may be more susceptible to the spread of norovirus than others. Food trucks or street vendors may not have the best areas to keep their hands clean, so be cautious of these establishments. Buffets are also problem areas, especially since so many people from the general public can handle the food. Be cautious of these establishments, especially if you see people handling the food without gloves.
    • Fast food restaurants are also known for fast-paced service, which may also lead to poor hand hygiene. The best option is to make most your meals at home, where you can control the food preparation.[8]
    • There are also certain foods that you should avoid when eating out because they are easily contaminated. For example, shellfish, salads, sandwiches, ice, fruit, and cookies are common foods that can carry the norovirus.[9]
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    Try to visit less crowded places. Since norovirus is highly contagious, you may want to avoid places where crowds gather. Some places are hard to avoid, so taking extra precautions may be your best option. For example, you might wear a face mask or wash your hands right after a trip to the grocery store. Keep in mind that transmission in these places is not common, but if you are worried about contracting norovirus, then you can take extra precautions.[10] Places you may want to avoid include:
    • supermarkets
    • shopping malls
    • crowded parks
    • movie theaters

Part 2
Keeping the Virus from Spreading

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    Clean contaminated surfaces. When you or a family member is sick with norovirus, you need to keep up with decontamination cleaning practices. After you or family member has vomited or had diarrhea, make sure to clean the room or area where the event occurred. Vomiting creates a spray of aerosolized droplets that settle on all surfaces. You will need to clean all surfaces exposed to vomit or diarrhea with household cleaners that contain bleach.
    • You can make your own bleach solution by mixing 5 tbsps to 1 1/2 cups bleach to 1 gallon of water.[11]
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    Wash laundry. During the time when symptoms are prevalent, all linens and clothing should be washed. Wash any materials touched by you or the sick family member with detergent in the longest wash cycle available. You should also dry them on the highest setting as well.
    • To handle the items, especially those soiled with vomit or feces, wear rubber gloves. Pick up the linens or clothes carefully, making sure to hold them still so the matter won't shake off and you don't spread the virus. Walk them carefully to the washing machine for laundering.
    • Whether you wear gloves or not, always wash your hands after dealing with any linens or clothes touched by an infected individual.[12]
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    Keep infected family members at home. Any one in your family who has norovirus should not be out in public. This can spread the virus to others because you are a carrier while you are sick. Whether it is you or your child who has norovirus, the infected individual should not leave the house.
    • Avoid sending your children to school so they don't infect other children.
    • Don't go to work or school while you are sick either. You run the risk of transmitting the virus to everyone around you.[13]
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    Cut down on airborne transmission. The norovirus can spread through the air if you are in close contact with someone who has the virus. In order to cut down on air transmission, close the toilet lid before you flush the toilet to avoid letting the virus into the air. If you are comforting someone who is vomiting, make sure that you turn away when the person vomits.
    • After you've cleaned up after a sick individual, don't hang around. The virus may still be in the air, so clean the area and then go to an area of the house where the infected person has not been.[14]
    • If at all possible, keep the sick individual, whether it is you or a family member, in one part of the house. This will help limit contact with other people in the family and cut down on possible transmission.
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    Test for norovirus. Newer techniques have evolved and made it possible to test infected individual and suspect food with rapid and inexpensive testing. Your doctor can test a stool sample to see if you or a family member has the virus or is a carrier.[15] Your doctor can use the RT-PCR, or real time polymerase chain reaction, or Enzyme Immunoassays to test stool samples from individuals who may be sick. These tests can also check suspect food sources. These tests are sent to a lab and the results are typically available the same day the sample is sent.
    • There are commercial versions of these tests, but they are not FDA approved.[16]
    • These tests are readily used in healthcare settings, such as outbreaks in nursing homes and hospitals in order to check for possible outbreaks of the virus. However, they are less readily used in outpatient setting and occupational medicine settings for food care workers.[17]

Part 3
Understanding Norovirus

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    Notice the symptoms. Once you contract the norovirus, the symptoms will appear in 24 to 48 hours. The norovirus attacks your gastrointestinal tract, which causes nausea, severe vomiting, and diarrhea. It also causes body aches, stomach cramps, headaches, and fever. In children, vomiting, often projectile, is more common.[18] Diarrhea is the predominant symptom in adults.
    • Symptoms are short lived, lasting only 48 to 72 hours. However, you can still be contagious up to 3 weeks after you contract the virus.[19] For example, one gram of stool contains 100 billion viral copies of the virus.[20][21]
    • After the symptoms of norovirus go away, you may have some different symptoms such as an upset stomach, constipation, and acid reflux.
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    Be aware of the complications. The most common complication of the norovirus is dehydration. This is especially common in young children and older adults. Monitor your hydration levels or your family's to ensure hydration. If you suspect dehydration, seek medical attention. However, the virus does not cause any long term problems in most individuals.
    • Norovirus can become serious children, older adults, and individuals who with compromised immune systems. In rare cases, the virus can lead to severe dehydration, hospitalization, and death.[22]
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    Know how the virus is spread. There are many ways that the norovirus is spread from person to person. The virus is spread via fecal-oral transmission. This means that any contact with infected feces poses a risk of transmission. When people don't adequately wash their hands, their hands are microscopically soiled, which can then spread the virus to inanimate objects as well. Studies indicate that the virus can exist for some time on indoor surfaces or inanimate objects, such as a brush or a glass.
    • The virus can also continue to live in aquatic environments such as toilets or lakes in which sewage has contaminated the water. This means that contact with infected water can cause transmission of the virus. You can also contract the infection from aerosolized vomit, which can be left behind on surfaces where the vomit was, transferred onto your skin, and then transferred to your mouth through touch.[23][24]
    • Not everyone exposed to the virus ends up with symptoms. However, these individuals are carriers of the virus and can spread it to others.[25]
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    Learn if you are at risk. The ease of transmission, combined with the vigorous pathogen of the virus, make it a specific risk for food handlers. One infected food handler is capable of infecting hundreds to thousands of persons. The CDC estimates that a full 50% of transmissions of this virus in the US occur via infected food handlers.
    • This is due to multiple factors. Given that the disease has a relatively short symptomatic period and only lasts a few days, many food workers may wait for the symptoms resolve without seeing a doctor. This is because the cost of medical treatment is high and the wages earned by food workers is low. Therefore, the workers resume work while still highly infectious.
    • In non-food handlers, the infections sweeps through families and close contacts, but infrequently reach the level of a full outbreak.[26][27]

Sources and Citations

  1. CDC, 2010: An Update on Current Guidelines of Prevention of Norovirus Outbreaks
  2. Moe, Christine L. Preventing Norovirus Transmission: How should we handle Food Handlers. Clinical Infectious Diseases 2009. Vol 48 (1) pp. 38-40
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Categories: Infectious Diseases