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Norovirus Infection
April 15, 2010
Marcy McMillian
Effie Boothe
What is norovirus?
• Also known as– Norwalk-like virus– Caliciviruses (family Caliciviridae)– Small round structured viruses
• Viral infection– Not improved with antibiotics– Live only in human host
• Most common cause of gastroenteritis outbreaks
Symptoms
• Nausea• Vomiting• Diarrhea• Abdominal cramping• Incubation 10-50 hours• Duration 1-2 days
How is norovirus spread?
• Found in stool or vomitus
• Infection spreads by– Consuming contaminated food or liquids– Touching contaminated surfaces or objects– Person-to-person contact
• Day care centers and nursing homes more vulnerable to both spread and effects of illness
Treatment
No vaccine or antibiotic available
Supportive care--fluids--rest
Hospitalization may occur in vulnerable groups
IV rehydration may be indicated
Outbreak Data
Enteric Outbreaks 2005-2010N=255
0
10
20
30
40
50
60
2005 2006 2007 2008 2009 2010
# o
f o
utb
reak
s
year
Norovirus
All other outbreaks
* *
* Preliminary data
Norovirus by Transmission Mode
Unknown12%
Foodborne37%
Person-to-Person
51%
Norovirus by Setting
Other25%
Hospital7%
8%29%
Restaurant31%
School/DaycareLTCF
Norovirus Outbreaks 2005-2010N=112
0
5
10
15
20
25
30
2005 2006 2007 2008 2009 2010
# o
f o
utb
reak
s
year
LTCF
All other outbreaks
* *
* Preliminary data
Median Number ill from Norovirus Outbreaks by Year
0
10
20
30
40
50
60
2005 2006 2007 2008 2009 2010
LTCF
Med
ian
# i
ll
year
All other settings
* ** Preliminary data
Hospitalizations by Setting
LTCF63%
Other13%
Restaurant12%
Retirement Community
9%
Prison3%
Prevention and Control
Prevention and control of norovirus
• Frequent handwashing
• Wash fruits/vegetables, steam oysters
• Cohort patients
• Disinfect using bleach-based cleaner
• Exclude food workers and HCWs for 48 hrs after symptoms end
TDOH response to norovirus
• Evaluation of trends
• CDC recommendations
• Laboratory capacity for identification increased
…additional TDOH responses
• Statewide annual review
• Fact sheet for long term care facilities
• Development of viral gastroenteritis fact sheet for Tennessee HDs
Conclusions
• Norovirus is a serious illness
• Illness can spread quickly in congregate settings
• Important to educate LTCF and other partners about prevention and control
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