A Health Concern for Those Living With Compromised Immune Systems
March 14, 2003
Norovirus is now the official name for the group of viruses previously called Norwalk-like viruses from the family Caliciviridae. These viruses cause acute gastroenteritis (AGE) in humans, which is characterized by nausea, vomiting, diarrhea and abdominal cramps, and can include low-grade fever, chills, headache, muscle aches and lethargy. Children often experience more vomiting than adults, but most persons typically have both vomiting and diarrhea. The incubation period is 24 to 48 hours. Symptoms usually start abruptly and last only one to two days, however some people may take up to a week to completely recover. Elderly people, children, and the immunocompromised can become severely dehydrated, requiring significant fluid and electrolyte replacement.
Because the infective dose (the number of organisms needed to cause disease) is very low in Norovirus infection, the disease is easily spread person-to-person. The virus is present in the feces and vomitus of an infected person, and transmission occurs primarily through the spread of the virus on hands, toys, bathroom surfaces and contaminated food, etc. There is some evidence that Norovirus may also be transmitted via aerosolized vomitus to persons caring for, or cleaning up after acutely ill persons. Infected persons may remain infectious for up to one month after onset of symptoms. There are many different strains of norovirus, so people can develop illness repeatedly when exposed to different strains of the virus. Treatment typically consists of supportive care, primarily fluid and electrolyte replacement.
Laboratory testing for noroviruses is not routinely performed and is not available at most commercial laboratories. For epidemiologic purposes, such as confirming the cause of large outbreaks, testing of feces and vomitus for noroviruses by reverse transcriptase polymerase chain reaction (RT-PCR) is available at the Washington State Department of Health Laboratory with prior approval through Public Health-Seattle & King County.
Good hygiene, especially hand washing after using the bathroom, after changing diapers, and before preparing food is the best way to prevent the spread of noroviruses and other types of AGE of infectious etiology. Other methods of prevention include:
There have been a number of outbreaks of norovirus infection in the past year, both locally and nationally. Recent laboratory-confirmed outbreaks in King County have occurred at nursing homes, daycare centers and among hospital staff. For more information about testing specimens for noroviruses in the setting of an outbreak, contact Public Health-Seattle & King County at 206-296-4774. For summary articles on recent outbreaks nationwide, and general information on norovirus infection, go to:
Article reprinted with permission from Public Health-Seattle & King County's EPI-LOG Newsletter, Feb. 2003.
Laurie Stewart, M.S., is Epidemiology Surveillance Coordinator in the Communicable Disease Epidemiology and Immunization department of Public Health-Seattle & King County. She can be reached at firstname.lastname@example.org. Public Health-Seattle & King County's Web site is www.metrokc.gov/health.
This article was provided by Seattle Treatment Education Project. It is a part of the publication STEP Ezine.