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A CUP OF HEALTH WITH CDC
Wash Your Hands – Don't Share Germs!
Norovirus Outbreak in an Elementary School — District of Columbia, February 2007
January 17, 2008

[Announcer] This podcast is presented by the Centers for Disease Control and Prevention. CDC – safer,
healthier people.

[Matthew Reynolds] Welcome to A Cup of Health with CDC, a weekly broadcast of the
MMWR, the Morbidity and Mortality Weekly Report. I’m your host, Matthew Reynolds.
Health officials learned about an outbreak of gastroenteritis, a flu-like illness, in a
Washington D.C. elementary school. During the first week of February 2007, about one
in four students and teachers became ill with symptoms that included nausea, vomiting,
and diarrhea. Generally, this type of illness is spread by person-to-person contact,
however, in this outbreak, they found that contact with shared computer equipment
contributed to the spread of the illness. Norovirus was the cause for this outbreak and is
known to cause most acute gastroenteritis outbreaks in the U.S.
Dr. Shua Chai is an Epidemic Intelligence Service Officer with the CDC and is working
in Washington D.C. with the District of Columbia’s Health Department. Dr. Chai is
joining us by phone to discuss this norovirus outbreak. Dr. Chai, welcome to the show.
[Dr. Chai] Thank you very much for having me.

[Matthew Reynolds] First Dr. Chai, tell our listeners what the term norovirus means
and what it is?

[Dr. Chai] Norovirus is really a highly infectious virus that’s the most common cause of
nausea, vomiting, and diarrhea outbreaks in the United States. Once infected,
norovirus usually takes about a day or two to develop symptoms and these symptoms
include nausea and vomiting, watery diarrhea, stomach cramps, and sometimes a low
fever. Symptoms can last from one to three days and really, people can become
dehydrated with this type of infection.

[Matthew Reynolds] Well the symptoms that you just mentioned, symptoms like
nausea, vomiting, diarrhea, they’re pretty common, especially in the winter months. So,
is norovirus a kind of flu or is this different than the flu?

[Dr. Chai] Well, when people have a bout of nausea, vomiting, and diarrhea, they often
refer to it as the stomach flu. But the stomach flu is actually not the flu at all, but is
actually caused, most of the time, by the norovirus, which is this highly contagious virus
that’s spread person-to-person and from eating or drinking something contaminated or
touching a contaminated surface. However, the cause of seasonal flu, the one you get a
vaccination for each year, is actually caused by the influenza virus - a totally different
virus. The seasonal flu is spread by breathing in particles from someone’s sneeze or
cough and you tend to get other things, such as fever, cough, congested nose, and
body aches. So norovirus is actually a different virus, although it is sometimes called
stomach flu.

[Matthew Reynolds] Well, we’ll talk about that - those symptoms and prevention - in a
few minutes, but I want to turn our attention to this outbreak. In Washington, D.C., how
did that health department first learn about the students and teachers that became ill at
the school?

[Dr. Chai] Well, one of the best things that we have out there are these school nurses.
Various school nurses at this elementary school called the D.C. Department of Health
and told us there was really a larger than normal number of students and teachers who
had become ill with nausea, vomiting, and Diarrhea, so that’s how we first learned about
it.

[Matthew Reynolds] How do you make the determination when you get a call like that
if you’re dealing with an outbreak, instead of or rather than a few people who are just
becoming ill around the same time? What’s the connection?

[Dr. Chai] Well, usually when somebody has called us, it’s at a point where there’s
some concern. The criteria we usually use is anything that is beyond expected, and
usually with norovirus, because it is so contagious, so many people have become ill by
the point, they -somebody has contacted the Department of Health.

[Matthew Reynolds] How do you treat someone who’s come down with norovirus
illness?

[Dr. Chai] Norovirus is actually not treatable as a virus, but what we do is called
supportive care. In others words, making sure folks keep hydrated. And also, the other
part is also to keep people who are ill away from people who are not ill to prevent the
transmission of this illness.

[Matthew Reynolds] Well, let’s talk about that a little bit more because you mentioned
a couple of times that this is a contagious disease. It spreads very quickly and easily,
especially in groups, I would think, that are in close contact with each other. What do
you recommend for preventing or reducing the spread of norovirus?

[Dr. Chai] Well, there are three things that are very important that we especially found
through this outbreak investigation of norovirus at this elementary school. First and
foremost, it’s always very important for any disease to wash your hands very thoroughly
and frequently with soap and water; that’s the number one way to prevent the spread of
disease. The second thing that we found, especially in this outbreak of norovirus, was
that ill persons really should stay at home for a day to three days after symptoms
resolve. That’s not since symptoms begin, but actually after symptoms resolve, cause
people can continue to be infectious during that period of time. The third, which was the
main thrust of this investigation, was that shared services and objects, including those
not commonly cleaned, such as computer keyboards and mice, should be thoroughly
disinfected with dilute bleach during outbreaks of norovirus.

[Matthew Reynolds] Where can our listeners get more information about the
norovirus?

[Dr. Chai] Well, we really want people to educate themselves about norovirus and their
own health and one great way to do this is to go to the CDC website at www.cdc.gov.
On the website, they should search for norovirus, spelled N-O-R-O-V-I-R-U-S for
additional information.

[Matthew Reynolds] Dr. Chai, thanks for sharing this information with us today.

[Dr. Chai] Thank you for having me.

[Matthew Reynolds] That’s it for this week’s show. Don’t forget to join us next week.
Until then, be well. This is Matthew Reynolds for A Cup of Health with CDC.

[Announcer] To access the most accurate and relevant health information that affects you, your family
and your community, please visit www.cdc.gov.